Nurses in my facility are being asked to witness signatures from patients (or their substitute decision-makers) for the purpose of obtaining consent for a procedure. The physicians tell us that we are only responsible for witnessing the signature and not for getting the informed consent. Is this true or are we accountable for determining that an informed consent was obtained?

CNO believes that whoever requires the informed consent should also obtain the patient's signature. Some employers, however, require nurses to obtain the patient's signature on consent forms as part of their role.

The most important part of the consent process is informing the patient about the proposed treatment and what to expect. This includes informing the patient about:

• the nature of the treatment,

• risks and side effects of the treatment

• alternative courses of action

• potential consequences of not having the treatment

Patients also should have the opportunity to ask and receive answers to questions they have about the treatment.

A patient's signature is meaningless if the patient is not informed. Nurses are often told that when they obtain a patient's signature on a consent form, they are only witnessing the signature and not verifying that informed consent was obtained. However, nurses have ethical and professional accountabilities to ensure the patient is fully informed and capable of giving consent.

Nurses should ask patients if they understand what it is they are consenting to and if their questions about the proposed treatment have been answered. If the nurse believes the patient has less than a full understanding of the proposed treatment, the nurse must act as a patient advocate to ensure the patient receives the necessary information.

Nurses' accountabilities exist regardless of employer policies about the role of the witness.

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