Victims of any kind of sexual assault are traumatized—they’re anxious, vulnerable, and, not surprisingly, scared to trust. They need help.
In 1994, Dr. Christine Jackson noticed that when victims of sexual assault were brought into area hospitals in Baltimore City, neither physicians nor the nurses had been trained in how to collect evidence or detect injuries for these patients. Police, though, expected that the staff was trained. As a result, the outcomes of the kit collections were terrible.
Dr. Jackson wanted the hospitals to do better for these patients. So she founded the Mercy Medical Center Forensic Nursing Program. Back then, says Debra S. Holbrook, MSN, RN, SANE A, FNE A/P, specially trained nurses, which were called Sexual Assault Nurse Examiners (SANE) or Sexual Assault Forensic Examiners (SAFE), were trained and educated in comprehensive care of victims of sexual assault. Mercy Medical Center, in Baltimore City, was designated the point center for this kind of medical forensic care.
“The Mercy Medical Center Forensic Nursing Program now cares for almost 1,000 patients each year, and sees all forms of interpersonal violence including sexual assault; domestic, dating, and stalking violence; elder and vulnerable populations abuse, neglect, and maltreatment; human trafficking; strangulation; trauma; chronic abuse of foreign nationals seeking asylum and T/U Visas; and suspects of all person’s crimes,” explains Holbrook, the Director of Forensic Nursing at Mercy Medical Center. Holbrook says that the program is also one of the only mobile ones in the United States—meaning that the nurses involved are able to travel to various hospitals, etc., throughout the area. “For 25 years, the Mercy Forensic Nurse Examiner (FNE) Program has been the only mobile program of its kind in Maryland, seeing patients in all surrounding hospitals including Johns Hopkins Hospital, the University of Maryland Medical System, Shock Trauma, and all emergency departments, nursing homes, and prison systems. The Program has also created Memorandum of Understandings with all branches of the military, seeing victims from the U.S. Naval Academy, Ft. Meade, Ft. McHenry and Reserves, and Kimbrough Army Hospital.”
Currently, the program has 32 FNE who provide coverage every hour of every day of the year. Holbrook explains that these nurses must first participate in a mandatory curriculum, which includes 40 hours of didactic training, a preceptorship including partnering with stakeholders to gain a working understanding of the criminal justice system in the Baltimore City jurisdiction, and a rigorous preceptorship by skilled FNE until the trainee is competent and comfortable enough with practicing independently.
All the cases they are involved with are peer reviewed by leadership as well as peers to make sure that they are accurate and complete. Holbrook says that nurses are prepared to testify in court in either a fact or expert capacity as needed. Most nurses in the program work at hospitals other than Mercy, but they are on a per diem status with the Mercy FNE program.
When nurses are finished with their training, Holbrook signs off on them, and they are certified by the Maryland Board of Nursing as FNE. “This assures competency, uniformity in practice, and accountability under the license of Registered Nurses in Advanced Practice,” she says.
As expected, there are challenges for FNEs who work with this program. “The challenge of working with victims of crime is that we never see a happy case,” says Holbrook. “Never. Day in and day out, we see patients victimized by unimaginable violence and cruelty, and that wears on you when you care for a large volume of patients or when you peer review the work of fellow program team members.
“Most of our nurses have full-time jobs, and family, and are attending school—and they do this work in their free time. Why? Because they are highly skilled, compassionate men and women who have a passion for caring for patients who need our care. The greatest reward we have is watching our patients, who have arrived in devastation, leave as survivors of their crimes with resources to seek justice. They know they were believed and cared for and that they have support in the coming weeks and months ahead of them.”
If you are thinking about getting into this kind of work, Holbrook has tips for you:
- Make sure you are going into this work for the right reason. If you have been assaulted in the past, make sure you have had therapy and worked through it. Being burdened with these types of cases has an ugly way of bringing out memories, and we do not want you to be re-victimized.
- Know that you need to “stay in your lane.” As a forensic nurse, you cannot be an advocate for your patient or you risk having a patient bias. As a collector of evidence, an FNE must maintain neutrality.
- Take care of yourself. Most nurses only stay in the field for two or three years because of burnout.
For more info, go to www.bmoresafemercy.org.