Nurses are, sometimes reluctantly, on the front lines of the fight against child abuse. They’re among the first to see children seriously injured at the hands of adults, and they may be uniquely positioned to help ferret out more subtle signs of abuse.
At the WakeMed children’s emergency room, one of the state’s few pediatric emergency rooms, nurses see about 45,000 children a year. And just about every day, they’ll see at least one who’s been abused or neglected.
Jennifer Farmer, a WakeMed nurse supervisor, has made helping these children heal and helping to bring their abuses to justice, her key concern. A certified nurse examiner in pediatric sexual assault, Farmer has worked to educate and coach her follow nurses in dealing with abuse cases.
Farmer developed protocols for nurses to help detect child abuse among patients, and helped get more resources in place to care for them. In the past year, she spearheaded a program to take photos of injuries, which has helped in the prosecution of offenders.
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Edward Keating, manager of the children’s emergency department, had spent much of his career in the adult emergency room, and was surprised by the sheer number of child abuse cases that come through the children’s ER.
He was also impressed with Farmer’s commitment to both helping the children. Her work allowed the department to pull in more resources, including the cameras they use to document injuries.
“She saw the need and pulled this whole program together as a staff nurse with nothing but an old battered laptop,” Keating says. “A picture is worth a thousand words when it comes to these cases. We’re reporting what we see so that other people can see it down the road, and because of that, some people who hurt children are going to jail for a long time.”
Farmer was born in Boone but grew up in Raleigh, one of six children in a rowdy blended family – a fact that for years she says made her dislike the idea of having or working with children.
Her opinion was swayed after accompanying her father, a pediatrician, on his rounds at the hospital.
“When I watched him, I could see how much he got into his work but also how much he got out of it,” she says.
Always interested in science and research, Farmer went to college at N.C. State University first planning to be a veterinarian, then a genetic researcher. She abandoned the latter career idea when found she disliked the isolation of the lab.
“I didn’t want to spend my days without being around people,” she says.
She worked overnight shifts at a veterinary hospital during and after college, a job that accustomed her to the 10 p.m. to 10 a.m. shifts she still works some days. But she was turned off by the expense of veterinary medicine, and chose to focus on human medicine by returning to school to study nursing.
She entered a fast-track program at UNC-Chapel Hill designed for people with science backgrounds to enter the high- demand field.
Farmer first worked at the WakeMed children’s emergency room through a six-month internship while she was earning her second bachelor’s degree.
Because the department only sees children, she says, the prevalence of child abuse cases is strikingly clear. It was also clear how difficult it was for nurses to work with abused children, despite the best of intentions.
“When I was first starting, I saw how terrifying these cases could be and how people carry it heavy with them,” she says. “It’s not easy to put their emotions aside and do the best thing for these kids.”
When she took a nursing job at WakeMed, she replaced a nurse who was working to establish a program for abused children. No one seemed eager to follow through with the program, but Farmer felt strongly about addressing the child abuse issue head on.
An estimated 700,000 children were victims of physical abuse, sexual abuse or neglect in 2014, the most recent year data was available, according to the U.S. Department of Health and Human Services. The same year, nearly 1,600 died from this abuse.
“As a whole, a lot of people want to say, ‘I don’t see this. I don’t want to deal with it,’ ” she says. “But when you get past those uncomfortable emotions, you see that this is a part of our society that crosses all races, all genders and economic status. You can’t sweep it under the rug.”
Her first step was to establish clear and consistent protocols for dealing with abuse and neglect cases. She found through her research that doctors had such guidelines, but while nurses were trained to recognize and report suspected abuse, how and when they did so could vary widely.
Without a clear process, nurses’ opinions and biases can creep into the highly emotional cases. Some might feel compelled to exaggerate the facts based on their suspicions, for instance, while others are more likely to avoid confrontation.
She developed a systematic approach used at WakeMed that helps ensure these incidents are consistently reported and documented.
“It’s a difficult part of our job and it can be very stressful and frustrating,” WakeMed nurse Susan Worley said of the child abuse and neglect cases. “[Farmer] has been a big advocate for these children and a great wealth of knowledge for our department so that we can do what’s best for them.”
The guidelines lay out which types of injuries are most likely to be the result of abuse or neglect, and the exact steps to be taken. Some of the warning flags are injuries where the causes are vague, or the explanation given by parents seems unlikely for a child of a particular age.
Children are checked for signs of previous injuries, and in some cases child custody officials will visit the scene of an accident to establish whether an injury could have been an accident, using dummies to reconstruct the scene.
Farmer also worked to forge and strengthen ties with law enforcement, social service agencies and area nonprofits to form teams of professionals that help children and families deal with abuse.
Other WakeMed hospitals are in the process of adopting the guidelines, and Farmer says she fields calls from other hospitals that are interested in following suit. In the fall, she’ll share her department’s experience with using photo documentation of abuse at a national nursing conference.
Born: November 1981, Boone
Career: Nurse supervisor, Children’s Emergency Department, WakeMed Health and Hospitals
Family: Children Fiona, Isaiah and Adelaide
Education: B.S. Biology and Genetics, N.C. State University; B.S. Nursing, UNC-Chapel Hill