Child Abuse: An Ethical Challenge for Nurses

By Suzan Miller-Hoover, DNP, RN, CCNS, CCRN, Contributor
Child Abuse: An Ethical Challenge for Nurses
To report or not to report, that is the question that many healthcare professionals have had to answer far more frequently than we’d prefer. One in 10 families with children younger than 18 will have an incidence of abuse (USDHHS, 2010). As mandated reporters, the biggest questions we often ask ourselves are: “What if I report this person/family, and I’m wrong? What will happen to them if it isn’t true?” Then again, “What if I don’t report, and the child is further injured, perhaps even killed?”

What does the law actually require of mandated reporters?
It depends on one’s location, as state laws and policies vary; for our purposes, we’ll use California as an example. California Penal Codes § 11165.7 and § 11166(h)-(i) require that professionals and institutions which suspect or have reason to believe that a child has been abused or neglected must report that abuse.

Would it help to know that the U.S. maltreatment rate is less than 1% of the U.S. child population? Of that 1% rate: 78.35% is neglect: 17.8% is physical abuse: 9.5% is sexual abuse, and 7.6% is psychological maltreatment (USDHHS, 2010).

Would it help to know that the social workers in most healthcare institutions are often expert reporters and that you do not have to report on your own? Healthcare is fortunate to have these highly-skilled reporters willing and able to help you differentiate between reporting and not reporting. Reporting child abuse is a multidisciplinary team effort, which includes law enforcement.

Would it help to know that California’s Penal Code § 11165.7 through § 11167 contains language which protects the individuals and institutions that are mandated reporters? This same Penal Code has standards for making a report and rules regarding when to include or omit the reporter’s name. The reporting laws require reporting when there is a “reasonable suspicion” of abuse. While it is usually clear to determine when to report a flagrant incident of child abuse, borderline cases can be much more difficult to evaluate, creating a moral and ethical dilemma.

In one example, a parent reluctantly brought her child to the hospital for evaluation, but feared that when the doctor saw the child’s bruises, (the reason she was brought in for medical care to begin with), she would be reported for child abuse. The mother sought advice from a medical family member, who reassured her that most healthcare professionals stay clear of jumping to conclusions. In the end, the child was evaluated for extensive bruising and was found to have leukemia.

In conclusion, the act of reporting child abuse remains a moral and ethical dilemma. It not only requires that healthcare professionals remain astute activists with the intent to protect the child, but to provide help for the suspected abuser, as well. Remember, “The report of abuse may be catalyst for bringing about change in the home environment, which in turn may lower the risk of abuse” (Chadwick Center, 2012, pg.8). If you suspect, you must report!

For state-specific laws and policies, go to www.childwelfare.gov and use their State Statutes Search. As always, check with your facility for their Policies & Procedures. To learn more about child abuse and the role of the mandated reporter, refer to the RN.com CE course, A Nurse’s Guide to Child Abuse.


California Penal Codes:
a. Professionals Required to Report Penal Code § 11165.7
b. Institutional Responsibility to Report Penal Code § 11166(h)-(i)
c. Standards for Making a Report Penal Code §§ 11166; 11165.7
d. Privileged Communications Penal Code § 11166
e. Inclusion of Reporter’s Name in Report Penal Code § 11167
f. Disclosure of Reporter Identity Penal Code § 11167

Chadwick Center. (2012). California Child Abuse & Neglect Reporting Law, pg. 1-57.

Child Welfare Information Gateway. (2014). Mandatory reporters of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.

U.S. Department of Health and Human Services, Administration for Children and Families, Youth and Families, Children’s Bureau (2010). "National Child Abuse and Neglect Data System (NCANDS) 2009 Child Maltreatment Report". p. ix.

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Dr. Miller-Hoover is a certified Acute and Critical Care Pediatric Clinical Nurse Specialist and has worked in nursing for more than 30 years. Her nursing career has taken her from the bedside, to education and leadership in critical care units where she has cared for patients of all ages. Dr. Miller-Hoover is a published author in peer-reviewed nursing journals and has been accepted for various poster and podium presentations at national conferences.