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I’m Interested in Being a Sexual Assault Nurse Examiner – Part 1

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

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I interviewed a forensic nurse/sexual assault nurse examiner nurse (SANE) a few days ago. It’s something I’ve always been interested in. I’m a sexual assault survivor, and I know I have a lot to offer other victims. I’m also a fiction writer and I just finished my first mystery novel in which the heroine decides to become a SANE nurse, so I need to know more to write book #2. This article covers the basics of what and how. Read part 2 for more about the daily life of a forensic nurse.

Is forensic nursing for you?

  1. 1. Have you ever thought about being a forensic nurse?

    • Yes
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    • No
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    • I am already a forensic nurse.
      4
    • I am studying to be a forensic nurse.
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I’m Interested in Being a Sexual Assault Nurse Examiner – Part 1

WHAT IS A FORENSIC NURSE?

I found Lacy (not her real name) through Facebook. I sent a message to all my nurse buddies asking for an introduction to a Forensic nurse/Sexual Assault Nurse Examiner. I’d already done a lot of research on this occupation because it’s one of those career options that has always appealed to me. I even applied to be a SANE nurse when I was working oncology, but I didn’t make the cut (it’s highly competitive in some places). Forensic nursing appeals to me because it contains so many elements: crime scene investigation, the legal system, law enforcement, advocacy and patient care. The idea of bringing perpetrators to justice appeals to me as well. Lacy first learned of the SANE nurse position in her regular duties as an ER nurse. She said the position interested her because of her involvement with supporting victims of human trafficking (click the link for more information on human trafficking).

Forensic nurses serve victims of sexual assault, intimate partner violence, neglect, and intentional injury by collecting evidence and giving testimony. They also provide support and advocacy.  Joseph Biden, former vice president of the United States said, “Forensic Nurses play an integral role in bridging the gap between law and medicine. They should be in each and every emergency room.” (IAFN Website). Forensic nurses provide care for patients who have been victimized by violence. They often work in a hospital setting with emergency room personnel but may also work in a medical examiner’s office doing death investigation, with community anti-violence programs, in corrections facilities and disaster settings.

TRAINING

To be a forensic nurse, you need to be a registered or advanced practice nurse with two years or more of experience. It’s especially helpful to have advanced physical assessment skills, experience with ER, critical care and maternal child health nursing. The first step is to find training that meets International Association of Forensic Nurses (IAFN) SANE education guidelines. The 40 hours of training will have a classroom and clinical component. You can’t put SANE after your name, however unless you have completed the SANE-A (Adult) and/or SANE-P (Pediatric) certification. Lacy completed two, eight-hour days in the classroom and then found a volunteer opportunity that allowed her to perform 13 speculum exams as part of her clinical work. She has decided not to become SANE certified at this time, explaining that certification isn’t required for her job and that she’s heard the exam is insanely difficult. She said, “I heard they [the IAFN] are working on revising it to make it easier to achieve certification.”

Lacy has taken courses on sexual assault, documentation, and even strangulation, which is apparently very common in sexual assault cases. She told me that some are seated/in-person and some are online.

Law enforcement came to speak to the SANE trainees as well. Lacy told me about the training that police officers are now getting about how to interview victims of trauma. She sent me a link to a video that we should all watch about how trauma fragments our memories (I can identify with that). She said that often law enforcement will complain; “Police tend to assume the victim is partially to blame. They think the victims must be lying because they can’t keep their story straight.” She went on to explain, “They don’t understand how trauma affects memory. It’s not that they are lying, they literally can’t remember what happened. Trauma causes you to become scattered and to forget details or tell things in the wrong order. The video she sent me is called Post It Notes Analogy for Effects Of Trauma On Memory.

THE JOB

According to Monster.com, the median salary for a forensic nurse is $39/hour or $81,800/year. The bottom 10% make $50,000 and the top 10% make $140,000.

I went digging around for jobs and found one posted a week ago in Salinas CA at Natividad for a full time SANE coordinator. You’d need a vaild CA RN license, BLS and two years of recent SANE experience. The duties of the job include assessing potential child abuse victims, counseling families, work with multidisciplinary team including law enforcement, social services, behavioral health and victim’s assistance.

I was excited to find out that forensic nurses can be coroners or medical examiners in some states. In the US, death investigation lies with either a coroner or medical examiner. A coroner is an elected official who may have no specific educational requirements. A medical examiner is typically an appointed physician with training in forensics. 

Critical components of any death investigation

  1. Medical/social history
  2. Examination of the body
  3. Scene investigation

You can earn certification through the American Board of Medicolegal Death Investigators (ABMDI). I checked to see if nurses can be MEs in my state, North Carolina and I can! So cool to think I could be a coroner or medical investigator. 

There are also degrees (MSN and PhD) in forensic nursing, though it doesn’t seem like many of the jobs I found posted require a degree in forensic nursing. Any information you could possibly want can be found on the IAFN website, including a video about forensic nursing https://www.forensicnurses.org/. 

I'd love to hear your comments on this job. Are you a forensic nurse? Would you ever consider this job? Why or why not? 

Thanks for reading!

Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is also a mother of four who loves to write so much that she would probably starve if her phone didn’t remind her to take a break. Her work experiences as a hospital nurse make it easy to skip using the bathroom to get in just a few more minutes on the computer. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses.com. In the guise of Safety Nurse, she is sending a young Haitian woman to nursing school and you can learn more about that adventure: https://www.gofundme.com/rose-goes-to-nursing-school

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I am a full time forensic nurse at my hospital. It is more than collecting evidence and testifying. As a nurse, I am providing trauma informed, comprehensive nursing care. Evidence collection is secondary to the medical and emotional needs of my patients. My job includes gathering patient history, event history, a head to toe exam including genitalia, photography, and assessment for emergency contraception, STI prophylaxis, HIV and other preventative care. I provide referrals for medical follow up and advocacy. I also make sure the patient has a safe place to stay. This is a hard job and a nurse has to take extra steps to manage stress and do self care. It’s not all swabs and CSI. I also work per diem in my community as a medical examiner. I work alongside law enforcement and forensic pathologists to make cause and manner of death determinations. This is also a hard job. Self care is a must as many forensic nurses leave these jobs after 2-3 years.

Traci, MSN, RN, SANE-A, SANE-P, ME

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

10 Followers; 42 Articles; 224 Posts; 14,475 Profile Views

3 hours ago, Traci Zema said:

I am a full time forensic nurse at my hospital. It is more than collecting evidence and testifying. As a nurse, I am providing trauma informed, comprehensive nursing care. Evidence collection is secondary to the medical and emotional needs of my patients. My job includes gathering patient history, event history, a head to toe exam including genitalia, photography, and assessment for emergency contraception, STI prophylaxis, HIV and other preventative care. I provide referrals for medical follow up and advocacy. I also make sure the patient has a safe place to stay. This is a hard job and a nurse has to take extra steps to manage stress and do self care. It’s not all swabs and CSI. I also work per diem in my community as a medical examiner. I work alongside law enforcement and forensic pathologists to make cause and manner of death determinations. This is also a hard job. Self care is a must as many forensic nurses leave these jobs after 2-3 years.

Traci, MSN, RN, SANE-A, SANE-P, ME

Traci, thank you so much for chiming in. Any errors in this article are my fault, and not the fault of Lacy, who I interviewed. She actually told me a lot about the emotional support she provides for patients, and I foolishly left that out. It sounds like I might have come across as a CSI junkie, which wasn't my intention. I am grateful for your input and for the work you do.

I have a question - what kind of training do you get for the emotional support angle? It sounds like you are doing many of the same jobs a therapist would do, but in an emergent situation. I'm curious as to how you learn how to do it?

Thanks again for educating me and the allnurses community.

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

10 Followers; 42 Articles; 224 Posts; 14,475 Profile Views

3 hours ago, Traci Zema said:

My job includes gathering patient history, event history, a head to toe exam including genitalia, photography, and assessment for emergency contraception, STI prophylaxis, HIV and other preventative care. I provide referrals for medical follow up and advocacy. I also make sure the patient has a safe place to stay. 

Traci, MSN, RN, SANE-A, SANE-P, ME

Traci, I wanted to let you know that I wrote an additional piece on this topic - if you are interested in reading and commenting: 

 

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I do want to say a thank you for bringing this topic up and interviewing a SANE for it. We have a serious shortage of forensic nurses and hospitals with forensic nurses in this country. SANE training includes some emotional support techniques as well as education in trauma informed care. I also have previous RN experience in psych so I bring that to the table for my patients and colleagues. I’m open to any more questions that you may have.

Traci

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Traci - I would love to hear more about this field of nursing.  I am still a student trying to find my way. I was doing a mental health ride along for home visits yesterday and said that I should look into this particular area of nursing - and here it shows up!!  

How did you become a medical examiner and how did you go about working with law enforcement?

 

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Many sexual assault nurse examiner programs are an on-call programs where nurses still work on their units full time then pick up extra shifts for SANE. 

In North Carolina, physicians, PAs, NPs, RNs, and EMT/paramedics can be appointed as medical examiners. I was fortunate to have a friend who is now retired that introduced me to the medical examiner world.

Regardless of what Forensic Nursing pathway you take, there is always a chance that you will be interacting law enforcement and the court system. It’s part of the work.

Warmly,

Traci

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Thank you Traci.  We have a good number at my hospital and the main trainer for our state is here as well.  I plan to drop her an email to get more information, but I wanted to make sure that I wasn't doing something prematurely as a student making myself look like an idiot before getting out of school.  I don't want to start off with a bad impression.

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