Critical Concepts | Legal / Ethical

Mandatory Reporting in Nursing: More Harmful Than Helpful?

  • Mandatory reporting in nursing is a federal requirement in all 50 U.S. states.
  • Although it requires the provider to break patient confidentiality, it was conceptualized for the betterment and safety of the patient upon leaving the healthcare facility.
  • Not sure how you feel about mandated reporting? Keep reading!

NCC News & Content Team

November 19, 2021
Simmons University

In healthcare, you encounter many people on a daily basis; which is great! 

You are exposed to various populations, backgrounds, life experiences of others and so much more. 

However, this may not always be a good thing.  

As a nurse, you see patients when they are in their most vulnerable state. In some cases, they may trust to confide in you, and in others, they might present ‘red flags’ that reflect a potentially dangerous dynamic outside of the healthcare setting.  

In the U.S., 10% of adults ages 65 or older are at risk of experiencing abuse, and 90 out of 1,000 children per population will become victims. 

The prevalence of abuse and neglect among all populations is staggering, and as the healthcare provider, you must be informed on the common signs, symptoms, and symbols.  

Mandatory reporting in nursing requires providers to relay any findings of abuse or neglect to law enforcement. Failure to do so could result in being reprimanded by the facility and reported to the state-specific board of nursing for further punishment.  

Interested in learning more about mandatory reporting in nursing? Let’s dive in!  

child in hospital bed

When Did Mandatory Reporting in Nursing Begin?

Mandatory reporting was not conceptualized and implemented solely for the healthcare professions, in fact, it was created for educators, law officials, and various other professionals, too. Essentially, any career that works with civilians must follow a mandatory reporting protocol.  

We are sure you’re thinking, “Yes, the idea of mandatory reporting is great, but how long has it been around?”  

In 1874, it was illegal to inflict inhumane acts onto animals, however, the same protections for humanity did not come for a century. 

The Child Abuse Prevention and Treatment Act (CAPTA) was enacted by The US Congress in 1974 and provides:

“Federal funding and guidance to States in support of prevention, assessment, investigation, prosecution, and treatment activities and also provides grants to public agencies and nonprofit organizations, including Indian Tribes and Tribal organizations, for demonstration programs and projects.” 

However, the first state to enact and implement mandatory reporting laws was Iowa in 1978. 

Now, over 40 years later, all 50 states (as well as all U.S. territories) hold mandatory reporting statutes. 

As previously mentioned, this mandate not only requires the healthcare professions to report signs of abuse or neglect but also educators, public health servants, law officials, counselors, and social workers as well. 

nurse and patient

What Are Some of the Common Signs and Symptoms of Possible Abuse or Neglect?

According to the Mandatory Reporting Guide offered by the Iowa Department of Human Services (DHS), there are various physical and behavioral signs of child abuse or neglect that all mandatory reporters should be aware of; some of these include:

Physical Behavioral 
  • Bruises and welts in unusual patterns and in various stages of healing 
  • Cigarette, immersion, or rope burns 
  • Fractures of skull, nose, ribs, or facial structure in various stages of healing 
  • Multiple spinal fractures 
  • Bite marks and lacerations 
  • Pain or itching in genital area 
  • Difficulty in walking or sitting 
  • Pregnancy 
  • Torn, stained, or bloody clothing 
  • Positive test for presence of illegal drugs in body
  • Afraid to go home; frightened of guardians 
  • Extremes such as aggressiveness or withdrawal 
  • Destructive, antisocial, or neurotic traits 
  • Poor self-esteem, lack of confidence  


Is Mandatory Reporting in Nursing Benefiting the Patient?

Is Mandatory Reporting in Nursing Benefiting the Patient?  

It is important that we preface this question by stating that every scenario, patient, and circumstance is different. Additionally, mandatory reporting in nursing is required by law. 

As a provider, ensuring patient confidentiality is of the utmost importance in practice; however, mandatory reporting takes precedence. 

Although this is often in the best interest of the patient, studies show that mandatory reporting can worsen situations outside of the healthcare setting, impact the information given to the provider, and interfere with a patient’s willingness to seek help.  

The ethical dilemma of mandatory reporting can not only create hesitancy for the patient, but the provider as well.  

In a meta-synthesis overviewing 44 articles worth of provider perceptions of mandatory reporting in child neglect and abuse, it was determined that 73% of articles found that participants claimed there were negative and adverse effects following the reporting process. 

For example, the patient not being removed from the harmful dynamic where the abuse/neglect worsened. An additional example was children entering the foster care system where the abuse/neglect was worse than the “family-of-origin” environment.  

If a provider takes an oath to do no harm, but it is not guaranteed that the harm will subside upon reporting, it can be a difficult decision to make; however, it is the law to report.  

Of course, there is a necessity for mandatory reporting, especially in circumstances where children are involved who cannot speak for themselves effectively, but approaching this mandate from a different perspective can be eye-opening. 

We hope that this breakdown has provided you with more insight as you continue throughout your career and receive more exposure to mandatory reporting in nursing. 

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