The nurse in the morgue – Part 3 of my interview with a forensic nurse

SafetyNurse1968, BSN, MSN, PhD

Did you know? Forensic Nurse is sometimes called "autopsy nurse" or "death investigator".

You may have read part 1 and part 2 of this series about Lacy, a forensic nurse who spends part of her workday supporting victims of sexual assault, and part of her day working in the morgue. I didn't have space to discuss the work she does in the morgue, which I found to be intriguing. It's one of those nursing jobs you don't hear about much, but it's so important. I did some research and discovered that this job title is sometimes called an "autopsy nurse" or "death investigator.” These nurses often work with a coroner or medical examiner (ME) to determine cause of death.

Lacy described her work in the morgue, "If a patient dies in the hospital, the nurse fills out the death packet and then we got to the unit and collect the body and bring it down to the morgue to wait for the funeral home to pick it up. Bodies come in from the outside as well, from overdose or motor vehicle accidents. Sometimes we assist the medical examiner with collecting evidence if they need our help. They decide if the decedent goes to autopsy. Those are done in the [state capital]. Or the hospital can do an autopsy on request, but that's a whole different system.” She went on to say, "If the ME is on the scene and they lock a body bag, we don't touch it. Sometimes the ME will decide they don't need to investigate the site based on the officer's report. We will then document belongings, do a pill count, inventory the body. It's usually car accidents, OD, suicide. We have to be careful about lifeshare, though that's usually not an issue with a fatal demise like an OD, but people who die in the hospital, the nurses are good about notifying lifeshare if there's an organ donation. That doesn't happen very often.

Lacy described her first case in the morgue: "I was orienting with another nurse and a car wreck came in. I was nervous about what I might see. The nurse I was orienting with told me it might bother me the first time, but that I would get used to it. We had just opened the body bag when his cell phone rang. It was in his pocket. I just looked at her and was like, 'what are we supposed to do'? She said, 'we just turn them off and inventory the phone.’ It freaked me out, I was not expecting to hear a cell phone ring.”

She recalled another tragic moment, "A father and mother were in a car wreck. Mom was ejected from car, baby was ejected from car, dad was in neurotrauma on a vent. The infant was able to donate valves, and the decision to do that had to go to the grandparents to decide. That was a tough one.”

"The overdoses can be difficult when you deal with the family. It's one thing if their kid has been in rehab, if they know drug abuse is happening, but the ones who have a son at college here, and the family is from [far away]– they have no clue their kid is doing drugs. The family is surprised and devastated. It adds another layer.”

What is the role of the nurse as coroner or medical examiner?

As I mentioned in Part 1, Nurses can actually become coroners or medical examiners. According to the International Association of Forensic Nurses (IAFN) the responsibility for death investigation lies with either a coroner or a medical examiner.¹ A coroner is an elected official who may or may not have specific educational requirements. A medical examiner is typically an appointed physician with training in forensic pathology. There are currently 11 states that have coroners, 22 with medical examiners and 18 that employ a combination of both. I was curious about my state, so I googled death investigation in my state and found the Office of the Chief Medical Examiner. I ended up calling the office and found out that nurses can be MEs in my state. It is highly recommended for this job that you earn certification through the American Board of Medicolegal Death Investigators(ABMDI).²

I read several interesting articles about nurses who work as Medicolegal Death Investigators (MDI). Job responsibilities include taking photographs of the body, the evidence and sometimes even the crime scene. They work closely with law enforcement to determine exactly what has happened when an unwitnessed or suspicious death occurs. These nurses must have excellent documentation skills and are often called upon to testify about their findings. The downside is on-call hours, being called to scenes no matter the weather, and the disturbing scenes that MDIs may witness. The benefits include providing resolution for family members, and never seeing the same thing twice.³

The U.S. Department of Justice has published crime scene investigation guidelines.⁴ You can read through them by clicking the link. As in so many areas of medicine, crime scene investigation suffers from a lack of standard expectations. I was surprised to learn that there is no system of death investigation that covers the more than 3000 jurisdictions in the U.S. No nationally accepted guidelines or standards of practice are mandated for death scene investigations. There is no professional degree, license, certification or minimum educational requirement; there is not even a common job title for the thousands of people who routinely perform death investigations in this country.

I went to the ABMDI website to see if there were any jobs for MDIs in my state. The closest one I found has a starting salary of $40,000 and the minimum requirements are a Master's Degree in a related field or a Bachelor's degree with three years of experience in death investigation. However, I kept reading and it states that if a person with current ABMDI certification applies for the job, they will be considered.

I don't think I'm ready to go out and get ABDMI certification just yet, but I continue to be fascinated by the idea. I'd love to hear what you think about this nursing job, especially if you have experience in this field.

REFERENCES

The nurse in the morgue – Part 3 of my interview with a forensic nurse

Did you know? Forensic Nurse is sometimes called "autopsy nurse" or "death investigator".

What is the role of the nurse as coroner or medical examiner?

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