Colleen O'Brien, on forensic nursing

By Glen Fest
June 21, 2004

What brought you to forensic nursing?

I had an ER background, and so I was familiar with the issues around forensics, be they evidence collection in trauma patients or alcohol-related victims. I had gone to court for some of the cases involving patients in the ER 85 and I noticed that for all the things that we did well in the ER, I thought we could do better taking care of sexual assault victims. I heard of a program in Minneapolis, checked it out, and came home feeling we could do this in our community.

What services and programs did you see lacking for sexual assault victims?

First of all, victims of sexual assault were not always a high priority in an ER, so there were long waits. Sometimes, there were problems with maintaining the chain of evidence. There were multiple opinions from physicians about how the clinical issues would be handled. Multiple people were seeing victims — for example, a social worker, a cop, a doctor, a nurse, and that appeared to be very stressful for survivors. So the concept of having one person who was an expert and could do everything from start to finish, including going to court, seemed to be a model much more advantageous for the victim.

Where do most forensic nurses work?

Forensic nursing is multifaceted. There are coroners’ offices, domestic violence [settings], and nurses who work in a hospital or clinic setting. There’s the sexual assault subspecialty, and that includes children, adolescents, adults, male, female, and elderly. The majority of SANE programs across the country are hospital-based, although you will find programs in district attorneys’ offices, rape crisis centers, and there are a couple [of community-based programs] that work out of YWCAs.

Have funding levels for forensics nursing been adequate over the years?

I think hospitals have taken the lead in finding additional funds to support these SANE programs. Some hospitals have even done secondary missions of having domestic violence programs. Across the country, hospitals have really stepped up to the plate to provide the funding for forensics. There are some hospitals that have a clinical nurse specialist whose job is specifically forensics. Communities [are funding] where those needs can be met — the YWCA, a prosecutor’s office, a rape crisis center.

What are some ways an RN can move into a career in forensic nursing?

There are many levels of forensic clinical practice within the basic nursing level, for example, working in an ER or being on a psych unit. If we’re looking at the next step of doing domestic violence assessments, sexual assault assessments, or death investigation assessments, you’re really looking at advanced practice. In a SANE program, it’s often recommended that a nurse have a minimum of one to two years of basic nursing practice before she moves into the forensic field surrounding domestic violence and sexual assault.

What are some topics of discussion in the forensic nursing field?
We are still going through our growing pains. The practice in forensic nursing has become more and more recognized, certainly on the issues [surrounding] the standards and practice for adult and child SANE certification. Also, how to get more funding for hospitals that want to provide the service. Our responsibility is not just for sexual assault care, but also domestic violence. There’s the issue around [more] suspect exams being done by forensic nurses. The expansion and growth of forensics and how it fits into nursing is certainly a topic of conversation.

What is the purpose of the Violence Against Women Act National Focus Group on standards, practice, and training for SANE exams?

We are looking to implement standardized [SANE] protocols and guidelines in the near future. Because forensics is a relatively new field, what we’re trying to do is unify those standards. We did find that from community to community and state to state, there was a lot of variation, so our goal was to provide a common basic protocol.