Child Abuse

[cjl_RN, BSN]

I want to share with you a scenario I experienced today at the very end of my day. Middle School 1000 students.

3:15- Counselor calls nurse says look into this situation. Student A is on his way down. Student A notified teacher his right arm is hurting and something happened at home.

3:20- examine student notify counselor of findings. Counselor comes in and speaks more in depth with student. Counselor says come to my office and YOU can make the report.

Go to her office

I said I will share the medical information. I asked where the teacher was who the student initially reported to if they would be apart of the call. She chuckled and said “No why would they come.” I said cause he was the one that suspects abuse. She said he didn’t say he suspected abuse. I said then why did he call you and not me. She said he did try to call you. I said no he didn’t. (Trust me this teacher is not afraid to send students. He will send 3 at a time, even though I’ve instructed teachers one at a time unless they both got injuried) Anyways, she said well I don’t know. She said really you need to do the investigating when a student is sent to you and report it. She said myself or any of the teachers didn’t have to be involved when the last nurse was here. (I have been here this school only-1st year) I wanted to say the last nurse quit after 2 years bc she was taking on so much, but I didn’t ! She told me I need to learn how to ask more questions and what to ask. I said I was always taught whoever the first person the student tells is the person who has to report it. I of course would then examine for injuries and make sure they don’t need further medical care. She told me teachers can’t stop what their doing in class and investigate and make the call. She basically wants me to handle all the abuse. Counseling, medical, and reporting. I do not think that is right! Of course If the child came me first certain, however I’d still get the counselor involved.

What are are your guys thoughts? Am I wrong am I right?

[Rose_Queen, BSN, MSN, RN]

What are the mandated reporter laws in your state? Mine is pretty clear that teachers are indeed mandated reporters. If so, then the teacher needs to be making the report. However, you may be wise to protect yourself.

[OldDude]

3 hours ago, cjl_RN said:

...I said I was always taught whoever the first person the student tells is the person who has to report it. I of course would then examine for injuries and make sure they don’t need further medical care...

What are are your guys thoughts? Am I wrong am I right?

You said it right here. Stand your ground. If you're not the initial outcry your only role is to assist in documenting signs/symptoms and assess for the need for immediate medical/emotional attention.

[Flare, ASN, BSN]

11 hours ago, OldDude said:

You said it right here. Stand your ground. If you're not the initial outcry your only role is to assist in documenting signs/symptoms and assess for the need for immediate medical/emotional attention.

Yes! I am more than happy to assist with a report and make the call WITH the initial staff member to field the complaint from the student. I will happily make the pd notification (part of our procedure here in my state) if the level of response warrants it - after all, I sit next to a phone all day. But do not just send a child down to me and call me (or worse, send me a stapled note) saying "Jason said... you should probably call CPS". Oh no, it doesn't work that way. I'll check him, see if he tells me the same story but you better be working on some coverage and get your tail down here.

[OyWithThePoodles, RN]

Agree with the above. Check with your state laws, here teachers (that includes school counselors) are mandated reporters. Don't budge on this one, but be respectful. It's apart of teachers mandatory computer training every year here that states the one who first hears the report needs to make the call.

I've had teachers bring me kids and tell me to call, I nicely remind them that the student never crossed the threshold of my office so why on earth would I call, and that I would be more than happy to assist them in the call.

[BunnyBunnyBSNRN, ASN, BSN]

Also, the job of "investigation" is on CPS. If abuse or neglect is suspected, our (meaning school nurse, counselor, teacher, custodian - whoever the child reports it to) job is to report it.

You need to look into your state laws and/or school district policy. I've worked in schools where, even if I was the one who suspected abuse, I was directed to advise the counselor so she could do the report.

In my school, the staff member who has the initial suspicion makes the call. That does not mean that I will not check the child, give my opinion, etc. Often times a teacher might have a concern based on what an injury looks like, or what a child tells them happened at home and they ask me to check it out and make a decision about whether they should call or not.

[ruby_jane, BSN, RN]

In Texas all adults are (theoretically) mandated reporters. The teachers in my district go through the same training that I do. If the teacher did not think it was abuse (and that's a grey area), but the counselor specifically sent the student for you to document abuse - the counselor should report. I have, on occasion, sat with a counselor at his computer to assist. But I agree with OD - the counselor shirks his/her responsibility as a mandated reporter when s/he sends a kid specifically to have you report.

[UrbanHealthRN, BSN, RN]

I've gone a few ways ways with this.

If there's concern for abuse because of a conversation with the student, or something the student said, then I like whoever heard those words to make the call, so that there's no "lost in translation" effect going on.

If there's concern for abuse because of a physical finding, then I don't mind taking a look and, if what I see is concerning, making a call. I'm certainly no abuse expert, and as mandated reporters we're not here to decide if something is definitely abuse or not, but with the physical stuff, teachers like my assessment skills.

I'm also happy to bounce ideas off a coworker who is thinking about making a call based on some other category of concern, but at the end of the day, they know it's on them to call.

[pedi_nurse]

3 hours ago, BunnyBunnyBSNRN said:

Also, the job of "investigation" is on CPS.

This is what I came here to say. This counselor should know better. You can ask a few questions to determine if the student is in immediate danger which would warrant a call to the police, but it is ONLY CPS and the police's job to investigate.

[yaRNthrower, BSN, RN]

Cjl, You were absolutely right. Shame on the counselor trying to dump all of that on you. They know better. I had something very close to this happen recently too. My person's reluctance seemed to stem from just not wanting to make the call coupled with the fear of reporting and being wrong. I reassured them it is not our job at to investigate or be 100% certain. You give your suspicions and facts that you have then CPS will handle the investigation. I offered to be there and walk them through the steps if they would like. Then said person got attitudinal and gave me a little of the old, "Well, our nurse always did it where I was before. I can't believe you are not going to call." In the end I nicely told them an amalgamation of all of the advice already listed above and sent the ISD instructions.

What I thought with a squished up Kermit the Frog face was:

Um hum.

Well, we all sat through the same training 4 months ago together and that is not how it is going to go anymore. You know exactly what you are supposed to do you just don't want too. You see the kiddo everyday. You are the one that holds the suspicions you get to make the call. You decided to call me with six minutes left on a Friday wanting me to get all high and holy over a child that has not been to see me. However, the vague bits you told me seemed fairly juicy so you had better make that call weather you want to or not. Here is the number. Here is the number.

So, you are definitely not alone.

I really had nothing special to add.

It was nice to let it out though.

I haven't had lunch yet so I am typing, eating, and having random thoughts. I have had at least one teacher on every campus try to push this onto me at some point. Years ago a teacher brought a scared little first grader by the hand to the clinic and in a stern voice told the child, "Tell her what you just told me."

Whoaaaaa!!!! Let me stop you right there... I'll never forget those terrified big brown eyes. That poor sweet tiny human ?

Isn't it funny the way things are a bit different but so much the same. At any given time there are a handful of us doing almost exactly the same stuff just change the names and locations.

Sometimes not even the names as I have worked with at least one Kathy at every job I have had.

Parallel Universe.

Whee!

[WineRN]

I agree with everything that was already said and I am sorry you were put in that situation.

Handling child abuse is by far the worse and most heartbreaking part of this job.