Before becoming a nurse, I worked for more than a decade in the criminal justice and legal field. It was there that I discovered my passion for serving those in need, protecting the greater good, and making a difference. Deciding to pursue forensic nursing was a natural transition for me. I was able to combine my love and knowledge of the criminal justice system with my desire to use science and social elements to bring healing to those impacted by crime or traumatic events. I came to the field of emergency and forensic and nursing in 2014. Helping people on what is very well the worst day of their life is what forensic nurses do.
As a result of the pandemic, individuals impacted by interpersonal violence have been less likely to seek medical care and treatment. In the early stages of the pandemic, many individuals reported being fearful of entering the emergency department, regardless of the extent of their illness or injury, for fear of contracting COVID-19. As healthcare resources began to diminish, nurses from all practice areas were being re-allocated to meet the needs of the critical patient loads being seen throughout the healthcare setting. Forensic nurses were forced into other patient care areas, which further exacerbated a shortage of qualified forensic nurses practicing in the workforce.
Last March, I saw this play out as an educator with the Indiana SANE Training Project; a program of the University of Southern Indiana’s College of Nursing and Health Professions. As the health of our country begins to improve, I’m hopeful that forensic nurses will quickly return to the frontlines to once again serve patients impacted by crime and trauma. Understanding the value of forensic nurses and the impact on patient outcomes is essential. (Check out the resource I put together with more information if you want to go deeper.) Forensic nurses are an important part of the medical care team, an asset to the criminal justice system, and a crucial part of patient-centered care that is necessary for building resilience needed for holistic healing.
Here’s a glimpse of a day in my life while I was working as a forensic nurse in a level I trauma center:
Bed huddle and report
Chart reviews. Conducting peer review of medical forensic examination documentation of other forensic nurses serves not only as an educational opportunity to learn from experiences and practices of other nurses in the facility but also serves as a quality assurance tool.
A follow-up appointment with a patient impacted by domestic violence includes assessing patient safety, obtaining additional photos of the patient’s injuries to document injury progression, conducting a lethality assessment, providing advocacy resources, and ensuring the patient is medically and psychologically stable.
A follow-up appointment with a pediatric patient impacted by child sexual abuse includes repeat anogenital photographs to document the progression of findings and/or rule out abnormal anogenital variants. Safety planning is addressed, and the patient is currently in the custody of non-offending family members and does not have contact with the offender, who is on a no-contact order. The case remains under investigation per the Department of Child Services case manager who presents with the patient and family member. Photographs will later be surrendered to law enforcement via subpoena if necessary for investigative purposes (per hospital policy for anogenital photographs).
Charting and documentation on previous two patients, including body map diagrams and downloading photos and sending to medical records.
Assessment and medical forensic examination of a pediatric patient who sustained multiple dog bites from a neighborhood dog. I report the animal bite to the Department of Health and obtain photos of the patient’s injuries before and after medical intervention. Charting and documentation including body map diagrams and downloading photos and sending to medical records.
Follow-up phone calls to provide results to patients who completed sexually transmitted infections (STI) testing in the emergency department during sexual assault examinations and filing the appropriate paperwork with the State Department of Health on positive results.
Lunch is interrupted early by my trauma pager. A patient who sustained a gunshot wound is due to arrive in 10 minutes. I grab supplies, put on my gown, and prepare for patient arrival.
Gunshot wound (GSW) patient arrives. I obtain multiple photos of the patient upon arrival, working around the trauma team and communicating with the patient (as able) to provide informed consent and obtain a history of events. The patient sustained multiple gunshot wounds. As the patient is taken to surgery, I collect, package, and initiate the chain of custody for their clothing as evidence. These items are surrendered to law enforcement. After surgical intervention, the patient’s injuries should be re-photographed.
A patient with a report of domestic violence arrives. I explain the medical forensic examination, obtain informed consent, and ensure a social work consult is ordered. The patient does not wish to report to law enforcement at this time; however, children were in the home at the time of the altercation and witnessed the violence, so a report to the Department of Child Services is warranted. I provide advocacy and aftercare resources, including how to notify law enforcement if they decide to pursue legal action, and when and how medical forensic examination records may be obtained. Then I begin charting this patient encounter.
Call from operating room (OR) requesting I come to the OR and witness foreign body removal from the patient that sustained multiple gunshot wounds. Educate OR team not to wash or clean off foreign bodies during removal process (if it can be avoided), not to “mark” on the item in any way to identify it, encourage the use of rubber-tipped forceps, and to avoid placing items into stainless steel dishes, as this can alter the surface of lead or brass projectiles/shell casings. Establish and maintain chain of custody on foreign bodies removed from the patient. Documentation includes photographs of foreign bodies removed and body maps.
Finish up charting on previous patients.
A new call to complete a legal blood draw on a patient involved in a motor vehicle crash causing fatality. The patient consents with law enforcement present and is advised that samples will be surrendered to law enforcement. Obtain sample with law enforcement present and surrender samples to law enforcement.
Assisting in the emergency department with various tasks including IV starts, EKGs, and discharges.
Called to assess a patient who reports sexual assault. I complete sexual assault examination with evidence collection and meet with patient and law enforcement. I then later meet with the patient and victim advocate and provide for safety needs, wraparound services, and prophylactic treatment for sexually transmitted infections. Technically, my shift ended at 1900, but I ensure the patient is safely discharged, evidence is locked up, and chain of custody is maintained. All required charting, downloading photographs, etc., will be done tomorrow.
Angie Morris, BSN, RN, CEN, SANE-A, SANE-P, EMT-B, DM-AFN, is the Indiana SANE Training Project Coordinator in Indianapolis, Indiana, USA. She is a member of Sigma’s Omega Chapter.