Nurse of the Week Michael King has been dedicated to both nursing and the law for 15 years. His latest challenge—as Commander of the New York City Police Department’s Special Victims Division—calls for him to draw upon both of his professions.
The Jamaican-born officer/RN emigrated to New York at the age of 16, and enrolled in an emergency medical technician program after he entered college. After four years of training paramedics, King joined the NYPD as a beat cop in 2000. As a rookie policeman, he attended nursing school and worked in city hospitals during his off hours. By 2005 he was a licensed RN. King eventually became a forensic nurse, and spent his off-duty time as a coordinator at the Wyckoff Heights Medical Center’s sexual assault response team. Meanwhile, he pursued his NYPD career as an investigator, a crime scene commander, and later as the executive officer of the Joint Terrorism Task Force.
John Miller, the NYPD’s Deputy Commissioner of Intelligence and Counterterrorism, who recommended King for the Special Victims command, says “If we didn’t have Mike King, I am not sure we could have invented him. At SVU he can combine his experiences of helping people in trauma, his knowledge of science, forensics and investigation and his sense of justice in a way no one else — at least no one else I know — could.”
King’s understanding of the close relationship between forensic nurses and police sex crime units makes him keenly aware of both the wide picture and the details behind the operation of an SVU. He also has first-hand experience with rape kits from his stints as a nurse at hospitals in Long Island and Brooklyn. King says his team uses a “science-based technique that encompasses compassion, sensitivity, and the knowledge of psychological trauma.” He wants to extend training in this area toi patrol officers as well, as “they are usually the first ones at a scene to interview a survivor of sexual assault.”
For an interview with Michael King, see this video at PIX11. More details on King’s background and career are available in this story from AM New York.
When people experience sexual assault,
they may sustain more than just physical injuries; trauma also affects short-
and long-term mental health. The medical treatment needed may require a
provider to examine parts of the body that were recently violated, which can
cause more distress. When reporting an assault, survivors often lack the
information they need about how to proceed.
Sexual assault nurse examiners
(SANEs) are trained to help survivors across this spectrum of patient care.
From providing evidence-based treatment to performing assessments to collect
forensic evidence that can be used in a criminal trial, these nurses play a
critical role in supporting survivors at the beginning of their recovery
process.
What Is the Role of a Sexual Assault Nurse Examiner?
When a sexual assault survivor comes to a SANE-certified hospital or community health center, a sexual assault nurse examiner is the first point of care, according to Kim Day, forensic nursing director for the International Association of Forensic Nurses (IAFN). SANEs ask the patient if they would like a forensic exam, which can be completed even if the patient decides to not report their assault to law enforcement.
“Just going through the process with
someone and providing holistic patient-centered care for that patient during a
traumatic time in their life can really impact the way they leave the
hospital,” Day said.
Forensic exams are meant to document
trauma from the assault and collect evidence that could be used in a criminal
trial. This includes taking a medical history; documenting scratches, bruises,
abrasions, and other injuries on a body map diagram; taking photos of injuries;
collecting DNA swabs to be processed; and observing the patient’s behavior. In
cases where toxicology information is relevant, SANEs will also perform those
tests on a patient.
In addition to performing a forensic
exam, the main duty of a SANE is to provide holistic nursing care for the
patient. Survivors of assault may need access to testing for pregnancy, as well
as prophylactic antibiotics to prevent the contraction of diseases. Depending
on the patient’s needs, SANEs also provide referrals to see other specialists,
such as a licensed professional counselor, who can help them in their recovery
process.
The SANE in Court: It’s Not Like “Law and Order”
Beyond working in the clinical
setting, SANEs are qualified to testify in court if a patient’s case goes to
trial. The specialized training SANEs receive prepares them to effectively
answer questions regarding evidence discovered during a forensic exam. However,
while SANEs can play a critical role in the trial process, the legal aspect of
the job is not the main focus, Day said.
“If the nurse goes into this work
thinking that they’re going to get the bad guy and put him behind bars, they
will fail at this… because that is not what we do,” she said. “The work we do
is nursing. We take care of the patients.”
This is a key factor to consider when choosing to become a SANE. Nearly 80 percent of sexual assaults are not reported to law enforcement, according to a Justice Department analysis of violent crime in 2016 (PDF, 669 KB). While performing a forensic exam and being prepared to provide evidence in court is a requirement of the job, the emotional and medical needs of a patient come first.
SANEs are trained to work within a multidisciplinary team, also known as a Sexual Assault Response Team (SART), which includes survivor advocates, members of law enforcement, and mental health providers. Together, these professionals coordinate the response to survivors of sexual assault.
What Is a Sexual Assault Response Team?
SANEs and other trained health care
providers: When an individual decides they
would like to have a sexual assault forensic exam (SAFE), health care providers
like Nurse Practitioners (NPs) or SANEs address the initial physical and
psychological needs the patient might have as a result of their assault.
Survivor advocates: Individuals who need access to information and emotional
support can work with an advocate to navigate their path to recovery. A
survivor may reach out to an advocate via a crisis center, or one may be
brought in to support someone who has decided to seek treatment at a hospital
or report their assault to the police.
Law enforcement: In cases where an individual decides to report their
assault, police officers and detectives are responsible for taking statements,
coordinating with the hospital to receive the results of the forensic exam, and
investigating the alleged assault.
Prosecutors: In cases where the survivor has chosen to report their
assault and enough evidence is present, prosecutors are tasked with making the
decision on whether to bring the case to court.
Therapists and counselors: In the aftermath of an assault, whether a case goes to trial
or not, survivors need additional support to continue their recovery process.
Mental health professionals trained in working with sexual assault survivors
may provide care at any step in the recovery process, from coping with the
immediate aftermath of an attack to navigating long-lasting trauma.
SANE education programs are designed
to train nurses to address survivors’ specific needs. After completion of this
training, SANEs become uniquely qualified to treat this vulnerable patient
group. This means that they can provide trauma-informed care to minimize the
harm of invasive exams that may trigger a patient. In doing so, they can also
equip their patients with forensic evidence that can be used if they decide to
report their assault.
One of the key challenges of
completing a sexual assault forensic exam (SAFE) is examining a patient’s
physical injuries without retraumatizing them. To help survivors feel
comfortable, SANEs ask for consent during each step of the way while providing
information on why they are doing each test.
“Consent is not just a piece of
paper with a signature on it,” Day said. “It’s a process throughout the exam.”
In practice, the process of asking for consent may resemble the following:
The SANE
will inform the patient what body part they will examine and ask permission to
do so. “I’m going to examine your neck now
to see if there are any injuries. Do I have your permission to do so?”
If the
patient grants this permission and the SANE notices something that may require
a sample collection, the nurse will again ask for permission to collect a
specimen and explain why collecting that evidence is appropriate. “I notice a scratch that wasn’t
mentioned when I documented your health history. There may be DNA or other
materials near this wound, so I would like to swab it. Is that OK with you?”
In any instance where the patient
does not want a test performed, the SANE is directed to honor the patient’s
request. This integration of consent throughout the exam is meant to give the
patient a sense of control, a feeling that may have been lost during their
assault.
What Are the Requirements to Become a SANE?
Because SANEs work with a patient population that requires specialized care, nurses are required to meet certain expectations in order to take on this role. While some nurses go through training at the local level or through smaller programs, IAFN offers the most recognized certification for SANEs. Nurses can become certified as a SANE-A to care for adults and adolescents or a SANE-P to work in pediatrics. Some nurses elect to pursue both certifications so they can provide care to patients across all age groups.
Steps to SANE Certification
Education: To become a certified SANE, a nurse must have the minimum of a registered nursing (RN) license.
Experience: Prior to starting the certification process, a nurse must have at least two years of clinical experience working as an RN or at a higher level, such as an NP.
Training: As part of the certification process, nurses are expected to complete 300 hours of SANE clinical skills training.
Testing: The final requirement to become a certified SANE is to pass a certification examination. IAFN holds exams two times a year.
Texas
A&M University recently announced that the College of Nursing has
received approval for its Center
of Excellence in Forensic Nursing, transitioning the forensic nursing
program into a state- and federally funded center. The new designation will
help expand the capabilities and funding resource opportunities, pushing
forward the College of Nursing’s initiative to advance forensic nursing
education, outreach, and research.
Forensic
nursing is a specialty role focused on the intersection of health care,
criminal justice, and the legal system. Registered nurses and advanced practice
registered nurses can specialize in forensic nursing, allowing them to provide
specialized care in the areas of interpersonal violence prevention, intervention,
investigation, and post-trauma care. Areas of practice within this specialty
include sexual assault, death investigation, corrections, disaster aftermath,
risk management, intimate partner violence, child maltreatment, elder
mistreatment, and human trafficking.
Nancy Fahrenwald, PhD, RN, PHNA-BC, FAAN, professor and dean of the Texas A&M College of Nursing, tells today.tamu.edu, “The Center of Excellence in Forensic Nursing will accelerate multidisciplinary efforts to devise and implement comprehensive strategies that address interpersonal violence across the life span. We are now in the best position to engage scholars throughout The Texas A&M University System to develop and disseminate new knowledge, positively impacting health and social outcomes for those affected by violence.”
Texas
A&M’s new Center of Excellence in Forensic Nursing allows for an expansion
of the college’s Master of Science degree and graduate certificate in forensic
nursing programs. The Center will also provide interdisciplinary and
professional education course trainings available to health care providers, law
enforcement agencies, social workers, and others seeking advanced education in
treating victims of violence.
To
learn more about the newly designated Center of Excellence in Forensic Nursing
in the Texas A&M University College of Nursing, visit here.
Jocelyn Anderson, a forensic nurse and
researcher at Penn State University,
found her calling in the field of forensic nursing after completing her final
nursing practicum in a South African intensive care unit (ICU). During
her time there, she primarily witnessed two types of violence—physical and gun
violence, and sexual assault violence. Oftentimes, the victims of sexual
assault would come into the ICU after attempting suicide following their attack.
Forensic nursing has
emerged as a discipline to help curb the harmful effects that sexual assault
victims face. The International
Association of Forensic Nurses defines forensic nursing as the practice of
nursing globally when health and legal systems interact. According to the U.S.
Bureau of Labor Statistics, the field of forensic nursing is expected to see a 26
percent growth rate over the next decade.
Originally from a
rural community in Minnesota, Anderson had never been exposed to this kind of
violence before. She had been introduced to forensic nursing during her training
but she wasn’t aware of the opportunities the field had to offer until her time
spent in South Africa led her to enroll in a forensic nursing graduate program to
help victims recover from sexual assault trauma.
After earning a
nursing degree, there are several forensic nursing certificate programs and graduate
programs available in the field. After completing these programs, graduates serve
as the first line of treatment to victims. Individuals with training in
forensic nursing can also become sexual assault nurse examiners (SANEs), which
are nurses specializing in domestic violence, child abuse nurses, death
investigators, legal nurse consultants, and more.
After completing her
graduate degree, Anderson worked at Mercy Medical Center in Baltimore and the
University of Pittsburgh Medical Center as a forensic nurse. Her role also
involved helping patients who wanted to seek criminal justice for the crimes
committed against them. She provided patients with interventions, such as
evidence collection and photo documentation, and collaborated with law
enforcement officials and attorneys to facilitate prosecuting these sensitive
cases.
Anderson tells news.psu.edu, “As the forensic nurse responding in these hospitals, we were responsible for providing both forensic and medical care to those patients after a sexual assault. The physical impacts as well as the mental ones on these patients were the two main aspects we focused on right when they entered through the door.”
The field of forensic
and sexual assault nursing is relatively new but it is already proving to help
provide better care for victims of sexual assault trauma. Research examining
these programs has shown that patients who received care from a specifically
trained forensic or sexual assault nurse after an assault were more likely to
be given the appropriate care and medication and more likely to have a sexual
assault kit collected correctly. Therefore, they are also more likely to have
their criminal case moved forward and the traumatic experience will be lessened.
To learn more about Jocelyn Anderson, a forensic nurse and
researcher at Penn State University who helps support sexual assaults victims
and serves as an advocate for advancements and growth in the field, visit here.
Forensic nursing involves working with the aftermath of violent situations. Violence is both a health care and a legal issue, so this places forensic nurses in a unique leadership position to connect health care, science, and the legal system. Forensic nurses partner with law enforcement and other agencies to investigate and resolve events such as domestic violence, sexual crimes, child and elder abuse, homicide, and suicide.
What Education and Certifications are Required?
Registered nurses with an associate degree or a BSN and a good foundation of clinical experience can pursue this specialty through a certificate program or an advanced degree (MSN, DNP, PhD) and board certification. Forensic nurses also have their own professional association, the International Association of Forensic Nurses (IAFN), which provides opportunities for networking and professional development as well as education and certification resources. The Commission for Forensic Nursing Certification (CFNC) currently offers two certification options: Sexual Assault Nurse Examiner-Adult/Adolescent (SANE-A) and Sexual Assault Nurse Examiner-Pediatric (SANE-P).
What Do Forensic Nurses Do?
These specialized nurses work in emergency rooms, coroner’s offices, police departments, and even the FBI. They examine the victims of violent crime, collect and analyze evidence, and document injuries. How the nurse treats the patient—the victim of violence or the family left behind—can have a tremendous influence on the ability of that individual, their families, and loved ones to recover post-trauma.
Success Through Adaptability
Forensic nursing requires the ability to cope well with the stressors of working around extreme circumstances. The work involves public health, behavioral health, pediatrics, geriatrics, and even medical legal consulting. The versatility of the highly trained forensic nurse enables them to better care for those citizens who are most vulnerable in our society.
