Combine your nursing skills with forensic science to help victims of violence and trauma

Takeaways:

• Forensic nursing is a specialized nursing field focused on providing nursing care to patient populations affected by violence and trauma.
• Forensic nursing integrates nursing concepts with legal and forensic science concepts.
• The scope of forensic nursing is broad to encompass the many patient populations affected by violence and trauma.

IN THE CURRENT ERA of the #MeToo movement and prominent sexual assault disclosures, these types of crimes are finally receiving the attention they deserve. Our society is acknowledging what research has been telling us for years about the high incidence of sexual violence in the United States. According to a recent Centers for Disease Control and Prevention (CDC) report, more than 36% of women have experienced contact sexual violence in their lifetime and 19% have experienced attempted or completed rape. Men also report high rates of sexual violence; more than 17% have experienced some form of contact sexual violence in their lifetime and nearly 2% have experienced attempted or completed rape.

A benefit of the increased media and cultural attention on sexual assault crimes is that in many areas of the United States more victims are reporting the crimes to receive forensic medical examinations by sexual assault nurse examiners (SANEs).

Many healthcare personnel and nurses are familiar with SANEs but may not realize that forensic nursing is a much broader nursing specialty that encompasses caring for patients who’ve experienced all kinds of violence and trauma.

Forensic nursing scope and specialties

Forensic nursing combines nursing care with the legal system and forensic sciences. Forensic nurses care for patients who’ve experienced violence and other traumas, such as natural disasters. Patients include living and deceased victims as well as perpetrators of violence. The patient population also extends to communities and society at large. Forensic nurses collaborate with other professionals outside of healthcare, but they’re nurses first and use the nursing process to provide compassionate, holistic care. This distinction clearly defines forensic nurses as healthcare professionals rather than criminal justice or forensic science professionals.

As forensic nursing grows, subspecialties will advance to meet healthcare and societal needs. (See Forensic nursing subspecialties.) But regardless of the subspecialty, forensic nurses focus on improving patient and legal system outcomes. They address the bio-psycho-social-spiritual needs of patients affected by violence and trauma to promote physical and psychological health and recovery. Additionally, forensic nurses use proper evidence documentation, collection, and preservation practices to ensure optimal analysis findings.

Only RNs can take specialized forensic nursing education, but forensic nurses come from a variety of educational backgrounds—from associate to doctoral degrees. Many forensic nurses have experience in emergency departments, intensive care units, women’s health, medical-surgical units, or mental health/psychiatric units.

SANEs make up the largest group of forensic nurses in the United States. In fact, about 72% of the International Association of Forensic Nursing (IAFN) members are SANEs. IAFN provides online education for SANE training and sponsors the certification examinations for both adolescent and adult SANEs (SANE-A) and pediatric SANEs (SANE-P) as recognized by the American Nurses Credentialing Center’s Magnet Recognition Program^®. Nurses must meet the eligibility requirements before taking the credentialing examination.

In some parts of the United States, the SANE role has expanded to include providing nursing care and examinations for patients affected by interpersonal violence, strangulation, torture, physical child abuse, child neglect, and elder abuse. They also care for the suspects of violent crimes.

Employment settings

Forensic nurses work in a variety of healthcare settings: hospitals, emergency departments, clinics, correctional health centers, and medical examiners’ or coroners’ offices. (See Forensic nursing care settings.) Many forensic nurses work on-call, ready to respond when a patient needs their specialized care, while others are employed as full-time forensic nurses. States, jurisdictions, and healthcare facilities vary on their payment structure for forensic nursing services, providing on-call, case-by-case, hourly, or salaried wages.

Educational options

Forensic nursing education is holistic, ranging from learning about assessment of the psychological impact of trauma to documenting physical injuries and preserving evidence. As forensic nurses intersect with the criminal justice system, education also is provided on expert testimony. A variety of online forensic nursing education programs are available through IAFN. Several universities offer courses specific for SANEs or death investigators, and graduate forensic nursing programs range from master’s to doctoral degrees. When exploring SANE education opportunities, look for programs that meet IAFN guidelines. And keep in mind that to practice as a forensic nurse, you need both classroom education and clinical experience.

Key forensic nursing concepts

RNs already practice many forensic nursing concepts, including compassionate, patient-centered, objective, culturally sensitive, and evidence-based care. However, forensics’ education expands on these key concepts to incorporate a thorough understanding of trauma-informed care, including knowledge of the neurobiology of trauma and interventions to promote healing and restore power and control to patients who’ve experienced violence and other trauma.

Objectivity

Objectivity is critical to forensic nursing, both in terms of nonjudgmental care when documenting findings and facts and in interactions with the legal system when serving as an expert witness or consulting for prosecuting and defense attorneys.

Cultural sensitivity

Culturally sensitive forensic nursing care involves an awareness of cultural and societal influences on violence, abuse, and trauma. It also requires a commitment to social justice and access to care.

Evidence

All aspects of forensic nursing care—from patient assessment to evidence collection and documentation of injuries—must be based on research and best practice guidelines.

Violence prevention

Violence prevention is also a foundational concept within forensic nursing. Under IAFN’s Vision of Ethical Practice, the scope of forensic nursing practice includes a responsibility to address violence prevention to promote healthier communities and nations.

Learn more about forensic nursing

Nurses have always provided care to victims and perpetrators of violence. Forensic nursing expands that role to individuals and communities to promote recovery, health, and justice.

To learn more about forensic nursing, visit the IAFN website (IAFN.org). Note that many states have IAFN chapters with contact information. You also can read more about forensic nursing in the official peer-reviewed journal of IAFN, Journal of Forensic Nursing, and in American Nurse Today (myamericannurse.com/forensic-nurses-strides-social-justice/).

Julie L. Valentine is an assistant professor at Brigham Young University College of Nursing in Provo, Utah, and a forensic nurse with Wasatch Forensic Nurses in Salt Lake City, Utah.

Selected references

Amar A, Sekula LK. A Practical Guide to Forensic Nursing: Incorporating Forensic Principles into Nursing Practice. Indianapolis, IN: Sigma Theta Tau International; 2016.

American Nurses Association and International Association of Forensic Nurses. Forensic Nursing: Scope and Standards of Practice. 2nd ed. Silver Spring, MD: American Nurses Association; 2017.

Price B, Maguire K, eds. Core Curriculum for Forensic Nursing. Elkridge, MD: International Association of Forensic Nurses; 2016.

Smith S, Zhang X, Basile K, et al. The national intimate partner and sexual violence survey: 2015 data brief. Centers for Disease Control and Prevention; 2017. www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf