A preschool aged girl visits the school nurse and reports that she no longer wants to visit her grandfather in his home because he "hugs me too tight and touches me down there.”. She has told her parents that she does not want to spend the weekend with her grandparents, but her parents say that she has no choice. What is the most appropriate action by the nurse?

Choice A rationale Planning a home visit is an inappropriate initial action because it delays the mandated reporting required by law when a health professional suspects child abuse or neglect. The nurse’s primary legal and ethical obligation is to ensure the child’s safety by reporting the immediate danger of sexual abuse to the proper authorities, such as Child Protective Services (CPS), before any further contact occurs. Delaying reporting can put the child at continued and immediate risk of harm. Choice B rationale While involving the principal might be a step in the school protocol for addressing safety issues, arranging a meeting with the parents and principal before reporting is a significant failure of the legal mandate to report suspected child abuse immediately. The child's statement constitutes reasonable suspicion of sexual abuse, which requires direct reporting to CPS. Discussing the allegations with the parents first could potentially increase the child's risk or compromise the necessary investigation. Choice C rationale Advising the child to re-report the abuse to the parents is inadequate and unsafe, as the child has already reported to the parents who subsequently dismissed the concern and mandated the visit. This action places the responsibility for protection back on the child and the unresponsive parents. The nurse has a professional and legal duty to bypass the non-protective parents and report the alleged abuse directly to the appropriate governmental protective agency (CPS) immediately. Choice D rationale Reporting the alleged abuse to the local child protective agency is the legally and ethically required action for a mandated reporter, such as a school nurse, when there is a reasonable suspicion of child sexual abuse. The child's specific, explicit, and concerning statement about inappropriate touch, coupled with parental non-protection, necessitates immediate reporting to initiate an investigation and prevent further exposure before the impending visit.