This places an added and unfair burden upon the shoulders of nurses, as they may be able to note the emotional and physical signs of abuse, yet they may not have all of the child's medical facts and personal history at their disposal or full authority over the case.
Although the nurse may feel that he or she should defer to the physician's judgment, discussing with the physician why he or she does not wish to report the case as abuse is an important first step in taking proactive action. The physician may be reluctant to report the abuse, not because he or she does not feel that there has been some maltreatment, but because the physician does not think the child's mother is responsible. The nurse may need to remind the physician of their ethical responsibilities as health care practitioners in reporting abuse, regardless of the source. Also, the physician may even be unaware of how to report abuse. Together, the nurse and physician can see if they can gain access to the child's medical records to gain a better sense of the child's past history, and ideally the two could speak to the child's primary pediatrician.
This will also provide clues as to what type of action might be required to protect the child. Even attempting to determine if other children have been recently injured at the day care facility, by talking to the mother, might be possible. Regardless, because of the young age of the child, and the fact that the child is not under the eye of teachers or other authorities than the mother and the day care where the child was injured, the nurse has an additional ethical and moral, as well as legal responsibility to investigate the abuse.
Works Cited
Child Physical Abuse Under-Reported by Healthcare Staff and 1 in 5 Worry About Getting it Wrong." (30 Oct 2006). Medical News Today. Retrieved 20 Mar 2007 http://www.medicalnewstoday.com/medicalnews.php?newsid=55269
Terry, Ruth Anne. (Aug 2004). "Abuse Reporting Requirements."
Board of Registered Nursing. State of California. Retrieved 20 Mar 2007 http://www.rn.ca.gov/practice/pdf/npr-i-23.pdf
