If it were not for personal tragedy, Pam Rowse, RN, might be just another anonymous Las Vegas nurse excelling in emergency care as she has in critical care, as a flight nurse, paramedic coordinator and educator/trainer. But the violent death of her 14-month-old granddaughter focused Rowse's nursing career and turned her into a self-made national figure in child advocacy.

Kierra Ashley Danielle Harrison was shaken and slammed to death in 1997 in her second week with a Las Vegas day care provider. Rowse learned at the arraignment that despite previous allegations of child abuse, Nevada had issued the provider a day care license. It was one of those

" 'What's wrong with this picture?' moments," Rowse said. "It was imperative for me to personally find some kind of positive outcome from Kierra's death."

The 48-year-old assistant nurse manager at Las Vegas' St. Rose Dominican Hospital, Rose de Lima campus, steeped herself in information about shaken baby syndrome and child care regulations and, after nine months, founded the nonprofit Kierra Harrison Foundation for Child Safety (www.kierraharrison.com).

Rowse said that being an RN made it easy to move into child advocacy. Now, in the name of Kierra, she educates the public and health professionals about shaken baby injuries and works with victims' families and prosecutors.

She's shared Kierra's story on national television-"The Maury Povich Show," "Geraldo" and MSNBC's "Issues Live," and on TV stations covering the Las Vegas valley. She also lectures about the dangers and consequences of shaking babies to high-risk groups, among them high schoolers and teens in juvenile detention facilities.

Fathers are the most likely to shake an infant, Rowse said, followed by day care providers. "Mothers are actually the least likely to shake their babies."

In 28 years of nursing, "I've seen too much," Rowse said. But injured child after injured child doesn't make the next case any easier to digest than the last one or the one before that. And there's always one more, like the limp 2-year-old carried into University Medical Center's adult emergency department earlier this year. Rowse, then working as a charge nurse, suspected child abuse.

In the immediacy of the crisis, Rowse said, "I was able to maintain my clinical position. I kind of push it all in the back of my head and say, " 'This baby needs me right now. That's the most important thing.' After it was done, I broke down and I cried. And I sobbed."

Rowse said that when a pediatrician later confirmed her suspicions of abuse, the reaction of one adult-care emergency physician was, "Oh, my gosh, you were right."

While nothing takes away the pain of a fatally abused child, Rowse said that some families find solace in donating organs. Kierra's heart, lungs, liver, pancreas and kidneys went to dying children in need of transplants. The Clark County medical examiner allowed the donation of Kierra's organs, she said.

"In many states, particularly in smaller communities, the medical examiners refuse to let parents donate organs in these children because they know they're going to be homicides" and are concerned about evidence, Rowse said.

But in the last two years, the National Association of Medical Examiners, in consultation with the Shaken Baby Alliance, issued guidelines for shaken baby cases. Now, Rowse said, "If we have a resistent M.E. someplace, we can say, 'Go to your national organization.' I felt very good about being able to do that."

Rowse serves on the Shaken Baby Alliance's national advisory board. She's also co-founder of the national Shaken Baby Coalition, the southern Nevada ambassador for Day of the Child, chapter chairwoman for an organization called "My Parents and Grandparents are Survivors" and on the Nevada Women's Leadership Council.

It's a high-profile résumé that Rowse, who said she's about halfway to earning a BSN degree, couldn't have imagined in high school, where science and English were her strong suits. "My mother," she said, "kept saying to me, 'Pam, you need to get some skills that make you independent.' She wanted me to become a secretary."

Contact Phil McPeck at getpjm@aol.com.