Can Nurses Be Required to Obtain Informed Consent?

[Kunle Emmanuel]

In this scenario, nurses are being required to obtain informed consent for a transplant patient to receive an organ from a high-risk donor. Is this right?



A registered nurse (RN) wants to know the limits of responsibility of nurses when it comes to obtaining patient consent. Here's the situation:

I work as an RN and a certified clinical transplant coordinator in Pennsylvania. Recently there was an incident in which the transplant surgeon did not document consent from the patient to receive an organ from a high-risk donor.[1] Consequently, our managers now are considering requiring the RN coordinator to discuss with the patient and document consent to receive an organ from a high-risk donor. Does this fall within the scope of nursing practice?

It may be within the scope of practice of nursing to provide the patient education necessary to obtain informed consent, but that doesn't matter in this scenario. Why? Because under common law (case law) in this country, the surgeon always holds full responsibility for giving the patient the information needed to obtain informed consent. The surgeon's responsibility remains, even if the surgeon delegates that work to someone else.

My analysis of the risk in this situation is as follows: The surgeon is clearly responsible if a patient has not been given enough information to make an informed decision. If the surgeon or the hospital requires a nurse's take on the consent process, the nurse, as well as the surgeon, is responsible for meeting the standard of care. If there is a problem and a patient sues for lack of informed consent, then the nurse, the hospital that employs the nurse, and the surgeon all will be sued. So, it makes no sense for a hospital to take on a duty that is clearly the surgeon's responsibility.

Although the hospital may hope that a nurse would be more conscientious than the surgeon in giving patients information, the nurse who takes on the consent process is going to have to rely on the surgeon for some information. If the surgeon didn't remember that the donor was high-risk or didn't take the time to communicate that to the patient, then I wonder whether the surgeon would take the time to communicate important information to a nurse who is delegated the responsibility for patient consent. There is nothing in it for the nurse or the hospital if a nurse takes over for the surgeon in the consent process.

Furthermore, the surgeon is compensated for the time it takes to obtain consent through the global fee for surgery. The hospital, by agreeing to take over that work for the surgeon, could be violating Stark laws, which limit the value of a hospital's nonmonetary compensation to a referring physician to $392 per year.

If a surgeon wants to delegate the consent process to a nurse, then the surgeon should hire a nurse. That would protect the liability of the hospital and the nurses employed by the hospital.

Response from Carolyn Buppert, MSN, JD Healthcare attorney

http://www.medscape.com/viewarticle/865037

[Kunle Emmanuel]

Margaret Persaud
Certainly agree that obtaining the consent should be the sole responsibility of the surgeon.Thank you Carolyn for such a great explanation.

rosie brubaker
Great info, but difficult to follow when the patient is set to go to OR, and everyone says here is the consent, hurry up. It takes a strong RN who is fully backed by administration.

Kathlene McCloy
I have worked at a teaching hospital where the physicians ALWAYS did the consents, and we as RNs were truly only witness to signature. For the last 10 years I have worked for a community hospital (albeit a large one) and the MDs CONSISTENTLY place orders for us to get the consent. In fact, if it is an anesthesia or IR procedure, the MD does not actually meet the patient until the TIMEOUT begins. We explain the procedure, we explain the risks, we ask them to sign (or call the family to get consent) and then the MD signs it when they arrive on the unit. RARELY do I hear them tell the patient or family the risks and benefits. Also, the HOSPITAL requires a blood consent and the nurse is always responsible for that.

Should we as nurses be fighting this battle with MDs and the administration??

[Kunle Emmanuel]

Read more here
viewtopic.php?f=22&t=1390

[sova163]

Hello! Very interesting topic, thank you raised it
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[Queenet]

Ogunmakin Gabriel
No way, it is responsibility of a surgeon please

Rotbe Gabriel Joseph
You are not the one doing surgery why you be the one to take consent

Adene Ese
Within the scope of nursing practice, it is not the duty of the nurse to obtain consent.
The nurses duty is to ensure the informed consent is obtained and the patient questions and fears are duely answered

Glory Atakpo Agbati
A nurses is required to obtain an informed consent prior to procedures , guide them through reassurance ,and allaying their fears and anxiety,while the doctors jurisdiction is to obtain the written consent prior to any procedure.

Sam Omowumi Orebiyi
A nurse is only required to witness the informed consent while the surgeon gives the detailed information abt the surgery and the nurse must see that the patient understands every informations given to her related to the surgery.

Oluwadamilola Famuyiwa Atoyebi
Sam Omowumi Orebiyi yes oooo don't foolishly witness so you dont foolishly get in trouble with the Dr

[Queenet]

Atabure Philo
Sam Omowumi Orebiyi so the nurse can sign d witness column

Nuhu Bala
In good hospital setting the doctors are responsible to obtain consent from the patients because they are one doing the surgery.

Oluwadamilola Famuyiwa Atoyebi
This is solely the Dr's responsibility ' Dr doing the procedure ' this should not even be delegated to another Dr. The nurse should only ensure and witness intelligently.

Nana Takai
You only obtain informed consent from a patient on a procedure to be performed by you.
For renal and other surgeries, it is the surgeon who obtains informed consent from the patient.
How can a nurse obtain consent for a procedure to be performed by the doctor?

Rotimi Toyin Alabi
No,it should be done by the surgeon, is not the duty of the nurse to obtain an informed consent prior any surgery pls

Ella Eby Okoye
It not the Nurse's Responsibility, she just needs to make sure the consent has been signed

Kate Chiekwe Chukwurah
Nurses don't get an informed consent from patients except in Anaesthesia management when the nurse Anaesthetist is taking the case, consent for anaesthesia is obtained, or she witnesses in a situation where they sign only one consent. But in your case, as a specialist, you're not the one carrying out the procedure, so you don't have the locus standi to obtain an informed consent, but you can witness.

Marthy Jessy
Every health worker is entitled to obtain consent for procedures being carried out by them. You only obtain consent for procedure you do not for another person's procedure as it is the person doing the procedure that can explain in detail the procedure he or she is about to do.

Naomi Okonobo Endurance
Abegol. Please!!!! This nota case of I am competent and relevant. Please organ transplant is a very major procedure. It is a a highly risky adventure. It is ethically and medically reasonable and sound that the surgeon or his team take the responsibility of taking the informed consent. The RN coordinator can witness that the consent has been taken. Period.
Except the RN is a Messiah that want to bear all the responsibility, accountability, risk, possible litigation and blames and any eventuality while the surgeon and his team take all the glory. OYEMBURU

[Queenet]

Helen Attah
Pls in general hospital anybody can obtain consent

Olufemi Iseyemi Folakemi Rn

Helen Attah nothing like in general hospital, upgrade and follow the new trend, we were taking it before but we have to change .

Toyin Olasunkanmi Johnson Akomolafe
Olufemi Iseyemi Folakemi Rn one of the anomalies I observed in a general hospital when I was there for clinical posting

Olufemi Iseyemi Folakemi Rn

A nurse can only witness it, the person going in to do the surgery should explain the procedure and take the consent!

Blessing Isaac
A nurse can only witness to ensure that the patient understands the type of surgery, the extent the organ can be tampered with, the possible side effect, complications and post surgical treatment options. It allows the nurse to witness the willful signing of the consent form by the patient ensuring that the patient is not a minor, mentally stable, not signing under duress or drug effect.Only the doctor or surgeon performing the surgical procedure that has the right to obtain informed consent not the nurse. The nurse only serves as a witness.

Emilia Kalu Omenyi
Not at all,a can witness while the surgeon or his team obtains an informed consent from the patient.

Deb Oti
Firstly your fundamental role as a nurse is to enhance patient safety and at the very least do no harm .
Autonomy is not just about an individual’s right to refused procedures and treatments, but it also entails involving individuals positively in decisions regarding their procedure or treatment ( Greaney et al.,2011). Autonomy is relevant to both the patient and the nurse and has a vital place in the network of ethical principles ( Benjamin and Curtis, 2010) .
As a nurse you have the autonomy to act independently and interdependently depending on the situation keeping the hospital policy in mind.

On informed consent your duty is to share information, provide advice , assist patients with the decision-making process with the aim to encourage and promote the autonomy of the patient seeking care or treatment. Usually the preference of your patient is central to the process do not give any false information or manipulate your patient to sign the form.
Yes as a nurse you can give the consent form to a patient to sign if the hospital policy states the nurse hands the consent form to the patient. in-fact your patient should trust you more to spend time and educate them , Never ever decide for your patient if the should go on with the procedure or not , simply tell them all you know about the process and if the have any queries relating to the surgical aspect invite the doctor to speak with them. Ideally the team of doctors must have spoken to this patient first . If you have a doubt speak to your ward manager and if you are the ward manager go to your CNO and then to the top . But I strongly believe you can hand in a consent form is left for the patient to decide. Stick with your facility policy . Is not unethical to follow your hospital policy on who should hand in a consent form, more so before the procedure the surgeon will require if the consent form is signed so you definitely not alone on this one

Olufemi Iseyemi Folakemi Rn

We are discussing the ideal here,I suppose!