Training Options

bsnurse

I would love to see more discussion on this and learn more about how different hospitals and communities are implementing a complete sexual assault response team (SART) to address the real need for a united effort to care for sexual assault victims.

I recently started the IAFN course and do plan to finish and take the exam to be SANE-A. I am a full time staff RN at a local trauma center so I am looking at this issue from an ER point of view, a womans point of view, as well as a member of the community in which I live.

I have long believed that the ER is a horrible place for a woman to end up after a rape. Generally speaking our ER's are overcrowded and understaffed and the nurses and physicians aren't trained to collect forensic evidence and for the most part, many of the staff see it as outside of our scope of practice. We aren't trained in law enforcement (many don't want to be, which is fine) and we are totally unprepared to care for the victims who are trusting us to help them.

The ER is the first stop for LE with these victims and usually the first place a family member/friend will bring a loved one who has been sexually assaulted. The action or inaction of the ER staff in those critical hours after an assault quite literally sets the scene for future prosecution of the perpetrator. The best legal team in the world can't convict without evidence. There must be a process in place that insures consistent standards of care for these pts, just as we have for MI's,CVA's, traumas etc.

This must also be a collaborative effort. Everyone involved in the legal process must work together to insure the very best possible care is given to these victims and that everything possible has been done to assist in prosecution of the perpetrator.

As I previously stated, I am fairly early into my training, and the more I learn the more questions I have. I am very impressed with the effort thus far. I have spoken with our local prosecutors. I had a chance to ask them what they needed from me, what I can do to insure the best possible outcome of these cases. I have spoken with our crime lab and was able to learn the best ways to collect evidence, the proper way to store the evidence, and the correct way to transfer evidence from person to person or agency to agency. I was able to speak with my local victims advocacy center to get their input on what resources they have available and how to best facilitate them. I spent time with law enforcement to better understand their roles/regulations as well as for them to understand mine.

Again I'm very impressed with efforts put forth by my hospital and community thus far. It seems to me that the most "resistance" is coming from the medical community. As sad as it may sound, in my experience, the relationship between the legal community and the medical community has always been an "us vs them" type of attitude. We have all been taught from day one to "CYA", document, document, document. Most of us would agree that lawyers are the bane of our existence, and make our roles as care providers much more difficult that we feel it needs to be. The idea of working as a team with the legal community, with a common goal, is really very foreign to many of us. I hope that with continuing education, and a collaborative effort on all our parts, we can change that.

I will be interested to follow this discussion as I continue on my educational experience. I would love to hear what issues have come up with others who have already implemented a similar system in their hospital or community. I would love to share ideas, what worked, what didn't work, what policies must be in place to make this effective. As I said, the more I learn the more questions I have and this would be a great venue to explore the options available and discuss the many issues I can for see as this process unfolds in my community.

I have been a sexual assault nurse for 4 years and coordinate the program at our hospital. The first problem is sexual assault patients usually are not critical. They aren't going to die in 20 minutes if they aren't in the cath lab. However as minutes turn to hours valuable evidence is lost.

I have found my 2 best allies are staff nurses and police. Once you provide educate to nurses, they begin to realize how important and tedious evidence collection can be. I evaluate 50 sexual assaults per year. The average ER doc did may 5 cases per year before the program started 6 years ago. They did not have a clue how to correctly collect evidence. When the hospital admin complains about the cost of training I have a secret weapon.....lawsuit! It gets their attention every time. I have an article from The New York Times about a victim who successfully sued a healthcare system for mishandling,mislabeling, or just plain losing her evidence and her attacker was set free. She was awarded and "undisclosed amount". I can forward to anyone who wants it. It was published in Aug 2000.

I started a year or so ago doing in-services for the local police. They get annual credit for attendance. The hospital pays me for community education. Almost every police department investigator and child protective service worker have my personal cell phone number. I can met them at the ER door and avoid the waiting room. It benefits everyone. However I get very little sleep sometimes.

If you want to get the fastest results (even though it will be time consuming and slow) educate the staff. I sometimes use this. If you were in labor who would you want to deliver your child an OB/GYN or a Dermatologist? All will say OB/GYN. But why? Both are physicians and have received training. Right? Or could it be the OB/GYN is more qualified, received more training, and has more experience?

Victims have already been assaulted once....the ER enviroment usually provides them a second assault.

I started as a SANE at our hospital and furthered my education from there. I had to do a lot of self starting to get the experience needed to round out my education. Luckily, I hooked up with some pretty great forensic nurses who could guide me and let me come train with them.

I now work with the Medical Examiner's office doing death investigations. I also have a partnership with the local DA to perform functions needed for criminal investigation and/or prosecution (assault exams, bodygrams, evidence collection, crash investigation, etc.).

It took a lot of self initiative to get to where I am. People are resistant to this newer field of nursing, but professional respect and education of the partners go a long way. Law Enforcement is pretty receptive to your education and abilities after you show them what you can do. I say to all who are interested in this field - be a self starter! Go on ride alongs, hang out with the DA for a day or so, put together presentations to educate those professionals on how they can utilize your abilities and education. Make friends (bring food! LOL). But, nothing is worse than a nurse coming in to "show them boys how it's done." That just goes down in flames.

The same goes for hospital staff and physicians throughout the facility.

bsNurse

I'm taking the second part of my SANE course next week. This has been kind of exciting. The community is really backing us up,.we were even on the news! It was troubling to hear that there are only 15 SANE trained nurses in my state and 13 of them work for one hospital (the hospital that is doing our training). The news segment also reported that our town is 2nd in the state in most reported sexual assaults and there is no one trained to care for these people! I'm hoping all the media attention will encourage more budget options for us.

I'm trying to make myself a list of questions to ask during my classes next week. I'm sure the more I learn the more questions I will have.

Just wanted to update you. I'm hoping this program works out well, so far so good.