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Forensic nurses and their role in sexual assault evidence collection

Nurse holding up a clipboard with a teal ribbon

When someone is sexually assaulted, they may choose to go to the hospital and have a rape kit done. Oftentimes, it is a forensic nurse, a nurse who specializes in evidence collection, who will conduct this examination. In honor of Forensic Nurses Week, we checked in with forensic nurse Tammy Bimber, MSN, RN, SANE-A, SANE-P, CEN, to learn more about the role of these nurses. Tammy shared with us what got her into the field, the day-to-day responsibilities of a forensic nurse, the rape kit evidence collection process, and more.

Tammy has over 20 years of nursing experience, including 18 years of experience as a Sexual Assault Nurse Examiner (SANE), and teaches nursing full-time. She lives in New York and travels back and forth to Pennsylvania for her work training nurses and students on how to help patients heal through victim-centered treatment. 

Where do you work?

I work many jobs. My full-time job is a nurse instructor at Jamestown Community College, and part-time I work for two different facilities, including SAFE-T at Penn State University, as a SANE through Telehealth. We use an online source called Zoom where we are able to guide and support the on-site nurse, who is usually in a rural area, in conducting examinations. Along with my part-time work, I also work through a secondary agency called Southern Tier Health Care Systems as a hands-on SANE, conducting the examinations at UPMC Chautauqua. 

How long have you been a nurse?

I have been a nurse for 26 years, but I have been a SANE for 18 years. I have worked all over Pennsylvania and New York.

When did you realize you wanted to be a forensic nurse?

When I first started in the emergency department over 20 years ago, I was given a collection kit and basically told “read the directions, go in the room and conduct the exam.” I was standing in the room, reading the directions, trying to figure out what to do, with zero guidance and struggling in front of the patient. It was not centered on them at all or focused on what that individual needed at that time.

On top of that, there was another experience where I had a girl, around 15 or so, who said she had consensual sex with her boyfriend. Her mother demanded she have a rape kit done because the boy was four years older and [she] wanted to charge him with statutory rape. The patient was screaming and didn’t want to continue, but after her mother talked her into it, she consented. At that time, I didn’t know the laws and rights she had, and I felt hopeless. I believe she was coerced, and I knew I never wanted someone to go through that again. Shortly after the incident, I was offered the opportunity to take a sexual assault training and jumped on it. I have been committed to helping and supporting patients’ needs ever since. There was no one there that was able to give her options and resources. 

What is it like being a forensic nurse?

Being able to give them answers and help them through what they need and are looking for is the best feeling in the world. Utilizing trauma-informed care, where you have training and talk to patients, it gives them empowerment and control that they’ve lost -- it is so important. The victim advocates are a huge part of helping the victims, and they are always there to help give them emotional support, and also support me as well. I lean on them heavily. 

What is the time commitment like? 

You have to manage your time, or you burn out, so you have to learn a balance. Over the years, I have learned that it is okay to turn down exams and spend time with my family instead. It is extremely time-consuming, even when you’re away from work, but I love it.

What certification do SANEs need?

It varies. If we go through the International Association of Forensic Nurses (IAFN), they designate the SANE-P, referring to pre-pubescent children, and SANE-A, referring to adolescent and adult examinations. Different states also have different certifications, such as the state of New York, where I was required to have additional certifications. Being a SANE requires that you have the registered nurse degree, an additional 40-hour didactic (both SANE-A and SANE-P together have a 64-hour didactic) plus time outside that you have do clinicals and precepting.

What is the workplace dynamic?

It varies from institution, hospital, or facility you are at. If the dynamics are put in place the way they are supposed to, it runs like a well-oiled machine. If you have advocates called immediately upon the patient’s arrival, that gives additional support during the set-up of the kit, during the exam, and basically the entire process, including giving a statement to law enforcement. If the dynamics are not put in place, such as training and education, the patients don’t get what they need, and it doesn’t run as smoothly. 

What is it like working with law enforcement?

It depends on the city. In rural communities, police jurisdictions are very territorial and fight for cases, but don’t always have the training or resources to do so. When you have more training, not only are they more comfortable with taking care of the patient, but they are more equipped in dealing with the situation. It has gotten better over the years and more departments are enforcing more training, but there is always room for improvement.

What improvements have you seen since you started? 

It has improved immensely since I started 18 years ago, but there is always opportunity for better practices. People with higher training are rarely available, especially in rural areas, so nurses with less training are treating patients, and there is also very little help to begin with. Telehealth gives nurses the extra help they need, even if we aren’t physically there.

What is a rape kit?

A rape kit is what we refer to as the ‘sexual assault evidence collection kit.’ The exams take 3-4 hours, and each state/jurisdiction has their own variation of a rape kit. These kits typically contain the materials in the collection of forensic evidence from any individual that may have had sexual contact, such as evidence collection bags, clothing, swabs, and smears. 

What are your thoughts on the rape kit backlogs? 

I think the change is slow, but there has been a huge push on ending the backlog, which is commendable. I think the strides they have taken to track how many kits are backlogged and begin the testing is a good start to where we need to be, but we definitely still have a long way to go. I don’t believe the public understands the importance of these kits, that there is a ways to go to educate the importance, and acquiring the funds to do so. It is important to keep going so we can bring perpetrators to justice.

What resources are victims given?

We promote recovery and healthy healing, so we provide all patients with resources to seek the treatment they need after the exam. They are given law enforcement’s information, the victim advocacy information, housing information, along with information on the legal system, if they want updates on their case, and counseling options. 

Where do victims go after treatment?

Whatever they feel is best, whether that is going to a friend or family member’s house, going to a temporary housing center, or going home. They are given a contact number for victim advocacy if they have any other questions or concerns.

What do you say to people who are unsure if they want to get a rape kit done because they are afraid it will be re-traumatizing, or they aren’t sure if they want to make a formal report?

My first words are always, “It is your choice.” After that, I go through the process and the evidence collection kit, including photography, along with information about emergency contraception and STIs [sexually transmitted infections]. I let them know that they can go through the entire exam, and even though they sign the consent form, they have a right to stop the exam. They are able to pick and choose what they will and will not have done (i.e. having pictures of their legs done but not their stomach) and they can stop at any time.

What are other things that forensic nurses do? 

Keeping the patient safe is the biggest priority. If the patient has any type of medical condition, especially if it has to be addressed immediately, we have to keep the evidence intact while treating the issue. If the patient is well and able, we do a complete medical history (documenting the patient’s description of the event of sexual assault), a full-body assessment, while being supportive and non-judgmental through the process. We also photograph high-quality and identifying photographs, with and without a ruler, and make sure the patient gets home safely and securely. 

What would you tell someone who wants to become a forensic nurse?

It is the most rewarding job – being able to help people and support them in their time of need. It is difficult, time-consuming and mentally straining, but there is nothing else that I would want to be doing. I have to be honest: I have had nightmares and have definitely been scared, but it is worth going through all that to help people when they need it the most.  

Additional Resources: 

International Association of Forensic Nurses