I see this confusion come up over many incidents that raise questions in a practitioner's mind. The running theme seems to be that you shouldn't report things unless you know for sure what is happening. This is backwards. While most people appear to have good intentions and don't want to get anyone in trouble without just cause, the entire concept of reporting possible abuse and neglect is based on the premise that the reporter is passing along the information so that objective parties who are trained to investigate will step in and pin down what is or isn't going on. THEY will be the ones who determine what is happening.
For a nurse to say, "I'm not sure if this is a reliable reporter," or "We don't really know what happened," and use such thoughts as reasons not to report is to abdicate the responsibility to protect the vulnerable. If we don't know what happened, it's our job to either find out directly or, if that isn't feasable, to alert those who have the authority to pursue that information further.
As nurses, we don't have to have all the answers. That's a job for the investigators. But they can't do their part if we don't raise--and share--the questions.
That's all we need in order to start the ball rolling--questions that do not have satisfactory answers. If the patient is an unreliable reporter, it's all the more important that someone throw a flag on the play and ask for further review.
We don't have to prove anything. We have to ask questions for those who may not be able to inquire on their own behalf. If we're wrong, that's okay. We still did right by the patient. But if something seems fishy and we keep quiet because we don't have proof, we may well be perpetuating a bad situation.
Of course, we can try to gather simple information on our own. If answers are forthcoming and they seem logical, consistent and correct, problem solved. But if the responses seem hinky or there are gaps or conflicts from one person to the next, that shouldn't be the end of the story. It could be that policy wasn't followed. Or there is no policy and there needs to be one. Caregiver training may need beefing up. The agency or facility might be lacking in supplies, equipment or adequate staffing.
The bottom line is that, beyond the basic checking of facts, WE don't have to investigate matters. WE don't have to decide whether there was ineptitude or intentional wrongdoing. WE don't need to take action to address whatever gaps or faults exist.
Our role is to call attention to things that don't add up, patients who seem to be suffering unnecessarily, and situations that expose the vulnerable to undue danger and distress, and let the powers that be take it from there.