PhD, MS, MSN, RN, APRN-BC, CDCES, CCRN
You may be wondering if any nurse is SANE nurse considering the difficult work climate we have been working in for the past two years. A SANE nurse is not a statement of our mental status but an acronym for a specialized forensic nurse.
SANE stands for Sexual Assault Nurse Examiner and is an RN specially trained to assess, examine and collect specimens from a client with a reported sexual assault. When a male or female of any age present a statement of sexual assault to an emergency department, there are special skills needed to carefully collect the specimens and complete a physical exam that may become a legal statement of a sexual assault. A SANE nurse is trained to provide both the physical exam and emotional needs of a client in this difficult time.
In the United States, there are an average of 463,634 victims age 12 and older of rape and sexual assault (Department of Justice, 2020). It is estimated that a rape, or sexual assault, occurs approximately every 68 seconds. The age group most at risk of sexual assault is between 12-34. According to the National Sexual Assault Hotline, one in six American women have reported a completed rape or attempted rape in her lifetime.
According to the Rape, Abuse & Incest National Network, which is the largest anti-sexual violence organization in our nation, about 90% of rape victims are female (RAINN, 2022). Native Americans are at greatest risk of sexual violence compared to other races. A cultural group at higher risk than the general population are females who serve in the military. Much publicity was given to the atrocities towards women in the military.
A SANE nurse evaluates and treats a patient who has survived a sexual assault, or even an alleged sexual assault, whether male or female. In a holistic way, the SANE gathers a report of the incident with cultural and age-appropriate considerations for gender, age, ethnicity, and culture. Collecting a historical and chronological account of the incident lays a foundation to establish the options and direction for care.
The SANE may collect forensic evidence from a physical exam and request lab testing and diagnostic radiographs to become a legal documentation of the event. The SANE is trained to be sensitive to the situation yet objective in the collection of important data.
The exam may include forensic evidence collection, testing and treatment or prevention of sexually transmitted diseases and the human immunodeficiency virus (HIV), and pregnancy prevention after a rape. The process includes caring for the victim in the immediate time frame and coordinating follow-up services with community-based sexual assault advocacy, and medical and law enforcement partners.
According to the International Association of Forensic Nurses (IAFN), which was founded in 1992, a SANE nurse must complete a training course that includes both didactic and clinical skills and take a certification exam from the International Association of Forensic Nurses (IAFN).
In some states a SANE is called a Forensic Nurse Examiner. Other healthcare providers such as physicians, physician assistants, and military providers may use these other titles after completing the IAFN training and be called a Sexual Assault Forensic Examiner or a Sexual Assault Medical Forensic Examiner (for military). There is an additional exam that can be chosen for those who work with pediatric populations.
Unfortunately, having a SANE on hospital staff is not very common. Not all hospitals have a SANE. It is also unfortunate that many cities do not have very many police officers designated to sexual assault, which makes the process of getting medical, psychological, and legal help difficult for a victim.
Often if a woman is raped and even decides to present herself to an emergency department, she will be redirected to a different hospital where there is a SANE who can treat and process her appropriately.
That may mean leaving the first hospital and driving or finding public transportation to go to another hospital. Many women leave the first hospital where they were hoping for medical attention, and just go home because of the barriers and difficulty of the process. Because the SANE requires additional training and skills, not all emergency department nurses are equipped to deal with the specific physical exam, specimen collection, and implications of a sexual assault.
One goal of the SANE is to secure appropriate specimens of the vagina, anus, or penis that may be permissible in court if a prosecution is sought against the assailant. Incorrectly collected or processed specimens may be nullified in a court if the specific protocol is not followed. For that and many other personal reasons, many victims won’t even report a rape and less seek prosecution from a complicated, costly, and often ineffective legal system.
The sexual assault hotline also provides trained volunteers to help answer calls and direct victims to hospitals where a SANE is available. The phone number is: 1800-656-HOPE (4673). Volunteers and paid workers are trained to ask relevant questions in a nonjudgmental tone, help calm the victim and direct them to resources in their specific community. Even if you are not able to complete the SANE training, you can volunteer for the hotline and will receive free training for that.
We need more nurses trained in forensics who can correctly collect specimens from a sexual assault, complete a thorough head to toe assessment, document correctly the chronology of events, and coordinate care after a sexual assault.
The training and certification results in a SANE nurse. Public awareness and education for sexual assault prevention and protection are also duties a SANE may be involved with. To become a SANE, go to the International Association of Forensic Nurses website to learn about certification and receive the training.
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