Are Nurse Practitioners Legally Obligated to Report Domestic Violence?

Are nurse practitioners obligated to report domestic violence? This is a question I haven't asked myself enough over the past few years. Working in the emergency department we have an on-site police officer on the floor at all times. Any time a suspected case of violence or assault comes through the doors, the officer takes a report. Reporting domestic violence, however, is a touchy subject. Some argue it may even do more harm than good. 

The U.S. Department of Justice estimates that nearly 37 percent of women visiting the emergency department present as a result of domestic violence. Chances are, whether you work in the ER, a clinic, or another hospital setting, you've missed a case or two yourself. With domestic violence such a pressing issue, it's important that we as nurse practitioners understand the ramifications of and obligation to report or not report these cases. 

What Do State Laws Say about Reporting Domestic Violence?

Moat states have laws either directly or indirectly addressing the reporting of at least certain forms of domestic violence. Laws regarding the reporting of abuse or violence among adults vary from state to state. In general, they fall into four categories:

  1. States that require the reporting of injuries caused by weapons.
  2. States that require the reporting of injuries caused in violation of criminal law, by violence, or through non-accidental means.
  3. States that specifically mandate the reporting of domestic violence.
  4. States that have no mandatory reporting laws.

A few states take things even further than requiring that healthcare providers report suspected domestic violence. These states mandate training in screening for and identifying victims. The Compendium of State Statutes and Policies on Domestic Violence and Health Care gives an excellent state-by-state outline of reporting policies when it comes to domestic violence. 

The Pros and Cons of Mandatory Reporting Guidelines

As a healthcare provider, my initial reaction to laws mandating the reporting of domestic violence is that, of course, they are beneficial. What kind of person would I be if I noticed someone fall victim to violence without alerting the authorities, at the very least. However, there are a few valid arguments against reporting these acts. 

In some cases, the mandatory reporting of violence discourages domestic violence victims from seeking treatment. Or, a reported incident may spark retribution on part of the abuser. Victims fear that seeking medical attention may place them in even greater peril. Mandatory reporting policies also infringe on the fine line between patient-provider confidentiality. Furthermore, they limits victims' power over their own lives. Given that the victim has intimate knowledge of the situation, they may feel they are better prepared to take appropriate action themselves. 

What Do You Think?

The subject of reporting domestic violence is a touchy one and, unfortunately, one that we as nurse practitioners deal with all too often. How do you approach the issue of domestic violence in your practice within your state's guidelines? Do you know your states policies regarding the reporting of these kinds of crimes?

 

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