Please don't tell me I have to work in the ER?!

[**All Heart RN**]

I'm hoping I can at least receive a few responses from Forensic Nurses...

I'm a new RN and have been working on a Cardiac unit for the past year. I'm ready to leave my unit and pursue what I've always had an interest in which is Forensic Nursing. I was first introduced to Forensic Nursing 10 years ago as a Rape Crisis Advocate on my college campus. I've always been intrigued by the SANE's role and have plans to obtain the SANE-A certification, possibly a Master's in Forensic Nursing, and will definitely go back to school to become a NP.

Unfortunately, I have to wait one more year before I can take the SANE-A certification exam since it's a requirement to be a nurse for 2 years prior to certification.

I am lucky enough to have an informational interview scheduled with the ED Nurse Manager on Tues Mar 8. I'm so excited to have the opportunity to be able to ask all of the questions I have about being a SANE in the ED...the only problem is that I have a great fear, knowing my strengths and my weaknesses, that the ED is not the place for me.

The HR rep informed me that the ED at the hospital I currently work for is shying away from hiring new grads because of how other new grads have struggled in the ED over the last several years.

I've never really had the desire to work in the ED due to the overwhelming amount of stress that comes with working in such a hectic environment. However, I've always had an interest in Forensic Nursing and also have a B.A. in Psychology and feel that this specialty will be a great fit for me.

Where else can I gain some experience? I work for a large teaching hospital in a fairly large city but there are no stand-alone SART clinics...the only one that exists in my state is more than an hour away.

Where else, besides the ED, can I gain some experience as a SANE?

[a4n6nurse]

You are not going to want to her this, but the if your real desire is SANE, ER is where you need to be. A major portion of SANE nursing is a generalized exam for trauma. The more exposure you have to evaluating trauma and being able to relate it to mechanism the better. Hopefully your program is one where autonomy is the norm for the nurses. In our program no patient of mine sees an MD unless they request it, (never happened yet) or I feel it is necessary. (a few times). We are talking like 4/450 exams. As a true Forensic nurse you need to have the confidence to know who needs X-rays, labs, etc. You also need to have the trauma exposure to be able to "expertly" testify as to the validity of injuries against their stated stories. Also really think about your choice. IF you feel that general ED nursing will be too stressful realize forensic nursing; examinations, documentation, evidence collection and ultimately testifying are great stressors in their own right. Just my $0.02.

[Raidernurse]

I agree. And, having worked in an ED for 15 years, I will say that I would not want to work anywhere else. As much chaos and stress as there is, there is also the lower acuity populations...sutures, headaches, etc that are a nice break from the codes and MIs. I think that you would be a great asset as a SANE certified ED nurse.

As they say on the cerial commercial: Try it, you might like it!

[**All Heart RN**]

I appreciate the replies!

[shoegalRN, RN]

I am a SANE and work in the ER.

You should consider the ER if you want to be a SANE because there is alot of autonomy required for the SANE position. As the SANE, YOU will be doing your own exams. YOU will be giving the meds according to protocol. YOU will need to make the decision if you need to draw labs or send off to x-ray.

On top of that, YOU are responsible for all evidence collection and speaking with the police and detectives. And you may be supeoned (sp?) to go to court to testify in a case.

In my area, there is another agency that have their own SANE's, but most of them are ER or OB nurses.

If you really want to be a SANE, check into transferring to the ER, or atleast shadowing there for a shift or two. SANE nursing is stressful in itself.

Good luck!

[TeenyTinyBabyRN, BSN, RN]

I work in NICU, and one of our nurses is a SANE nurse. She has never worked ER and only gets calle down their to do the evaluations/exams.

[starrernurse]

Most SANE are ED nurses however I know a lot of nurses from different areas that are SANE as well but usually u sign up for call through the ED. I know clinic nurses, VA nurses, NP's,. You just need to find a SANE program. My facility offers it to outside people as long as someone pays the fee. All in all you don't have to be an ED nurse to be a SANE and to be certified you have to do the 40 hr didactic / clinical training. The test online is to qualify you as an expert once you are already a sane and not a requirement that I am aware of.

[SEDK]

I agree with what others have said as well. I have been a SANE-A and SANE-P for the past 6 years. I'm not sure if you've completed the training course yet, but you cannot take the certification exams without completing the training course. If you log onto the IAFN website they have all the requirements listed.

I would contact your local SANE programs and ask to shadow or take call with a nurse for a shift. You might want to see a couple of cases prior to jumping in. We actually require that potential candidates see at least one case before an official offer to hire is presented. Training is expensive and costly and nurses really need to understand what they're getting into. It's also a drain on SANEs who have been there for years to train new nurses only to have them leave a short time later.

Our unit also requires that our nurses obtain the TNCC certification within the first year of employment. Not all of our SANEs are ER nurses but like others have said you need to know how to describe with a fair amount of confidence and authority the difference between abrasions, and lacerations or bruises and ecchymosis in front of judge and jury. After all you are qualified as an expert witness in most cases. Our unit is a freestanding unit. We are not ER based, which I like a great deal. Truthfully I wish they were all like that. We will do exams in the hospital if we need to, that is the patient is admitted, or it needs to be done in the OR. However the majority of our 40-50 cases a month we do in the office. But, that means we need to function safely and comfortably with a fair amount of autonomy. We need to know what the risks are post strangulation and what S/S to be watchful for. What to do with a patient who maybe withdrawing, overdosing, bleeding, cutting her wrists in the bathroom, or passes out during a blood draw. Do you just keep swabbing or send her out?

The ER is a stressful job, but I don't think it's anymore stressful than SANE can be. There are days where you're up for more then 48 hours, you've had exam after exam and you can't remember who's tear belonged to whom, and you're praying your pager doesn't go off again because you feel like you head may explode if it dose. Attorneys that land baste you the stand, hired "expert witnesses" who are brought in to slam your testimony, despite the fact that you've already said you're objective and don't have any allegiance to either side or outcome. But at the end of the day, I do love it. It's been a great learning experience and has made me an overall stronger provider. That being said though I'm on call tonight and crossing ALL my fingers hoping I don't get paged!