Witnessing vs. obtaining consent: What's the difference?
Thank you to the College of Registered Nurses of British Columbia for permission to adapt their case study.
RN roles and responsibilities in the consent process
As Susan walks into the room, Mr. Yan turns and smiles. Recently diagnosed with an aggressive form of cancer, Mr. Yan is being admitted for same-day surgery. While performing her admission assessments, Susan notices the surgical consent form, typically completed in advance at the surgeon’s office or the pre-admission clinic, is not signed.
Susan tries to confirm with Mr. Yan that he has consented to surgery, but they are having difficulty understanding each other. When Susan asks questions in English, Mr. Yan responds in Cantonese. Susan calls a hospital interpreter and when he arrives a few minutes later, Susan learns that Mr. Yan did speak to the surgeon and agreed to the surgery, but that he remembers very little else about the conversation.
Obtaining consent vs. witnessing a signature
Obtaining consent and witnessing a signature on a consent form are two different things. Witnessing a signature on a consent form does not verify that informed consent was obtained. Susan’s employer policy allows her to witness Mr. Yan’s signature, but she knows it’s not appropriate for her to take responsibility for obtaining consent for care or treatment provided by another health professional. In this situation, it’s the surgeon’s responsibility to obtain informed consent from the client.
As a registered nurse, Susan knows she has professional responsibilities when verifying consent. She is aware that the practice standards expect her to follow current legislation, standards and policies relevant to her practice setting (1.2). She doesn’t remember the specifics from her employer policy so she decides to review the one pertaining to consent.
What are Susan's overall professional responsibilities and accountabilities?
Susan knows she must do the following, regardless of whether the consent form is signed or not:
- Confirm Mr. Yan’s identity and verify that he has consented to the surgical procedure.
- Determine if Mr. Yan has sufficient information and understanding about the surgery.
- Advocate for Mr. Yan to get more information as needed.
What does Susan do?
With the interpreter’s help, Susan and Mr. Yan review the consent form together. When they have finished, Mr. Yan signs the form. Susan witnesses his signature.
During their conversation, she learns Mr. Yan has additional questions about the surgery. Susan then telephones the surgeon to let him know he’ll need to speak with Mr. Yan before the procedure, and notes that an interpreter will need to be present.
Disclaimer: Our case studies are fictional educational resources. While we strive to make the scenarios as realistic as possible, any resemblance to actual people or events is coincidental.