Sexual assault survivors are incredibly vulnerable, especially in the immediate aftermath of the attack. As a forensic nurse and sexual assault nurse examiner (SANE), many of the survivors I’ve cared for are etched in my memory. It’s my job to ensure that their sensitive state doesn’t compromise their care. For example, an adolescent patient came to my clinic traumatized and scared after being sexually assaulted by her mother’s boyfriend. During our initial conversation, I noticed her raspy voice, which her mom confirmed was abnormal. After further examination, I recommended that we complete a strangulation assessment, during which the perpetrator’s DNA was recovered. While she might not have thought to mention it at first, the disclosure of strangulation added charges to the perpetrator’s offenses. It also served as an important and undeniable validation of the patient’s terrifying experience, which is critical to a survivor’s ability to heal.
Because of my training, I was able to make sure that this young woman received the care she needed. But imagine if she hadn’t received specialized care from a provider specifically trained to recognize warning signs, perform tests, and provide support in this important moment? According to RAINN (Rape, Abuse & Incest National Network), on average, 463,634 people 12 or older experience rape and sexual assault each year in the United States. Sexual assault and intimate partner violence (IPV) remain all too common among people of all ages. However, not all victims have access to the care they need after these attacks.
Unfortunately, as in all healthcare sectors, we don’t have enough forensically trained nurses to reach every community. According to the National Council of State Boards of Nursing, approximately 100,000 RNs left the workforce during the COVID-19 pandemic due to stress, burnout, and retirement. The number of forensic nurses also has fallen. Membership in the International Association of Forensic Nurses (IAFN) rose from 4,500 in 2018 to almost 6,100 over the next 2 years before falling to 5,600 in 2022. As of 2021, only 2,135 SANE-certified nurses work in the United States. According to IAFN, only 17% to 20% of American hospitals have SANEs on staff.
Low awareness of this career opportunity contributes to these low numbers. Forensic nurses (and more specifically, SANEs) treat survivors of sexual assault and physical injuries, IPV, strangulation, and other forms of abuse. They frequently serve as expert witnesses who give testimony on the evidence they’ve collected in a particular case. They complete forensic medical exams (FME) with the option of evidence collection, forensic photography, testing for sexually transmitted infections, and prophylaxis against pregnancy. Even if a survivor declines evidence collection, a comprehensive health exam the SANE can complete a physical exam to assess the individual’s current health status. The survivor has full control of their FME and can stop at any point or skip standard steps.
SANEs offer a level of care that goes beyond the bedside. They care for one patient at a time, maintaining the survivor as their sole focus. The extensive training and certification received by SANEs promote rapport between providers and patients, which leads to a better understanding of patient needs and improved outcomes.
Covering six hospitals in the Chicago area on call, all of which see a considerable volume of assault patients, I’ve witnessed this shortage firsthand. Resources are spread thin, which makes it challenging to ensure each of our assault patients receives the level of specialized care they deserve. Essential services are even harder to come by in rural areas, where women might be more likely to suffer from IPV (and more severe abuse) than women in urban areas. However, RAINN reports that survivors in almost all rural communities in the United States must travel hours to access a SANE—one of several reasons many survivors don’t report their abuse. Many may not even know that this type of care exists.
We can change this troubling reality. The first step is education. We must raise awareness about the field of forensic nursing and the benefits it offers to communities. We must stress the critical need for more practitioners and how they can receive training. A study in by McFadden found that most universities don’t include forensic nursing as part of their curriculum, even though patients who’ve experienced abuse can be found in every healthcare setting and are often missed.
In addition to working on the frontlines in the Chicago area to support survivors, I share my experience and expertise with nursing students, mentoring the next generation of forensic nurses at institutions like my alma mater, Chamberlain University, part of Adtalem Global Education. I want students to know that, although this area of nursing can prove challenging, it’s critically important and immensely rewarding.
Even as we continue to pursue every possible avenue to prevent sexual assault in this country, those who do experience these crimes must have access to the care and support they need from a knowledgeable and specially trained practitioner. Forensic nurses, including SANEs, serve an essential role in the healing process of survivors. In celebration of National Nurses Week (May 6-12), I’m working to raise awareness of this critically important specialty and ensure that new nurses coming into the field are well trained and equipped to provide competent, compassionate care to patients in their time of greatest need
Jeana Friday, MHS, MS, BSN, RN- CPN is a forensic nurse for Endeavor Health in Chicago, IL.
References
Garnand I. ‘Nobody really knows’ where to find the right care after a sexual assault. The Center for Public Integrity. September 21, 2023. publicintegrity.org/health/find-care-sexual-assault-nurse-examiner
International Association of Forensic Nurses. Statistics. forensicnurses.org/statistics
Edwards, K. M. (2015). Intimate Partner Violence and the Rural–Urban–Suburban Divide: Myth or Reality? A Critical Review of the Literature. Trauma, Violence & Abuse, 16(3), 359–373. https://www.jstor.org/stable/26638364
RAINN. Congress moves to address critical shortage of sexual assault nurse examiners; RAINN partners on bipartisan legislation. February 15, 2022. rainn.org/news/congress-moves-address-critical-shortage-sexual-assault-nurse-examiners-rainn-partners
RAINN. Victims of sexual violence: Statistics. rainn.org/statistics/victims-sexual-violence
McFadden P. The assessment and exploration of forensic nursing concepts in undergraduate nursing curricula: A mixed-methods study. Int J Nurs Educ Scholarsh. 2021;18(1). doi:10.1515/ijnes-2021-0101
National Council of State Boards of Nursing. NCSBN research projects significant nursing workforce shortages and crisis. April 13, 2023. ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis
