A male emergency room nurse, who had never done a rape kit or exam for a female, was ordered to do so by his ED charge nurse or face insubordination charges.
Although he had practiced nursing for 28 years, he had never done such an exam nor did he have any training to do so. He asked if he was right to refuse to conduct the exam. He also wondered if female victims of sexual assault should only be examined by female sexual assault nurse examiners or SANEs. As you may know, the use of specially trained RNs to conduct exams or work with rape kits of victims of sexual assault or abuse is a growing trend across the U.S. Several titles are used for these specially-trained RNs, including SANEs, forensic nurse examiners, sexual assault forensic examiner and sexual assault examiner.
- SANEs are "RNs who have completed specialized education and clinical preparation in the medical forensic care of the patient who has experienced sexual assault or abuse," according to the International Association of Forensic Nurses.
- Forensic nurse examiners obtain special education and fulfill clinical requirements, which allow them to collect forensic evidence when the commission of a crime has occurred.
- Sexual assault forensic examiners and sexual assault examiners are broad titles used for a healthcare provider who has been specially educated and completed clinical requirements to perform these important exams.
In view of these titles and their requirements, the reader does have a realistic concern about conducting the exam and doing the rape kit with no training or experience with which to handle the procedures. Doing so may result in evidence being compromised, if not totally unusable in prosecuting a case. In addition, a patient's need for support, crisis intervention and information specific to this type of assault may not be provided due to the lack of theoretical theories of how individuals respond to trauma of this nature.
It is interesting to point out that the reader stated in his question that he has done "male sexual assault" exams. Without questioning the reader's ability to conduct these exams, it seems only reasonable that any victim of any type of sexual assault or abuse should be examined by a healthcare provider with special training and expertise.
Reader has right to refuse
From a legal perspective, the reader was right to refuse to perform something for which he had no training or experience. Accountability and responsibility for one's actions is the hallmark of a professional, and he was correct that if he did do the exam, he might "be a risk to the outcome of the case" for the victim. Unfortunately, being accountable and responsible for one's actions is not something some employers relish. Most likely, at a minimum, he was written up for his refusal. It is hoped that if he were disciplined by the charge nurse, he grieved that discipline and, as part of the grievance, also requested he and his colleagues be given the training needed to conduct these exams in the future. The reader's gender in no way prohibits him from conducting an exam and rape kit once he is properly trained to do so. A 2012 study of 728 SANE respondents (four of which were male) titled, "Do Men Belong in Sexual Assault Nursing?," that, among other topics, explored perceptions of male SANEs, the needs of patients and care of a sexual assault victim by male SANEs, and the level of care by male and female SANEs. The study reported that only one patient declined to be treated by a male SANE. Moreover, the study contained comments by the four male SANE respondents that incorporated positive approaches to the use of male SANEs. One of those comments is quite telling: "Professionalism, empathy, honesty, competence (and on-and-on) are the skills needed to be a SANE. Gender is not a skill." The study encouraged further research be done to determine patient satisfaction when cared for by both male and female SANEs. In answer to this reader's uneasiness about males treating female victims of sexual assault, male SANEs do exist and provide care consistent with their special training and expertise. You can read more about their contributions to this specialty area of nursing practice on the International Association of Forensic Nurses website.
Victim always comes first
One last comment. Although the reader did not raise this issue, nor was it discussed in the research study, it is important to stress the comfort level of the victim of a sexual assault when undergoing a rape examination.
If he or she is "uncomfortable" with the gender of the SANE, the victim should share those concerns with the nursing staff and/or the ED nurse manager.
It may be that there are no other qualified SANE examiners in the ED where the victim receives care. Even so, sharing whatever concerns exist may result in some accommodation for the victim. As an example, if the SANE is a female, and the patient would prefer a male SANE do the examination, a male ED staff member may be able to be present during the exam by the female SANE if agreeable to all those involved.
Courses related to 'violence and sexual assault'
CE253-60: Sexual Assault and Rape (1 contact hr) The FBI indicates that 89,098 rapes were reported to law enforcement in 2015, up 6.3% from 2014. People who have been raped or sexually assaulted enter the healthcare system through many avenues. Nurses and first responders may encounter them in the field, the ED, or in obstetric or primary care settings. These patients may also be found in pain clinics; in specialty centers for GI, genitourinary, or neurological workups; or in gynecological or urologic settings as they move from specialty to specialty, seeking a medical diagnosis of their symptoms. Healthcare professionals of various disciplines who ask the right questions and assess and observe these patients can help tremendously. 60133: Domestic Violence Advocacy (2 contact hrs) According to the Center's for Disease Control and Prevention's Injury Center Division of Violence Prevention, intimate partner violence is a major public health concern, with one woman in four and one man in seven age 18 and older in the U.S. having been victims of severe physical violence by an intimate partner in their lifetime. Healthcare issues brought about from the abuse can persist for more than 15 years after the violence ends, which increases annual healthcare costs. That number accounts for more than 10 million women and men entangled in an abusive situation each year, and that doesn't take into account stalking and rape. There needs to be a focus on recognizing abuse and prevention, as many cases go unrecognized even when victims seek out medical care, due to healthcare provider barriers to assessing for abuse. Lack of specific training in intimate partner violence is one of the leading barriers identified by nurses and physicians. CE269-60: Adolescent Dating Violence (1 contact hr) Dating as a concept has an outdated meaning for today's young people. Few report dating as it was experienced in previous years; rather, many teens report, "hooking up, going out, talking or fooling around." Dating violence, however, does occur within the social interactions of adolescents and young adults, despite what it is called with about 10% of all adolescents reporting some form of physical violence in their dating relationship. Boys and girls are just as likely to hit a dating partner as they are to be hit by a dating partner. This educational activity will provide an update on the topic and provide tools for identification and prevention of adolescent dating violence.
