sexual assault/evidence collection in ER?

  1. I had planned on taking the week long sart course offered at my hospital. I have the course approved and I am all signed up for it.

    My last shift proved to me that I am not cut out to be a sart nurse. I need any advice and help y'all can give me.

    I will try not to bore you with the details...But...

    Yesterday was "boy day" in the ER. We were laughing because we are usually over-run with "girl" nurses. We had waaay more "boys" then "girls" yesterday. I had triaged for 8 hours and was ready to choke the next n/v/d x 3months that came in the door, my charge took pity on me and set me free to "resource" A 15yo "rape" victim came in. The only other female nurse was truly up to her armpits in pt care. It would have taken hours for me to get report and let her do the rape. So against my better judgement and with the prodding of our ER doc who said he would "walk me through" this...I ended up being the primary nurse on this case. It was an ugly one. I had never done this before (only observed) I was compassionate and caring and I know that I was comforting to this poor kid...But, I don't think I collected some of the evidence properly...I feel just sick about this. The other female nurse had done a "few" rape kit collections and talked me through it, but she had told me that I was to collect all the swabs. Which I did. But the doc came in when I was done, pulled me into the hall and said that HE was to have collected all the swabs...I also let the police officer talk to her before I gathered my evidence...I didn't know that we took priority over law enforcement.

    Basically I am freaking out that I may have accidently damaged a court case with my inexperience.

    I know that I will refuse the next "sexual assault" that comes my way. But what now? will I be called in to court?

    The 15yo was drinking...she made some really poor decisions, but she truly was raped...But she is unable to id her attacker (or unwilling) But, if they find them the dna evidence I collected must be perfect... and I am afraid it isn't.
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    Joined: Oct '05; Posts: 165; Likes: 25


  3. by   sirI
    Hello, scrmblr,

    I can imagine your anxiety about this. Yes, it could be a problem later due to specimens not obtained per protocol, chain-of-command, etc.

    Don't be discouraged, however, if this is something in which you are interested. Just observe and learn your hospital's protocols/policies regarding the procedures. Please, don't NOT take the the course. You are interested and this is a great start (the course). You'll feel much more confident afterwards. And, get down your hospital's P&P........

    Good luck.
    Last edit by sirI on Oct 1, '06
  4. by   andhow5
    You know what? You did what needed to be done - you comforted your patient, and did the best you could for her to your abilities.

    I've only had to do 1 rape kit (thank our almighty God!), and it made me SO nervous that I felt like puking on the patient. I went through the kit step-by-step, per the included instructions, collecting my specimens, and then receiving the specimens the doctor had to collect - but still...

    In Indiana, cases are getting thrown out by this simple question in court, "Are you (the nurse) specially trained, or certified in any way to collect these specimens?"

    Most people have answered "No", because they are not SANE-certified, and based on that simple "No", it gets chucked.

    So - it's a no-win situation, in my opinion...

    In your case, however, as long as the collected specimens didn't leave your side until you handed the kit off to the appropriate person, then you should be alright.

    *crossing fingers for you*
  5. by   mother/babyRN
    Please don't refuse the next sexual assault case, if asked. You feel badly but she feels worse and this is how we learn lessons (I'm talking about us nurses here). If you refuse something or someone because of your discomfort level, think of how it would be if everyone felt that way. Now you know some important things to do with a collection and because some of those things weren't done by the book means that they are things you won't ever forget to do OR teach someone else. Besides, even on the very basic level YOU were a patient advocate. Remember, "she" was just a little girl....Please re evaluate your decision because the patients (we) need you and each other. It is only a mistake if you continue to repeat it..Other than that, Its a lesson. Nursing is all about brushing yourself off and getting back in the trenches even when it hurts your mind, soul and heart. As a former rape "victim" and the author of "She", please at least re think you gut reaction to avoid being there or collecting evidence....WE need you....Thanks, Martha
  6. by   Altra
    You did the absolute best you could for your patient given the circumstances.

    From the details you've provided it seems it may be a difficult case to prosecute because the patient was intoxicated -- that is not fair or moral but is often the legal reality.

    I also strongly encourage you to complete your SART course if this is an area that interests you. Think how much better prepared you'll be to truly advocate when a similar situation arises.

    Wishing peace for you & your patient.
  7. by   mom2michael
    You sound like a wonderful, caring, compassionate person who just simply needs more confidence. Take the SANE class, take more rape patients and learn. I agree, they are only mistakes if you keep making them. Right now you learned a valuable lesson and the proper steps that need to be taken. Lessons. That's it. Each case is going to be different and another lesson you will learn.

    A sad reality is that most rape cases do not make it to court for so many reasons. If this one doesn't, please don't get discouraged. Chances are there were many mitigating factors that caused the case to be dropped and evidence collection probably won't be one of them.

    Read up on your P&P, observe more exams, take the course and your confidence level will soar.

    I'm glad there are people such as yourself because rape cases are things I do not handle well at all but that is simply from lack of experience on my part. Our facility requires SANE RN's do the exam and actually the doctors have very little to do with the patient except what is necessary. Our house supers are SANE certified so they do the exams and evidence collections, if they aren't available they we call in another SANE RN to do it.
  8. by   KatieBell
    You should definitely take the course. I am surprised that anyone not certified is allowed to do this. Every place i've been at several nurses have been sent to the class, they are then placed "On call" and are committed to that, unless one of them is already working, and even then, because we are busy they usually end up coming in to do it. If enough of your staff are certified I would highly suggest an "On call" schedule for sane exams.

    It seems as if you were worried about not doing things correctly, well, the only way to be sure you are is to get that course under your belt.
    Best Wishes, and I think it's great that you are willing to do it!!!
  9. by   crossroads12266063
    Can anyone tell me if there is only uncontested oral sex will there be any way to prove this with DNA testing. Facts: 15 hours after, gone to the bathroom twice however, no shower
  10. by   canoehead
    Quote from andhow5
    In Indiana, cases are getting thrown out by this simple question in court, "Are you (the nurse) specially trained, or certified in any way to collect these specimens?"
    I'm not SANE certified, but I've been forced to learn on the job, and frankly I hate the pressure. One tiny mistake can throw out the case. IMO police officers should have SANE people on call, or even if the rape crisis lines had SANEs on call it would make more sense than having people come to the ER and try to fit them in with MVA and chest pains, but not appear rushed.

    My impresson of the exam was that I am totally capable of collecting swabs, and YES I have been specially trained and have lots of experience with that. What I don't have experience with is the emotional reactions, and the legal landmines. If called to court I would say that the swabs are accurate, but if you start to try to find legal reasons to throw out the case it won't take long....

    I didn't become a nurse to tangle with the legal system.:angryfire
    Last edit by canoehead on Jun 5, '08