The nurse is caring for a client who was admitted for chest pain. The client is oriented to person and place, but is often confused about the month of the year or what season it is. A family member tells the nurse, “I’d like for you to sign as a witness on my mother’s living will, in case something happens to her and we need to make health care decisions for her.” Which is the best response by the nurse?

  • “Let me have a copy so my attorney can look at it.”
  • “My unit manager will need to come witness with me.”
  • “Do you think your mother understands what is going on right now?”
  • “I’m sorry, but it is against policy for staff members to witness client forms.”
Number 4 is correct.
It is never in the nurse’s best interest to sign legal documents with clients that are not part of the admissions or informed consent process. The nurse knows the client is not fully oriented to person, place, and time; therefore, the nurse is not acting in the best interest of the client as a client advocate. The nurse may also face disciplinary action from the state board of nursing, or could become involved in a legal case if anything happens to the patient. Most facilities would not allow nurses to sign as a witness on these types of documents. Asking for a copy of the document implies that the nurse will witness it, which is incorrect. Having a copy of the document in the nurse’s possession away from the facility would be a HIPAA violation. The unit manager may not serve as a witness in this situation. Asking the daughter if the client is aware of what is going on incorrectly implies that the nurse might sign the document. The nurse has the clinical training and expertise to determine when a client is not fully oriented—not a family member.