Healthcare providers are one of the few professionals that regularly come into contact with the vulnerable populations most at risk for abuse.
There are an estimated 21 million victims of human trafficking worldwide, and it’s estimated that 30-88% of U.S. trafficking victims visit a healthcare professional at least once during their captivity. In addition to potentially identifying victims of trafficking, you may also come into contact with children, the elderly, or dependent adults who are victims of abuse, as well as adults seeking medical help resulting from intimate partner violence.
Almost every U.S. state identifies healthcare workers as mandated reporters: professionals with a legal obligation to report instances of abuse or neglect.
What are your mandatory reporting requirements as a nurse, and how can you find training to support your legal obligations to report?
What Types of Abuse Are Nurses Required to Report?
Most legislation requiring nurses to report suspected abuse relates to protecting vulnerable populations, such as child abuse, elder abuse, and dependent adult abuse. As a healthcare provider, you may also be required to report intimate partner violence, as well.
Child abuse and neglect instances are as common as they are heartbreaking. The CDC reports at least 1 in 7 children have experienced child abuse or neglect in the past year, a statistic that is likely to be underestimated due to the number of cases that go unreported.
Child abuse includes:
Physical Abuse: Physical abuse is the non-accidental act by a caregiver which causes or creates a substantial risk of physical injury to a child. The injury may result from a single or repeated episode, ranging in severity from minor bruising to death.
Emotional Abuse: Emotional abuse in children is defined as behaviors, speech, and actions of parents, caregivers, or other significant figures in a child’s life that have a negative mental impact on the child. Child emotional abuse is an often misunderstood form of trauma that can cause damage to a child’s developing brain, leading to long-term learning difficulties, problematic behaviors, and increased incidences of physical and mental health issues.
Sexual Abuse: Nationally, every 9 minutes, child welfare services find evidence for a claim of child sexual abuse. Child sexual abuse is a form of child abuse that includes sexual activity, but child sexual abuse does not need to include physical contact between a perpetrator and the victim. Any contact of a sexual nature that involves a minor can be considered sexual abuse.
Neglect: Child neglect is the failure of a parent, guardian, or other caretaker to sufficiently provide for the care of a child’s basic needs. Child neglect and abuse are often defined together in the law, but essentially, child abuse occurs due to harmful actions, while child neglect occurs due to inaction.
Elder and Dependent Adult Abuse
Approximately 1 in ten elder Americans (aged 60+) have experienced some form of elder abuse. California’s Adult Protective Services reports that 28% of adult abuse cases include the abuse and neglect of a dependent adult, an adult between the ages of 18 and 64 whose ability to carry out normal daily activities is restricted due to physical or mental limitations.
Common types of elder and dependent adult abuse include:
Physical Abuse: Physical elder abuse may include slapping, hitting, beating, bruising, or causing someone physical pain and substantial risk of death, injury, or suffering. This could also include confining an adult against their will or the inappropriate use of physical or chemical restraints or psychotropic medications.
Sexual Abuse: Sexual abuse is a form of physical abuse and includes physical force, threats, or coercion to facilitate non-consensual touching, fondling, intercourse, or other sexual activities. This is particularly true with vulnerable adults who are unable to give consent or comprehend the nature of these actions.
Emotional Abuse: Psychological abuse of an elder or dependent adult includes actions that result in fear, agitation, confusion, severe depression, and other forms of serious emotional distress. This may include threats, harassment, or intimidation by the abuser.
Non-Physical Forms of Abuse: Elder abuse can include many non-physical types, including caregiver neglect, self-neglect, isolation, abandonment, and financial abuse. The annual loss by victims of elder financial abuse is estimated to be at least $36.5 billion.
Intimate Partner Violence
Intimate partner violence, also known as domestic violence, is abuse within the context of an intimate partner relationship. Intimate partner violence (IPV) typically occurs when one relationship partner uses abuse tactics to assert control over the other partner. Discover 7 types of intimate partner violence.
The U.S. medical community treats millions of intimate partner rapes and physical assaults annually. According to data from the CDC’s Intimate Partner and Sexual Violence Survey, about 1 in 4 women and 1 in 10 men have experienced some form of IPV in their lifetime.
IPV does not carry the same reporting requirements as abuse to children, disabled adults, and the elderly. One reason that IPV reporting is not mandated to the same degree is protection for victims.
The ultimate goal of mandated reporting is to enhance the safety and well-being of victims. Many IPV victims, however, fear that reporting and intervention can actually increase their risk of physical violence and retaliation from their abusers.
Reporting suspected IPV abuse can also be seen as not respecting the autonomy of IPV survivors to make their own decisions about leaving an abusive relationship or staying—which some victims may choose as a life-preserving effort.
Abusers often go to extreme measures to prevent their victims from leaving. A U.S. Department of Justice survey of men who killed their wives reports that threats of separation and actual separation were most often the events that precipitated the murder.
While healthcare professionals may not be required by state legislation to report suspected IPV, there may be instances where you are treating an IPV victim when other reporting requirements apply.
Most state reporting laws for healthcare workers fall under one of these four categories:
- States that require reporting of injuries caused by weapons
- States that mandate reporting of injuries caused in violation of criminal laws
- States that specifically mandate domestic violence reporting
- States that have no mandated reporting laws
The U.S. Department of Justice research report on the Extent, Nature, and Consequences of Intimate Partner Violence recommends:
“To better meet the needs of intimate partner violence victims, medical professionals should receive training on the physical consequences of intimate partner violence and appropriate medical intervention strategies.” - US DOJ
How Can Nurses Determine Their Reporting Requirements?
Nurses and other healthcare professionals are typically mandated reporters of abuse in almost every state. However, mandated reporting requirements can vary from state to state, as can the requirements for reporting and the process for making a report.
Determining your reporting requirements can be difficult, especially since requirements can vary based on the vulnerable population being victimized. As mentioned above, some victims require a report by law for every type of abuse, while others may only require a report in certain instances, such as an injury caused by a weapon or in violation of criminal laws.
In order to determine your reporting requirements, you may need to do one or more of the following:
- Consult mandated reporting laws in your state
- Consult your state nursing board for abuse reporting requirements
- Take a mandated reporter training course
What Type of Training is Available for Nurse Mandated Reporters?
Mandated reporter training can help nurses and healthcare professionals understand their obligations as mandated reporters, recognize signs of suspected abuse, determine how, when, and where to make a report, and understand what investigating agencies can and cannot do in response to your report.
Role-specific training may be available to help you understand your specific requirements as a healthcare professional in your state.
For example, nurses in California can take a general child abuse reporting course and then a healthcare professional-specific course focused on specific situations and concerns related to the evaluation of child abuse and neglect in a medical or healthcare setting. California nurses can take these trainings at mandatedreporterca.com.
For other states, a general mandated reporter training course may help you fulfill your duties. Completion of a mandated reporter training course will provide you with a certificate of completion, which you can provide to your employer administrators to show you’re up-to-date on this critical training course.
Whether you take a general mandated reporter training course or a profession-specific course tailored for healthcare professionals, taking mandated reporter training can help you understand your requirements and prepare you for your mandatory reporter duties.
Healthcare professionals can come into contact with vulnerable at-risk populations and are uniquely qualified to identify and report suspected instances of abuse. Saving a life as a medical professional goes beyond medical practice and procedure; you could be the person who saves a child, elderly, or dependent adult from continued abuse or neglect by taking your role as a mandated reporter with the seriousness it deserves.