Examining crime victims, collecting evidence, confirming findings, treating patients with medications, and providing resources to help them begin recovery all are part of a forensic nurse’s responsibilities.
Forensic nurses know that much of their workday may seem like a scene from a popular emergency medical TV series, but it’s not that drama that drew Barbara Kern-Pieh to her position as Clinical Care Supervisor of a team of 20 nurses in Hennepin County’s Sexual Assault Service in the Minneapolis, MN area. No two days are alike for Kern-Pieh. It’s rewarding, she says, in that we can help a patient begin recovery from what is a very traumatic event.
Sexual assault nurse examiners are registered nurses with ER, obstetrics, ICU, or school health experience who have an interest in forensic training. A 40-hour information week is followed by 1 to 200 hours of collecting evidence for cases by observing and then taking a national written exam sponsored by the International Association of Forensic Nurses (IAFN). Forensic nurses may work in acute care, corrections, medical examinations, psychiatric, insurance, or consulting settings. Many sexual assault nurses work 3 to 4 days a week at another job, such as in a nurse’s office or a clinic, and then work on call the rest of the week. The Hennepin County hospitals served by Kern-Pieh’s team have someone on call all the time, each nurse for an average of 8 to 12 hours at a time.
One of Kern-Pieh’s shifts played out as follows:
11:00 p.m. Kern-Pieh arrives and checks in. She’s scheduled for a night shift this week after 48 hours off since her last 12-hour workday. Being well-rested is critical for working these long hours. When we get a call, says Kern-Pieh, “we’re responsible for responding to that patient within 45 minutes to an hour and then getting the consent of that patient to report the crime.”
11:15 p.m. A patient arrives, saying she was raped the night before last. Most of Kern-Pieh’s interactions with patients are within hours of the crime, but some victims are reluctant to immediately report incidents of abuse. Fortunately, some evidence can found 3 to 5 days later. “We do a medical forensic exam, collecting evidence that can indicate through DNA identification who committed the crime,” Kern-Pieh explains. “Other evidence on the victim’s body confirms what the victim says happened. For example, the victim might say, ‘He pinched me,’ and nurses will look for evidence of that on the victim’s skin.”
12:10 a.m. Kern-Pieh has completed the preliminary examination of the walk-in patient. If necessary, she’ll also administer medication to treat any sexually transmitted diseases or prevent unwanted pregnancy.
12:50 a.m. The patient has decided to allow evidence to be preserved in order to press charges. “We collect evidence in a way that doesn’t compromise the evidence and preserves it from contamination and degradation,” says Kern-Pieh. If she needs to, she can testify that the swabs she used were locked up and secured. “Today our techniques are so streamlined that few cases go to court,” she explains. Although it may take 3 to 6 months to get results to police, defendants are presented with the evidence against them and often settle out of court.
1:20 a.m. As Kern-Pieh passes the patient off to a counselor, she meets with a few of her colleagues to discuss the case before filing her report. Stress is managed by talking through tough cases, and nurses talk regularly in debriefings. “I wouldn’t recommend this field to someone with an experience of assault in their own background,” says Kern-Pieh. She looks for nurses who can think and work independently, communicate well, be team players, and take a thorough medical history, all without losing their emotional objectivity.
1:45 a.m. Kern-Pieh returns to filing her report on the night’s first patient.
2:20 a.m. Having finished her report, she leaves a note instructing the day staff to contact the patient’s legal counsel.
2:50 a.m. Another patient arrives at the clinic, obviously upset and showing clear evidence of physical abuse. Initially she is unwilling to talk about what happened. Kern-Pieh gently tries to coax more information from her during the initial examination.
3:35 a.m. Kern-Pieh’s patient eventually admits that she’s been repeatedly beaten and sexually assaulted by an abusive husband. Great sensitivity helps these nurses meet challenges and also see rewards over time. “We help patients identify what happened and provide them with access to resources,” she explains. “We let them know that things will get better and give them a walking stick for that journey. That’s not always smooth,” she says, “but no matter what, even years later, there are resources out there to help, and we refer the victim to those resources.”
4:00 a.m. The patient doesn’t want to press charges, hoping instead to convince her husband to undergo counseling. Kern-Pieh advises her that the evidence collected from tonight’s examination will still be available if she changes her mind.
4:20 a.m. Kern-Pieh helps arrange an appointment for her second patient to meet with human services personnel the next day. “It’s really hard to see victimized people so committed to saving relationships which are clearly unhealthy,” she laments. “But it’s got to be the patient’s choice. And maybe there’s hope there for things to get better, a hope that’ll help begin a real recovery. But I always worry about letting a patient go back to a bad situation.”
5:10 a.m. Kern-Pieh finishes her report on her second patient. She takes a quick lunch.
5:30 a.m. Things have quieted down. Kern-Pieh avails herself of the opportunity to pare down the pile of paperwork waiting at her desk.
7:00 a.m. Kern-Pieh’s shift ends. With relieved satisfaction on her face, she confers with the incoming day shift before heading home. She’ll have the day and the next night off before her next workday.