Informed consent and client rights in nursing: who decides, and what the nurse does
Valid consent, the nurse's part, who can consent, the right to refuse, and teaching clients their rights: the rule for each, for practical nurses in Canada.
- A signature only records that someone agreed. Look behind it.
- A capable client decides, and can refuse or change their mind.
- When a client cannot decide, the law's order names who does.
In informed consent, the client decides. A capable client gives or refuses consent, and when a client cannot decide, the law names who does. The nurse checks that the consent is sound and makes sure the right person decides. This guide follows two clients across two days and links to a lesson on each part.
Five rules about consent and client rights
| Part | The rule |
|---|---|
| Valid consent | Capable, informed, voluntary, and for this procedure. A new signature does not repair a consent. |
| Your part in consent | The provider who proposes a treatment explains it. You check, hold, and call them back. For your own care, you get the consent. |
| Teach client rights | Say the right in plain words. Then ask the person to say it back. |
| Who can give consent | A capable client decides. When a client cannot, a legally appointed person ranks ahead of the family. |
| The right to refuse | Ask why, inform, and respect the answer. Report it and document it. Never hide a medication in food. |
Look behind the signature
Client R is booked for a knee replacement, and her son says, “She's signed the form, so just take her in.” Then she tells you, “My son told me I have no choice.” A signature only records that someone agreed. Consent must be capable, informed, voluntary, and for this procedure.
So you hold the surgery, tell the surgeon and the nurse in charge, and document what she said. You do not ask her to sign again. A capable client can also withdraw consent at any time, even at the operating room door.
Read the full lesson: what makes consent valid.
Hold, call back, and use the interpreter
Client R says, “I signed, but I don't really know what they are going to do.” You hold her premedication, because a drowsy client cannot take part in a new explanation. The surgery, its risks and the other options are the surgeon's to explain, so you call the surgeon back.
Her son offers to interpret. A relative may soften or leave out information, so you follow your employer's policy and ask for the interpreter service. For the care that you give, you explain, ask “May I go ahead?”, and stop on a no.
Read the full lesson: your part in consent.
Teach the right, then ask to hear it back
Client R believes that in hospital she has to accept it all. You tell her that she has the right to be told about each treatment and to say yes or no, and that you care for her either way. “Do you understand?” checks nothing, so you ask her to say it back.
Later a new care provider tells client H that he cannot see his own chart. A client has the right to ask to see their own record. So you teach her to bring the request to the nurse, and you ask what she will say next time.
Read the full lesson: teach rights, then check understanding.
The right person decides
Client R's daughter does not agree with the surgery. Client R is capable, so her consent is the one that counts. A sixteen-year-old who understands his stitches can give consent, as your province's law allows.
The next day client H is confused and cannot tell you what is proposed. His brother was legally appointed, and a legally appointed person ranks ahead of the family. Nothing is urgent, so the team waits for the brother. The provider who proposes the treatment judges capacity, and you report what you see and hear.
Read the full lesson: who can give consent.
Respect a capable client's refusal
Client H refuses his diuretic, and a colleague says, “Just mix it into his food.” Hiding a medication in food is a trick, so you say no. You ask why, you tell him what each treatment is for, and you respect his answer without arguing.
You report the refusal and the reason to the prescriber, document it, and keep assessing his breathing. A refusal covers one treatment, and all his other care continues. When a clear client becomes confused, that is a change in the client, so you assess and report it.
Read the full lesson: the right to refuse treatment.
Consent laws differ between provinces. Follow your regulator and your agency's policy. For health records and interpreting in one shift, see records, interpreting and the right to refuse.