KC4NSICRN

brii asked if shoegal goes to crime scenes. While she responded that no, she does not, in reality, the crime scene actually comes to HER! Each victim of a crime is considered a crime scene where you would observe, document, collect evidence and photograph. What you are doing is documenting a "picture" that will tell law enforcement exactly what that crime scene looked like, what you saw, what you collected, what you photographed. Especially in the case of a violent death, documentation is so important. Not only will law enforcement and the justice system need to be able to picture in their minds what was right in front of you, but if you ever have to go to court on a case, wouldn't you want the documentation to be this good? Now, let's take this one step further: let's say a patient dies of a violent act and comes to your ED, followed by the family. The grieving process tells us that it's important for the family to say goodbye,right? I agree, but you still have an evidentiary responsibility to perform. Short of wrapping crime scene tape around the body, you still need to balance letting the family say goodbye and protect that crime scene and not let the family disturb any evidence. So, what worked for me was speaking gently and succinctly to the family PRIOR to them going into the room to view the body about how important it is to protect the evidence. I would not let the nurses "prepare the body for viewing" by washing the face. If there was blood there, I would tell the family, just as you would tell them that they would be seeing the endo tube, etc. I would try to find a clean hand for them to hols and cover the rest with a sheet. If the hands were bagged, I would tell them that, too and why. I would station a security officer in the room if need be, also letting the family know that this is standard in cases like this. And I would go with them. I would not allow the family to uncover the patient, nor would I allow them to hang over the body: they may transfer some of their own evidence! I hope this helps to give you something practical today that you can use tomorrow. Good luck! ~KC

ShoegalRN, for awhile there, I thought you and I had worked at the same hospital.

Here are the answers to the interview questions. Originally I was going to send it in a document so the previous responses are included; Those responses are in italics and mine follow in non-italic. Please note that although I no longer work in a hospital, I did for many years. I think what I do can give you a different perspective of what a Forensic Nurse does. Interview Questions Please tell me a little bit about your educational background and how you decided to become a forensic nurse. I have my BSN in Nursing. I decided to become a SANE based on my love of forensic science. I wanted to combine nursing and forensics. I also wanted to be a strong voice for domestic violence victims. KC: I have a Diploma in Nursing with 34 + years of experience. I can trace my interest in Forensic Nursing way back to my curiosity as a child. Figuring out how things work, solving puzzles, finding out what happened and how. My career had always been in Adult Trauma and Emergency: I like not knowing what's coming in the door next and taking care of it. I was a Flight Nurse on a helicopter ambulance and worked the trauma rooms when not flying. It was Easter weekend around 1985 and we had deaths to call in to the coroner's office. I was calling them all in and the Death Investigator said we had had more deaths than a (he named) a much larger city, and complimented me on my reporting. He asked if I would be interested in attending a Death Investigation Seminar and I said yes, and from there I was hooked. I began attending and then joined the International Association of Forensic Nurses (IAFN) and met Virginia Lynch, RN, the Pioneer of forensic Nursing. From there I've attended so many great seminars on this topic that I began to teach a forensic Nursing presentation around the country and in Canada. It's been one of the best career decisions I ever made. There so many different areas within the Forensic Nursing framework that you can go into. I am now self employed as a Forensic and Medical Legal Nurse Consultant and Licensed Private Investigator. Before Hurricane Katrina I was employed also at an Urban Level 1 Trauma Center as a Forensic Nurse Liaison. I created that position and it grew as the years went by. I did all forensic activity in the hospitals (we had sister facilities connected by a shuttle bus) except SANE and I would consult at both campuses. I worked all death cases, handled all terminal care activities, identified any unknown patients admitted to the hospital and searched for their families, and was Coordinator of the Organ tissue and Eye Donor program. I worked with Law Enforcement agencies from all over the USA, funeral homes from all over Louisiana and many of the alphabet agencies (DEA, ATF, FBI) as well. Hurricane Katrina closed my hospital and they did not call my job back, so I explored other areas of nursing. I miss that job a lot though and believe the need is still there. Where are you currently employed and explain what your job entails from day to day. I am an ER nurse employed in a level one trauma teaching facility. My job as an ER nurse changes literally from minute to minute. I can have an assault victim in one room, someone having a heart attack in another room, and someone having a miscarriage in another room. If I am assigned to do Trauma that day, and if a trauma comes in, I drop everything I'm doing and head off to the trauma bay. Pretty much the jack of all trades. KC: My practice is in my home office and I try to stick to a schedule. 9-10: Emails and answer phone calls 10-12: Case reviews 12-2: Case reviews, client interviews, investigations 2-3: Report development 4-5: Marketing What is one of the most exciting cases you've ever worked on? Don't really have too many, just one high profile case that will most likely go to court where I will have to testify as an expert witness. The case made the news, the suspect was in custody, and there was lots of forensic evidence to be collected along with the incident being witnessed. KC: I have so many! The best answer to that is: The next case! But I have worked an Eraser Killer case, much the same as Scott and Drew Peterson, where they have done away with their wives and report her missing and later it's found that she was murdered. The working theory of why they commit these crimes is they would rather not hurt their wives by divorcing them, so they do away with them instead. In my previous job I had a patient who came in unconscious and unidentified. He was a very good looking young man, clean cut, and was hit by a car at the intersection right in front of our hospital, so naturally we thought he might be a doctor, nurse or student of one of the medical or nursing schools nearby. I ended up having to get him fingerprinted and place an article in the Associated Press in order to identify him. This happened the month after 9/11 and I even had families from New York calling. Psychics even called! What is the most satisfying aspect of being a forensic nurse? Knowing what I do makes a big difference. KC: Ditto! You are a nurse, but you have skills that other nurses do not possess, so you have the honor of helping patients in ways that other nurses can't. Not everyone wants to be a Forensic Nurse, but then not everyone wants to be an ICU or ER nurse, either. Also, in my job now, finding that one piece of evidence that solves the case or that is the clincher to obtain a guilty verdict. Giving a voice to those who feel powerless in the face of those who have wronged them. What is the least satisfying aspect of being a forensic nurse? Hearing the victim's story. I try not to get so wrapped up in the story because it makes me angry at the suspect and then I can't focus on doing my evidence collecting. KC: I can't think of one (except for developing spreadsheets for my reports). What, if anything, do you like more about this job than being a staff nurse? The autonomy. KC: Ditto! Also, I like being a go-to person. When nobody knew what to do about a situation at my old job, they would call me and I would either handle it or find out how to handle it. I learned something new every day this way. If students are interested in this position, how would they begin their journey? You have to be a detail oriented person. Every fiber, every hair strand will count. You should start off trying to get into ER nursing, although you do not have to be an ER nurse to become a SANE (at least not in MY area). Learn the female reproduction parts like the back of your hand. You can work OB and become a SANE. Go to all forensic nursing education opportunities. Join the International Association of Forensic Nurses. Watch every reality crime show out there, Discovery ID is a favorite channel of mine! KC: I agree with being inherently meticulous, have exceptional observational and documentation skills. I watch all those programs too but am frequently irked by the unreality of it all. I remember the first CSI show I saw, they were walking all over the evidence and I actually picked up the phone, but who was I going to call? Those programs are also having a deleterious effect on our judicial system, as juries now expect even the smallest law enforcement agencies to have DNA results "by the second commercial." In other words, they expect all of law enforcement to be like on TV and it's just not realistic to think so. I like the true crime shows better. I would suggest working ER also. After you learn more about forensic nursing, you will soon see that every aspect of nursing has forensic applications. What is the average salary for a forensic nurse? I get paid by the case. I get a stipend for each case I do, along with an hourly rate for how long it takes me to complete the case. Each case takes an average of 4-6 hours. KC: I also get paid by the case. I set my own fee schedule and require a retainer to cover the first several hours of work. What are the usual hours for a forensic nurse? I am required to be on call 3 days a month. I also get on-call pay. I work anytime someone needs me, and I generally try to stick to M-F, 9-5, but an email can come in any time and I will respond to it. Do you see, on average, more male or female forensic nurses? I see more female cases on average. However, I have done a male case. KC: I see more female Forensic Nurses but male Forensic Nurses are also a valuable part of the team. Do you work with a team? What is everyones role? There is a team of SANE nurses at my hospital. We also work closely with law enforcement (the sex crimes unit) and organizations that support victims of rape and domestic violence. We work closely with detectives, as well as the prosecutor's office. The SANE is repsonsible for evidence collection, completing a rape kit, doing a pelvic exam, taking pictures of injuries (genital and non-genital), collection blood and urine, and placing orders for meds, x-rays, or CT's as needed. There is a ton of paperwork, which also includes collecting the victim's statement. We also work with social workers to place victims in shelter if needed. KC: I have a business partner who is also a nurse. We are both trained Death Investigators and he has been a Deputy Coroner in the past. He specializes in marketing and Multi Media presentations for court, so he designed all of our promotional materials. He has the computer and technical knowledge that I lack. I love the nitty gritty, down and dirty part of the investigative work. We make a great team! Today we were studying photos of a death scene in which a potential murder was staged to look like an accident. We are both Cajun and have a strong work ethic. Are there tangible goals to work for? Will I see concrete results when the job is done? Basically for me, it's to complete the case. I get paid on each completed case. There is a report that comes out that tell you how many complete cases make it to court. KC: In my old job, I reported sexual assaults that went undiscovered in the ER, for ex., when a trauma patient is so severely injured that she may go straight to the OR and upon reading the records, discover that she came in from an assault or other injury and she had no pants on. I would then report that to the SANE Director and an evidence kit would be collected. As an ER Supervisor and later as a Forensic Nurse, I was part of the Rape Crisis Network, where we had a sort of Grand Rounds and would discuss each case. Members of this task force included the DNA testers, the police, social workers, advocates, prosecutors from our parish and surrounding parishes. We would get an update on how we were doing in our evidence collection quality, find out how many cases went to court, how many were successfully prosecuted, what was lacking on those who didn't make it, how to improve our care, and also educate there was an educational piece to it. Using this method, especially when you have multiple jurisdictions as members, you may even be able to research trends perpetrators are starting to use, and you can even notice if more than one suspect has used the same MO, and catch a serial rapist. One that comes to mind is that in several cases, the perpetrator tied the shoe strings of the victims' shoes together. By having these meetings, law enforcement was able to look at those cases with new information and a serial rapist was put away. It could be something as simple as the words he used to lure her into his car, or what he said during the commission of the act. Are there clear lines of responsibility? YES! The responsibilty of the SANE is to do evidence collection. We are also responsible for calling the police department and speaking with the sex crimes unit if the patient wants to report the crime. We are responsible for taking pictures of injuries (genital and non-genital), doing a pelvic exam, collecting blood and urine, and ordering meds for prophylaxis (sp?) STD prevention. We also can order x-ray or CT if indicated. KC: See above for Team. So far on my team there is only my business partner and I. Since it was my company first, I'm the president. We subcontract if there is a need for an expert who is currently practicing, or if the case is out of our expertise. For example, I would sub-contract a geriatric or chemotherapy case. How flexible is this position? How structured is the environment? I am only required to be on call 3 days a month. Our program is very structured. The ER docs pretty much let us have at it as long as the patient is medically cleared. Self employment offers the greatest flexibility, but it has pros and cons, like other jobs do. Are the hours regular and the duties consistent? Depends on what hours you are on call. No one case will be the same, but you do the same duties in each case, unless the patient refuses to have a forensic case done, but wants to be "checked out" anyway. Even if the patient does not want to report the case to law enforcement we used to keep the kit (if allowed to collect it) for a certain amount of time and still offer pregnancy prophylaxis and STD testing. __________________________________________________________________________________________________ In conclusion, I again apologize for not getting back to you earlier. This was an interesting thing to do! and I really enjoyed the other nurses' responses. I hope this helps your presentation. And if you or anyone else has any further questions, please do not hesitate to ask. ~KC

Silly me, I apologize. I'll answer your questions tonight and post them here.

Here i am, what can i help you with?

Chris, Each state has its own system, there are two, as stated above: Elected coroner (lay person over 18, unless MD is running, they take precedence over the lay person) and Medical Examiner system (has to be MD). In some very small parishes, the coroner is the owner of the ambulance service or the funeral home. There are RNs who are coroners, and I would strongly encourage you to seek more information from the International Association of Forensic Nurses. You should be able to find all the information you need, but I would also check with your state. You might try your local coroner or Medical Examiner's office. another resource is NAME, National Association of Medical Examiners. Death Investigation is a fascinating career! PS. Hey sirI! ~Karen

I would like to expound(who me? expound? lol, yes, me) on something I was writing about above, the case of the in-custody death with ligature marks around her ankles. As you may realize, forensic nurses are there to document what we see in that situation. In-custody deaths are mandatory coroner's cases, and thus must be reported as well as your observations of the ligatures. Why are these automatic coroner's cases? one reason is to protect the rights of the prisoner but another is to protect the facility. Finding the truth is what matters: Did the patient have these ligature marks when she entered the jail? OR did they occur because the jail restarined her? I just wanted to point out the two possible opposing causes.

Re: Job shadowing When I was working at a trauma center as a forensic nurse, I had students shadow me on the job. It was a great learning experience for them as I went about the normal activities of my day. Both of us learned! One day, we had a great learning experience as an in custody death came into our ER as a code allegedly from a diabetic episode. Oh, the learning that took place that day! While I in no way mean to sound disrespectful, here you have a patient who came to us with CPR in progress, the code was unsuccessful. So in a teaching hospital, you are presented with a learning opportunity, and we should take this opportunity to learn something that might help another. Do you agree? With my shadow student and the other ER nurses close by and the curtains to the code cube closed for privacy, an inspection of the body was undertaken. We found ligature marks around her ankles! Ok, what does this tell you? Was she tied to the bed in the prison infirmary? Were these marks from ankle shackles? It is not up to us to say how it happened, just to observe that these marks are present. We discussed the possibilities and it was a learning experience for everyone, from the observation of evidence, to the documentation in the nursing notes. We were able to correctly report this to the coroner and the investigation had an element to it that would have been lacking if we had not noted this important observation. This, then led to looking into a practice that had been in place for years at our facility, the tying of hands and feet together prior to placing the body in the morgue bag. Formerly, we had used only shrouds to perform our post mortem care and the tying of extremities was used to create a smaller package to enshroud. With the purchase and use of the zippered morgue bags, we no longer needed to use the tying method, which by itself can steer an in-custody death investigation in a whole new mistaken direction. Thus, I began the process of changing the policy on post mortem care and removed the gauze ties from the morgue packs altogether. The change in policy required in servicing of all units, therefore requiring my services as the forensic nurse even more. If you place what I have just written into an algorithm, you can see the impact that having a forensic nurse in house can make a difference and the education and better outcomes that can follow. What do you think? I think you are on the right track with the experiences you are getting with LE! In fact, I'm kind of wishing I was there! Good luck and let us know how you progress.

Originally Posted by ForensicMI I'm actively pursuing a career in Forensic Nursing. I've already have enough knowledge on it and know how to get certification in my state. My question is, do you recommend getting experience with police officers/ those in Law Enforcement? If you have, what types of things did you do? Have you done ride alongs with police officers? If so, what questions have you asked? I've looked around in this thread, but I've also looked around other sites, and some recommend getting to know your local police officers/law enforcement agency's. Thanks for your responses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dear ForensicMI, Without knowing more about how you're pursuing your career in Forensic Nursing, I'm going to pose some Q&A for you to think about and my responses. Before I do so, I want to be clear that I am not trying to be a smart aleck, but to respond with experience, of which I have much. 1. How are you pursuing your career in FN? What certification are you going for? Where? 2. How are you measuring that you have enough knowledge? I have been practicing FN for almost 21 years and still learn something every day. Each case brings new knowledge or a desire to research something that came up that I felt I didn't know enough about. I think that's one of the things we who are interested in FN have in common, a thirst for knowledge, a hunger for more. If you do any work with LE, I would advise not telling them that you have enough knowledge. That statement could put their backs up right from the start and limit how much you can learn from them. However, if you go in with the attitude that THEY have a lot to teach YOU, you will earn their respect, give them an invisible pat on the back and you will learn so much more. 3. Do you already work as an RN? What area do you work in? You will encounter forensic applications to patient care in every area of health care, all along the continuum. The ability to recognize forensic patients when you see them is a key part of being a forensic nurse. Did you know that a large majority of women who seek emergency care are victims of abuse? An old statistic is 55%! Over 50% female homicides are a result of domestic violence, staggering statistics and mine are old stats. 4. Is LE present in your daily work, such as in the ED? If so, I would talk to them every time they come in. Buddy up to them to them, if you will. I would be asking what do you think happened here? How can I as a nurse, help you to do your job? If the crime scene team comes in, watch how they collect evidence. If the photographer comes in, ask about the pictures they take. Did you know that when a victim of shooting comes into the ED and resuscitation is unsuccessful, that body is now a crime scene and should be treated as such? Did you know that you should protect that body when the family goes in to see the deceased and wants to lay on them and cry so the grieving process can begin? I would definitely recommend getting involved with LE, depending on your answers to the questions above. There are so many facets to FN that it's a bit difficult to adequately cover all of them. Other things to do are: Take a tour of the coroner's office. Take SANE training. Take a tour of the police station. Go to community police meetings. Volunteer with either of them. Once you start to develop a relationship with them, and they see your real interest by asking intelligent questions, they will begin to respect you and see you as being a Forensic Nurse who can partner with them in the fight for truth and justice. It has been said that Forensics is the intersection of medicine and law. I hope my little speech here has sparked some more questions for you to ask and I look forward to helping answer them. Good luck in your new career! KC007

Amandamaren, Thank you for that validation! KC

Prettyladie wrote: you said the person had a MI and died himself? I was referring to one of the students in that horrible class I spoke about in an earlier post. one of them gave an insulin overdose and the patient died as a result. Later, that student had a heart attack and died, and our thougts were that it was due to the stress of the legal issues that ensued(no pun intended). And to all the critics of grammar, punctuation, etc., with all due respect, if it is too much work or not that important to decipher a poster's message, then by all means, please press next. I am not trying to be mean, ugly or disrespectful, but do you realize how much time you took to write something that may have hurt someone's feelings when they were upset and asking for help? AND holding a 5 month old? We are not perfect and now that I've said my peice, I am moving on. My apologies in advance if I mispelled something. Good luck!

Oh, my God is right. I couldn't believe this happened to me. Anyway, you learn and move on.

Holly, You need to stand up and say something. I'm going to tell you what happened to me, it's along story, but first, when you go to whomever you choose to tell, you need to have your dates, scores, facts all in order to present evidence in a orderly chronological fashion. Write it out, and a day or two later, read it again, make your corrections and keep it to yourself that you are doing this. If you mail it, send it certified and get a reciept to be returned to you when they recieve it. Now here's what happened to me: I was asked to be the RN (on paperwork only) to oversee a pilot program for an LPN class. I agreed and continued to work my regular schedule and not go to the class. A few weeks into the class, I heard that the other instructor was doing very unethical things, and MY NAME was on the paperwork. Oh but no! This was a pilot program, which to me means you have be above the minimal standards and have no possibility of scandal or impropriety for the pilot to be successful and turn into a regular program. So I decided to drop off some of my schedule and go in and teach some classes myself. We were teaching insulin administration and the class had already learned it but were practicing hands on demonstrations. When one student picked up a catheter tip 60 cc syringe to give INSULIN, my fears were confirmed. The students began confiding in me, telling me all the stuff the other instructor was doing while I was not in the classroom. He was treating one half of the class differently than another half, sexually harassing others, giving his teaching notes to his favorites, curving grades, and whiting out failing scores, writing in passing scores and making copies to send to the state. I saw what was going on and wrote it all up. I went to the state board. As it was suspected that i was the person who told the state about, I was chastised by some of the hospital admin and told that if the program got shut down I would have to report to the human resources department. My supervisor was sobbing when she told me this. Apparently they knew what was happening, but the higher ups wanted this program at all costs. I dropped out of teaching the class, and later learned that a student had killed a patient with an insulin overdose and later had an MI and died himself. I am telling you this to say that I feel like I chickened out by quitting the class, but looked what happened! I never identified mysself to the school as the whistleblower. I did not lose my job, but I was so depressed and felt so bad about all this that I waited a few months and then moved to another school. It really shook my belief in what is right and what is wrong. Unfortunately, the quality of the class was such that two deaths occurred as a result. So please, tell someone about this. Identify yourself or not, but if you are close to graduating, wait until after. Good luck!

for the jcaho standards, here is what you need to know. i got this from doing a google search, it's apparently a proposal, but it contains the information you're looking for. i included the statement about the proposal because i thought it was also informative. some of the information (the standards) can be researched and used to persuade your administration to pursue adherance to standards, by utilizing your talents and advancing yourself professionally, increasing your own marketability and realizing just what an asset you are to the facility! forensic science has been classically associated with investigations of suspicious or wrongful deaths. however, in the past decade, a new discipline, living forensics, has emerged, focusing on trauma survivors and the perpetrators of violent acts. this new forensic arena is germane to healthcare personnel in any setting, and bridges the gaps that have traditionally distanced them from law enforcement and the judicial systems. the requirement to educate nurses in the fundamentals of forensic science was firmly established in 1997 when the joint commission on the accreditation of healthcare organizations (jcaho) published its revised standards for patient assessment. the guidelines require that all staff members be educated to identify victims of abuse, violence and neglect, and be able to collect and safeguard physical evidence associated with a known or potential criminal act. the purpose of this proposal is to develop an asynchronous, interactive learning program for the world wide web, which will enable nurses and other healthcare personnel to identify forensic cases and to properly document and manage evidentiary materials. jcaho core standards guidelines e.s.5.1.0.1 criteria needed to identify possible abuse victims ho.3.2.15 es.5.2.10.1.1 types of abuse to be addressed: ho.3.2.15.1.1 physical assault rape or sexual molestation domestic abuse of elders, spouses, partners, children es.5.1.2.10.2 procedures for patient evaluation. ho.3.2.15.2. patient consent examination and treatment hospital role in collection, retention and safeguarding of specimens, photos and other evidence notification/release of information to authorities es.5.1.2.10.3 referral list of private and community based family violence ho.3.2.15.3 agencies available through the hospital es.5.1..2.10.4 medical records documentation to include examinations, ho.3.2.15.4 treatment, referrals to other health care providers and community based agencies and required notification of authorities es.5.1.2.10.5 requires appropriate staff to be trained in injury identification ho.3.1.15.5 and procedures needed to work with abuse and assault survivors i hope this helps! kc4

Rdaven1, I would like a copy of this list, too. I am in Louisiana and need all the help I can get. Kudos to you in advance for sharing!