Should an ER Nurse Perform Sexual Assault Examinations?

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As a travel nurse, you always find yourself in a new work environment with staff and managers you don’t know.  Traveling to different facilities every 13 weeks can be stressful.  For an ER nurse, you may find yourself in a very busy emergency department.

ER nurses have a special skill set since they have to know how to act quickly and efficiently under stress.   They need to be multitaskers and while remaining cool.   Though these nurses are usually ready for anything, on occasion they may be asked to treat a patient or perform a task that requires more specialized training.

Treating victims of sexual assault

Victims of sexual assault can be male or female.  Most often they are female and the trauma can be physical as well as emotional. As nurses, we are trained to recognize signs of possible domestic abuse or sexual assault. Nurses and physicians are mandated reporters and we take that mandate seriously. As healthcare professionals, we are not necessarily trained to do the sexual assault exam.

In the “old” days male nurses were not allowed to provide hands-on care for a female patient and since there were very few male nurses it was not an issue.  Today male and female nurses perform most of the same duties. However, there are a still a few areas where the patient is not comfortable having a male nurse.  One of those areas is sexual assault examination.

Training for sexual assault exam

Although an ER nurse may be trained and highly skilled in ER medicine a sexual assault examiner requires specialized training.  As a nurse would you be comfortable doing an exam you had never done before?  Would you want to risk losing evidence of assault if you did not collect and secure it properly?

The trend today is for facilities to use specially trained RNs to conduct exams or work with rape kits for victims of sexual assault or abuse. These RN’s go by several titles, to include SANEs, forensic nurse examiners, sexual assault forensic examiner and sexual assault examiner.  All of them require clinical preparation in the medical forensic care of the patient of sexual assault or abuse according to the International Association of Forensic Nurses.

Should you refuse to perform a sexual assault exam?

A critical component of the exam is that the RN conducting the sexual assault medical forensic exam is committed to providing compassionate and competent health care.   The RN collecting evidence has to be thorough using the appropriate techniques.  As a SANE nurse you have to be prepared to testify in court if needed.

Forensic nurse examiners obtain special education and fulfill clinical requirements allowing them to collect evidence of sexual assault or rape. In view of the required training and responsibility would you feel comfortable doing the exam without it?

Performing the examination may result in evidence being compromised.  Evidence that may be totally unusable to prosecute a case if not collected, processed and stored correctly.

Victims need support

Victims need support and crisis intervention specific to this type of assault.  If the victim is uncomfortable with the gender of the SANE they should let the manager of the department know.  The victim comes first and the staff should respect their request.

If there are no other qualified SANE examiners in the ED to perform the exam it is possible some other accommodations can be made.  A good example would be if the examiner is a male and the victim prefers a female then ask a female staff member to be present during the exam.

Right to refuse

If you are an RN working in the ER and you are not trained to perform a sexual assault rape kit you have the right to refuse that duty.  You have the right to refuse to do something for which you haven’t been trained.  Furthermore, you are legally responsible for the care and processing of the evidence of a crime. As a nurse accountability and responsibility for your actions is the trademark of your profession.

For a male or a female nurse if the exam is not performed correctly the outcome of the case could be at risk.  Remember the skills needed to be a SANE are professionalism, honesty, and competence.

For more information on SANE:   Sexual Assault Forensic Examiners

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Cheryl Roby, RN

Cheryl J. Roby is a retired RN and US Army Nurse Major. She has over 30 years of nursing experience and 26 years of military experience in the Army Nurse Corp. During her nursing career she has traveled as part of her military experience visiting many of the 50 states and once to South Korea. Her medical training began during the Vietnam era when trained as an army medic. She went on to train as an OR tech and then as a LVN/LPN. She completed nursing school and was direct commissioned into the reserve Army Nurse Corp. nurse. She appreciated the challenge of working in various specialties and expanding her clinical and professional skill sets. Her time in the Army Reserves and California National Guard gave her the opportunity to travel to most of the 50 states and working in other medical facilities. During her career she spent years as an OR nurse, Occupational Health Nurse, Hospice Nurse, Forensic Nurse, Nurse Case Manager for developmental disabilities, Parish Nursing as well as being a Nurse Entrepreneur.

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