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The stark reality in 21st-century America is that child abuse is reported to authorities every ten seconds. During the time they are being trafficked, 30-88% of survivors of human trafficking see a healthcare provider. In addition, 10 million men and women are abused by an intimate partner every year.
Would you know your responsibility as a nurse and mandated reporter if you suspected a patient was potentially trapped in these dangerous circumstances? It is crucial to understand the actions to take when faced when suspecting abuse or neglect. This guide explores the legal definition and responsibilities of a mandated reporter, how to identify abuse and neglect, and how registered nurses can care for patients who have experienced such maltreatment.
What Is a Mandated Reporter?
According to the National Association of Mandated Reporters (NAMR), mandated reporters are "people required by law to report suspected or known instances of abuse," including "known or suspected abuse or neglect relating to children, elders, or dependent adults." Intimate partner violence (IPV) and the abuse of both dependent adults and adults with disabilities also fall within the realm of the mandated reporter.
Currently, 47 states have designated professions wherein workers are mandated to report child maltreatment, as well as the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands.
Most every individual who works with elders is required to report suspected abuse in all states. In California, even those caring for elders without compensation are responsible for reporting.
"IPV, also known as domestic abuse, doesn't have the same legislative requirements as other types of abuse," states the NAMR. "In most instances, IPV reporting falls under injury by firearm or assault/abuse requirements for health practitioners. In California, for example, any health practitioner providing services in a health facility, clinic, or physician's office who knows or reasonably suspects that a patient is the victim of assaultive or abusive conduct or a firearm injury is generally required to make a report."
With the abuse of dependent adults or adults with disabilities, NAMR explains that every state other than New York stipulates mandated reporter requirements for this vulnerable population. However, 15 states have universal reporting and some states "provide broad definitions of who should report (e.g. all medical personnel) making it important that professionals review the statute for their own state."
What Responsibilities Do Nurses Have as Mandated Reporters?
Like all healthcare professionals, every nurse bears the ethical and legal responsibility of following regulations as mandated reporters in their state. What nurses are required to report — and the legal forms — also vary by state.
No matter how emotionally triggering or disturbing a situation, nurses must maintain an objective stance when completing documentation of suspected or actual neglect or abuse. Opinions, emotions, and judgments of either the survivor or perpetrator should be left out of any legally binding report.
If a mandated reporter fails to report abuse, they face significant consequences. For example, Florida may charge the individual with a felony and a fine of up to $1 million. Forty states label the failure to report as a misdemeanor. Other states may elect to upgrade the charge to a felony in certain cases. Employers may also receive penalties for obstructing staff member reports.
In addition, false reporting carries a variety of penalties depending on the state. In Florida, Illinois, Tennessee, and Texas, such an action is treated as a felony. Meanwhile, California, Maine, Minnesota, Montana, and Nebraska impose no such penalties.
For more details, ChildWelfare.gov offers a state-by-state listing of mandated reporter regulations.
How To Identify Abuse and Neglect in Patients
When interacting with patients, identifying abuse and neglect is an important aspect of nursing assessment. Whether human trafficking or another form of abuse and neglect, the nurse plays a pivotal role as a frontline advocate who bears the legal and ethical responsibility to document and report what is observed or perceived.
Many survivors of human trafficking seek medical care during the period in which they are being exploited. Signs of human trafficking may include, but are not limited to:
- The patient does not have control of their money, identification, or passport.
- The patient might tell you they are visiting the area but cannot offer details about arrival or departure dates, an address, or a phone number.
- They display closed body language or appear withdrawn and submissive.
- The patient might be anxious, fearful, and depressed.
- They are vague about their address or where they live.
- The patient is malnourished; has unexplained bruises, burns, or injuries; or may have evidence of untreated sexually transmitted diseases.
When assessing for elder abuse, the nurse may choose to use an assessment tool, such as the Elder Abuse Suspicion Index. This index directs the clinician to ask the following questions of the patient while noting that a positive response to at least one question has a sensitivity of 47% and specificity of 75% for elder abuse.
- Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids or medical care or from being with people you wanted to be with?
- Have you been upset because someone talked to you in a way that made you feel shamed or threatened?
- Has anyone tried to force you to sign papers or to use your money against your will?
- Has anyone made you afraid, touched you in ways that you did not want or hurt you physically?
Signs of child abuse may include:
- A lack of supervision by a responsible adult
- A withdrawn, depressed, apathetic, or passive demeanor
- Unaddressed medical issues, bruises, cuts, and burns
- A parent and child who rarely look at one another, or otherwise obvious parental indifference
- A statement by the child that they are always alone or that no one takes care of them
An assessment of abuse, neglect, trafficking, or exploitation is subtle in nature. The nurse must use communication, empathy, emotional intelligence, and motivational interviewing skills to make an objective assessment. They provide accurate documentation and follow up with the patient.
Tips for Caring for Patients Who Have Experienced Abuse and/or Neglect
Caring for patients who have experienced abuse or neglect requires thoughtful, compassionate, and highly professional care.
- The nurse must remember that the individual who has experienced abuse may feel shame, guilt, or embarrassment. Both adults and children may feel responsible for what occurred, no matter how improbable or illogical that may seem.
- Listening is one of the most powerful things you can do. A nurse with highly developed skills in listening, motivational interviewing, and emotional intelligence can bring the patient comfort.
- Although it may be difficult, the nurse should remain objective and neutral in terms of both their communication with the patient and documentation of the facts, no matter how abhorrent the treatment suffered by the patient.
- It is essential to reassure the patient that whatever reaction they are having to trauma is to be expected. Present them with access to trustworthy organizations and professionals who can walk with them through recovery.
The Rape, Abuse, and Incest National Network (RAINN) website features a database of state regulations regarding the reporting of sex crimes. It showcases important information for laypeople, healthcare providers, and other professionals. In addition, the American Medical Association offers support for providers who find themselves in situations involving suspected abuse.
Nursing and Mandated Reporting FAQ
Why is mandatory reporting important in nursing?
As the largest segment of the healthcare workforce, nurses are the lifeblood of the healthcare system. The most trusted profession in the U.S. as evidenced by the Gallup Poll, nurses serve as advocates, protectors, and witnesses for vulnerable patients in need of professional, legal, ethical, and moral support in the face of abuse and neglect.
What is the nurse's responsibility if there is a suspicion of abuse?
Individual state governments dictate a nurse's legal responsibility to report suspected abuse. The facility, agency, or organization employing the nurse may also have its own internal documentation and reporting policies as well.
What types of abuse are nurses mandated to report?
Depending on state regulations, nurses must report a variety of cases, including elder abuse, child abuse and neglect, the abuse of persons with disabilities, and those who have experienced sexual abuse.
How should the nurse documented the abuse?
Documentation of actual or suspected abuse is a crucial action to be taken by a nurse. A nurse must state the facts of the case and leave all feelings, judgments, and opinions aside.
Resources for Nurses
Resources for Survivors of Abuse and Neglect
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