Never delay reporting suspected child or elder abuse to confront the suspected abuser first.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client tells the nurse about abuse at home. The nurse's priority is to:
Answer: B. Ensure immediate safety, provide a private supportive environment, document objectively, and report per mandatory-reporting requirements/policy. Confronting the abuser or ignoring it is unsafe.
Question 2 of 5
Which client should the nurse see FIRST when several clients are reporting symptoms simultaneously?
Answer: B. A client reporting sudden severe shortness of breath with new chest tightness has a potential airway/breathing/cardiac emergency and is the priority. A client requesting a warm blanket, one asking about a meal, and one wanting the television channel changed have comfort needs that can wait.
Question 3 of 5
A registered nurse is delegating tasks for a client with anemia to unlicensed assistive personnel (UAP). Which task is appropriate to delegate?
Answer: A. UAP may perform tasks within their scope that do not require nursing judgment, such as obtaining vital signs, assisting with hygiene and ambulation, and recording intake and output. Assisting the stable client to ambulate and reporting how they tolerate it is appropriate. Assessing for reactions, teaching about medications, and evaluating transfusion tolerance require the licensed nurse and cannot be delegated.
Question 4 of 5
Three clients call at once. Which does the nurse attend to FIRST?
Answer: B. Prioritize the airway/breathing/circulation threat: a client reporting difficulty breathing is seen before pain medication or a bedpan request.
Question 5 of 5
A charge nurse is delegating care on a mental health unit. Which task is appropriate to delegate to unlicensed assistive personnel (UAP)?
Answer: B. UAP can perform tasks within their training that do not require nursing judgment, such as 1:1 constant observation of a client on suicide precautions while reporting to the nurse. Assessing suicide risk, conducting therapy, and teaching about medications require licensed nurse judgment and cannot be delegated.
Keep the streak going with more questions like these, each with a full rationale.
What is mandatory reporting?
Reporting is based on reasonable suspicion, not proof, and overrides patient confidentiality. Failure to report can result in legal liability and loss of license.
Key points to remember
- Mandatory reporting requires reporting reasonable suspicion of abuse or neglect of children, older adults, and vulnerable persons; proof is not needed.
- Reporters who act in good faith are legally protected from liability, even if the suspicion is unfounded.
- Mandatory reporting is a legal exception to HIPAA and patient confidentiality.
- Certain communicable diseases (e.g., TB, syphilis, measles) must be reported to public health authorities.
- Failure to report when required can result in fines, license discipline, and criminal charges.
- The nurse reports to the designated agency (Child Protective Services, Adult Protective Services, or public health), not just to a supervisor.
Nursing priorities
- Document objective findings, direct quotes, and observations factually without interpretation or accusation.
- Report suspected abuse or neglect to the appropriate agency within the legally required timeframe.
- Ensure the patient's immediate safety and separate them from a suspected abuser when possible.
- Preserve any physical evidence and use a body diagram to document injuries.
- Notify the provider and follow facility protocol for suspected abuse.
Patient teaching
- You are in a safe place and we are here to help you.
- We are required by law to report concerns for your safety, and this is to protect you.
Red flags: report now
- Never delay reporting suspected child or elder abuse to confront the suspected abuser first.
- Report immediately any injury pattern inconsistent with the stated history.
- Do not require certainty before reporting; reasonable suspicion is the legal threshold.
References
Clinical references for this topic
