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The Importance of Sexual Assault Nurse Examiners

Nurse examiners make a difference in the lives of sexual assault victims

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Bite marks need to be scraped. Hair needs to be combed through, to gather and preserve any debris that might be caught within. Bruises need to be photographed.

While these are certainly not the most glamorous or pleasant tasks a nurse performs, for the victims of a sexual assault, it is of utmost importance that they are done promptly and properly. At Nantucket Cottage Hospital (NCH) in Nantucket, Mass., 7 nurses have completed the state's new Sexual Assault Nurse Examiner (SANE) training and certification program as of summer 2016. As a result, they can perform high-quality, forensic medical-legal exams on sexual assault victims.

During the weeklong educational program, nurses complete 48 hours of didactic training, which includes classroom lectures, hands-on training, and a mock court case. They must pass a written examination and demonstrate competency through preceptored examinations with seasoned child sexual abuse clinicians/experts before becoming certified and credentialed through the Massachusetts Department of Public Health.

Evidence Speaks for Itself
"This is a nurse's chance to make a real difference in a child's life," said Martha Lake-Greenfield, RN, SANE, nurse manager for the emergency department at NCH. "If we do our job right, the evidence will speak for itself, and the victim may not be asked to testify in court."

SANE examiner from Nantuckett Cottage HospitalThe Massachusetts SANE program piloted in Cape Cod and Nantucket in 2001 and was officially approved by the Department of Public Health in fall 2015-allowing community hospitals to take on an expanded role when caring for their patients and sparing already traumatized children from the hassle of traveling to the mainland to receive care. This is especially important, because according to information on the state's web site, "Timely evidence collection is critical, as forensic evidence in young children disappears quickly."

'No Harm' Principles Prevail
The Massachusetts Pediatric Sexual Assault Evidence Collection Kit, designed according to "do no harm principles," is used by emergency department clinicians when examining children younger than 12. The kit contains envelopes and cotton-tipped swabs that are used to gently swab the external portions of the child's body for forensic evidence such as saliva, semen, skin cells, and other foreign material. All evidence collection steps are noninvasive and should not cause the child any discomfort.

A forensic exam performed by a SANE can take up to 4 hours to complete. During that time, the SANE examines the child from head to toe, carefully looking for signs of injuries. Extra attention is given to examining the genitalia in a manner that is not painful or invasive.

SEE ALSO: Earn CE: Responding to Domestic Violence

Explaining Empowers Victims
"The goal is to empower the victim, who has already been through a horrific experience, by explaining every step of the evidence collection process," Lake-Greenfield said. "Before I scrape under the fingernails, I will state, 'There might be skin follicles from your attacker underneath, so I need to scrape that area with this tool.'"

In the future, NCH may add a tele-nursing component to the SANE program. "SANE-trained nurses could use their expertise to guide their non-SANE-trained peers through this type of exam remotely, to benefit pediatric victims in rural areas," she explained.

Massachusetts district attorneys anecdotally report that alleged perpetrators are more likely to plead guilty before trial when the prosecution presents evidence collected by a SANE-saving the state enormous prosecution costs and sparing victims further pain and trauma.

Anne Collins is a staff writer. Contact her at

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