If a patient asks the nurse to be their substitute decision maker, what should the nurse do?

• A. The nurse should reject and contact a social worker
• B. The nurse should agree unless there is a conflict
• C. The nurse should discuss with the physician
• D. The nurse should explain only if asked

Answer: (A)

When a patient asks the nurse to be their substitute decision maker, the nurse must keep professional boundaries and protect the patient’s autonomy by ensuring decisions are made by someone legally authorized, not by the nurse personally. The appropriate action is to decline taking on that role and involve social work to help identify and arrange a legally recognized surrogate, such as a durable power of attorney for health care or an advance directive, with the patient’s input and in coordination with the physician as needed. This approach avoids role conflict for the nurse and ensures the patient’s wishes are documented and respected. Agreeing to serve as the SDM, unless there’s a formal designation, would create a conflict of interest; simply discussing with the physician can be part of the process but doesn’t address the surrogate designation itself; and explaining only if asked misses the opportunity to guide the patient toward a proper arrangement.