One of the most challenging roles in nursing is how Tara Henry characterizes her other nursing job, the one that wakes her up at night or interrupts a family dinner. In her regular nursing role, Henry, MSN, FNP-C, SANE-A, SANE-P, works in the ED of Alaska Native Medical Center and Yukon-Kuskokwim Health Corporation. Her other job is an on-call position as a forensic nurse examiner with Forensic Nursing Services of Providence Health
Colleague Jennifer Meyer, RN, BSN, SANE-A, SANE-P, agrees forensic nursing is not traditional, yet is very satisfying. In forensic nursing, we have the opportunity to help patients whove been victims of violent crimes to take back control and regain their dignity, she said.
Meyer and Henry were stretched even further last fall in their roles as forensic nurses. A lack of trained staff meant a temporary cut in overnight services at Providence. Vigorous recruiting and training has restored 24-hour service, Meyer said, which at Providence ideally means 16 forensic nurses on-call. Their center averages 25 patients monthly.
Staffing trouble is by no means specific to Alaska, said Meyer, who is clinical nurse manager for the center where the forensic nursing services are located.
Forensic nurses typically work on-call while being employed in other nursing positions. They provide care to people affected by crime, whether through domestic violence, abuse or neglect. Since sexual assault is the most common specialty within forensic nursing, many begin as sexual assault nurse examiners, as Meyer and Henry did.
Certification and training
RNs who take the required 40-hour SANE class and become certified sometimes may receive their clinical training after being hired. Educational guidelines are specified by the International Association of Forensic Nurses. Degree programs and national certification also are options.
Interacting with multiple disciplines
Working as a forensic nurse involves interacting with multiple disciplines, Meyer explained. Patients often are referred by law enforcement agencies or victim advocates, or may be seen in the hospital ED. The FN performs a medical forensic exam, explains the patients options for reporting the incident, collects information about the crime, gathers samples and documents injuries for use by the criminal justice system.
We also provide referrals, Meyer said. In addition to medical care for injuries, victims often need emotional or mental health support, advocacy from a local rape center or legal resources.
Working with law enforcment
At Providence, forensic nurses collaborate frequently with law enforcement personnel who share office space near the Providence campus.
Sgt. Kenneth McCoy of Anchorage Police Departments special victims unit often collaborates with the nurses and believes the community is extremely fortunate to have a coordinated team responding to sexual assault crimes.
The forensic nurse plays a critical role in the [sexual assault team] response by collecting evidence that can be a key piece in the police investigation, he said.
While FNs work with law enforcement, Henry emphasized they function based on nursing protocols. The FN does not have a law enforcement role, though law enforcement may utilize information we obtain, she said.
A FN generally sees a patient up to 96 hours after an assault and spends about four hours with the victim before discharge. Then the nurse must complete a number of items after the patient is discharged: packaging samples, processing lab work, and handling technical and clerical details, including photographs. While some assault victims return for a follow-up exam, most dont see the FN again. However, the nurse often must testify in court.
The multidisciplinary collaboration appealed to Meyer who first recognized the need for effective victim care while living in rural Alaska. I saw patients waiting for hours in the waiting room and not getting adequate care. I felt that needed to change, she said.
She said its rewarding to make a difference for those affected by sexual violence by giving patients the opportunity to take back the control they lost when assaulted.
Forensic nursing is not for everyone. Meyer said nurses often take the 40-hour class, then realize the intensity and on-call commitment is too much.
FNs easily burn out, Henry acknowledged. The antidote is prevention and good self-care. She credits a strong support system and physical activities hiking and snow sports for giving her a break from the job.