Kathleen Hackett has what she considers one of the toughest jobs in nursing.
A sexual assault nurse examiner at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, Hackett recalls getting a call from a colleague.
“She…burst into tears (and) said she couldn’t handle it anymore,” Hackett said, noting that the colleague soon left the position.
“We lose many of these nurses within a year or two after they’ve been on the job. Work with these kinds of traumatized patients—the adults and, especially, the children—can be extremely stressful.”
That’s one reason why 700 of the nation’s roughly 5,600 hospitals still lack a single nurse who’s specially trained to examine sexual assault victims, an expertise that can yield the kind of results, including DNA and other physical evidence, used to prosecute rape cases.
Hackett, who coordinates the Sexual Assault Nurse Examiner (SANE) program at her Ohio hospital, also trains forensic nurses whose work is often seen as central to the prosecution of sexual assault cases. She trains prosecutors as well.
While sex assault cases, are often successfully prosecuted without forensic assistance, the evidence SANE nurses collect is “highly preferable,” said Matt Redle, the lead prosecutor in Sheridan County, Wyo.
“Can you successfully prosecute a sexual assault case without a SANE nurse? Yes,” added Redle, who co-chairs the National Commission on Forensic Science Subcommittee on Reporting & Testimony.
“But your odds of success are better with a forensically trained expert examiner.”
An American Prosecutors Research Institute study concluded that rape cases in which SANE evidence had been collected—and in which sexual assault response (SART) teams were involved—were almost twice as likely to result in the arrest of an alleged sexual assault perpetrator.
And of those arrests, 68 percent resulted in convictions.
Documenting the Crime
Forensic evidence gathered by SANE nurses includes semen, blood and urine. Additionally, the nurses document genital injury and other physical trauma that may exist. They check for sexually transmitted diseases and pregnancy, and secure that evidence to lessen chances that it might be altered or tampered with.
That successful prosecutions of sexual assault cases are based, at least partly, on the work of SANE nurses helps drive the 3,000-member International Association of Forensic Nurses, based in Elkridge, Md., to push for more SANE nurses.
The association has used, among other tactics, a three-part documentary on sexual assault forensic nursing to try to get the word out about the need for SANE nurses, said Jennifer Pierce-Weeks, the association’s interim director and director of its educational programming.
Her organization, Pierce-Weeks said, is working to curb the relatively high turnover rate among its nurses.
“Some people have the idea that it’s a glamorous job, the kind you’d see on television shows like CSI, when actually it’s very much not that,” said Pierce-Weeks. “This is one of the most vulnerable patient populations you’ve ever encountered.
“It’s rewarding work. But you really need lots of support to do the work. You need to have people around you who understand the work and do the work.”
Almost a decade into her own nursing care, Pierce-Weeks, in 1995, got certified as a sexual assault examiner. She was compelled, she said, by what she witnessed, back then, as an emergency department nurse in a hospital in Claremont N.H.
“I got a lot of the sexual assault victims,” she recalled. “They were really treated differently. They were judged by health care providers and by law enforcement … And there were all these conversations about whether this was a real sexual assault, and what the patient could have done to prevent it.
“There was a lot of judgment attached to it, but not a lot of patient choice.”
Which meant some patients ended up opting not to report the assault to police, Pierce-Weeks said.
In addition to providing medical care, SANE personnel are groomed in what to expect when, given their evidence-gathering, they are in the courtroom on the witness stand.
“What we know,” Pierce-Weeks added, “is that evidence collected by sexual assault nurse examiners is better than what may be collected by those in health care who have not been trained. If you speak to prosecutors, they’ll tell you that the more you have DNA to back up what the victim is saying … the more likely you are to have a (successful prosecution) …
“Without it, for the victims, this sometimes can be a crapshoot.”
In addition to educating nurses, collaborating with prosecutors and crime lab personnel, her organization also partners with End Violence Against Women International and AEquitas, a prosecutors’ resource group that addresses sexual assault, human trafficking and related crimes.
Currently, Pierce-Weeks’ organization and the International Association of Chiefs of Police is training law enforcement and forensic medicine professionals in Egypt.
Back at home, her association’s bid to get more sexual assault nurses in the nation’s hospitals, in part, requires persuading health care administrators of the need.
“Especially in rural areas—where, say, you’ve got five sexual assault victims instead of 500 of them—the health care system will not necessarily be inclined to provide resources that cost them money in an area where the volume of patient is low,” she said.
“For these exams, one forensic nurse spends, on average, about four hours with a victim. The health care system is built on a kind of 15-minute model. These exams will not yield the reimbursement they would get for, say, cardiac catheterization.
‘More Than a Criminal Justice Issue’
“But if they look at the overall health effect … in terms of the mental illness (that sexual assault victims do suffer), maybe they will begin to understand that this is much more than a criminal justice issue. That’s how many hospital administrators view this—as a criminal justice issue, a social issue but not a health care issue.”
Said Ohio nurse Hackett: “The reality is they need a SANE nurse. That’s the best care victims can get … I’m not rushing them through because I have 12 other patients to see. This is my only patient in that moment. I can do the advocacy, do the entire exam, report back to the physician, get this patient plugged in with an agency that can provide supportive, psychological care.
“I go to court a lot and it still not easy. It’s out of the box for a nurse … So this isn’t a job you do for money. It’s a job you do because you want to take care of these of patients.”
Katti Gray is a contributing editor for The Crime Report. She also coordinates 25 national, regional and local journalists for the 2015-2016 John Jay Center on Media, Crime and Justice /Langeloth Foundation Fellowship on Health and Justice Reporting, and is a former Rosalynn Carter Mental Health Journalism Fellow. She welcomes your comments.