Nurses are often the first and possibly the only professionals — whether medical or legal — that a survivor of sexual violence has contact with following an assault, yet many clinics and hospitals do not train nurses in the complex medical and forensic processes required to properly treat these trauma patients.
Although 321,000 people are sexually assaulted in the U.S. every year — the equivalent of one assault every 98 seconds, according to the Rape, Abuse, and Incest National Network — just 1,725 Registered Nurses (RNs) in America are currently certified as sexual assault nurse examiners (SANEs) through the International Association for Forensic Nurses (IAFN).
At The Pennsylvania State University College of Nursing (Penn State CON), nurse educators are working to fill this educational need by introducing students to sexual assault nursing through unique programs.
An Introduction To Forensic Nursing
In Penn State CON’s forensic nursing certificate program, undergraduate students and practicing nurses learn the complexities of caring for patients who have experienced all types of violence.
“The forensic program really goes beyond medical care to give specialized knowledge of the legal system and skills in injury identification, evaluation, and documentation,” says Mary Alyce Nelson, a CON instructor and coordinator for the RN to BSN program. An online offering, the RN to BSN is for registered nurses who have earned an associate degree and are advancing to a bachelor’s of science. The forensic nursing certificate is offered online as part of this program, though CON undergraduates can also enroll; in addition, it is offered at several of Penn State’s satellite campuses throughout the state.
As with most specialty areas of nursing, individuals who are interested in becoming a forensic nurse typically go through the requisite training after two or three years on the job, according to the IAFN website. An increasing number of undergraduates are drawn to this field, however, which is why Penn State allows them to enroll in the program, says Nelson. She attributes this increased interest to a growing awareness of violence in general, including sexual assault. Treating survivors is typically seen as a subspecialty of forensic nursing, says Nelson, as the basic lessons are the same.
“Some of the nurses who go into this certificate program are interested specifically in becoming SANEs,” Nelson says. “That’s not limited to women; we emphasize that sexual abuse is not exclusive to any gender or race because we want our nurses to be able to work with anyone who has experienced this type of violence.”
The certificate program consists of four courses that cover issues such as the nurse’s role in investigating abuse, techniques for violence reduction, collecting evidence, and even testifying in court. “They learn that a nurse’s proper observation, collection, and preservation of evidence can play an important role in determining the legal outcome whenever someone has been exposed to a traumatic event,” says Nelson.
Perhaps most important, students learn how to help patients heal mentally and emotionally following an act of extreme trauma. While anyone can learn the technical process for administering a rape evidence kit, for instance, it takes unique training and devotion to become an effective patient advocate, Nelson says.
“It’s always about approaching a patient with compassion, letting them know they aren’t to blame, and allowing them to make choices,” she says, noting that forensic nurses and SANEs must be experts in patient legal rights, such as having the choice to be examined or press criminal charges. “It’s about giving them back some control and letting them know we [as nurses] are here to help support and empower them.”
While only practicing nurses can actually earn the forensic nursing certificate, completing the program shows that undergraduates are ahead in planning for careers in this field, says Nelson. Similarly, nurses who earn a certificate will still have to complete additional clinical training and — depending on their employer’s requirements — pass board certification, she notes.
Like sexual assault nursing, the certification process and requirements for forensic nurses depend largely on individual training programs — typically taught through community colleges, clinics, or hospitals — and certification boards. Whether or not a forensic nurse or sexual assault examiner has to be licensed as such in order to practice also varies by state and even employer, according to IAFN.
Addressing Pediatric Sexual Violence
Sheridan Miyamoto, PhD, FNP, assistant professor at Penn State CON, introduces students to sexual assault nursing through the university’s Child Maltreatment and Advocacy Studies (CMAS) program. Future nurses interested in pediatric care can minor in the interdisciplinary CMAS program, in which Miyamoto leads a course that teaches medical responses for underage victims of sexual abuse. It’s often the first time that students realize caring for victims of sexual violence is a career option, she says.
“Because they’ve been introduced to [sexual assault nursing] in the classroom first, students see it as more accessible and understand how they can be effective in the role of a SANE,” says Miyamoto. “This course gives them time to explore that career path, and they really come away thinking they are well-prepared to understand the issues they may face in caring for these patients.”
Many nurses who earn SANE certification decide to do so after already starting their careers — when years on the job have shown them the great need for this type of specialty care, Miyamoto explains. Teaching students about this need is pivotal to growing the SANE workforce and empowering future nurses to start planning their careers, she says.
“[Sexual assault nursing] is an area where there’s a real dearth of people who go into the field” because so few nursing programs address it, says Miyamoto. She estimates that one in four nursing students who enroll in the CMAS minor end up wanting to pursue forensic and sexual assault nursing as a career. “I regularly hear back from those who have graduated and gone on to practice for a year doing emergency or ICU work and are now ready to pursue [the necessary training].”
While forensic and sexual assault nursing education is rare at most institutions, there is evidence that efforts to raise awareness of these career paths are beginning to gain traction, says Angela Amar, PhD, dean and professor at the University of Nevada, Las Vegas School of Nursing. An expert in forensic nursing and in cultivating diversity in the profession, Amar has helped design forensic nursing programs for several universities and is active in contemporary research in the field. Recently, she says, the College Resources Services Administration (CRSA) began awarding federal funds for universities to create SANE training programs as well as conduct research on how to make such programs scalable and sustainable.
“There are a few schools that have courses in this, but certainly more should consider the ubiquity of violence in our society,” says Amar. “Often people in nursing will tell you that all nurses, whether they know it or not, have treated survivors because there are so many patients who have experienced this type of trauma and never tell anyone.”●
Mariah Bohanon is the associate editor of INSIGHT Into Diversity. To find board-certified SANEs in your area, visit forensicnurses.org. This article was published in our January/February 2019 issue.