Nurses who work in late-stage care, either in palliative care or in hospice care, should be aware that all nurses, both registered and licensed vocational nurses, are considered mandatory reporters in California.  Under the Welfare and Institutions Code, anybody who has “full or intermittent” responsibility for patient care in a facility “shall report” anything that “reasonably appears to be abuse.”  The phrase “shall report” means that reporting is mandatory, and any nurses who fail to report what “reasonably appears to be abuse” could be accused of committing unprofessional conduct, especially if they are charged with a crime for failure to report.  The report must be made to either the county health department or to law enforcement.

These code sections apply to all nurses in every facility, but they are especially important for nurses who provide care to the severely or terminally ill, or for nurses who work at nursing homes where their population could suffer from delusions or dementia.  It also illustrates the important of proper and consistent charting when patients bruise easily or can develop skin abrasions or lesions as a result of a medical condition.  In addition, when there is an incident between patients that could “reasonably appear to be abuse,” it must be reported, even if the incident is successfully handled internally.

Licensed nurses should make sure that their facility has a clear policy on mandatory reporting of suspected abuse and that they receive training from their facility regarding where and when to report.  Because the law includes anybody who has “full or intermittent” responsibility, the individual nurses who are connected to the patient, including administrators and supervisors, are all considered reporters.  It would be unwise for a licensed nurse to expect that a mandatory report is being taken care of by someone else or by a supervisor.  An individual nurse can face license discipline for the failure of his or her facility to take proper action.  Be sure that your facility trains you on when and how to file a report, and make sure you carefully monitor your patients for abuse, especially in sensitive populations like those discussed here.

If you are a licensed nurse and you are concerned about your obligations under the law or an incident at your workplace, consider contacting an experienced licensing attorney for a consultation.

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