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.
Specializes in Trauma Surgery, Nursing Management.
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 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.
(Insert admiration emoticon here) RN/W, you continue to amaze me with your words of wisdom. You are SO right. It does take quite a bit of time (and a great deal of frustration on our part as nurses) for a woman to leave an abusive relationship. It is quite the quandary for her. She desperately wants help on the one hand but desperately wants to keep quiet on the other hand. What to do?
The biggest fear of an abusive man is to be found out. This fear is compounded when his victim must seek medical care. His senses are on high alert, and chances are good that even if his victim says nothing, she will be punished anyway because he suspects that something was said.
Abused women are in a catch 22. If they leave the abuser, they must now constantly look over their shoulder...for YEARS. They may not have anywhere to go. The choices that are offered may seem more scary than living with the abuser. Have you ever heard of the saying, "Better the devil you know than the angel you don't"? Change is scary for everyone. Anything unfamiliar is a challenge. Abused women must overcome both the uncertainty of leaving as well as the repercussions she may face if her plan to leave is not successful. Remember that these women have had their self confidence insipidly and systematically dismantled.
When I have a pt that comes into my OR with injuries that appear to be the result of abuse, I request that the attending surgeon write a consult for social work. These social workers are professionals, and are well versed on the intricacies of domestic violence.
But yes, it takes time. We can plant the seed, as rn/writer states. The rest is out of our hands.
1. This varies from state to state, as noted by the previous poster's quote from CA's Nurse Practice Act.
2. Be clear about what is required: mandated reporting is reporting to law enforcement and/or a designated governmental agency such as child protective services. What some of you are describing as "reporting" is just getting the hospital social worker involved. This is a valuable resource for the patient, but is not the same as reporting to an outside agency.
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.
i agree with this. if a patient denies abuse and they are a competent adult then it truly is a waste of time and resources getting the authorities involved. that being said, i do think that if you suspect abuse you should handle the interview/assessment differently than just the routine, "do you feel safe in your home?" check. "have you ever been forced to do anything against your will?" check. "where do you work?" check. showing a little empathy and concern without a clipboard in your hand (like someone suggested going to the bathroom and shutting the door, putting your arm around the patient, etc) and just generally letting them know that you're concerned and you care may illicit more of a response. when it's just a "routine question" to them you're going to get just a routine answer.
i've been in an abusive relationship. i was young, stupid, and broke. i didn't realize HOW BAD it was until i got hot at work one day, tied my jacket around my waist, and had a stranger (a male customer) practically follow me around asking about my bruises and begging to help. i thought, "wow, this guy is crazy!" and i'm sure he thought, "wow, this girl is pathetic." even though i blew him off (out of embarrassment and that i pride myself on being independent) the fact that a STRANGER recognized that i had been abused and was very vocal about it opened my eyes. a patient may actually think that their bruises 'don't look that bad' and that nobody else would notice. EVEN if they refuse help, i think it's important that you let it be known that you KNOW they are abused. this is a sore subject for me because even though i was abused i'm with the camp who believes that grown ups can make their own decisions and if they don't leave then that's their choice. i understand all the hardships involved. i went through them. i pretended to sleep when he got up for work, threw my stuff (what would fit) into bags, and drove to my hometown without knowing where i was going or if i'd have enough gas to get there. i left everything that wouldn't fit in my car behind and my car (broken windshield and all, inflicted by him) was all i had. i got a job at a fast food restaurant and was by all definitions of the word homeless until i saved up a couple of paychecks. THANK GOD i didn't have a child with him, but actually if i did have a child i would've been able to get housing, food stamps, etc., so i don't feel that is a good excuse either for someone who REALLY wants to leave.
anyhow, it's not harsh in saying that "it's a waste of resources if they deny abuse." it's a reality. if they aren't ready to leave then they aren't going to. if they don't trust YOU enough to admit abuse they definitely aren't going to open up to a police officer or some other official.
As a former victim of DV, I can speak a little bit about this from the other side.
Reporting every instance to the police would do more harm than good. Rn/writer spoke the words of truth better than I could of put them myself. Reporting to the police is a very scary thing. You are worried about what will happen if he is arrested. You not only have to deal with his increased anger, but a lot of times he is the sole source of income into the household. If he is put in jail, how are bills going to be paid and food put on the table? An abused woman feels like she has no one to turn to. In my case, I was completely isolated from my friends and family, and even after my mom found out she would try to make me do exactly what she wanted me to do. You feel under so much pressure and stress, it is very hard to handle.
On the same note, whenever I would seek medical treatment, I would never tell anyone at the hospital about the abuse (and no one asked in my case either, there never were any questions about feeling safe etc). I was afraid that they would report it. It would have been nice to know that I could just talk to someone and be informed, while still making decisions for myself. It would of helped me a lot just to have someone to let it all out to and be given advice and knowledge about ways to help myself.
So no, I don't think every case should be "reported". However, if abuse is suspected it doesn't hurt to let the victim know that she can have someone to talk to that will support her and not judge her.
Btw, it has been my experience that police have no sympathy for victims of DV. they know from the word go that it will not be their last visit for a particular couple. As stated before, it can take years (took me 7 and I'm still trying to get completely out) and police look at it more as a waste of time than anything else.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.
The assumption is on the ability for them to go to the authorities themselves. Madated reporters are just that....Mandated by law. There are no laws mandating the reporting of adult non-disabled abuse. It's up to the one being abuse to report it themsleves. Seem unfair? It is, but right now.....unless the abused wants to press charges there is nothing that can be done to protect them against violence.
The system itself is overwhelmed with those they have to protect......the ones who cannot protect themselves.....the young, the eldery and the disabled. Those are the ones reported to authorities.....the others I report to social service and call them to to speak to the patient. Even when the patient denies the abuse and insist they fell down the stairs (for the 8th time that month) I remind them we are here to protect them and I'll give them domestic violence information and safe house info with the discharge papers in hopes if they really need protecting they'll remember there is a place to go and it will save their life.
Here is a hypothetical story........a nurse was working in a rural ED. The local medics brought in the wife of a local police officer. The police were originally called because he was seen dragging her into the house, across the parking lot, by her hair, holding their your son in his arms......on Valentines Day. He drug her into their apartment where he was heard to give her a few more hits, got some beer from the fridge and went to the neighbors house with his child in his arms, said his wife had had too much to drink at their dinner and was sleeping it off. Another neighbor called the police, they broke down the door and found this battered woman lying in her own vomit form a concussion,unconscious, on the floor. Her husband was arrested, that night, and charged with assault and battery with intent to murder, endangerment and other charges that fit the crime. The wife, in the ED, was extremely frightened and injured requiring surgery to repair her face and facial fractures as well as casts applied to the extremities stated she was afraid the next time her will kill her. When this went to court,several monthds later, the wife "did not recall" making those statements, and the pictures were "eaggerated", the injuries were deemed "not so bad" and the wife remembers falling down a few times from being drunk. That officer went home that day reinstated with his weapon returned to him in court:devil:.....the nurse involved moved. He was convicted a few years later of the murder of his wife. and it was all perfectly legal.....until he killed her.
This story:rolleyes: is the reason the law needs to be changed but the system is so overwhelmed right now they cannot take on anymore work, so right now.... it is perfectly legal for the abused to deny their injury and the abuser to go free. You can report the other reporting injuries like with penetraitng injuries or projectile objects involving knives and guns and sometimes that will help in protecting the victims. Sometimes just asking if anyone is hurting you is enough to get someone to say yes and you can get social services involved to intervene. It is very hard to get the abused to admit abuse let alone act upon it, by the time a woman is physically battered there has been long term verbal abuse to put her in a vulnerable state of no self esteem and to isolate her from her family, therefore, giving them the feeling of no way out......and for some to leave is to die.
Unfortunately, it isn't fair and it's very sad. BUt continue to ask if anyone is physically or emotionally them at home and if you get one yes answer.......maybe you'll save one life.:heartbeat
Specializes in Emergency Dept. Trauma. Pediatrics.
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.
At my facility we report all suspected abuse. It's a part of our admission stuff. We ask the person and mark their answer and then in a separate field we mark if we suspect any abuse and what type. It automatically fires a social worker consult.
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 act on her behalf. 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 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.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Review the Nurse Practice Act in your state. As RNs, we are REQUIRED to report abuse:
"Registered nurses are among the health practitioners who must report known or observed instances of abuse to the
appropriate authorities. This mandate applies to those situations that occur in the RN's professional capacity or
within the scope of employment. Registered nurses must also be aware that failure to report as required is also
considered unprofessional conduct and can result in disciplinary actions against the RN's license by the BRN."
This is straight from the California Nurse Practice Act.
Required to report and Mandated to report to the proper "appropriate authorities" can mean your social service department or administration. The federal mandates and forms are a separate entitiy from just the "proper authorities" and are reported to federal agencies for investigation. As you brought up it is important to know your state Nurse Practice Acts and what is particular to you area of expertise as for example, there are very specific mandated reporting requirements specific to the ED. :)
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.
Ultimately, adults have choices.
The elderly...many do not work, have major health problems...do not suffer from abuse by choice and do not have the option to pack their things and walk away.
Children, cannot get a job and move out.
I'm not trying to sound heartless toward battered women, but women very often put themselves in very vulnerable positions that allow someone to have control over them to start with and then when they find themselves in a domestic abuse situation, they "feel" that they have no choice.
1. Women need to finish high school AND college. Don't have babies until you are done with both...this is the key to being independent...no matter how hot that guy in high school is or what he promises you.
2. They never need to have more children than what they can afford to support ON THEIR OWN. 50% of marriages end in divorce...just because your husband earns a big salary that allows you to stay at home...don't have 4 kids just because you can...b/c if your husband leaves you for the floozy down the street or starts beating the crap out of you every day...what will keep you there is the fact that you know if you had a job tomorrow, you won't be able to feed your kids.
3. MAINTAIN EMPLOYMENT, even on a part-time basis. It is much more difficult to get a job if you have no or low job skills than if you have been working part-time for years.
4. MAINTAIN YOUR CREDIT...I am a HUGE advocate for a husband and wife to have ZERO joint accounts unless it is the house...b/c I cannot tell you how many people that I know have their credit destroyed due to a divorce..this is all because of joint accounts...that makes it hard to get an apartment, buy a new house, get more credit when needed, etc.
5. MAINTAIN A SEPARATE BANKING ACCOUNT. My parents did this the ENTIRE 55 years they were married. It is not a matter of trust, it is a matter of having access to money someone else cannot remove and there when you need it ON DEMAND.
Women, put themselves into vulnerable positions and they also don't like the options they have when there is a plan to get out. There are domestic abuse shelters everywhere. So many women don't want to leave their children's toys behind, or their favorite clothes, or the house, etc. To me, none of those things are worth paying for with a beating.
So, I don't advocate mandated reporting for domestic abuse because they do CHOOSE to stay and be a victim...if they are at the hospital, that is their time to speak. I have done several domestic violence assessments on women that come in to have babies. I always tell them, "If you feel you are in danger, it is easier to get you help here at the hospital than after you go home."
The saddest part, is that you know what is the #1 reason women ultimately leave their abusers?
When they start beating the children.
Sad, that it has to come to that...not to mention that children that grow up in these relationships very often grow up to become abusers or learn to have love through abuse.
I think that if a woman presents to the ER having been beaten and refuses to have her abuser arrested, if they have children living with them, social services needs to be called.
I don't care what anyone says, the children are being MENTALLY AND EMOTIONALLY abused having to witness their mother getting beat up.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
However...on a side note.
I think that if a woman presents to the ER having been beaten and refuses to have her abuser arrested, if they have children living with them, social services needs to be called.
I don't care what anyone says, the children are being MENTALLY AND EMOTIONALLY abused having to witness their mother getting beat up.
Absolutely!!!!!!! and I have filed with DSS (or whatever state social worker agency is called) for child abuse when the parent is being abuse by the SO.....you are right...it is abuse. I will uses any legal means possible to get services in the home.
.......a nurse was working in a rural ED. The local medics brought in the wife of a local police officer. The police were originally called because he was seen dragging her into the house, across the parking lot, by her hair, holding their your son in his arms......on Valentines Day. He drug her into their apartment where he was heard to give her a few more hits, got some beer from the fridge and went to the neighbors house with his child in his arms, said his wife had had too much to drink at their dinner and was sleeping it off. Another neighbor called the police, they broke down the door and found this battered woman lying in her own vomit form a concussion,unconscious, on the floor. Her husband was arrested, that night, and charged with assault and battery with intent to murder, endangerment and other charges that fit the crime. The wife, in the ED, was extremely frightened and injured requiring surgery to repair her face and facial fractures as well as casts applied to the extremities stated she was afraid the next time her will kill her. When this went to court,several monthds later, the wife "did not recall" making those statements, and the pictures were "eaggerated", the injuries were deemed "not so bad" and the wife remembers falling down a few times from being drunk. That officer went home that day reinstated with his weapon returned to him in court:devil:.....the nurse involved moved. He was convicted a few years later of the murder of his wife.
and it was all perfectly legal.....until he killed her..thumb.jpg.5aa4d55557c0228e31b94de19666bbbb.jpg){kind=small}
canesdukegirl, BSN, RN
1 Article; 2,543 Posts
(Insert admiration emoticon here) RN/W, you continue to amaze me with your words of wisdom. You are SO right. It does take quite a bit of time (and a great deal of frustration on our part as nurses) for a woman to leave an abusive relationship. It is quite the quandary for her. She desperately wants help on the one hand but desperately wants to keep quiet on the other hand. What to do?
The biggest fear of an abusive man is to be found out. This fear is compounded when his victim must seek medical care. His senses are on high alert, and chances are good that even if his victim says nothing, she will be punished anyway because he suspects that something was said.
Abused women are in a catch 22. If they leave the abuser, they must now constantly look over their shoulder...for YEARS. They may not have anywhere to go. The choices that are offered may seem more scary than living with the abuser. Have you ever heard of the saying, "Better the devil you know than the angel you don't"? Change is scary for everyone. Anything unfamiliar is a challenge. Abused women must overcome both the uncertainty of leaving as well as the repercussions she may face if her plan to leave is not successful. Remember that these women have had their self confidence insipidly and systematically dismantled.
When I have a pt that comes into my OR with injuries that appear to be the result of abuse, I request that the attending surgeon write a consult for social work. These social workers are professionals, and are well versed on the intricacies of domestic violence.
But yes, it takes time. We can plant the seed, as rn/writer states. The rest is out of our hands.