Forensic Nursing: The Specialty Too Many Patients Can’t Access

As a new nurse, almost everything scared me, at least a little. I watched senior nurses, with their calm and self-assured demeanor, care for patients with gruesome traumatic injuries, comfort the families of those who have died suddenly, and face our chaotic emergency department without hesitation.

I promised myself someday I would get there, too. Then, one day during my orientation, I discovered a scenario that created fear in even the most experienced and stoic nurses: the patient reporting sexual assault. At the time, I didn’t understand why the patient seemed to be avoided, and the nurses and doctors scrambled for someone who knew how to care for them.

It didn’t seem right. I thought this woman needed someone to acknowledge her pain and provide empathy, kindness, and caring. Just when it seemed that no one would rise to the task, the SANE nurse walked in.

Finding My Passion in Forensic Nursing

The Sexual Assault Nurse Examiner (SANE), or Sexual Assault Forensic Examiner (SAFE) nurse, in her calm and confident way, spoke directly to the primary nurse, residents, and attending. I watched as the trepidation and worry faded from them, and their shoulders relaxed from the tension they had been holding. She gathered the team, created a plan, asked for background on the patient, and listened intently to their reply.

Then we went to see our patient, the college-aged girl, who had come by herself to seek care after being sexually assaulted the night before. Taking the lead, the SANE nurse introduced herself and our team by role and name, and the advocate was seated on the patient’s right. As a new nurse, it was intense; I could only imagine what the patient was feeling and how the SANE would approach them. Then she sat across from the patient and said very simply and with genuine empathy, “I am so sorry that this happened to you, but I am really glad that you’re here.”

In that moment, her words were the catalyst for the patient to begin healing wounds we couldn’t see. The patient smiled a small smile, with tears in her eyes, and said a quiet “Thank you.” It was at that moment that I found my passion for forensic nursing.  

What is Forensic Nursing?

Ok, maybe we have all had those moments in our nursing career where we reflect on an interpersonal connection, and it sparks our passion. But it felt like I had discovered a piece of myself that had been missing. I instantly decided, ‘I’m going to be a forensic nurse.’ So, what is forensic nursing? It is so much more than empathy and caring and being a SANE.

It is the bridge between healthcare and the criminal justice system. Victims of crime and violence often need to seek medical care because of what they have experienced. Forensic nurses are on the front lines, working in various settings, and are specially trained to provide the best possible care for their patients. 

Survivors of sexual assault are not the only group to benefit from their expertise. Forensic nurses serve the abused, victims/survivors of interpersonal violence, victims of human trafficking, incarcerated people, the deceased, and families impacted by violence. They are experts in injury assessment, evidence collection, chain of custody, trauma-informed care, and the legal rights of their patients in both the criminal justice system and healthcare.

And that’s not to mention all the new technology, photography equipment, and advancements in forensic science that impact their practice.

The State of Forensic Nursing

So, what does it take to be a forensic nurse? Forensic nursing is a specialty that requires advanced education, training, and personal development. A forensic nurse’s key characteristics are self-awareness, attention to detail, strong critical thinking skills, and adaptability. They are second only to knowledge and experience.

But the most important thing to know about forensic nursing is that it will take drive and resiliency to continue to steer the ship into uncharted nursing waters.

Despite how far forensic nursing has come and grown, there remain areas of this country where people must continue to drive hours for expert care by a SAFE or SANE. Forensic nursing is still in its infancy. The success and future of this specialized field of nursing rest on the collaborative efforts of nurses everywhere to bring awareness to their health systems, nursing schools, and communities. It is care that should be provided in every state and health system.

 

The Future

The last 24 years of my life have been spent caring for others in emergent scenarios -- first as a paramedic for a commercial ambulance company and for the last nine years as an emergency department (ED) nurse for a busy level I trauma center.

For many nurses, especially those in the ED, the last three years yield similar narratives, regardless of where you work. The boarding, ratios, and general increase in violence in and out of our departments have taken their toll. We are all searching for the “passion” we once had but now struggle to ignite. But no matter the challenges faced by our profession, I continue to feel hopeful because I have found forensic nursing.

In the second week of November, we recognize forensic nurses internationally and their work for victims of violence. Being a part of this unique and growing nursing specialty has given me purpose and peace. Forensic nursing is integral to addressing the needs of our rapidly changing world. If this is your spark, check out the International Association of Forensic Nurses (IAFN) to look up resources in your state.

 

Rachel K. Henderson BSN, RN, EMT-P, SANE-A, CEN, SAFE, works full-time as a dual role SAFE/ED RN and is pursuing her MSN in Forensic Nursing. She is an active member of the International Association of Forensic Nurses (IAFN) and is the current CT Chapter President. She is mom to two teenage boys and a furbaby named Stella and wouldn’t be able to juggle it all without her partner in all things, Craig.

Bedside SANE Emergency Forensics