ED RNs at risk doing ASAs?

Esme12, ASN, BSN, RN · Jan 29, 2014

Unfortunately as far as I know there are no states that require SANE nurse perform a rape kit. The facility must show that they have proven "competency" of the nurses to do a rape kit but being a certified SANE nurse isn't required.

Does anyone know anything else?

1EmergencyRN · Jan 29, 2014

Esme12 - that's my best guess too. Thanks for the comment! I've contacted a lawyer to get a legal perspective now as well, and am curious what they say as to the risk against our licenses. (granted my greatest concern is the quality of care for the patients!)

Altra, BSN, RN · Jan 29, 2014

Hello everyone! Help! I work in an ED where they have any and every ED nurse do ASA kits. It all depends on timing and rotating turns, basically luck of the draw. The ED RNs are given a "once over" on what's in the kit by another ED RN as far as what's in it and how you generally process them. The person doing them never does them side by side with anyone experienced, you basically learn as you go. There are no SANE RNs on staff. I started recently working as a Forensic Examiner and am being thoroughly trained on the exams, additionally I will be completing my SANE course next month. The concern is: Are these ED RNs liable for negligent practice when doing the kits, knowing that the standard is to have SANE training? As far as we know, we are the only hospital in Western WA that does not either have SANE nurses on staff, or that contracts them out. I have been attempting research to see if there are any legal means to support or dismiss this practice, and have even contacted my practice insurance agent for assistance. However in the process, one of my co-workers was just written up for insubordination and immediate suspension for refusing to do an ASA exam, based on her concern for the safety of her license. I am reaching out to all of you to see if you may have any additional perspectives or advice on the matter. Thanks for any help!

Let me first say that I completely agree that having sexual assault exams performed by SANE-trained nurses is of course preferred.

However ... can you shed some light / provide some reference for your statement that it is a "standard" to have SANE training in order to perform an exam? Or for exactly what license liability exposure is caused by completing a kit without formal SANE training?

1EmergencyRN · Jan 30, 2014

Altra - sure! We (staff RNs in our dept) have recently found out that we are the only hospital in at least the Western 1/2 of our state that does not have SANE certified RNs performing the exams. Also, in my new job as a Forensic Examiner, I have been reading literature from medical journals that indicates that SANE training is the desired level of training preferred for a proper exam. Also, some of our coworkers were in discussions with an RN who told them of a case where a co-worker in another state was performing ASA kits without SANE training, as we do, and in their case that RN went to court to testify on the ASA kit. The kit was subsequently thrown out due to improper evidence collection and then the victim was murdered shortly after by the alleged assailant. That hospital was sued and the RN performing the kit was personally sued and they both lost. We have been attempting to find out where this case happened so that we could find the literature on it, but have had no luck so far. It has brought up the question of concern over liability in many of our staff RN's eyes, but most concerning is the lack of proper technique, education and care that we are providing to these particular clientele and trying to ensure that we give them every chance to have the correct interventions provided without any further detriment to their being, their safety and to the overall process.

360jRN · Jan 30, 2014

We don't have SANE coverage at the facility I'm currently working. It's our practice to advise Pt's that we can collect the evidence; however, there is an increased possibility that it will be thrown out in court d/t an uncertified person collecting it. We then offer transfer via PD to the closest SANE which is a little over an hour from us.

Editorial Team / Moderator · Feb 5, 2014

Also, in my new job as a Forensic Examiner, I have been reading literature from medical journals that indicates that SANE training is the desired level of training preferred for a proper exam.

There is a big difference in saying SANE training is required vs. desired (preferred). Heck, the ENA wants all triage nurses to hold CEN certification; is a non-certified RN negligent for triaging without his/her CEN? Nope.

With that said, I would definitely advise patients to go where the SANEs are, especially if they're going to be going forward with legal action. Where I am a SANE, patients can choose to have the evidence collected and have it held for a period of time without involving law enforcement, as long as they haven't told anyone outside a limited circle of professionals that the event occurred. This encourages them to get the medical screening/care without having to worry RIGHT THAT MINUTE about law enforcement/court/facing the alleged perpetrator/all that stuff.

I don't think it's outside the scope of RNs to do the kits for patients. I know that before our hospital had a SANE program (and this is still done at another hospital nearby), evidence is collected by the ED physician with an RN assistant, all while hovering over kit instructions. I can't imagine how long that takes, and how much worse it would be for the alleged victim to have to endure the extra time! They usually just want to go home and shower. But the physician has to order the diagnostics and write for any prophylactic meds, so they're just as involved, too.

Anyway, best of luck in your SANE program. I hope you find it rewarding and you don't get burned out by constantly being on call like I was! Going to Afghanistan was a reprieve from SANE call, haha.

pro-student · Feb 6, 2014

It's not outside the scope of practice however this is treading on very thin ice in another way. If a sexual assault case goes to trail, the individual who collected the evidence will invariably be subpoenaed to testify about evidence collection, chain of evidence, etc.. If the nurse who performed the exam is untrained to do so, this is fuel for the defense to have the evidence collected thrown out thus making the case virtually impossible to prosecute. Also, any minor deviation from procedure can be used my the defense to try and dismiss the evidence.

So while it is highly unlikely to negativity impact the nurses license, they are dangerously close to setting up a situation where guilty perpetrators go free. In my area, there is a community organization which provides on-call volunteers with SAFE training and certified by the state to 8 ERs. If there is no way to have a SANE available, the staff RNs at the very least need to be trained and evaluated on doing a rape kit and reassessed annually. This should be no different than staff demonstrating competency in any other skill if it is expected as a job requirement.