About half of nurses surveyed did not agree they played a defined role in the informed consent process.1

“We know much more about informed consent in research, but not as much about informed consent in the clinical setting,” says nurse bioethicist Connie M. Ulrich, PhD, RN, FAAN, one of the study’s authors.

Researchers interviewed 20 registered nurses from various clinical settings at a large academic medical center. Almost all (19) agreed patient safety is directly linked to how well patients understand informed consent.

“Nurses are present at the bedside and in the best position to assess informed consent and its importance in patient safety and quality care delivery,” says Ulrich, the Lillian S. Brunner chair in medical and surgical nursing at Penn Nursing.

Ulrich and colleagues expected that most nurses witness informed consent or participate in the process. They also knew patients frequently turn to nurses for help understanding complex informed consent documents. Indeed, the study confirmed both concepts. “What was surprising to learn was that nurses did not feel as though they had a defined role in the informed consent process,” Ulrich reports.

Some nurses reported they believe informed consent was perceived as just a clerical task. Nurses said they did not have enough time to play a more central role in the process. About 20% of participants said they had received no ethics education. “Nurses continue to face difficult ethical issues in their daily practice, and they need a foundation to support their decision making,” Ulrich says. Investigators did not examine the process of informed consent specifically, only how nurses perceived it. “There is still much we need to understand about how informed consent is being obtained within busy clinical units,” Ulrich observes.

It is entirely possible nurses need more resources to facilitate informed consent conversations with patients and families, and to advocate on their behalf when misunderstandings may arise. “We need to give nurses the tools to address ethical concerns in clinical practice,” Ulrich suggests.


  1. Axson SA, Giordano NA, Hermann RM, Ulrich CM. Evaluating nurse understanding and participation in the informed consent process. Nurs Ethics 2019;26:1050-1061.