Why aren't nurses mandatory reporters of ALL abuse?

Annisme · Jul 9, 2011

? I was under the impression that it is mandatory to report all abuse and/or assaults, even when the victim does not want to cooperate. I know that I have reported several domestic abuse/assault cases to the authorities.

Double-Helix, BSN, RN · Jul 9, 2011

It's different when the victim admits that they are being abused. Then it is reported. Suspect abuse is not. But if a woman comes into the ER with a broken arm, as a black eye and several old bruises and states that she "fell down the stairs" that isn't reported to authorities. But if a child came in with the same assessment and story, it would be.

linearthinker, DNP, RN · Jul 10, 2011

Because competent adults are presumed to be able to advocate for themselves.

BluegrassRN · Jul 10, 2011

According to some standards (JT?), we're supposed to assess every admit for abuse. We ask if they feel safe in theIr hOme environment, and if they have any domestic concerns. What are we supposed to do beyond that, if a pt says there is no abuse? The police and social welfare organizations are over burdened as is. What use is there in investigating an alleged domestic violence between two adults, both of whom deny it? There's no one to press charges, no witnesses. A complete

Waste of time and resources.

If ever person is assessed for DV, I think we've done what we can.

greenfiremajick · Jul 10, 2011

One of the things that comes to mind, is that mandated reporting came about due to the fact that the elderly and children are usually powerless to stop the abuse. They also have people in charge of them, that can come after you, if you DO report the abuse if there weren't a mandate in place. You CAN report suspected abuse of adults (especially if they're disabled or somehow incompetent).....

Everyone that is a nurse knows that we are mandatory reporters of suspected child and elder abuse, but I've always wondered why we aren't mandatory reporters of domestic abuse as well.
Victims of domestic violence (men or women) are a very vulnerable population. They may be just as scared and powerless as a child or elderly person. I understand that an adult in this situation is legally considered competant to make his or her own choice, but an elderly person who is being abused might not have any cognitive deficits either. As a nurse, we report suspected abuse in the elderly because they cannot advocate for themselves. Victims of domestic abuse cannot always advocate for themselves either. The victim might not have access to money, might be isolated from friends and family, might believe the abuse is his/her fault, or might fear for the safety of his/her children or family. They truely may not be able to ask for help.
So please help me understand why, when a child or elder is being abused, nurses report it to the authorities, but when a victim of domestic abuse comes into the ER, we do not.

rn/writer, RN · Jul 10, 2011

In the hospital where I work, we always try to get a few minutes alone with the patient, even if it's nothing more than helping her to the bathroom and shutting the door. In that brief time, we ask if she feels safe, if anyone is causing her harm or fear, if anyone is threatening her or making her do things against her will.

If she says yes to any of those questions, we will arrange a social services consult with a hospital social worker. If she says yes and asks for help, we will ask social services to alert the police. The first scenario is much more common than the second.

Why? Because it can take a long time for a woman to truly leave her abuser. And if others step in and force more help upon her than she is ready to receive, she usually ends up going back and getting punished for drawing attention to what's happening. Or she finds another man who is just like the first one.

It can take a number of baby steps over many months or even years for a woman to feel strong enough and fed up enough to draw a line and really mean it.

A dear friend of mine had an abusive husband. She left him once, but he made promises and got counseling for a little while, and, because they had three children together., she felt she had to go back.

I learned not to push her, but to be ready to listen and offer concrete types of support. It took another four years until she was finally ready to leave for good. In the nine years since that time she has remarried a wonderful man, become a loving stepmother, and encouraged her ex to get help for the things that have messed up his life.

It's horribly frustrating for those of us in healthy relationships to watch others live with abusive partners. But we have to allow them to call the shots and make decisions based on where they actually are (instead of where we'd like them to be) or we replace one controller with another--ourselves.

It is actually by respecting an abused woman's autonomy that we start building her worth up in her own eyes. This takes time. But every little piece of the puzzle helps.

As nurses, we can offer help. We can plant the seed of self-respect. We can let each woman know that she deserves better than to be intimidated and hit. But then we have to wait for her to be ready. Rushing things short-circuits the process the same way helping a baby bird to break out of its shell leaves it weak and vulnerable. That inner wrestling match serves to make her strong and resilient and determined to insist on decent treatment.

Waiting until an abused woman is strong enough to leave her abuse is a tough challenge, but one that pays off in the end.

eslvn · Jul 10, 2011

Um, I was also under the impression that we are to report suspected abuse. Maybe I missed something but I was told that if we have any suspicion that we are to get social services involved and try to get the man or woman(victim) alone to try to help them, but we cannot force help on them, if they wont take it. But really I am pretty sure we are to report it.

rn/writer, RN · Jul 10, 2011

Let me just say that getting hospital social services involved is the first step. THEY are usually the ones who decide about whether or not to report to the police.

Iif you have concerns, start with facility social workers. Let them evaluate the patient and her circumstances and make the judgment call about going further with a complaint and involving law enforcement and/or governmental social services.

bjaeram · Jul 10, 2011

You are not mandated to report it and in fact you CAN'T report it if they don't want you to. You can have social work talk to them and you can offer support and phone numbers but you can't report it to the police or adult protective services or anything.

This may very by state I don't know but we only report...child abuse, elder abuse, gunshot and stab wounds. Bar fights with fists or bottles are not reportable. Rape and sexual assault are only per victim request. Spouse abuse is not. Nothing is without permission but the four.

I don't really undestand it except it's pointless to do it if the person will not press charges. If we reported every abuse or assault that came through our door we would have to hire our own police officer.

bjaeram · Jul 10, 2011

? I was under the impression that it is mandatory to report all abuse and/or assaults, even when the victim does not want to cooperate. I know that I have reported several domestic abuse/assault cases to the authorities.

Nope you shouldn't report them unless the victim wants to press charges...it won't do any good.

rn/writer, RN · Jul 10, 2011

Nope you shouldn't report them unless the victim wants to press charges...it won't do any good.

And it could do harm if the abuser makes his victim pay for the attention, even though it wasn't her choice to get it.