Recently on a busy night shift I found myself working in the paediatric (with the kiddies) section of the emergency department (ED). Our ED is quite large with various sections including, Triage, waiting room, sub-acute, acute, and resus to name a few areas. All these sections require nursing staff and nurses are allocated to a certain section each shift depending on a few variables addressing things such as skill mix, time of shift, how busy the department is and any other things the manager needs to address.
Staff can check the allocations for the next day to see where they will be working the following shift. I rarely do this, I like to turn up on the shift not knowing where I will be working, I think if I check the day before then I may spend the whole time until the shift starts worrying about how busy it will be or whether or not I’ll cope with where I’m allocated to. Luckily in regards to the coping issue I work with fantastically supportive senior staff and the issue of not coping…well it wouldn’t be an issue, all I have to do is raise my voice for some support and it would be there and if need be I would be reallocated to a different area for that shift. Anyhow I have digressed, so back onto the topic, on a busy night shift I found myself to be in the paediatric section for the night. I was actually really chuffed with this as I always am when allocated to work in paeds because I enjoy working with the kiddies a lot.
I feel very confident working with children and families, I think this in part is because of having children in my life for nearly half my life. I feel I can build a good rapport with parents and try to be a good advocate and carer for my patient and their family. I also always try to address and alleviate any of their fears or concerns in regards to the patients presenting health complaint.
There are often two types of parents that bring their children into and emergency department, those that have used their common sense to deduce that their child needs emergency medical attention and those that just plain have no idea. For example, patient brought in by parents for Asthma, good decision!!! Patient brought in by parents for tiny splinter in finger, no signs of infection, no distress in child, no attempt to get it out and not seen by local doctor………hhhhhmmmm medical emergency? I think not……………
And then there are those children that, well, something just doesn’t sit right! And if the stories aren’t adding up and matching the clinical/physical presentation then something needs to be done, the situation requires escalating to the appropriate services. As health care workers we are bound by the NSW Legislation as Mandatory Reporters:
who are mandatory reporters?
Mandatory reporters are defined in NSW legislation. They are those who deliver the following services to children as part of their paid or professional work:
- health care – doctors, nurses, dentists and other health workers
- welfare – psychologists, social workers and youth workers
- education – teachers
- children’s services – child care workers, family day carers and home based carers
- residential services – refuge workers, community housing providers
- law enforcement – police
Any person with direct responsibility to provide the above mentioned services must report risk of significant harm to children.
Managers, including both paid employees and volunteers, who supervise direct services are also mandated to report.
Mandatory reporters are not obliged to report risk of significant harm to unborn children or young people (those aged 16-17 years). However they are encouraged to make a report if it is appropriate.
What does all this mean, well it means that as one of the above mentioned professionals if you have a concern, suspicion or evidence of a child or children being at risk of harm or neglect then it has to be reported to Family and Community Services.
It is a difficult situation when one finds themselves in a situation where they see, hear or sense that a child may be a victim of harm or neglect. Further to this is the unspoken emotional response to ones suspicion or findings. That moment where you feel like there is a giant stone dropped in your gut, the moment when you feel like you might be sick or lose your shit and start crying or demanding answers as to how and why this could happen to an innocent child?!
Then quickly followed by the moment where you regain your composure as a professional and think through your legal obligations. What have you seen, heard or suspected that has led you to consider making a report, are your concerns significant enough to warrant making a report? If you find yourself asking these questions and wanting to discuss them with someone a great first port of call is your Nurse Unit Manager. Discussing your concerns with a senior staff member can help you decide if your concerns warrant a report to Family and Community Services. If between the two of you, you require further advice in regards to the matter then contacting:
Child Protection Helpline on (02) 133 627 (for mandatory reporters)
or
Child Protection Helpline on (02) 132 111 (for general public)
Above numbers are useful resources and will advise you of actions that may need to be taken. There is also an on-line service that requires you to fill in some information in regards to the nature of your concern and upon completion of this a report will be generated with action recommendations if any.
http://sdm.community.nsw.gov.au/mrg/app/summary.page
Now this is all very useful information as a mandatory reporter if you are certain about the facts you are putting forward, however what happens if your unsure and you are just going on things you have seen that don’t seem right and things you have been told that don’t add up? What do you do? What would you do? How would you respond if you found yourself in a situation where you thought the safety or wellbeing of a child was being jeopardised? All legal requirements aside……If you weren’t quite sure about your concerns? Colleagues or others that you had discussed your concerns with alluded to the fact that they thought you may be over reacting or that you should stay out of it? What would you do then? If you had that gut feeling and nagging doubt that something was not right with this poor child/children, would your moral obligation negate all the advice you had received?
http://www.keepthemsafe.nsw.gov.au/
Keep Them Safe is a government initiative that promotes a shared approach to child wellbeing, to encourage all members of society to be aware and accountable for children’s safety and wellbeing. It is not just for mandatory reporters but for everyone. To promote awareness of the tragedy that lies beneath the surface of so many children’s lives. Unfortunately children at risk of harm and neglect are out there in our communities. So what do we do? Who are we to say if someone is mistreating a child/children? Are we passing judgement on another persons parenting if we have suspicion that they are not providing the best protection or life choices for their child/children? These are some of the moral dilemmas that one may face if they have concerns regarding a child/children’s wellbeing.
Once faced with this situation my first response as a humanitarian, mother, carer, empathetic human being would be to address my moral obligation! How could I live with myself if I did nothing? How would I feel if I did nothing and as a result of my inaction the child/children were put at further significant risk of harm or worse even death? How could I live with that on my conscience? If my concerns were unfounded and no further action was taken, then was there any harm in me reporting my concerns? Is it better to report something based on a few small concerns, than not to report at all? Of course it is!!!! It would not matter to me, if ten people told me I was overreacting!! If I had a concern for welfare and it played on my mind, my moral obligation would be enough for me to warrant reporting it.
The Legal Requirement versus Moral Obligation debate doesn’t weigh to heavily on my mind because as I’ve said if it was against my morals not to report something then why would I not?! However the Legal Requirement is a bit of a loop-hole for Mandatory Reporters, a kind of skip to the end of your moral dilemma card. As a Mandatory Reporter if you come across a patient, child/children that you have a concern for in regards to neglect or harm then you are legally required to report it. The next steps that need to be taken are no longer decisions made by you rather ones that are made by Family and Community Services. Therefore if Family and Community Services were to advise you to contact your local police immediately in regards to the child/children you are reporting about then this is action you must undertake! Furthermore if Family and Community Services then dispatch a child protection team to take over the case that you have reported your concern about, then you relinquish your responsibility/care for the child/children to the new team involved.
There are policies and procedures in place in different ED’s that can be used as GUIDELINES on how to manage the care of a child/children that require a mandatory report being submitted regarding them. These are guidelines and should not be used to determine whether or not a report should be made. What determines whether or not a report should be made is your legal and moral obligation!!!!
Why would you not want to look out for the best interests of the child? Why would you not want to make them safe? Don’t ever feel like your making a judgement call on the family! Don’t ever not report because it’s too much paper work! Don’t ever not report because you don’t want to have to go to court in the future! Don’t ever not report because you’re not 100% sure of the facts because no-one ever really can be!!!
So if a Doctor or anyone ever second guesses your actions and says “Who made a Family and Community Report and who rang the Police at four in the morning?” And “Show me where in the policies and procedures manuals it says to take that action”? One can turn and say to them “it is OUR professional responsibility and legally required as mandatory reporters to escalate this case for further assessment” AND “it is also my moral obligation to provide protection to a child/children who may be at risk of harm or neglect”!!!! Or if someone says to you “remember not to let your emotions guide you, we are professionals” again respond with “Yes and as professionals it is our legal requirement to report it”. Try not to doubt or second guess your decisions and actions, let your legal requirements and morals guide you!!
As I said in the beginning I do really enjoy working in paediatrics and I hope I never have to experience cases like this. However if I do, I can assure you that I will speak out for those that cannot speak for themselves, I will break the shroud of secrecy and silence!! I will advocate against child abuse in any form!! No other persons opinion will sway me into subscribing to the behaviour of ignorance is bliss, what may be bliss for some, may well be hell for others!!
I hope for a world where people love, protect and rejoice in the beauty and innocence of children. A world where everyone recognises the vulnerability of childhood and as a world-wide community work together to always provide children with safety and protection; nurturing lives, filled with love!!!!
Peace, Love and Happiness xox 🙂
Noosha's Beautiful People 