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•Combine your nursing skills withforensic science to help victims ofviolence and trauma

IN THE CURRENT ERA of the #MeToo movement andprominent sexual assault disclosures, these types ofcrimes are finally receiving the attention they deserve.Our society is acknowledging what research has beentelling us for years about the high incidence of sexual vi-olence in the United States. According to a recent Centersfor Disease Control and Prevention (CDC) report, morethan 36% of women have experienced contact sexualviolence in their lifetime and 19% have experienced at-tempted or completed rape. Men also report high rates ofsexual violence; more than 17% have experienced someform of contact sexual violence in their lifetime and near-ly 2% have experienced attempted or completed rape.

A benefit of the increased media and cultural atten-tion on sexual assault crimes is that in many areas of

the United States more victims are reporting the crimesto receive forensic medical examinations by sexual as-sault nurse examiners (SANEs).

Many healthcare personnel and nurses are familiarwith SANEs but may not realize that forensic nursingis a much broader nursing specialty that encompassescaring for patients who’ve experienced all kinds of vi-olence and trauma.

Forensic nursing scope and specialties Forensic nursing combines nursing care with the legalsystem and forensic sciences. Forensic nurses care forpatients who’ve experienced violence and other traumas,such as natural disasters. Patients include living and de-ceased victims as well as perpetrators of violence. Thepatient population also extends to communities and so-ciety at large. Forensic nurses collaborate with other pro-fessionals outside of healthcare, but they’re nurses firstand use the nursing process to provide compassionate,holistic care. This distinction clearly defines forensicnurses as healthcare professionals rather than criminaljustice or forensic science professionals.

Forensic nursing: Overview of agrowing profession By Julie L. Valentine, PhD, RN, CNE, SANE-A

Career Sphere

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As forensic nursing grows, subspecialties will advanceto meet healthcare and societal needs. (See Forensicnursing subspecialties.) But regardless of the subspecial-ty, forensic nurses focus on improving patient and legalsystem outcomes. They address the bio-psycho-social-spiritual needs of patients affected by violence and trau-ma to promote physical and psychological health andrecovery. Additionally, forensic nurses use proper evi-dence documentation, collection, and preservation prac-tices to ensure optimal analysis findings.

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

SANEs make up the largest group of forensic nursesin the United States. In fact, about 72% of the Interna-tional Association of Forensic Nursing (IAFN) membersare SANEs. IAFN provides online education for SANEtraining and sponsors the certification examinations forboth adolescent and adult SANEs (SANE-A) and pedi-atric SANEs (SANE-P) as recognized by the AmericanNurses Credentialing Center’s Magnet Recognition Pro-gram®. Nurses must meet the eligibility requirementsbefore taking the credentialing examination.

In some parts of the United States, the SANE rolehas expanded to include providing nursing care andexaminations for patients affected by interpersonal vio-lence, strangulation, torture, physical child abuse, childneglect, and elder abuse. They also care for the sus-pects of violent crimes.

Employment settings Forensic nurses work in a variety of healthcare settings:hospitals, emergency departments, clinics, correctionalhealth centers, and medical examiners’ or coroners’ of-fices. (See Forensic nursing care settings.) Many foren-sic nurses work on-call, ready to respond when a pa-tient needs their specialized care, while others areemployed as full-time forensic nurses. States, jurisdic-tions, and healthcare facilities vary on their paymentstructure for forensic nursing services, providing on-call, case-by-case, hourly, or salaried wages.

Educational options Forensic nursing education is holistic, ranging fromlearning about assessment of the psychological impactof trauma to documenting physical injuries and pre-serving evidence. As forensic nurses intersect with thecriminal justice system, education also is provided onexpert testimony. A variety of online forensic nursingeducation programs are available through IAFN. Severaluniversities offer courses specific for SANEs or deathinvestigators, and graduate forensic nursing programs

range from master’s to doctoral degrees. When explor-ing SANE education opportunities, look for programsthat meet IAFN guidelines. And keep in mind that topractice as a forensic nurse, you need both classroomeducation and clinical experience.

Key forensic nursing conceptsRNs 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 toincorporate a thorough understanding of trauma-in-formed care, including knowledge of the neurobiologyof trauma and interventions to promote healing and re-store power and control to patients who’ve experi-enced violence and other trauma.

ObjectivityObjectivity is critical to forensic nursing, both in termsof nonjudgmental care when documenting findingsand facts and in interactions with the legal systemwhen serving as an expert witness or consulting forprosecuting and defense attorneys.

Cultural sensitivityCulturally sensitive forensic nursing care involves anawareness of cultural and societal influences on vio-lence, abuse, and trauma. It also requires a commit-ment to social justice and access to care.

EvidenceAll aspects of forensic nursing care—from patient as-sessment to evidence collection and documentation ofinjuries—must be based on research and best practiceguidelines.

Violence preventionViolence prevention is also a foundational conceptwithin forensic nursing. Under IAFN’s Vision of Ethi-cal Practice, the scope of forensic nursing practiceincludes a responsibility to address violence preven-

Currently in the United States, forensic nurses can special-ize in any of these areas:• sexual assault • interpersonal violence• intimate partner violence• child abuse and neglect• elder abuse and neglect• human trafficking• death investigation• incarceration• refugees with torture victimization history • mass and natural disasters.

Forensic nursing subspecialties

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tion to promote healthier communities and nations.

Learn more about forensic nursingNurses have always provided care to victims and per-

petrators of violence. Forensic nursing expands thatrole to individuals and communities to promote recov-ery, health, and justice.

To learn more about forensic nursing, visit the IAFNwebsite (IAFN.org). Note that many states have IAFNchapters with contact information. You also can readmore about forensic nursing in the official peer-reviewedjournal of IAFN, Journal of Forensic Nursing, and inAmerican Nurse Today (americannursetoday.com/forensic-nurses-strides-social-justice/).

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

Selected references Amar A, Sekula LK. A Practical Guide to Forensic Nursing: Incorpo-rating Forensic Principles into Nursing Practice. Indianapolis, IN:Sigma Theta Tau International; 2016.

American Nurses Association and International Association of Foren-sic Nurses. Forensic Nursing: Scope and Standards of Practice. 2nded. 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 andsexual violence survey: 2015 data brief. Centers for Disease Controland Prevention; 2017. www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf

The broad scope of forensic nursing encompasses manycare settings. • Forensic psychiatric nurses with an undergraduate de-

gree may work in mental health settings, while nurseswith an advanced practice degree may provide evi-dence-based therapies to both survivors and perpetra-tors of violence.

• Forensic nurse death investigators work within the struc -ture of medical examiners’ or coroners’ departments toinvestigate deaths, support family and survivors, and ex-plore the impact of the death on the community.

• Correctional forensic nurses care for patients incarcerat-ed in jails, prisons, and juvenile detention centers.

• Nurse legal consultants and nurse attorneys also fall un-der the umbrella of forensic nursing, addressing legal is-sues as they intersect with healthcare. Nurse legal con-sultants assist attorneys, while nurse attorneys representclients and healthcare organizations in legal cases.

• Forensic nurse doctoral researchers focus on studies rel-evant to forensic nursing science.

Forensic nursing care settings