From Forensics to Advocacy: What it’s Like to be a SANE (Sexual Assault Nurse Examiner)

From Forensics to Advocacy: What it’s Like to be a SANE (Sexual Assault Nurse Examiner)

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.

Why Is Access to SANE Care Important?

According to the Centers For Disease Control and Prevention (CDC), one in three women and one in four men have experienced sexual violence involving physical contact during their lifetimes. The effects of experiencing an assault can be both physical and psychological, necessitating specialized care that embodies the concept of cura personalis, or care for the entire person. This holistic attention to the entire individual is the expertise of clinicians like nurses.

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.

Not all hospitals have SANE programs. IAFN’s database of registered SANE programs   indicates that there are currently 962 in the United States. As a result, patients are sometimes required to travel long distances to access SANE care, according to a 2016 report on the availability of forensic examiners (PDF, 191 KB).   This means that the facilities with SANE expertise must be ready to do what they can to help every patient who walks in the door.

Trauma-Informed Care and Practicing Consent

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:

  1. 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?”
  2. 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.

Information for Further Reading

Citation for this content: [email protected], the online MSN program from the School of Nursing & Health Studies

Anti-Vaxx: a Sane Perspective on a Crazy World

Anti-Vaxx: a Sane Perspective on a Crazy World

The anti-vaccination (“anti-vaxx”) movement is a global phenomenon that has received a great deal of press, but how much do we really know about it? How do educated adults come to turn against medicines that have been saving literally millions of lives since the early days of smallpox inoculations?

Doctors prepare to vaccinate an infant.

One partial explanation is offered by health policy reporter Stuart Lyman. In a February column for STAT, he writes, “The [pharmaceutical] industry has been engaging in bad behavior for several decades, and these self-inflicted wounds have turned much of the public against it…” After reciting a horrifying litany of pharma-company scandals the public has witnessed, he concludes, “All of this has contributed to the prominent anti-pharma themes voiced by the anti-vaxx crowd.”

Anti-Vaxx is No Longer In Its Infancy

But “the anti-vaxx crowd” shows no signs of giving up their crusade anytime soon. From their original focus on parents of autistic children, they have proceeded to target orthodox Jewish communities and recently bereaved parents. Perhaps the most influential US group behind anti-vaccine campaigns is ICAN (Informed Consent Action Network). According to the Washington Post, ICAN, founded by former daytime television producer Del Bigtree, is largely funded by New York city philanthropists Bernard and Lisa Seltz, who have contributed $3 million since joining in 2012.

Lisa Seltz now serves as ICAN president, and continues to fund the organization’s message that the government and “Big Pharma” are colluding in a massive coverup regarding the hidden dangers of vaccines. Robert F. Kennedy, Jr, a nephew of the late president, runs Children’s Health Defense, his own anti-vaxx organization, and another flush-with-cash group, The National Vaccine Information Center, is run by Barbara Loe Fisher (who claims her son’s learning disabilities were the result of a 1980 DPT shot that was followed by “convulsion, collapse and brain inflammation within hours”).

Some Quick Tips from NSO’s Georgia Reiner

Considering that these wealthy and powerful organizations are finding fertile ground in today’s conspiracy-minded culture, DailyNurse interviewed Georgia Reiner, a risk specialist for Nurses Service Organization (NSO), to request a few tips for nurses who find themselves confronted by this strange controversy.

DailyNurse: What are the actual dangers posed by the anti-vaxx movement?

GR: It is important to state up front that the vast majority of people do vaccinate. However, the anti-vaccination movement has gained a lot of attention and helped foment outbreaks of largely preventable diseases that can be deadly. The anti-vaxx movement spreads misinformation and conspiracy theories online on social media, and by word-of-mouth in tight-knit, culturally isolated communities.

Anti-vaxx propagandists have helped to create pockets of unvaccinated people, which have contributed to public health issues like the measles outbreak seen recently in Orthodox Jewish communities in New York and New Jersey. These outbreaks of highly contagious diseases such as measles put vulnerable people, including newborn babies and people who have weakened immune systems, at great risk.

Outbreaks also distract and divert resources from other important public health issues, and cost state and local governments millions of dollars to contain. However, nurses are in an ideal position to counter this messaging.

DN: What are nurses doing to counter the anti-vaccination movement?

GR: Nurses are a trusted source of credible information and can have tremendous influence over the decision to vaccinate. This is true even for parents who are vaccine-hesitant. Working on healthcare’s front lines, nurses can help inform families about vaccinations and the role they play in keeping their children healthy and stopping the spread of disease. Nurses can also learn about questions parents may ask about vaccines, and how to effectively address common concerns.

DN: How can nurses cope with anti-vaxx parents?

GR: First, nurses should assume that parents will vaccinate. Research has shown that when healthcare providers use presumptive language, significantly more parents accept vaccines for their child. Then, if parents are still hesitant or express concerns, nurses should work with the treating practitioner to convey the importance of vaccines.

Nurses should listen to parents’ concerns, work to understand why they are questioning the science, and respond respectfully. Provide parents with information about vaccines and vaccine-preventable diseases, both verbally and in writing. Document parents’ questions and concerns.

If parents still decline to vaccinate, the parents should sign a Refusal to Vaccinate form. Parents should sign a new form each time a vaccine is refused so there is a record in the child’s medical file. To minimize potential legal exposure, nurses should document all discussions, actions taken, and educational material provided.

For further information, visit the American Academy of Pediatrics site document “Countering Vaccine Hesitancy.”

Climate Change: “Nurses are On the Move”

Climate Change: “Nurses are On the Move”

At the DC Climate Change rally: ANHE, the Alliance of Nurses for Healthy Environments

Alliance of Nurses for Healthy Environments at Washington DC climate rally

Just before a series of major climate change rallies were held in cities across the US, the journal Creative Nursing published a special issue on climate change. We spoke with special issue editor Katie Huffling, MS, RN, CNM and contributor/editorial board member Teddie Potter, PhD, RN, FAAN to learn more about climate change as a public health issue, and why so many nurses are attending these rallies and speaking out.

On September 20, the Washington Post interviewed them both as part of a major story on the DC climate strike. The headline was, “Why nurses, America’s most trusted professionals, are demanding ‘climate justice.’” That sounds like as good a starting point as any, so let’s begin by asking…

Why is climate change important to the mission of the health and nursing professions?

TP: In nursing we are charged to create environments for people to be the healthiest individuals and communities that they possibly can be. Climate change threatens that. It threatens our patients and communities on multiple levels. The health impacts of climate change are severe and serious, and they’re happening right now. So that why it is important for us to address this as nurses.

It’s no longer happening in some parts of the globe, or in some geographic areas; it’s happening everywhere. Unfortunately, it tends to have the greatest impact on communities that are already struggling to be healthy. If I am already challenged by being homeless, for instance, not having access to AC or heating can lead to real [health] problems, and we see people with such challenges often suffering worst and first from climate change.

And it’s important to point out that yes, the planet is warming but the impacts are very variable. Places that used to be cool are getting hot; some places that were usually dry are getting very wet. It’s the shift in patterns that has definite health consequences. In California, for instance, you might be more apt as a nurse to be aware of the impact of fires on the air quality affecting individuals and families and people who work outdoors.

But isn’t climate change a political issue? Why should nurses get actively involved?

TP: I hope we have made it very clear that climate change is not a political issue, any more than people having adequate food or clean air should be a political issue. It’s a health issue. And we need all people regardless of their political affiliation to be part of finding solutions and part of finding a healthier future for everyone.

KH: The Lancet has been publishing for the past few years an analysis of climate change and health and they are very clear that climate change is the biggest public health challenge that we face today. It’s a health issue, and the future of our children is at stake.

Are nurses already seeing health issues connected to climate change?

TP: In Minnesota, we’re seeing changes in our vectors. We see more [outbreaks of] Lyme disease and West Nile disease; we see more people affected by flooding and loss of housing and livelihoods related to flooding. Farmers can’t get their crops planted on time [owing to flooding] and they can’t get their crops harvested on time, so we’re seeing impacts in that area. Health care providers need to understand that there are things we need to be considering in order to protect our patients and teach families and to ensure that if a disaster is likely, that people have a plan. For example, we need to ask “What are you going to do when category 4 and 5 hurricanes come into your area?”

KH: One thing I would add is that no matter what type of nursing you do—whatever your patient population is—there’s some way that climate change impacts that population. For example, when you have extreme weather events, and you have renal patients, are they going to be able to get dialysis? Nurses working in that area have been real leaders in working on emergency preparedness. The same goes for oncology nurses—are your patients going to be able to get their cancer treatments in a timely fashion. There are some things when you first think of them, you don’t realize how it really does span any type of patient population.

“We need to be planning for these people.”

Teddie Potter

United Healthcare Workers East at DC Climate Change Rally.

United Healthcare Workers East at Washington DC climate rally

TP: Also, there are community nurses worrying about patients who are homebound and in need of oxygen and other things that require a steady source of electricity. We need to be planning for those people. What do you do when flood waters rise, and you can’t get out of your house because you’re wheelchair-bound? And your caregiver can’t come because they’re stuck [in the flood] where they are, and you can’t even get out of bed? All of these things have to be thought about.

KH: As an example of that, here in DC it’s gotten better because the local utilities have been addressing it, but there were lots of power outages accompanying extreme weather events during the summer. And when families with children on ventilators at home don’t have electricity for a few days, they end up having to take up an ICU bed because they’re not able to be on just a general floor.

TP: As a state that has a significant rural population, [In Minnesota] we are also concerned about people working outside who harvest and pick the crops. We’re concerned about dehydration. A while ago one of our Minnesota Vikings players died from heat exposure and dehydration at the Vikings summer training camp. This is not something that we’ve had to think about in the past. Hot and humid days can impact even young people in peak condition and we are having more and more days with high heat and humidity.

Are today’s nurses following in Florence Nightingale’s footsteps? Was she the first activist nurse?

TP: She was an activist but also a scientist. She was deeply committed to evidence-based practice and she was a brilliant statistician. She really looked at the environment as doing the healing for patients. As she said in Notes on Nursing, “medicine and surgery can remove obstructions… nature alone cures.” And she was a great believer in and taught about the importance of good food, adequate hydration, mobility, cleanly environments, and exposure to fresh air.

In the Crimean war what got her started was that they were seeing more people dying from the care they received in the hospital than from the injuries they received on the battlefield. So it was a care issue and that was what marshalled her and other women at that time to go to Turkey and set up an alternative way of caring—fresh air, clean sheets, adequate food—and people started surviving. It is deeply at the core of the nursing profession: we work with the environment to put people in a position to recover and have a quality of life. Nurses are on the move following the same principles today.

How can nurses get—and how are they getting—involved in the movement to reduce effects of climate change?

KH: I think there are a number of points of engagement. Nurses are really can-do people. When they find a problem, they want to fix it, and so when you start to learn about climate change and its effects, it is natural to immediately want to get engaged.

Healthcare workers at climate change rally in Minnesota.
Nurses and other healthcare professionals participated in Minnesota’s climate rally.

I think this is a great opportunity for nurses to get together—you know, strength in numbers—to elevate this issue and use our position as America’s most trusted profession to talk about it. Also, [it’s important to] meet with policy makers—whether it’s at the state, national, or local level—when you can speak with elected officials and help them to make that health and climate change connection. Because a lot of elected officials still don’t understand that it’s a health issue and if they want to protect the health of their constituents it’s an issue they need to be taking on.

And, it’s been very exciting to see so many nurses doing things like going to the different climate marches. It’s another way to show that nurses are leaders in the area around climate change. One of the things my organization (ANHE, the Alliance of Nurses for Healthy Environments) has been doing is we’ve created a nursing collaborative on climate change and health. This came out of a round-table we did at the White House during the Obama administration where we had around 20 nursing organizations and unions at this round table talking about what nurses can do about climate change and health. It was a really historic event. We were the first group of health professionals that they had reached out to at the time to do something like this.

After that, we decided we needed a strong collaborative effort, and that is how we created the Nursing Collaborative on Climate Change and Health. We have 11 organizations, and a couple more really large organizations about to sign on. Working together we show visible leadership among the nursing community as well as among policy makers.

Where can nurses find out more about the impact of climate change?

KH: Well, at ANHE (Alliance of Nurses for Healthy Environments) we have tons of resources on the website, lots of free tools for nurses to engage. We’ve got talking points, academic databases and case studies, resources for pregnant women and children, and much more.

We’re also part of the Nurses Climate Challenge, in which ANHE’s partnered with Healthcare without Harm. Basically in the Nurses Climate Challenge we have Nurse Champions that sign up on the website. The champions then go out and educate their fellow nurses and other healthcare professionals about climate change and health. They have a really robust toolkit with PowerPoints with notes and posters they can customize if they want to make a presentation at their monthly nursing meeting. Then we track each event: if someone does a presentation, they note how many attended. The first year we had a goal of 5,000 nurses and other healthcare professionals educated, but we quickly grew past that so we decided to up our goal to 50,000 nurses educated by 2022. And we just started that a few months ago, and we’re already past 10,000. It’s exponentially growing!

“It’s an amazing opportunity to prevent disease.”

Katie Huffling

I’d like to bring in another positive note: this is also the greatest opportunity that we have to impact public health. These things that we can do to affect climate change can have a widespread positive impact on health. It’s an amazing opportunity to prevent disease. And I think that that’s another core feature of nursing practice—that we want to see our patients become healthier and to not have to be treating them for these preventable illnesses. When we address climate change we can have such a positive impact on health.

TP: I’ll just add in that the dean of the Minnesota School of Nursing has appointed me the first Director of Planetary Health for the school, so that nurses can learn to apply what we do to care for the environment so that our patients and our communities will be healthier.

Suicide Awareness and Prevention Among Nurses: A Q&A with Risk Specialist Georgia Reiner

Suicide Awareness and Prevention Among Nurses: A Q&A with Risk Specialist Georgia Reiner

In recognition of Suicide Awareness Month, Georgia Reiner, a risk specialist for Nurses Service Organization (NSO), shares her expertise on the subject of nurses and suicide prevention with DailyNurse.

Q: What do you consider the most striking statistics on suicide in the nursing profession?

A: The phenomenon of nurse suicide has been largely overlooked by researchers in the US. The most prominent research in this area by Davidson and colleagues — just published this year — found that suicide incidence was significantly higher among nurses than the general population. The researchers found suicide rates of 11.97 per 100,000 person-years among female nurses and 39.8 per 100,000 among male nurses, compared to 7.58 and 28.2 per 100,000 person-years among general population women and men, respectively.

Q: Why might nurses be particularly at-risk? Are they more prone to depression than the general population?

A: More research needs to be done to determine why nurses have greater odds of dying by suicide than the general population. However, existing research has suggested that there are some collective risk factors for nurses, including undertreatment of depression and other mental health issues, knowledge of and access to lethal doses of medications, and a combination of personal and work-related stressors. The high-pressure, emotionally draining environment that nurses work in, compassion fatigue, burnout, and job dissatisfaction can each contribute to these risk factors.

Q: Is the phenomenon gaining attention in the healthcare field—and if it is, what measures are being taken to reduce the danger?

A: Yes, and work is being done by organizations like the American Nurses Association, the American Organization of Nurse Executives, the National Academy of Medicine, and the National Suicide Prevention Lifeline to try to raise awareness of the issue and promote protective factors. While systemic and organizational-level solutions in healthcare are critical to addressing burnout, depression, and suicide among nurses and other healthcare professionals, progress in implementing evidence-based solutions has frankly been slow or nonexistent. Therefore, it is also important for nurses to take individual action.

Q: How can nurses bring this problem to the attention of their own institutions?

A: Supporting nurse well-being requires sustained attention and action at the organizational level. This first requires buy-in and investment from leadership and managers. Nurses should work with their managers and organizational leadership to promote a healthier, more positive work environment that cares for nurses as whole people. This includes educating nurse managers and staff nurses about suicide prevention, how to offer support to someone who may be struggling, where to get help, and alleviating the stigma around suicide and depression.

Q: What sorts of self-care practices can nurses follow to reduce the risk of depression and suicide?

A: Nurses need to support each other and take time to have open dialogues with their colleagues about issues affecting them personally and professionally. Increasing connectedness, or a sense of belonging, has shown to be a protective factor against suicide. Nurses also need to work on an individual level to build resilience to cope with stressors in their professional and personal lives. Practicing mindfulness, eating well, exercising, getting enough sleep, limiting time spent on social media, and taking regular time off from work are all important. Speaking to someone, whether by going to a therapist or by attending a support group, can also help nurses feel better and improve their mental health and resiliency.

Q: Are nurses more or less likely to enter therapeutic treatment than people outside their field?

A: Nurses face many of the same barriers to mental health care as other people: the stigma associated with mental illness and asking for help, how difficult it can be to get the energy to reach out for help when you’re depressed, and then the time and cost associated with accessing mental health treatment. These barriers can be extremely difficult for some individuals to overcome by themselves, which is why it is so important for nurses to look out for one another.

Q: Are there resources specifically to help nurses who might be suffering from suicidal ideation or actively considering suicide?

A: It is important for nurses to learn about how they can look for signs of someone who may be struggling with suicidal ideation. Starting the conversation, providing immediate support, and helping someone who has suicidal thoughts to connect with ongoing support can help save lives.

If you or anyone you know are considering self-harm or suicide, feeling anxious, depressed, upset, or just need to talk to someone, it is important to know that there are people who want to help. The National Suicide Prevention Lifeline is available 24/7 at: 1-800-273-8255, as well as the Crisis Text Line, available by texting “START” to 741741 at any time, for any kind of crisis.

Also of interest: A Nurse I Know Tried to Commit Suicide

At NSO, Georgia Reiner is responsible for educating healthcare professionals on professional liability issues and risk management strategies by creating informative risk management content, including self-assessment tools, newsletters, webinars, and claim reports.

Time’s Up Healthcare: Advocating for Health Care Professionals

Time’s Up Healthcare: Advocating for Health Care Professionals

In the fall of 2017, the #MeToo and TIME’S UP movements began in Hollywood. While lots of organizations were advocating to protect women in a number of fields, they weren’t solely based in health care. On March 1, 2019 that all changed when Time’s Up Healthcare launched.

According to Tiffany A. Love, PhD, FACHE, GNP, ANP-BC, CCA, CRLC, Regional Chief Nursing Officer with Coastal Healthcare Alliance as well as one of the organization’s founders, Time’s Up Healthcare was “established in response to the common experience of power inequity, unsafe work environments, and a lack of inclusion at every level of health care leadership. The aim is to drive new policies and decisions that result in more balanced, diverse, and accountable leadership; address workplace harassment and other types of discrimination; and create equitable and safe work cultures within all facets of the health care industry.”

She took the time to answer our questions about the organization. What follows is an edited version of the interview.

You’re a founding member of the initiative. Why did you get involved?

I have worked in health care since the age of fifteen. I’ve experienced a lot of harassment and other types of discrimination over the years, and I had accepted it as a normal aspect of working in the health care environment. In more recent years, I decided that I would take a stand to create the change I wanted to see, and Time’s Up Healthcare offered me that opportunity.

What is the mission for Time’s Up Healthcare? What does the group hope to accomplish?

Our mission is to unify national efforts to bring safety, equity, and dignity to our workplace. We want to engage and support health care professionals and organizations from all disciplines to change policy and practices to support safe, equitable, and inclusive work environments. We want to raise awareness about the issues that health care professionals face. We also want to provide support for survivors through the Time’s Up Healthcare Legal Defense Fund.

Why is it important for this group to exist? How do you hope to change healthcare?

Time’s Up Healthcare is important because health care professionals need a group who will advocate for them without expecting anything in return. Time’s Up Healthcare is a 501(c)(3) foundation. Most of the work is done by volunteer health care professionals who donate their time and money to this important initiative.

As health care professionals, we are aware of the research that has proven patient safety is at risk when health care workers are forced to work in an environment that is not safe, equitable, or inclusive. The health of the employees as well as the patients is impacted by these conditions.

What do most health care workers not realize about harassment in the workplace? Or assault?

Many health care workers have been desensitized to harassment because it is so common. Harassment can be in the form of verbal aggression, exclusion, bullying behaviors, and the threat of physical violence. It can also take the form of assault through unwanted touching and even physical violence.

If nurses want to get involved with the group, what can they do?

We welcome you to join us at https://www.timesuphealthcare.org. You can sign up for our newsletter or purchase a pair of Time’s Up Healthcare scrubs under the shop tab. A portion of the proceeds will assist survivors through the Time’s Up Healthcare Foundation and Legal Defense Fund. You can also become a sponsor or encourage your organization to become a signatory who pledges commitment to align with Time’s Up Healthcare’s core statements.

You can also follow us on social media. We are on Twitter: @TIMESUPHC, Facebook: Time’s Up Healthcare, and Instagram: timesuphc. Look for Time’s Up Healthcare. You can also search the hashtags: #TimesUpHealthcare #TIMESUPHC and #TUHHERO.

Nurses Are in Dire Need of Better Mental Health Care

Nurses Are in Dire Need of Better Mental Health Care

Last month, Washington state Senator Maureen Walsh argued against a legislative action that would provide mandatory, uninterrupted rest times for nurses. Senator Walsh stated that such a provision could negatively impact patient outcomes in certain circumstances, and further insisted  nurses had ample downtime, and claiming that they “probably play cards for a considerable amount of the day.”

Her statement did not go over well within the nursing profession. The sound bite traveled fast and the senator’s office was quickly inundated with protesting phone calls and decks of playing cards.

Although Sen. Walsh was speaking strictly about specific nurses in specific facilities, one takeaway from professionals across the country was clear: nurses are overwhelmed and they need their concerns to be heard instead of dismissed by lawmakers.

However, serving this need is more difficult than may be evident at first glance. My company recently conducted a nationwide study of the challenges facing modern nurses, and learned that nearly half of all respondents (49%) had considered leaving nursing in the past two years.

This surprising and problematic statistic has many drivers, but one of the most pressing is a need for better mental health care for nurses. More than 35% of respondents reported that the state of their mental health had a negative impact on their work, with an equal percentage (35%) believing it is taboo to discuss mental health struggles with other nurses.

Far from enjoying idle time playing cards, nurses face heavy workloads and significant stress. Here are three factors that contribute to mental health struggles for nurses, as well as where the industry should focus its efforts to improve mental health care.

1. Burnout

Burnout has long been a significant issue in the medical profession, and in our study, 62% of nurses reported feeling regularly burned out. Nurses typically work long hours with heavy responsibilities, a demanding formula that can harm anyone’s mental health. Nearly a quarter of nurses (24%) reported taking medication for job-related anxiety and depression, with three percent of nurses reporting suicidal thoughts. 

Burnout also affected work performance for 44% of respondents, which was a contributing factor for the 49% of nurses who contemplated leaving their profession. If even a modest fraction of those nurses had actually abandoned their careers, the impact on the country’s already-understaffed health care system would have been catastrophic.

2. The Nationwide Nursing Shortage

The problem that compounds all other issues is the persistent nationwide shortage of registered nurses. The Bureau of Labor Statistics predicted 1.2 million vacancies would emerge between 2014 and 2022, and 91% of nurses reported that their hospitals were understaffed.

In 2016 we issued our first study on the welfare of modern nurses. At that time, 62% reported that the growing shortage had negatively affected their workloads. In our recent study, the number had skyrocketed to 88% of nurses.

This widening gap continues to progressively harm nurses’ mental health, with more than half (54%) reporting that the increased workload negatively affected their mental health. Patient care is also impacted, with 62% of nurses reporting that the shortage is diminishing the quality of care they could provide.

Administrators and government can do more to help alleviate the shortage, according to nurses. Responding nurses recommended using temporary staffing, offering government subsidies for schooling, and creating new nursing programs. Temporary staffing and travel nursing, in particular, were highlighted as a potential source of immediate relief in areas of greatest need.

3. Harassment and Bullying

Workplace harassment and bullying are a significant and widespread problem in nursing, just as they are in many industries across the country. Almost 40% of nurses reported experiencing harassment during the past year, a stunning number that demands a need for immediate attention.

Nurses battle this abuse in all areas of their work. Bullying and harassment come from other nurses (30%), patients (25%), physicians (23%), and administrators (22%). Reports of sexual harassment were less common than other forms of harassment, but 21% of nurses still face it, with the majority of incidents coming from patients.

If there is a silver lining, it is that incidents of workplace hostility may be decreasing for nurses: In 2016, 45% of nurses reported bullying and harassment, compared to 40% today. As the medical industry continues to address and eliminate this damaging behavior, the efforts will pay off in significant benefits to nurses’ mental health.

Senator Walsh’s comments may have come across as ill-informed, but they did spark a nationwide conversation about the heavy workload nurses carry and the negative impact on their mental health. Even as the senator retracted her comments, there were productive and crucial conversations taking place about improving work conditions and mental health care.

Reducing burnout, addressing the nursing shortage, and stopping harassment and bullying are issues that require attention from individuals and organizations across the entire medical industry. If we all work together to create solutions, we will take much-needed steps toward improving mental health for nurses.


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