Consent is a communication process
Informed consent concerns a person’s understanding and voluntary decision about a proposed intervention. A signature documents part of the process; it does not, by itself, show that the person understood the choice.
The AMA’s physician ethics guidance describes discussion of the intervention’s nature and purpose, risks, expected benefits and alternatives, including forgoing treatment. It also calls for assessing understanding and voluntariness. Nursing responsibilities within that process depend on the nurse’s role, applicable law and organizational policy; physician guidance does not define a nurse’s scope of practice.
Know the local responsibilities
Before participating, clarify who is responsible for obtaining consent, who explains the procedure-specific options and what a witness signature attests to in that setting. Do not assume that witnessing a signature means certifying every aspect of the discussion.
Useful questions for orientation include:
- Which professional answers unresolved questions about the intervention?
- How is language or communication assistance arranged?
- What is the process when a patient changes their mind?
- Who evaluates concerns about decision-making capacity?
- How are disagreements or suspected pressure escalated?
- What documentation is expected of each participant?
These questions make the workflow explicit before a time-sensitive situation arises. Follow the applicable emergency process when consent cannot be handled through the routine pathway.
Check the explanation, not just the form
AHRQ recommends teach-back during informed-consent discussions. Ask the person to explain the relevant information in their own words, then clarify and check again where needed. Teach-back is a way to check communication; it does not replace the authorized clinician’s consent discussion or a capacity evaluation.
In a fictional pre-procedure conversation, a patient says, “I signed, but I thought this was only a test.” The useful response is to bring that misunderstanding to the responsible clinician and make sure the question is addressed before proceeding through the routine process. Repeating “You already signed” does not resolve the discrepancy.
Keep the tone open. A person who feels tested may agree to avoid embarrassment. Invite the questions that matter to them, including what happens if they choose another option or do not proceed.
Document the unresolved issue and its resolution
Record your relevant observations, what the patient said, whom you contacted and what happened next, within your role and the approved documentation process. Avoid claiming that another professional supplied explanations you did not observe.
If a decision remains uncertain, use the designated escalation route. A delay in the paperwork and a genuine uncertainty about the patient’s wishes are different problems and may need different responses.
See capacity and nursing observations and surrogate decision makers for related questions.
Sources
- AMA Code of Medical Ethics: Informed Consent (accessed 2026-09-17).
- AHRQ: Use the Teach-Back Method (accessed 2026-09-17).