Forensic Nursing, Part 1

When people hear the word "forensic," their thoughts usually revolve around mysterious deaths and CSI-style investigations. In reality, the work performed by forensic nurses is much more diverse. According to the International Association of Forensic Nurses (IAFN), "Forensic Nursing is the application of nursing science to public or legal proceedings; the application of the forensic aspects of health care combined with the bio-psycho-social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity and traumatic accidents." One specialty of forensic nurses is the sexual assault nurse examiner (SANE).

What is a SANE?

I spoke to Mary Waters, an RN who works as a certified SANE at the Peterborough Regional Health Center in Peterborough, Ontario. For the past three years, she has been the clinical nurse team leader for the hospital's sexual assault and domestic violence program, and a member of the hospital's emergency response team. Additionally, Waters is enrolled in the Forensic Health Studies program at Seneca College in Toronto, Ontario.

Waters says the SANE's responsibilities include assessing the victim's physical and psychological condition, collecting physical evidence, providing preventative treatment for sexually transmitted infections and pregnancy, and offering referrals for further medical and psychological care. Waters also stressed that a SANE's first duty is to the patient, therefore they should collect forensic evidence only if the patient wishes it. If a case goes to trial, the nurse can testify as an expert witness. SANEs work in hospitals and rape crisis centers, and are often on call 24 hours a day.

Are SANEs certified?

After training and the successful completion of a certification exam, RNs can obtain the Sexual Assault Nurse Examiner-Adult/Adolescent (SANE-A) designation from the IAFN. Different employers may have their own criteria, and may not require certification for an RN to practice as a SANE.

What makes a good SANE?

According to Waters, because sexual assault examiners treat patients who have undergone a traumatic experience, strong communication skills are crucial. SANEs also require good problem-solving and documentation skills, as well as the ability to work independently. Since SANEs may need to testify in court, they must be comfortable with both the medical system and with the criminal justice system.

How has your job changed over time?

When she first began her job, Waters treated only adult sexual assault victims. In 2003, the central network that operates Ontario's 33 regional sexual violence and domestic violence centers expanded its mandate to include domestic violence and children who had been sexually assaulted.

In the same year, the network introduced free HIV prophylactic medication for victims who were at risk of contracting the virus. This change meant that SANEs were able to do more thorough follow-ups, since all patients who wish it receive a second consultation 48 hours after their first examination, and those who are on HIV prophylactic treatment are followed up for one month. Waters says that further patient contact has allowed her to follow up on abnormal test results, refer victims or their families for further medical or psychiatric care, and help patients navigate the criminal justice system.

Waters believes that the time has come for forensic nursing in Canada to expand to be more like it is in the United States, with roles in additional areas, including investigations of child abuse, elder abuse, and deaths.

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For information about additional roles of forensic nurses, as well as information about prospects and salary, see Forensic Nursing, Part 2.

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