Forensic nurses provide a critical early step in healing for victims of sexual assault, intimate partner violence, and child and elder abuse.
“There is no greater reward than to help empower a patient to better health and well-being,” said Pamela Holtzinger, MSN, RN, CEN, SANE-A, SANE-P, FNE A/P, forensic nurse program coordinator at Frederick Memorial Hospital in Frederick, Md. “They (assault and abuse victims) are the most vulnerable of the patients we see.”
Forensic nurses across the region respond when patients seek care after a sexual assault or other trauma that may require the collection of evidence.
“Patients get the most comprehensive medical and forensic care they can get,” said Jana Parrish, MS, BSN, RN, SANE-A, nursing director for the DC Forensic Nurse Examiners and DC Sexual Assault Nurse Examiner program. “My job is to gather the evidence, make sure you are medically safe and start the healing process.”
The District of Columbia Office of Victim Services supports the DC SANE program, which is staffed by forensic nurses from the nonprofit DC Forensic Nurse Examiners. A patient advocate from the Network for Victim Recovery of DC also responds to every sexual-assault call.
DC patients are encouraged to go to MedStar Washington Hospital Center in Washington, D.C., the home of the DC SANE program, but if the victim is medically unstable, the forensic nurse will perform the exam at another hospital. Last year, the DC SANE program served more than 400 victims, about a third from college campuses in the district, said Cortney Fisher, PhD, JD, DC SANE coordinator for OVS. Since the program started in 2008, the number of cases has grown by more than 15% every fiscal year, according to Fisher.
Typically, when a patient arrives at an emergency department for a forensic exam, the physician provides medical clearance and the forensic nurse and patient advocate are called in. The nurse arrives, obtains consents, begins the interview, and conducts a head-to-toe examination in a forensic suite. The forensic nurse documents the event and physical findings, and if the patient agrees, the nurse also will take photographs. The patient advocate helps the victim with the emotional trauma and stays with that person through the entire recovery period, and through the court process if the victim decides to involve law enforcement.
“You meet the patients and they are so broken and upset,” said Laura Clary, RN, FNE-A/P, SANE-A, CPEN, clinical program manager of the Sexual Assault Forensic Examination program at Greater Baltimore Medical Center. “It’s nice to be able to walk them through the process and give them some power back. At the end of the exam, they thank you for listening and believing.”“I find it rewarding, working with clients I am meeting, most often, at one of the most difficult times of their life,” said Heidi Bresee, MSN, CRNP, FNE A/P, coordinator of the forensic medical unit at Adventist Healthcare Shady Grove in Rockville, Md. “They see us collecting evidence and making a big difference in their lives.”
Women represent the majority of cases but males also suffer from sexual assault and abuse.
A large percentage of victims choose not to report sexual assault to law enforcement for a variety of reasons, but when the patient reports the assault and the perpetrator is caught or in intimate-partner cases, forensic nurses may be called to testify in court, often as expert witnesses.
“It’s rewarding to be part of the entire justice system,” Bresee said. “It’s a very big service to the community.”
Burnout is common and turnover high as nurses often internalize the emotions of patients. “You have to learn to leave work at work and not take it home,” Clary said.
Debriefing with colleagues and resiliency training can help relieve the emotional stress.
Nurses must learn to manage vicarious trauma, Parrish said. The DC program provides a peer-support program, led by a therapist, and recommends yoga as a self-care activity.
Bresee provides unique opportunities for the nurses to get together outside of work and allows forensic nurses in the Shady Grove program to take a sabbatical to regroup and come back refreshed. She finds it is an effective way to keep nurses with expertise in the field.
“I try to keep things in perspective and know the limitations of what I can offer,” Holtzinger said. “My value is what I can bring to the bedside for each individual patient.”
Debra Anscombe Wood, RN, is a freelance writer.