Randazzo then set up a conference call with legal counsel to walk them through the research thus far, including the response from The Joint Commission.
“I talked with them about how passionately we felt about this—that someone who has gone through this intense training who will be performing the procedure should be able to be the one to talk about it with the patient,” she says.
Randazzo explained to the counsel that the language she had encountered in the field pointed to the person with the most knowledge about the procedure as the one who should obtain informed consent. “We felt we had made something of a case for that,” she says.
The end result was something of a compromise. St. Mary's informed consent form was amended to say that the patient gave his or her consent to the nurse to insert a PICC line as ordered by the ordering physician. This allowed the nurse to handle the face-to-face communication.
“Before getting the go-ahead, I phoned the state board of nursing,” says Randazzo. “I laid it all out: 'Here's what we're trying to do, here is our research'...I told them we think this is the right thing to do, but felt a little weird about it still. But at the same time we were still seeing a lot of chatter in the field about it. To me there wasn't a clear division” on how to handle informed consent.
The hospital asked the state nursing association straight out whether there was anything in the nurse practice act that would prohibit a nurse from getting informed consent if he or she had the knowledge and expertise to perform the procedure.