In 2020, the Institute for Healthcare Improvement and the DAISY Foundation chose forensic nurse examiner Shelly Brown, MSN, RN, SANE-A, as the individual recipient of the DAISY Award for Extraordinary Nurses in Patient Safety award.
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Shelly Brown, RN[/caption] This honor recognizes individual nurses and nurse-led teams that demonstrate a commitment to outstanding, person-centered care with an emphasis on efforts that improve workforce and patient safety. Brown, Clinical Nurse V at Virginia Commonwealth University Medical Center, is a forensic nurse who is certified as a sexual assault nurse examiner for adults and adolescents. She was honored in part for the way she cared for a patient who had been abducted, drugged, and transported across multiple state lines. Brown not only provided the patient with immediate care and involved social services and law enforcement, but also arranged for ongoing care once the woman returned to her home and family, according to an IHI press release. In this Q&A, Brown shares her story with Nurse.com.
Why do you think you were honored with this award, and what has it meant to you personally and professionally?
I received the DAISY Award for the work that I do with and for survivors of human trafficking. But you don't do this type of work for the recognition.
You do this type of work because you want to make a difference in others' lives. You want to change the world to be a better, safer place for our children.
Every once in a while, it is nice to be honored for your sleepless nights and tireless efforts. I am deeply honored and will continue to be an advocate for human trafficking awareness, education, reform, and change.
What do you do on a daily basis as a forensic nurse?
I have been a Forensic Nurse Examiner for 13 years. Currently I serve as one of the team coordinators on the Adult Forensic Nurse Examiner Team. Daily, I provide healthcare and evidentiary services for victims and perpetrators of violent crimes. I specialize not only in sexual assault evidence collection but also in clinical forensic evidence collection. This includes all aspects of crimes -- gunshot wounds, legal blood alcohol collection, elder abuse, strangulation, suffocation, suicide attempts, overdoses, burns, dog bites, intimate partner violence (formerly known as domestic violence), stabbings, sexual battery, aggravated assault, malicious wounding, simple assaults, hangings, child abuse, suspicious situations, etc. I also serve in a forensic clinician role, in which I conduct a multitude of forensic trainings for high schools, colleges, career centers, nursing schools, hospitals, medical schools, emergency medical services, fire departments, police academies, state conferences, and communities. I serve on several different committees within the hospital and at the community, state, and national levels. I train and orient new forensic nursing orientees, nearly 19 in the past few years. The orientation process for a newly hired FNE takes a year. It is quite a commitment not just on the orientee's part but my part as well. Training a new forensic nurse takes a considerable amount of time and one-on-one, hands-on training. I go to court regularly to testify regarding the evidence I have collected. I am a certified expert in numerous jurisdictions. I serve as an expert consultant to commonwealth attorneys and law enforcement. I respond to calls and cases all over the hospital not just for evidence collection purposes, but for advocacy, follow-up, immediate needs housing placement, facilitation of social services, mental health coordination services, and safety planning. I also do a fair amount of administrative work. This includes coordinating evidence pick-up for numerous jurisdictions, picking up supplies from the Department of Forensic Science, dropping off anonymously collected sexual assault kits to the state storage lab, updating case logs, auditing charts, grant writing, policy writing, working on special multidisciplinary projects, etc. There is truly never a dull moment!
Why did you become a forensic nurse and what did you do as a nurse prior?
Forensic nursing is not for everyone. It is my calling. The work can be difficult and soul-taxing at times. The hours are long, and there is an increased risk of suffering from vicarious trauma due to the sheer severity and complexity of the cases.
I love what I do, and I have a passion for caring and advocating for vulnerable populations. I believe it is important for survivors to know that you see them, you hear them, you believe them, and you are there to support them through one of the most difficult days of their lives.
The relationship and rapport that is established during the evidence collection and patient care process often gives patients the support, hope, and trust they need to pursue charges against their perpetrators in a court of law. When evidence is collected by a trained forensic nurse, the case has a higher chance of being prosecuted, conviction rates are higher, and the perpetrator often receives a greater sentence. Before forensic nursing, I specialized in emergency medicine, trauma, and resuscitation. I noticed a strong correlation between trauma patients and forensic patients. Many of the injuries that patients have sustained, which caused them to meet trauma criteria, are often due to a violent crime. I noticed while I was caring for trauma patients, there were simple things that could be done to preserve crucial evidence such as bagging patients' hands, collecting clothing/personal items, preserving the body of evidence. (Once the patient leaves the scene of the crime, they then become the mobile crime scene.) I became very interested in forensics early on, and about one and a half years after I started working in emergency medicine, I cross-trained with forensics. I maintained both positions simultaneously for about seven years, and then six years ago I went to full-time forensics.
Please tell us more about caring for the patient who had been abducted, drugged, and transported across state lines. What did you learn from her and how is she today?
I cared for a young girl in her early 20s about a year and a half ago, who was a human trafficking survivor. She found herself in an unfortunate situation with her friends while traveling out of state and was left on the side of the road to fend for herself. The patient came from a family of truck drivers. She was always told if she was ever lost or needed a ride home, to go ask a truck driver and they would make sure she got home. So that is exactly what she did. The patient approached the first truck driver she saw, and he promised her he would get her home, which wasn't more than a half day's drive away.
The patient said by the second night, the truck driver began forcing drugs on her and selling her to five to six men per night. This went on for countless nights in addition to being beaten and raped by the truck driver, himself. The patient also reported being subjected to extremely inhumane conditions such as deprivation of food, drink, restroom privileges, and self-hygiene.
While the truck driver was dropping a load off to a big-name store in Richmond, Va., the patient was able to get out of the cab of the truck and walk over to a nearby parked car and asked to use their cell phone. The patient called her mother, who was hysterical, and informed her she had been on the national missing person's list for the past six weeks. The patient had no idea how long she had been in the cab of the truck. The truck driver approached the car and overheard the conversation the patient was having with her mother on the borrowed cell phone. The truck driver drove away, leaving the patient standing outside with nothing but the clothes on her back. The patient was brought to the hospital and was seen by a forensic nurse, who collected evidence. After 14 hours in the ER, the patient was due to be discharged. I was the oncoming forensic nurse and was asked to come see the patient to arrange for discharge. After about five minutes in the room with the patient, I saw red flags everywhere, and I knew she was a human trafficking victim. I told her if she was not completely honest with me, I would not be able to help her. I told her I was here to help, and she could trust me. I promised her I would get her home. The patient exploded in emotions and the horrifying details began to unfold. It took me the next 24 hours to enlist a multidisciplinary approach with hospital administration, social work, local police, and the FBI to get a direct flight to the patient's hometown with FBI escort and arrange for family to meet the patient at the terminal to transport her home. I sent a colleague to the store to buy essentials for the patient, like clothing, toiletries, etc., since the patient gave all of her personal effects for evidence collection. I called ahead to her hometown and scheduled a [obstetrician-gynecologist] follow-up and mental health counseling services with a local sexual violence advocacy group. I was so glad to reunite this patient with her family just six days before Christmas. The patient was so overwhelmed with emotion and gratitude, she left me a beautiful handwritten note on her bed that I found after she left. She called my her "angel," and she hoped that one day she would be able to see her "hero" again.
What I took away from this patient is to trust your gut. Does the story or injuries match what you are seeing? Is it plausible? I could have simply arranged for the patient's discharge like I was asked, but I knew something did not seem right.
I needed to put my eyes on this patient and ask her some questions. I needed to hear for myself what was going on. It was evident to me that the patient was in great danger, and if she was discharged from the hospital prior to full disclosure, she was probably going to die. I do not know how this patient is doing today. This is one of the most difficult parts of my job. Once all of the resources are in place, and the patient has been discharged, I will not ever see or hear from patients again unless they return to the hospital requiring my services or if we go to court. I find solace in knowing I did everything I could for her and got her back home to her family with resources in place.
Finally, what do you find most satisfying about your work and what do you find most challenging?
Some may think I am crazy, but I actually enjoy going to court and testifying. It is gratifying to me to see the entire case come full circle, ending with a dangerous perpetrator removed from the streets. The sheer relief in the survivor's eyes and on the faces of their family members is something I cannot explain.
Imagine living in fear every day of your life, and with one bang of the gavel, no longer having to live in fear anymore. It is soul-cleansing and renews one's faith in the criminal justice system.
I previously touched on one of the things I find most challenging about forensics. Once a patient has been discharged from my care, I rarely will ever see or hear from the patient again unless they return to the hospital and require my services or their case goes to court. There are so many cases that stay with me. They are deeply personal, and I carry them with me in my heart. I find solace in knowing I did everything I could for them in their darkest hour and treated them with dignity and respect. Every so often, I will run into a survivor at the grocery store or somewhere else. They are always timid to approach me, but if and when they do, they usually start out by saying something like, "You don't remember me, but you took care of me, and I just wanted to thank you. Can I give you a hug?" Little do they know, I always remember them, and they can always give me a hug.
Take these courses on forensic nursing and human trafficking:
Human Trafficking: Identification and Assessment (1.5 contact hrs) Human trafficking is a widespread form of slavery that exists today, even within the United States. Victims come in all genders, nationalities, sexual orientations, and ethnicities. This course covers the information, tools, and resources for healthcare teams to identify, assess, and treat these patients, and provides referral resources for legal and social services. Forensic Nursing and School Shooters (1.5 contact hrs) Many forensic nurses focus on interpersonal violence. At one time, schools -- a workplace for students, teachers, and nurses -- were considered safe. The reality is that violence on school grounds and inside school buildings is continuing in the aftermath of several high-profile cases of shooting homicides in these settings. Nurses working in the school, community, and emergency and psychiatric mental health settings can play a key role in the prevention of violence by understanding the dynamics and profiles behind these types of homicides. Sexual Assault and Rape (1 contact hr) People who have been raped or sexually assaulted enter the healthcare system through many avenues. Healthcare professionals of various disciplines who ask the right questions and assess and observe these patients can help tremendously.
