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Speck recalls another example: “A girl was forced to fellate her stepfather, which is a large percentage of what we see here. I was talking to the officer and asked him, ‘Where did she spit the semen?’ He admitted he hadn’t thought about that. I told him, ‘I’ll bet you’ve got her saliva with his semen in the garbage can.’ And there was the DNA evidence we needed.”

A multilayered discipline

As child advocates, forensic nurses in the pediatric arena do much more than just clinical examinations, Speck says. “Nurses are educated and trained for the biological, psychological, social, and spiritual assessment and treatment of patients. We’re trained to evaluate the whole person. In cases of child abuse, there’s nothing more critical than to look at the entire child in the family constellation, in the context of how they’re going back to the community.”

That takes a deep knowledge and understanding of a child’s developmental level, Rooms says, because there’s a big difference in accidental injuries and those inflicted purposely.

“A child who is hit by a car while riding his bicycle may have trauma, and he might be angry at the person who hit him, but on some level he realizes that the person wasn’t trying to run him over,” he says. “But when someone pins you between their legs and sexually molests you, or they beat you and break your arm, that’s not an accident. There are deep psychological consequences, and they’re ongoing.”

It takes a special person to be a pediatric forensic nurse.

“It’s a real commitment,” Clements says. “You have to find a place inside you where you realize you’re really helping these children.”

The reward comes when you realize you’ve helped a child process and get past the trauma.

“When a child can come to a point where he realizes that ‘this is a terrible thing that happened to me, but it wasn’t my fault. I didn’t want it to happen, but it did, and now I have to figure out a way to get on with my life,’ that’s when I feel successful,” Clements says.

Joining the team

Becoming a pediatric forensic nurse is much easier than it once was.

“There are several ways to get in,” says Burgess, author of Violence Through a Forensic Lens and many other books on the topic.

She mentions continuing education courses and certificate programs such as the one at the University of Pennsylvania and at her facility in Boston as good places to start.

“It really depends on the level of intervention you want to do,” Clements says. “There are many arenas for training to be a sexual assault nurse examiner. Once you start getting into the level of psychotherapeutic intervention or expert testimony, you have to have a minimum of a master’s in some kind of psychiatric nursing.

“There are only a few true forensic psych nursing programs in the nation, so people typically get a degree in psychiatric nursing and then do their clinical rotation in a forensic arena.”

Carey Goryl, MSW, SANE/SART, an instructor at Johns Hopkins University School of Nursing in Baltimore who teaches a forensic nurse examiner class, explains that the need for pediatric forensic nurses now outstrips the supply.

“The pediatric portion is definitely a couple of years behind forensic nursing in general,” she says. “I think there are a number of nurses who are more comfortable working with the adult and adolescent population. Children just seem to tug at their heartstrings a bit more. The idea of a child being victimized seems to be much more difficult for some.”

At Johns Hopkins, Goryl says, the adult, adolescent, and pediatric elements of the forensic nursing course were all packed into a single week at first.

“But that’s not enough time to get all that done,” she says, “so we decided to do a five-day and a four-day back-to-back. And that still wasn’t enough time for nurses to really understand what it is to be
a forensic nurse.”

The board of nursing recently changed the curriculum’s requirements, and students now are required to take the adult course first, become certified, and work in the community for a time before taking the pediatric course.

For nurses who want to make a difference in their communities, there are few more desperately needed or rewarding pursuits than coming to the aid of children in distress.

“The field is growing, and it’s an excellent time to get involved,” Burgess says. “We welcome all nurses who want to join in the fight against childhood sexual assault and are prepared to get the training to join our team.”

For more information

Violence Through a Forensic Lens , by Ann Burgess, RNCS, DNSc, FAAN, is available for $19.99 by calling (800) 866-0919.

Mark Cantrell is a freelance writer.