by Anonymous
The author of this piece attended undergraduate and graduate programs at the School of Nursing. Undergraduate degrees prepare students to become registered nurses (RN). Graduate programs prepare RNs to become advanced practice registered nurses (APRN) who can diagnose patients, treat medical conditions, and prescribe medications.
Like most nursing programs, Penn Nursing teaches RNs and APRNs to act as mandatory reporters. Mandated reporting encompasses state-based laws and policies that require healthcare workers to report certain types of harm to government agencies, such as law enforcement or child protective services (CPS). These include abuse or neglect of children and elders, suicidality, homicidality, or threat of imminent harm, either suspected or confirmed.
The philosophy is: when in doubt, report. Penn teaches us to believe we are neutral third parties acting in the best interests of our patients. Despite mandatory reporting’s lasting negative impacts, nursing school pedagogy does not reveal the weight of our responsibility.
Dr. Dorothy Roberts discusses how CPS, also referred to as the family policing system, disproportionately targets Black families for allegations of neglect related to poverty. Our “neutral reports” lead to Black, Brown, and Indigenous people being interrogated by cops and social workers, subjected to drug screens, and separated from their children. She points out that CPS “harms children and their families while failing to address the structural causes of their hardships.”
Mandated reports also strip away people’s autonomy, especially survivors of intimate partner violence. A California law passed in 1994 required healthcare workers who suspect that a patient’s injuries are a result of “assaultive or abusive conduct” to make a report to law enforcement, even if survivors do not consent. Survivors faced more violence in the wake of this law.
60 percent of people who were warned that their medical provider was obligated to report changed what they decided to disclose. Due to fear of retaliation from their abusers, survivors stopped talking with providers, cutting them off from potential community resources and support. Many stopped going to their medical appointments altogether.
When a Penn Nursing student pointed out mandated reporting’s disproportionate impact on people of color, an instructor unequivocally replied that it is our legal duty to report, and that our licenses are in jeopardy if we do not comply. According to this instructor, “You have nothing to do with the steps that come after you make the report.” We did not discuss the option of warning patients if we had made a report on their behalf.
We learn to obtain informed consent before performing any invasive and painful medical procedures, by laying out the risks and benefits of the treatment and ensuring the patient understands. Yet somehow, informed consent doesn’t apply when inviting cops and social workers to investigate our patients’ homes and intimate personal lives.
Many states classify substance use during pregnancy as child abuse. 26 states require RNs to report suspected substance use during pregnancy; 8 require drug screening. During pregnancy and birth, Black and Hispanic patients are subjected to non-consensual drug screens and reported at more than 1.5x the rate of White patients. These laws often make no exceptions for people taking controlled substances as prescribed. Jade Dass, an Indigenous mother in Arizona, took buprenorphine to treat her opioid use disorder throughout pregnancy. During the birth of her child, a nurse reported her to CPS for having buprenorphine in her urine. CPS then took her child away. This tragedy is inseparable from our country’s legacy of boarding schools and settler colonial violence.
In a nurse practitioner foundations class at Penn Nursing, a social worker and guest lecturer proudly described a moment where she took a mother’s child from her arms during a sting operation. She coordinated with law enforcement to arrest this mother after a doctor’s appointment. This ordeal began when the mother was subjected to urine drug screening at the hospital where she gave birth. Her test was positive for marijuana, and someone filed a report with the state child welfare system. This triggered an investigation that found a warrant for the mother’s arrest and resulted in this family’s separation. The lecturer implied her actions were necessary to protect the child, despite the physical and sexual violence prevalent in the foster care system where the child likely ended up.
A Penn nurse practitioner student shares: “It feels irresponsible to discuss mandated reporting as neutral and necessary. I questioned the ethics of reporting something considered ‘child endangerment’, which in a growing number of states includes the provision of healthcare to transgender children, or obtaining an abortion. My instructor merely replied that those laws don’t currently apply in Pennsylvania.”
It is not enough to say these laws don’t yet exist in Pennsylvania – they have a chilling effect on people everywhere seeking care.
Nurses and providers must resist demands to ensnare our patients in the criminal legal system for seeking healthcare. We cannot wash our hands of state violence when we hold the power to report.
Nursing school teaches us to fear scrutiny. We are subjected to mandatory urine drug screens and background checks, and face threats of criminalization for medical errors (see RaDonda Vaught). We are taught that by failing to report, we abandon our duty to our patients and risk our licenses and careers. The chasm grows between our legal and ethical duties to our patients, as the criminalization of abortion, substance use, and trans-affirming healthcare becomes more entrenched each year. Yet we continue to learn that our duty to report trumps whatever agency our patients have over their own lives.
We need the number one nursing program in the country to teach the truth about mandated reporting. Instead of relying on systems that don’t make us safer, we could learn about resources for people seeking support. What alternatives exist, and how do we care for our patients in ways that respect their autonomy?
Our patients deserve more than criminalization and surveillance.
Penn Disorientation Guide 