Abstract
The physical diagnosis and treatment of child abuse and neglect have traditionally fallen in the domain of physicians; however, nurse practitioners (NPs), registered nurses (RNs), and physician assistants (PAs) are assuming increasing roles in the evaluation and treatment of maltreated children. The role of nonphysician health care providers in evaluating cases of suspected child maltreatment (CM) is not without controversy and deserves close attention for several reasons. First and foremost, a diagnosis of suspected CM has serious civil and criminal legal ramifications. A “false positive” evaluation—concluding that abuse occurred when it has not occurred—could result in the wrongful removal of a child from his or her family, or criminal prosecution and conviction of an innocent individual, or both. On the other hand, a “false negative” finding—failing to diagnose suspected abuse when in fact it has occurred—could result in subjecting a child to subsequent abuse, resulting in increased physical and psychological harm. Because cases of CM often rely heavily on physical findings and laboratory evidence, examiners must be adequately prepared to perform such examinations. Expert testimony also plays a critical role in child abuse litigation. According to federal law, before a professional may testify as an expert witness, the judge must be convinced that the professional possesses sufficient “knowledge, skill, experience, training, or education” to qualify as an expert. Do RNs, NPs, and PAs possess the credentials necessary to qualify as expert witnesses in cases of CM? The purpose of this article is to describe the roles, responsibilities, and qualifications of NPs, RNs, and PAs working in the field of CM. More specifically, the results of a national survey of NPs, RNs, and PAs who perform physical assessments in cases of suspected child physical abuse, neglect, and sexual abuse will be presented.
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