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The evolving role of the forensic nurse


Although forensic-nurse characters may not appear on the TV show “CSI”, they play an important role in real-life forensic cases. For many years, forensic nursing has been a component of the nursing profession and practiced informally by nurses. In 1995, it gained specialty recognition by the American Nurses Association (ANA) Congress on Nursing Practice.

Officially, forensic nursing is defined by the International Association of Forensic Nurses (IAFN) as “the application of forensic science—combined with the biological and psychological education of the registered nurse—in the scientific investigation, evidence collection and preservation, analysis, prevention, and treatment of trauma and death-related medical issues.” In the United States, the forensic nurse role has evolved from the forward thinking of innovative sexual assault nurse examiners (SANEs) who sought to standardize their practice and increase networking with colleagues.

Forensic nursing is based on the integrated practice model developed by Virginia Lynch in 1990. Incorporating aspects of biological, psychological, sociological, spiritual, and cultural nursing, it focuses on coordinated, cooperative care and communication among agencies.

Specific roles of the forensic nurse

All forensic nurses deal with victims and family members who’ve suffered injury or violence, whether living or dead. However, forensic nursing practice has many subspecialties. Some forensic nurses are death investigators; depending on their practice locale, they may be eligible to run for the office of coroner or may work in conjunction with the medical examiner. These nurses help investigate deaths and communicate with decedents’ families.

Others work in psychiatric or mental health facilities. Many work cooperatively with other forensic nurses in prisons and correctional facilities to create plans of care.

Because SANE nurses initiated forensic nursing in the United States, most forensic nurses practice in emergency departments and sexual assault centers, caring for adult and child victims of sexual assault and molestation. SANE nurses perform forensic examinations, collect evidence, and educate and counsel victims of violent assault and molestation. They regularly testify in court as expert witnesses in sexual assault cases.

Some forensic nurses work directly with the legal system as legal nurse consultants. Still others work in hospitals and other in-patient facilities as clinical risk managers dealing with real-time events (such as falls, patient or staff injury, and deaths) and collaborating with quality assurance and risk management staff.

Education, regulation, and code of ethics

Many educational programs offer education in forensic nursing, ranging from certificate programs to graduate programs. (See http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=542.) The primary certifications currently available are the Sexual Assault Nurse Examiner Adult/Adolescent (SANE-A) and the Sexual Assault Nurse Examiner Pediatric (SANE-P). These are awarded to nurses who successfully complete the certification exam, which is based on experiential practice and application of sexual-assault nursing. Currently, an IAFN focus group is working toward offering a generalist and specialist certification/
recognition level for the practice of forensic nursing.

Many forensic nurses practice with a master’s degree or higher in an advanced practice nursing role. Postgraduate doctoral degrees in forensic nursing are now available. Like all nurses, forensic nurses have much to gain by attaining higher levels of education and preparation so they can deliver optimal patient care and promote the profession.

Forensic nurses come under the same regulatory practice parameters and legislation as other nurses. Each state has its own nurse practice act; the forensic nurse role is governed first and foremost by this act. In 2009, ANA and IAFN co-published a scope and standards-of-practice statement for forensic nurses, which identifies expectations for the forensic nurse’s role and practice.

Forensic nurses are accountable to the IAFN Code of Ethics. This code outlines the nurse’s responsibilities to the public and the environment, obligation to science, care of the profession, dedication to colleagues, and fidelity to clients.

Resources for forensic nurses

Most practice areas for forensic nurses are relatively new, so networking with peers and colleagues is crucial. To do this, forensic nurses can join IAFN and other forensic-based organizations and attend relevant conferences and workshops. (The IAFN website lists forensic nursing websites to promote global networking. See Helpful websites by clicking the PDf icon above.) Most states have their own IAFN chapters, which address state and local forensic issues. Like other nurses, forensic nurses should maintain memberships in national and specialty nurses organizations.

Future of forensic nursing

Forensic nursing is highly dynamic, with new developments and practice roles constantly developing and taking shape. For the individual nurse, this “newness” may pose a barrier to fully implementing a particular practice position. Much remains to be done to inform patients, communities, other healthcare providers, and nursing colleagues about forensic nursing and its role.

Forensic nursing may take more time to be fully accepted into standard practice. As with any new practice field, initial opportunities for application may be limited, but forensic nurses are making their own inroads. As forensic nursing continues to grow on a professional level through standardization of practice recommendations and professional status recognition, the forensic nurse role will evolve, and responsibilities and competencies will become more delineated. Today’s forensic nurses are paving the way for the forensic nursing practice of tomorrow.

Visit www.AmericanNurseToday.com for a complete list of references.

Joanie Jackson is assistant professor and DNP Program Coordinator at the University of Tennessee at Chattanooga School of Nursing.

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