Mandatory Reporting. Child Abuse.

ImageChild Abuse and Exploitation

As healthcare providers, especially in a pediatric world, we see and treat child abuse victims. We hear about it, we see, we treat, we comfort. Let’s see what are the numbers specifically for pediatrics? The horrifying truth is it is much more common then you think. According to recent statistics (RAINN.ORG)

  • 44% of victims are under the age of 18
  • 2/3 of all assaults are committed by someone known to the victim
  • Every 2 minutes another American is assaulted
  • Each year about 237, 868 individuals are assaulted
  • 60% of sexual assaults are not reported to the police
  • 38% of all rapes are either friends or an acquaintance

This is a difficult topic for anyone to discuss. After all, the question that plagues everyone is how can anyone do any type of abuse to a child. Let’s look at the numbers even more closely.

  • 15% of assault and rape victims are children under the age of 12
  • 7% of girls in grades 5-8 and 12% of girls in grades 9-12 said they had been sexually abused

  • 93% of juvenile sexual assault victims know their attacker

Keep in mind, these are numbers that have been reported, while many others have not been reported or the abusers have not been convicted and charges dropped. Child abuse and exploitation, it’s a horrific topic. It would be easier to turn the blind eye and say to ourselves this never happens. After all, these are children. It is one of the hardest things in my career and in my life, to treat and care for these children without wanting to cry and do all you can to protect them. After all, with healthcare in general, we decide to work in healthcare because we want to take care of others. As a pediatric nurse, our number one priority is the children we treat and care for.  As a nurse, I can speak of personal experience of treating and caring for these children.

As a professional we are mandated to report child abuse and neglect. 48 States including: the District of Columbia, American Samoa, Guam, The Northern Mariana Islands, Puerto Rico, and the Virgin Islands has a group of individuals listed who are required to report suspected child abuse or neglectful situations. Where as New Jersey and Wyoming do not list specific groups of individuals/professionals.

Individuals including: “Social workers, teachers and other school personnel, physicians and other health-care workers, mental health professionals, child care providers, medical examiners or coroners, and law enforcement officers. California, Connecticut, District of Columbia, Hawaii, Iowa, Illinois, Maine, Massachusetts, Nevada, Ohio, Vermont and Washington include coaches, camp/youth camp or residential camp personnel or owners, or recreational/sport program or facility personnel or administrators to report suspected child abuse or neglect” (

Abuse can occur within church systems, public, private schools, sporting groups and other public/private facilities. If abuse has occurred within a school system, church or any organization, many adults tend to overlook, to minimize, to explain away, or to disbelieve allegations of abuse. This is an act of denial (RAIN.ORG). This may be particularly true if the perpetrator is a family member or a friend.

Let’s review some warning signs.

Physical Signs (RAIN.ORG)
  • Difficulty walking or sitting
  • Bloody, torn, or stained underclothes
  • Bleeding, bruises, or swelling in genital area
  • Pain, itching, or burning in genital area
  • Frequent urinary or yeast infections
  • Sexually Transmitted Infections, especially if under 14 years old
  • Pregnancy, especially if under 14 years old
Behavioral Signs (RAINN.ORG)
  • Reports sexual abuse
  • Inappropriate sexual knowledge
  • Inappropriate sexual behavior
  • Nightmares or wetting the bed
  • Changes in appetite and either loosing or gaining dramatic amount of weight
  • Suicide attempts or self-harming, especially in adolescents
  • Seems threatened by physical contact, or shys away from any physical contact
  • Runs away
  • Very protective over siblings and assumes the protector role
  • Post-Traumatic Stress Disorder or Rape Trauma Syndrome symptoms

Common Reactions (

  • Shows sudden changes in behavior or
    school performance
  • Withdrawal
  • Depression
  • Sleeping & eating disorders
  • Self-mutilation
  • Comes to school or other activities early, stays late, and does not want to go home
  • Phobias
  • Psychosomatic symptoms (stomachaches, headaches)
  • School problems (absences, drops in grades)
  • Poor hygiene/excessive bathing
  • Anxiety
  • Guilt
  • Regressive behaviors – thumb-sucking, wetting the bed etc.
  • Additional information “What is Child Abuse and Neglect. Recognizing the Signs and Symptoms

So now the question is how can I help (

  • Listen and be there for the individual/child. Avoid being judgmental.
  • Be patient. Remember, it will take awhile for the individual to come to terms with the occurance.
  • Empower your loved one. During the occurrence of abuse, the individuals “power” is taken away from them. Encourage empowerment during this time.
  • If you are dealing with a situation that is involving a child, or your child. Give them a “safe” place and be a “safe” person to talk to.
  • If you suspect your loved one, or individual of suicidal thoughts, please get immediate medical attention. And continue to check in on the individual.
  • Most of all encourage the individual/loved one to report the abuse (call 911 in most areas). If our loved one has questions in regard to the process of criminal justice, talking with someone on the National Sexual Assault Hotline, 1.800.656.HOPE, can help.
  • Let your loved one know that professional help through various organizations.
  • If your loved one is willing to seek medical attention or report the assault, offer to accompany the individual wherever he or she needs to go (hospital, detectives office, police station, campus security, etc.)

If you suspect child abuse and/or neglect please contact your local authorities. Or if you have been assaulted or abused please contact the number below.

National Sexual Assault Hotline – 1.800.656.HOPE

Mandatory reporting of abuse and neglect

Here is a link of laws pertinent to your state. For additional information please look up your states statue of limitations and associated laws.

Laws in your state

Child Abuse and Sexual Abuse Resources:


Pandemics and Masks.

Flu Season….Isolation Precaution Season. Typically peaking in January or February.

Screen Shot 2014-01-30 at 2.52.54 AM

Sound familiar? When you walk onto the unit and 23 out of 24 rooms are in isolation. Mask… check. Gloves… check. Beautiful yellow drape… check. Ahh the thrills of flu season. Every nurse, physician, RT and any other health care personal that I am missing loves it. The time to sprint from room to room, while you effortlessly sport the latest fashion trend. Your yellow (at least ours are yellow) papery gown. Yup, it’s no Gucci or Prada but it will do. So let’s dive into this topic a bit. Let’s see if we can gain a fragment of knowledge for the next few minutes.

You have heard of H1N1, have you heard of H5N1, or now H7N9?

A new avian flu has decided to make an appearance. According to the CDC a new avian influenza  A (H7N9) strain, has been first reported March 2013 in China. So the question here, is there a fresh wave of H7N9 that we need to worry about?

Most cases are believed to have come about from exposure to contaminated environments and infected poultry. Infected poultry and people have been found in China. Though mild cases have been seen and reported, this strain presents itself with severe respiratory illness and with 1/3 mortality rate of those infected ( So the question here is how easily is it transmitted? It has not been confirmed if it can be transmitted between people, but there have been rare cases of transmission. Cases with poultry exposure have been found in China’s neighboring countries ( According to the World Health Organization (WHO), has reported 132 human H7N9 infections, with 44 deaths. The numbers have decreased most likely to the diligent efforts of China to eradicate the strain (

The major concern with this strain is the possibility of a pandemic exposure (reminds me a bit of the movie Contagion-if you haven’t seen it your in for a doozy). The CDC is following this strain closely, the fear is that this strain will develop the super bad guy ability to spread “and gain the ability to spread easily and sustainably among people”. Thus triggering a real life version of contagion (maybe not to that extreme but you never know). But you get the idea right? Studies have also shown like the seasonal flu/influenza virus, the avian strain also has a seasonal pattern: the strain seems to circulate at higher levels during the cold weather and at lower levels in warmer weather.

So what is being done to prevent and contain this? The CDC and other organizations are working on identifying a flu vaccine, in the case that it is needed. In addition, continuous flu based education is being conducted for those traveling between the US and China.

Screen Shot 2014-01-30 at 2.03.52 AM

So let’s look at some of the signs and symptoms to look out for:

  • Initial s/s high fever, cough
  • Severe PNA
  • Acute Resp. Distress Syndrome (ARDS)
  • Septic shock
  • Multi-organ failure

How do I know I may not have H7N9?

There are many factors, and similar symptoms with other strains. If your flu lasts longer than 10 days, with severe respiratory problems. Have you been to China and you have been in contact with someone who has been confirmed with this strain. You need to contact your doctor for any concerns or medical advice. Again, remember the flu strains all have similar s/s. Your doctor will determine course of action/treatment.

For additional questions I have added a link to the CDC frequent asked questions site.

H7N9: Frequently Asked Questions


Behavior Based Interviews

Behavior based interviews. Does this sound familiar?

The basic premise of behavior based interviews, is to discover how an individual, lets call this individual Nurse M. Cyrus, acted in specific employment-related, school-related situations. The logic behind this idea is to see how you behaved in the past because that will signify how you will act and perform in the future. As an interviewer I am looking at trends, I want to know if Nurse M. Cyrus as an individual, is worth the organization’s time and money and would Nurse M. Cyrus be worth the investment. Sounds cruel? No not really, right now the job market for new graduate nurses is the toughest it’s been for a while. I have worked at major metropolis hospitals- you need to take prepping for an interview seriously. Because, everyone one that is applying for a position I’m sure is a team player, good listener, get’s along with others etc. etc. etc. Big major hospitals have the choice to pick and choose the cream of the crop. Why? Allow me to give you to examples at 2 organizations I assisted with the hiring process.

1) Large Children’s Hospital can have 20 to possibly 30 open positions for their new graduate program. You are probably thinking, 40 slots I can live with that. Not when you have over 600 applicants in addition to yours. Get it? Your odds are 30:600, now does 30 still sound appealing?

2) Large Children’s Hospital # 2 has 23 open positions for new graduate nurses. They get over 700 applicants.

The kicker here is this. After you graduate nursing, let’s say your life long dream is to work on the pediatric cardiac ICU. Since you were little you wanted to be a nurse, and your mom is a nurse and your aunt is a nurse. And everyone you know is a nurse. And after your diaper years you had your little heat latched on to pediatric cardiac nursing. So now you are a fresh RN fledgeling straight after nursing school. And you have your heart set on Hospital #2. You should be fine there are 23 open positions. No. That unit alone may ONLY have 4 positions available. Ok so now your odds are 4:700 chance. So this is the time to bring your best foot forward. Not so much Miley’s best foot forward.

This is reality. The difficult thing is, and by no means am I trying to discourage you, it’s a tough job market than it was 10 years ago. I want you to know what you are up against. I need you to seriously take prepping for an interview seriously. So now that my introduction has captured your attention, let’s discuss behavioral based interviews.


  • Tell me about a time that you had to do multiple things at once. What was it,  what did you do, and how did it turn out?
  • Tell me about a time that you handled a difficult situation. What was the situation, what did you do, and how did it turn out.
  •  Tell me a time in which you had to not finish a task because of a lack of information.  How did you handle it? How did it turn out?
  •   Everyone has to bend or break rules sometimes. Tell me about a time that you had to do this. What was the situation. How did you handle it? And what was the end result?
  • Additional samples

Screen Shot 2014-01-28 at 6.10.31 PMBehavioral based interviewers are looking at what you have done, not what you would do in this situation. Again, we are looking at what have you done in the past at previous places of employment. If you have a small list of previous employers, give me a situation from nursing school. I cannot tell you enough how many individuals Many of these interviewers, like myself, want a real life story from you. In addition to your story I am looking for a beginning, middle and ending to your story.  This is where I feel throws people off. Is it just nerves probably.

But many answers to my questions have been “well this is what I would do if I was in this situation”.  What’s wrong with that reply? You are telling me this is what you “would” do. For behavioral based questions this is your first mistake,  unless you are able to quickly change your end game, then you are heading into a downward spiral. For prepping, look over sample questions.

Behavioral based interviews can be tough. But manageable and attainable.

Peals of Wisdom

Prep. Dress for success. Listen to what the interviewer is saying and asking. Good luck!

If you enjoyed this blurb, please subscribe to this blog.

P.S. If you have any  questions feel free to comment, or topics you would like me to blurb about feel free to let me know! Thanks!



Title got your attention right?

After all whats the point? I mean doesn’t the picture capture what nursing is all about? Is a Bachelors degree in Nursing (BSN), a complete waste of time and money? What do you think? Remember your degree will and has cost you an appendage or two. Do you have any idea how much school tuition is? Or an easier way to picture it is how many Ramen, could tuition alone buy? Or how much pizza? Let’s calculate an average nursing school tuition of about $54,000 (without any scholarships your smarty pants).

  • You could buy about 420948 bags of Ramen Noodles. Which would take  you about 2.5 years to cook, not including the time to heat the water. The Ramen contains about over 799999999 calories (give or take). The same amount of calories burned in over 2800 marathons, that’s 73360 miles!
  • You could have cheesy pizza that would be delivered every single day for 28 straight years! Hmm..I could definitely live with that. Let’s bring out the welcome mat to cardiac disease heaven while we are at it.

You get the point right? It costs monies, monies that many of us will be slaving away paying off the rest of our lives. And that’s not even including a graduate degree, for you over achievers. So again, why on earth when we can have an RN after our name, with an Associates degree in Nursing, would we subject ourselves to numerous student loans, when instead we could have 28 friggin years of pizza OR Ramen!?!?!? Tough call I know.

The various entry levels into nursing practice has been a hot topic over the years. More so now with more and more organizations attaining “Magnet” status. Over the years, researchers, hospital and academic leaders have found that education has and does make a difference in nursing practice. Some of the reason behind this is the advances in technology in medicine and organizational change, thus requiring a hire level of education (Spetz, J., & Bates, T. 2013). In addition to various advances, studies have shown inverse relationship between the mortality of the hospitalized patient vs. the number of BSN nurses. Comparatively showing a decrease in patient mortality to the increase in more educationally prepared nurses.

The Institute of Medicine (IOM) nationally recognizes the baccalaureate prepared nurse. The IOM has set a national recommendation that by 2020, at least 80% of all nurses receive his/her bachelor’s degree (Institute of Medicine 2011). In general there has been such an increase in advocacy for a higher level of education, that many more organizations are now requiring an entry level BSN. Throw in the BSN RN Magnet recognized nurse, it’s no surprise why the nursing profession is advocating higher levels of education.

Pearl of Wisdom

For those of you who are considering it, or even currently attaining your BSN. I will give you one piece of advice that I wish I knew before I started. You will be writing papers, you will be exploring your literature skills and your initials will become APA (American Psychological Association). All your nursing papers will be and forever more become APA formatted. In addition to learning how to save someone’s life, you will also need to learn how to properly format and reference all your papers. Keep in mind APA continues, or at least it feels like it,  to be updated with rules and so forth. So here is my gift to you….. It’s called PERLLA and it was my heaven sent (yes I used it for my Masters degree, if it worked for me, I promise it will help you). I swear by this, (no they are not asking me to advertise for them, and no I am not affiliated with them) it will make your life 10X easier. This is program that is very very reasonable in price especially when you have the mountain of student loans waiting for you once you graduate and enter working force. Anyways, I will add the link below and I do hope it makes your journey oh so much easier and then some (LINK BELOW).


Publication Manual of the American Psychological Association, Sixth Edition


AACN Supports NJ Resolution To Require BSN For State’s RNs. (n.d). RN, 69(10), 14.

Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health
Washington, DC: The National Academies Press.

Spetz, J., & Bates, T. (2013). Is a baccalaureate in nursing worth it? The return to education, 2000-2008.
Health Services Research, 48(6 Pt 1), 1859-1878. doi:10.1111/1475-6773.12104