Reporting child abuse

Nurses Safety

Published

So I'm doing a visit today and the lady who is heavily pregnant admits to m, she and her daughter and viciously beat/peed on/not allowed to eat due to her spouse/mother in law. I ask my doctor what to do about it and dr said pt has a plan to leave give her time before calling family and children. I am obligated to report! So I called when I got home and filed the report causing FACS to jump into action!

I know I did the right thing reporting but I feel so bad going against my doc... Am I right????? Am I wrong???

Sorry new grad

Specializes in Quality Nurse Specialist, Health Coach.

You did the right thing, we as nurses are under obligation to report abuse.

Specializes in Med/Surg.

You were mandated to report if even in good faith you believed that abuse was occurring, let alone if the patient flat out told you it was. They say that the most dangerous time for anyone in an abuse situation is when they are preparing to leave. Better to have the authorities provide her all possible resources and even better hopefully remove the abusers from the situation giving her the opportunity to leave in a calm fashion.

Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.

I'm confused. The mother in law is abusing a child, who belongs to a patient of yours who is also pregnant with another?

Either way, you did the right thing by reporting it. Even if she had a plan, something could happen before that plan is in effect. You can't force the person to get out of the situation, but you can do what you are required to do, and make the abuse known.

In my mind, this is not such a black and white issue.

In the state where I practice, we cannot report domestic violence unless the victim wants to report it. The reason for this is that you could make things worse for the victim and potentially get them killed.

On the other hand, we are mandated reporters of abuse of vulnerable populations, such as children, the elderly, and the disabled.

In my state, I would be legally required to report the abuse of the child, but forbidden to report the abuse of the mother unless she consents to me reporting it.

Touchy situation!

Specializes in School Nursing.

If it is a minor being abused, you have no choice but to report. In my state, nurses are legally required to report even the suspicion of child abuse. So, if it came to it and it was proven that a prudent nurse should have had reason to suspect abuse, and you did not report, you could be held criminally liable.

I also cannot tell from the OP if there is child abuse involved, however. If it is domestic violence amongst adults without the involvement of a minor child, the rules are different and may allow you to report only if the abused person requests.

You can also get social work involved-- you as a nurse can order a social work consult. You did good! I work in a PICU and see soooo many very sad child abuse cases. You may have just saved a couple of lives.

Specializes in ED.

You did the right thing, and shame on the doctor for allowing the abuse to continue.

Specializes in Infectious Disease, Neuro, Research.

Duty to report is generally pretty clear, within your State's NPA. I'm going to differ a bit here, with most, in that, "clearing your conscience", by reporting may have serious consequences for those we intend to help.

State agencies (and their success rates) do vary, but in general, my statement is, "DHS- Proudly placing children in need with drunks, druggies and pedophiles successfully for 25 years!" Not pretty or flattering, but very true.

In context, if your patient has a defined plan for leaving the situation, within a "reasonable" timeframe, she (most typically) will probably be better financially situated, her children are more likely to be with her, and she is less likely to be as dependant on the whims of State employees/the courts.

The problem with legislating morality is that it requires the individual to depend on the State. Around 9,000 years of recorded human history indicates that the State is a poor steward of such trust.

Am I saying not to report? No, but it would behoove one to have a solid contact with community contacts (DHS or similar) whom one can trust to help in evaluating cases individually, rather than cookie-cutter style. DHS(corporately) likes new dependants, as annual increases in needs mean annual increases in budget.

Specializes in School Nursing.

As a licensed foster parent I take offense to the above. The reality is that CPS will only remove children in cases of extreme abuse or neglect. Each child removed costs the state a great deal, so they are very selective in removing children that are in a state of immediate danger.

The ideas that foster parents are abusers, "drunks or druggies" or "in it for the money" (which I hear a lot and have to laugh considering what little reimbursement we get for the child's needs), are MYTHS perpetuated by a very few bad cases. If one teacher sexually abuses a student, does that mean all teachers are bad and we should disband the public education system? Of course not. Same goes for the foster care system. Yes, there are a few cases of abuse by foster parents, but this is FAR from the norm. Foster parenting is ridiculously HARD, and the majority of people who get into it do it because they want to help kids.

For all those people who want to bad mouth foster parents, I have one thing to tell them, sign up to do it yourself. Get licensed, take in some kids, and fight to make things better for them. You think you can do a better job, be my guest ;)

Specializes in Infectious Disease, Neuro, Research.

PS, I was not "bad mouthing" you or other foster parents, nor am I indiacting that you receive(d) Big Money for fostering. I have 4 family members who are currently, or have previously, fostered, and 6 who work for DHS/CPS. Believe me, I know, there is no "reward", other than helping the kids. (Unless you're crook, playing the system, which the system makes it fairly easy to do.)

States receive matching Fed funds for child welfare services(along with most other social-service programs). If funds are not used in the preceding fiscal year, they are surrendered, and will not be allocated to that State/Department in the following fiscal year. Translation: it benefits agencies to have dependants on the books. This is evident in any survey of public records (which State budgets are).

Equally, as I previously noted, State track records do indeed vary, but CPS, nationally, has a very troubled record. Social bias plays into the mix, as, regionally, courts have prejudice to either maintain children with immediate family, or to remove them from family, as a default, depending on the State and region.

For an assertion to be valid, it must be verifiable, generalizable, and repeatable. Examining CPS placements in your own state will reveal a trend, one way or another. In itself, this is neither good nor bad, the problem is that bias frequently takes the place of competent assessment. As you yourself would likely admit- there is a shortage of responsible, qualified, foster families. In turn, this shapes CPS policy and methods. I.e., CPS is not interested in making fostering easier or socially functional, but in limiting Departmental liability. This is the nature of bureaucracy.

State/Fed employees are difficult to terminate. State/Fed employees who validate their departmental budgets by expanding revenue and minimizing costs are rewarded. There is (generally) little assessment as to whether or not the decisions and acts are beneficial to the public, unless there is a crisis, and the Gvt. may be brought to litigation for malfeasance/gross negligence (as in OK and AK, recently, though this is by no means a regionally isolated probelm). There is little motivation to validate the safety/efficacy of the system in more than an LCD fashion.

Again, I did not say, "don't call", but it is absolutely necessary to take the time to develop quality referral contacts, so that we know we are handing fragile people off to others who can continue a chain of care, not simply a functionary who will get them 1/2 way through the rehab process, and tell them, "Oops! You're earning too much(in the career the .gov is supposedly helping them get into), your food stamps/child care is cut off as of Friday..."

People stay in crappy situations as much because the current model sets them up for failure, as any bad decision-modelling of their own.

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