A mother and child are brought to your Emergency Department after a motor vehicle crash. Routine toxicology screening reveals that the mother, who was driving, was under the influence of marijuana and opiates. She is a single mother, and the father is not involved with the child. You are concerned for the safety of the child, but aren’t sure what to do. You are aware of the mandated reporting law in your state, but don’t know if this meets the requirements.
The concept of mandated reporting seems like it should be simple and straight forward. But, in the life of an emergency department nurse, it is seldom so simple. The black and white case is extremely rare. In these cases, nurses tend to report without further questioning or reassessment.1 Many times, there are questions in the mind of a nurse, wondering “What if I’m wrong?” Nurses worry that they may not be doing the right thing, and are sometimes so afraid of making an error that they become too paralyzed to act. The idea of a referral to child and family services remains extremely taboo to many providers, causing hesitation.
This hesitation leads to decreased reporting, which can lead to missed opportunities to file a report for children potentially at risk. Any “missed” report could potentially lead to a devastating outcome, so removing the stigma attached to child abuse reporting is an essential task. There are several misconceptions regarding what is reportable and what is not, who is responsible for reporting, and the potential consequences of reporting or not reporting.
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The purpose of this article is to address some of those misconceptions and take some of the mystery out of the task of reporting. Some misconceptions are listed below with responses:
“I have to be 100% certain, I need solid evidence.”
You do not need any “solid” evidence, only reasonable suspicion that abuse or neglect has occurred. It is the responsibility of the child and family services team to investigate and make a final decision about what is safe for the child.
“I will cause them to lose their children”
Children are not always removed from the home. Often times, the child is sent home with the parents after education and the introduction of a safety plan. If child and family services deem that the child is not safe living in the home, the child will be placed in a safe environment. This may be necessary to achieve the goal of protecting the child.
“The family seems so nice; they can’t be abusing their child.”
This is an important one. Nurses may see a family as a “nice family” and feel that they are therefore at low risk of abusing their children. Injuries in these children may not be evaluated in the same way as they would if the child was from what appeared to be a “bad family.” Child abuse experts have described this population as one at particularly high risk because of the likelihood of bias.2 The important thing regarding personal biases is to constantly be aware of them. We all have biases, and it is important to examine them very closely.
“It’s the physician’s responsibility to decide.”
Every state has mandated reporting laws, and, in every state, nurses are among the list of those mandated to report. If you have a suspicion, it is absolutely your responsibility to report it. The physician may not agree with you, but that’s okay. You have an obligation as a nurse to protect the child and initiate the process yourself.
“I’m afraid that if I’m wrong, I’ll get in trouble. Or, worse, if I’m right, I’ll have to testify in court.”
As long as you have made the report in good faith based on your objective observations of the situation, you have nothing to fear. Immunity from civil or criminal liability is granted to anyone who makes a mandatory report in good faith. There is a chance you will have to testify in court, but should this happen, support should be provided by your institution and child and family services. Because you cared for the child during the incident in question, you could potentially be called to testify in court whether you were the person who reported the suspected abuse or not.
“I’m not sure how to report my suspicions.”
Every state has some version of a mandated reporting law. 3 Most child and family services departments have hotlines for this purpose. If there is not a hotline, a call may need to made to the local law enforcement agency. Your emergency department should have guidelines and resources on how to report. If they don’t, you should request that some be developed and provided to the providers.
Though nurses are legally mandated to report, suspicions often go under-reported because of the reasons stated above. Better awareness and clarification of these misconceptions and fears that many nurses experience may increase the incidence of reporting of suspected child abuse or neglect. This in turn could potentially decrease the incidence of unreported child neglect and abuse. As front line providers, Emergency Nurses provide an opportunity for additional screening of children at risk for child abuse. This additional screening could save the lives of children who could potentially otherwise perish at the hands of their caregivers.
1. Eisbach, S. S., & Driessnack, M. (2010). Am I Sure I Want to Go Down This Road? Hesitations in the Reporting of Child Maltreatment by Nurses. Journal for Specialists in Pediatric Nursing, 317-23.
2. Jenny, C. (2011). Child Abuse and Neglect: Diagnosis, Treatment and Evidence. St. Louis: Elsevier Saunders.
3. State Statutes: Current Through November 2013. (n.d.). Retrieved January 4, 2015, from Child Welfare Information Gateway: https://www.childwelfare.gov/pubPDFs/manda.pdf
Jennifer Tabek is the trauma program manager at Connecticut Children’s Medical Center.