Forensic nurses are an invaluable resource and play a vital role in treating survivors of domestic violence, child abuse, and sexual assault by advocating for their well-being and ensuring justice is served. As a component of this specialized role at the intersection of healthcare and the criminal justice system, forensic nurses are uniquely trained to partner with law enforcement to collect evidence and provide testimony in legal cases. Accordingly, the Emergency Nurses Association (ENA) and the International Association of Forensic Nurses (IAFN) attest, “It is best practice to include an officially trained forensic nurse in the care of patients affected by trauma and violence … to improve their physical and mental health outcomes and the chances for successful prosecution of assailants” (Navarroli, 2023, p. 3.).

Expertise Beyond Sexual Assault Cases

At first glance, most nurses may think that forensic nursing is related to the treatment and advocacy of sexual assault survivors. However, forensic nurses are uniquely prepared experts in other areas, including elder abuse and traumatic injury documentation, among others. They are specially trained to collect potential evidence for law enforcement professionals and are adept at identifying, describing, and documenting injuries. The detail in which forensic nurses document injuries has been lauded as an invaluable resource for the legal system (Reed et al., 2020).

The current trauma literature supports employing forensic nurses to meet the health and legal needs of patients experiencing intentional and unintentional trauma (Berishaj et al., 2020). Berishaj et al. (2020) further described forensic nursing as a specialty recognized as the provision of care when there are legal considerations associated with the patient’s health needs. Accordingly, healthcare organizations should expand forensic nursing services beyond sexual assault.

Moreover, the role of forensic nurses in disaster situations is invaluable. Technological, natural, or social disasters are considered threats to human rights and serious public health concerns. Researchers in Brazil recently examined the role of forensic nurses in disaster responses, including the 1995 Oklahoma City bombing, the 2001 World Trade Center bombing, and the COVID-19 pandemic (da Silva et al., 2023). As a result of this work, 24 competencies were identified aligned with the expertise of forensic nurses, including the three stages of disaster management: pre-incident (prevention and mitigation), incident, and post-incident. Despite this important recognition, forensic nurses remain widely underutilized.

Improving Access to Forensic Nurse Services

Despite the benefits of a robust forensic nursing program, healthcare organizations may experience challenges coordinating these specialized nurses. Prioritizing a consistent forensic nursing presence is imperative. If a patient presents for an examination and a forensic nurse is unavailable, they may require transfer to a facility with a forensic nurse If this occurs, many patients choose to forego care altogether. Alternatively, patients may also be offered an examination by a healthcare provider without specialized forensic training. In this case, patients are at risk of receiving substandard care and the forensic evidence required for successful prosecution may be of inferior quality, not collected, or incorrectly collected. Additionally, survivors may experience ‘secondary victimization’ or additional trauma due to substandard or poor treatment during a time of crisis (Miyamoto et al., 2020).

Recognizing the shortage of forensic nurses and the need to provide an important service, one Pennsylvania health system recently implemented an innovative solution. The Sexual Assault Forensic Examination-Telehealth (SAFE-T) program is specifically focused on sexual assault exams, though it may have applications for many other types of cases that typically involve the expertise of forensic nurses. A community-wide telehealth program was implemented with a shared vision and input from stakeholders. The program’s core elements include an expert telehealth sexual assault nurse examiner response team, education and training programs for sexual assault providers, sexual assault nurse examiner peer-review and support network, and cost-effective, secure, sustainable telehealth systems with reliable information technology infrastructure and support (Miyamoto et al., 2020). This program is applicable in many other settings with an inequitable distribution of forensic nurses and patient populations requiring specialized forensic care.

Conclusion

Forensic nursing is a highly regarded specialty, yet forensic nurses are underutilized in many rural areas. Their tireless efforts in providing compassionate care to victims of violence, meticulously collecting evidence, and collaborating with law enforcement contribute significantly to the well-being of survivors and the pursuit of justice. Investing in and supporting forensic nursing programs is critical to ensure all patients, regardless of location, receive equitable care in their time of need.

References

Berishaj, K., Boyland, C. M., Reinink, K., & Lynch, V. (2020). Forensic nurse hospitalist: The comprehensive role of the forensic nurse in a hospital setting. Journal of Emergency Nursing, 46(3), 286–293. https://doi.org/10.1016/j.jen.2020.03.002

da Silva, T. A., Haberland, D. F., Kneodler, T., Duarte, A. C., Williams, J., & de Oliveira, A. B. (2023). Forensic nursing competencies in disasters situations: Scoping review. Revista Da Escola de Enfermagem Da USP, 57. https://doi.org/10.1590/1980-220x-reeusp-2022-0486en

Miyamoto, S., Thiede, E., Dorn, L., Perkins, D. F., Bittner, C., & Scanlon, D. (2020). The sexual assault forensic examination telehealth (SAFE-T) center: A comprehensive, nurse-led telehealth model to address disparities in sexual assault care. The Journal of Rural Health, 37(1), 92–102. https://doi.org/10.1111/jrh.12474

Navarroli, J. E. (2023). Forensic nursing in the emergency care setting [Joint position statement]. International Association of Forensic Nurses and Emergency Nurses Association. Retrieved from https://enau.ena.org/URL/ForensicNursingintheEmergencyCareSettingPositionStatement

Reed, G. D., Symonds, A., Stier, A., Peluso, S., & Watson, S. O. (2020). Prosecutor preference for forensic nurse testimony: Outcome of expanding a forensic program. Journal of Emergency Nursing, 46(3), 310–317. https://doi.org/10.1016/j.jen.2020.02.014