Informed Consent

Clinical Insights with Dr. Nadja James 

INFORMED CONSENT

When a nurse signs as a witness on a surgical consent, what are they actually witnessing?

The informed consent process is the responsibility of the practitioner performing the procedure. That responsibility includes explaining the proposed procedure, expected benefits, material risks, reasonable alternatives, and answering the patient's questions before consent is obtained.

The nurse's role is distinct, but equally important. The perioperative nurse helps verify that the required consent documentation is complete, identifies discrepancies between the scheduled procedure and the patient's understanding, and advocates for the patient by recognizing and communicating questions or concerns that require the practitioner's attention.

Not every healthcare facility that performs surgery requires a nurse to sign the surgical consent as a witness. Regardless of whether a nurse's signature is required, the nurse's professional responsibility remains the same. Nurses continue to advocate for the patient by recognizing when the informed consent process may need to be revisited and by ensuring that unresolved questions or inconsistencies are brought to the attention of the practitioner before the procedure proceeds.

A nurse's signature on a consent form does not mean the nurse is certifying that the practitioner provided an adequate informed consent discussion. Likewise, the absence of a nurse's witness signature does not eliminate the nurse's responsibility to advocate for the patient.

Informed consent is a process, not simply a signed form.

Practice Takeaway

A nurse is generally not responsible for obtaining informed consent. However, nurses are responsible for recognizing and responding when a patient's statements, questions, condition, or the surrounding circumstances suggest the informed consent process may be incomplete. Patient advocacy doesn't end when the consent form is signed.

Reference

Association of periOperative Registered Nurses (AORN). Elements of Informed Consent and Key Surgical Consent Guidelines. 2024.

https://www.aorn.org/article/important-considerations-when-obtaining-informed-consent

[This post is intended for professional discussion and education. Nurses should always follow applicable state law, organizational policy, and their institution's procedures.]