If you’re interested in an allied health career, you have a lot of options beyond the traditional health care jobs. To figure out if you’re interested in an allied health career with a particular focus in biological studies you’ll need to evaluate your interests further. You may be drawn to a particular type of health care work because of prior experiences. Someone whose family has been affected by an inherited disease might decide to be a genetic counselor, for example.
Or, if you’re a big fan of one of the CSI shows or other shows related to true crime on television, you might be interested in working as a forensic scientist.
Considering your own personal interests is a good start, but you need to do more. You must factor into your decision information about current work opportunities, longer-term job prospects and earnings potential. Some jobs require extensive education, but some do not. You might be able to get a job with a two-year degree, but some employers prefer a four-year degree. You need to decide if the additional training is worth it to you.
Consider on-going training and certification requirements as well. We will discuss the specific educational requirements required to pursue careers in biological science fields later in this article.
Careers in Biological Sciences
Did you know that some biologists work with drug companies to research and test new products? They also wind-up in government organizations to study the economic impact of biological issues like the extinction of wild animals, the protection of natural resources and environmental pollution. Biologists in areas such as bioinformatics and computational biology use mathematics to solve biological problems, such as modeling ecosystem processes and gene sequencing. Journalists and writers with a science background write articles about up-and-coming biological issues. Open up one of your biology textbooks; an artist with a strong background in biology undoubtedly created those illustrations.
Clearly, those with a background in biological sciences are needed in a variety of different fields.
There are so many directions to take an interest in an allied health care career that it may be difficult to narrow down your choices to a few. Once you do, however, you can begin to investigate the educational requirements and schools that offer programs for training in these fields. If you know you’re not sure what you want to specialize in, look for a training school that offers a big variety of possibilities. That way, if you do change your mind, you may be able to switch careers without changing schools.
Every day science is learning more about human genetics and especially about how a person’s genes can affect their health. And you don’t have to have a Ph.D. in genetics to get involved. You could be a genetic counselor—someone who works with people who have genetic disorders, inherited diseases, or those who are at risk for genetic disorders. Genetic counselors work with other people in the medical profession such as medical specialists. Many provide prenatal counseling to people, but other types of jobs are also possible.
The work pays well, but not as much as some allied health care jobs. In 2002 the median income for counselors with a master’s degree and five years experience ranged from $47,000 to $56,000. Specialization in a specific disorder might help increase the range.
As a genetic counselor, your workday may include one-on-one sessions with people who are frightened or upset because they are discovering information about their genetic disorder. Therefore it is important that you posses a good bedside manner. Often you will have to explain, in every-day language, patients’ options and convey information about their disorder. If the problem has not yet been identified, you may work with them to learn more about their family’s medical history and order testing.
Some genetic counselors spend the majority of their time educating people and serving as a resource for patients and other health care professionals. Others research specific genetic diseases—and not necessarily in the laboratory. Genetic researchers sometimes work in communities of people who have close genetic ties, such as the Amish communities in Pennsylvania and Ohio. By talking to people in these communities, the counselors are able to track the spread of inherited diseases.
As a genetic counselor, you could also find work at a biotech company researching, designing or selling tests related to genetic disorders. As more becomes known about genetic diseases, demand for people who are able to do this kind of work will continue to grow significantly.
Working conditions for genetic counselors vary with the type of work they do. If you work with people as part of a health care team, you might spend most of your time in an office environment, even if the office is located in a hospital. Weekend and night hours aren’t required. On the other hand, going out in the field may require you to meet with people in their homes at their convenience.
To become a genetic counselor, you will have to get a master’s degree from one of 23 accredited U.S. graduate programs. (For a listing, go to www.gradschools.com/ listings/menus/genetic_cnsl_menu.html.) To become a certified counselor you must complete enough documented clinical work and pass the American Board of Genetic Counseling’s certification exam.
To be admitted to one of the master’s degree programs, you must first complete your undergraduate training. A relevant major such a biology or chemistry will help because it will help you meet some, if not all, of the graduate program pre-requisites. Undergraduate degrees in allied health including nursing or public health also provide a good foundation. The prerequisites for master’s degree programs in genetic counseling vary, so you have to research the requirements of particular colleges or universities. To be admitted to the Arcadia University (Glenside, Pa.) program, for example, you need to have taken biology, chemistry, statistics and psychology as an undergraduate. There are other requirements such as a satisfactory score of 1,000 or higher on the Graduate Record Examination.
If you know you’re interested in a career as a genetic counselor, the best approach is to start checking out master’s degree requirements while you’re still an undergraduate. Doing so will help you avoid having to take extra classes to meet pre-requisites.
Some programs have a specific emphasis. Brandeis University’s (Waltham, Mass.) master’s degree genetic counseling program has a special emphasis on inherited diseases that can cause disabilities. It is one of the few such programs in the country. Beth Rosen Sheidley teaches in the genetics program at the University, but worked for years as a genetic counselor working with under privileged people. She was interested in severely disabling diseases in which genetics are known to play a part such as autism and bi-polar disorder. Of her experience at the college, she says she chose Brandeis because of the focus of the program. “Among all of the genetic counseling programs in existence in 1992, Brandeis was the only program that focused on disability awareness issues. Today it is still the case that Brandeis puts an emphasis on exploring the perspectives of individuals and families living with disability.”
Real World CSI
If you have ever watched any of the CSI programs on TV, you probably have an idea about the kinds of work forensic scientists do. Whether that idea is totally accurate is debatable, but if you find the shows fascinating, then it’s worth exploring this kind of work in the real world. You’ll find the majority of jobs are with local and state governments, and you won’t spend much of your time in a routine office environment. You’ll either be in the crime lab, a morgue or on the crime scene.
The word “forensics” actually means “according to the law,” so people who do forensic work apply scientific methods to all kinds of legal issues. There are forensic accountants who examine company financial records, but most of the people who work in the forensic field examine physical evidence. There isn’t a lot of information about salary ranges for people who work in this field, but beginning salaries for crime scene technologists can start at $20,000. More experience means more money—experienced crime lab or crime scene personnel can make as much as $85,000. Lab directors and medical examiners can earn $100,000 or more. The bigger the city or state, the more money they pay. A lot depends on a particular city’s budget and crime rate.
According to Dr. Dale Nute, adjunct faculty member of the school of criminology and criminal justice at Florida State University, there are six general areas of forensic science practice: medical examiner, crime laboratory analyst, crime scene examiner, forensic engineer, psychological profilers, and people who provide specific forensic technical assistance (composite drawing, etc.).
He says that, of the group, medical examiners make the most money. They are the people who conduct autopsies of suspicious deaths, which can mean working odd hours and requires a medical degree. If you’re interested, get started in medical school, he says. “Select a residency that provides a forensic emphasis.” Taking a crime investigation and detection course is also a good idea and probably won’t be available in medical school.
Crime laboratory analysts are the folks who hang out in the crime lab looking at samples taken from a crime scene, including body fluid, tissue, hair and fibers. The work can be routine, but the hours are reasonable. Doing this kind of work usually requires a four-year undergraduate degree in a natural science. Nute recommends a degree in chemistry unless you’re interested in doing DNA analysis. In that case, a biology major with an emphasis in genetics would be required.
Crime scene examiners (also known as crime scene investigators) spent most of their working hours making detailed studies of crime scenes. They often try to reconstruct the crime using blood spatter patterns, examining bullet holes, and looking for other clues. After making the on-scene analysis, they usually need to write up their findings. So, people who do this kind of work have to like paying attention to detail and be willing to put the detail down on paper or testify to them in court.
Nute recommends a four-year degree in “either a natural science with an emphasis in law enforcement and crime scene processing or a criminal justice degree with an emphasis in natural science.” He doesn’t feel that an undergraduate degree in forensic science is necessary because he feels that learning how to do science as an undergraduate is the best preparation for a long-term career. Specialization can be done in graduate school. That said, however, there are a few dozen colleges and universities that offer bachelor’s degrees in forensic science.
You don’t need a bachelor’s degree at all for some of these jobs. You can get started as a crime scene technician, though, with as little as a certification earned online. Kaplan University offers such a program. There are also two-year programs that will get you on the crime scene in a legal way. To get a job as a crime scene examiner, though, a four-year degree along the lines of what Nute suggests is the way to go. Check local and state requirements carefully for additional requirements. Some require you to be a police officer first or require certification.
If you want to spend more than a few years studying, you’ll be preparing yourself for some of the best paying jobs, such as a lab director. With a Ph.D. in forensics you can consult, go into administration or teach at the college or university level. To find out more about forensic science careers, visit the Web site of the American Academy of Forensic Sciences at www.aafs.org.
Good Jobs, Excellent Prospects
Pretty much all allied health careers are on track to chug along at a healthy pace for the foreseeable future. But not many areas of allied health are as exciting as those in forensic science or as potentially life-altering as the work done in genetic counseling. And that’s just the beginning of the fields you can explore in biological science. You can travel to locations all over the world to research the natural world; develop public health campaigns against life-threatening diseases; work towards environmental management and conservation; or dedicate your life to educating others in the classroom, lab or in the field. Or as a biotechnologist you could work to improve the products we use everyday, or enhance the technology we to adapt agriculture, food, science and medicine.
From the very beginning, the study of biology teaches one to ask questions, explore the world around them and solve existing problems. If you possess that innate interest and curiosity, then this is the field for you. And no matter what career you choose in the biological sciences, you will be pursuing a career that is immensely satisfying and inspiring.
In the late 19th and early 20th centuries, many innocent black men were wrongfully lynched without trial in the Jim Crow South, often based on trumped-up charges of raping white women. Today, courts decide rape cases, and evidence collected by nurses can exonerate the innocent and identify the real perpetrators.
This careful work is the realm of sexual assault nurse examiners (SANEs), who make up the largest sector of forensic nursing, a specialty that blends nursing with the judicial system. In addition to working with victims of sexual assault, domestic violence, child abuse and elder abuse, forensic nurses collect evidence at crime scenes and assist with death investigations. They collaborate with police detectives and testify in court. Some forensic nurses work with prison populations and psychiatric patients. But regardless of their particular job focus, all forensic nurses have two key skills in common: unwavering objectivity and attention to detail.
SANEs work with victims of rape as well as other sexual assaults that do not involve penetration. They are trained to perform forensic examinations of victims, collect and package evidence for rape kits and counsel rape victims.
First recognized as a specialty by the American Nurses Association 13 years ago, forensic nursing still does not involve more than a thousand full-time jobs, by some estimates. SANEs and other forensic nurses typically work on a part-time, on-call or consulting basis, in addition to holding a full-time nursing job, usually in the same hospital. But nurses who have chosen this specialty say the work is unusually rewarding and contains future promise for more full-time career opportunities as the demand for these professionals increases. What’s more, acquiring training and skills in forensics can make nurses more valuable to their current employers, even if they are not able to work exclusively in the forensic nursing field.
A Day in the Life of a SANE
For more than a year, Geretha Diamond, MSN, RN, RN-BC, CASAC, SANE-A, has worked as a forensic nurse in the Bronx, which has the highest rape rate in New York City. Two to three times a week, she is on call for 12-hour blocks as a member of the Bronx Sexual Assault Response Team (SART) at North Central Bronx Hospital, in addition to her regular job as a nurse educator in the hospital’s psychiatric unit.
A SANE call comes in once or twice a week. One recent call awoke her at 6:30 a.m. on a crisp Saturday in mid October. Arriving at the emergency department, she met a withdrawn, visibly shaken 25-year-old woman. After making sure the woman had no serious injuries that needed treating, Diamond started the interview. The woman had been sexually assaulted by a man who was an acquaintance of one of her friends.
“Part of my job is to make sure she feels safe,” Diamond says. Victims who feel safe are more likely to give a full description of the crime and press charges against their attacker, she explains.
Diamond closely inspected the patient’s genital area for semen, hair strands, fibers and other evidence, packaged and labeled each piece, and put them in a rape kit for DNA testing. Looking for bruising and other signs of rape, she took photos with a digital camera and a culposcope, a microscope with a camera attached. She also gave the victim advice on how to deal with the possibility of sexually transmitted diseases and pregnancy.
The suspect in this case was arrested and the evidence Diamond collected was used against him in court. Studies have shown the courts prefer evidence that is collected by SANEs because it contains fewer errors than evidence gathered by other ED staff, leading to higher conviction rates and fewer wrongful convictions.
Not In It for the Money
Many nurses and students are intrigued by the idea of working in forensic nursing, viewing it as an exciting career alternative to bedside nursing. The reality, however, is that jobs for forensic nurses are still rare and the pay tends to be relatively low—about $2 an hour for on-call time and one to one-and-a-half times base pay for work on a case, which typically takes three or four hours.
SANE work is “time-consuming, it’s not paid that much and it’s stressful, particularly if you go to trial,” says Sultan Torshkhoez, MD, director of health and forensic services at the New York City Alliance Against Sexual Assault.
Karen Carroll, RN, SANE-A, NY-SAFE, associate director of the Bronx SART, agrees that it’s not easy to recruit forensic nurses, despite its glamorization in TV cop dramas. “It’s not for everyone to get out of bed at 3 o’clock in the morning when it’s snowing and it’s cold [to visit a crime scene or examine a victim],” she says.
Despite these drawbacks, nurses who do choose to become trained and certified as SANEs often do so because they are passionate about advocating for crime victims’ rights. Carroll, for example, is a survivor of sexual assault who did not want other rape victims to have to go through her unpleasant experience of being examined by a doctor who had no idea how to collect the evidence for her rape kit.
While the International Association of Forensic Nurses (IAFN) reports that SANEs are the largest group of nurses within the specialty, it estimates that only 600 to 700 of the 5,700 hospitals in the U.S. offer SANE services.
The problem is that cash-strapped hospitals are wary about financing programs they perceive as mainly helping law enforcement and not health care, Torshkhoez says. The U.S. Department of Justice is the primary funding source for SANE programs, but the pot has been shrinking under the Bush administration, he adds. Some states, like New York, provide extra funding for hospitals that want to offer SANE services, but it’s still not enough to cover the total cost of such programs—about $150,000 a year.
Health and Hospitals Corp. (HHC), New York City’s public hospital system, uses SANEs at all of its 11 hospitals, which include Carroll’s facility in the Bronx. But Torshkhoez reports that only seven of the city’s 45 private hospitals have SANE programs. To keep its programs cost-effective, HHC uses an approach in which one SANE program is shared by several hospitals—a solution that Torshkhoez would like to see the private hospitals adopt.
Minority SANEs Needed
While the job market for forensic nurses remains limited, there’s no denying that more minority nurses are sorely needed in this specialty. In a community like the Bronx, which is predominantly African American and Hispanic, Carroll says there is a great need for culturally knowledgeable SANEs who share the same ethnic background as their patients. At some hospitals, the forensic nurse may be the only caregiver of color that a rape victim sees.
Even though about one-third of the victims treated in Carroll’s program are Hispanic women, and half of them don’t speak English, she has not yet been able to hire a Latina SANE, so her team has to use interpreters or a language phone.
Cultural sensitivity and the ability to establish a trusting relationship with patients are important, because SANEs often deal with rape victims who are unwilling to report the crime. Carroll says this is a particular problem among African American women. She believes misogynistic rap lyrics legitimize rape and that black churches don’t encourage reporting. She was shocked when boxer Mike Tyson finished his prison sentence for rape and was greeted with what she calls “a hero’s welcome” in nearby Brooklyn.
Sexual violence against women is an even more daunting problem in Native American communities. American Indian and Alaska Native women have the highest sexual assault rate of any ethnic group in the country—fully 2.5 times higher than the national average, according to the Justice Department. Yet a 2007 research study by Amnesty International found that many Indian Health Service facilities have no nurses on staff who have been trained as sexual assault nurse examiners.
Desiree Allen-Cruz, domestic violence services coordinator for the Confederated Tribes of the Umatilla Indian Reservation in Pendleton, Ore., has cobbled together Justice Department grants to train two SANEs, one of whom is Native American. But she has not yet succeeded in convincing local hospitals to use them. For example, Allen-Cruz reports, one local Catholic hospital objects to use of the morning-after pill, which SANEs may recommend to a rape victim to prevent pregnancy.
Allen-Cruz, who is of Cayuse, Umatilla, Walla Walla and Nez Perce descent, believes Native American SANEs can help break down cultural barriers that might otherwise prevent Native rape victims from seeking treatment. “[Many Indian women have] a great deal of distrust of [Caucasian health care professionals],” she says, noting that in the 1960s and 1970s it was common for white doctors to secretly sterilize Native American women who had come to them for routine operations, such as appendectomies.
Colleen Palacios, RN, SANE-A, a forensic nurse who works at Yukon Kuskokwim Health Corp. in Bethel, Alaska, says she has been able to bridge cultural differences with her Alaska Native patients. She sees about 100 rape victims a year, most of them flown in from remote rural villages.
“There was a big learning curve when I first got here,” says Palacios, who is originally from San Antonio, Texas. “I didn’t understand what life was like in the villages. You have to build the trust and you have to understand that life in the village is all about survival. Culturally, I need to keep in mind that I must meet the patient’s needs, such as having a safe place [to stay].”
Now that SANEs have shown they can improve collection and documentation of evidence in rape cases, the next logical step would be for the judicial system to make greater use of forensic nurses’ expertise in other types of crime cases, such as domestic violence, elder abuse and murder investigations. But while more of these opportunities may open up at some point down the road, there is currently very little funding in these areas and few nursing positions exist for them.
Of course, stabbings, shootings and murders are meticulously documented, but this is traditionally the work of police crime scene technicians who are not nurses. Many forensic nurses, however, think their profession gives them a competitive advantage for performing these jobs, because of their clinical background. At a death scene, for example, “a nurse would think of opening the medicine cabinet to look for digoxin [or other prescription drugs that could provide clues to the cause of death],” Carroll says.
Another emerging opportunity for forensic nurses, especially SANEs, is starting their own consulting businesses. This option is best suited to experienced, entrepreneurial SANEs who are very self-directed.
After working in three hospital-based SANE programs in the Los Angeles area, Cari Caruso, RN, SANE-A, decided to contract her services directly to law enforcement agencies. She spent an initial investment of $9,000 to purchase equipment so that she could examine rape victims in her own office, away from the hospitals. She believes the hospital setting is usually unnecessary because only 2% of rape victims have serious injuries.
Today her business, Forensic Nurse Professionals, based in Pasadena, Calif., is thriving. Caruso has signed up with three police departments, including the one in Pasadena, to do SANE work for them. Still, she says she earns better money teaching SANE courses at a community college and working as a legal consultant for law firms representing defendants in rape cases.
Education and Certification
Despite the scarcity of job possibilities, forensic nursing education programs are flourishing. The IAFN Web site lists 36 graduate and certificate programs in the specialty, including those offered by Johns Hopkins University School of Nursing, Vanderbilt University School of Nursing, Duquesne University School of Nursing and the University of Washington School of Nursing, to name just a few. There are also online forensic nursing certificate programs, such as those offered by Kaplan University and Fitchburg State College.
Nurses do not learn forensics in their basic education, says Barbara Simmons, PhD, RN, a clinical assistant professor at the University of Illinois at Chicago College of Nursing. She teaches an advanced practice forensic nursing certificate course to students at the graduate level.
Of the 20 students currently taking her course, about a quarter of them are nurses of color. Minority nurses are “a good fit” in forensics, she says, because “they can understand many cultural nuances that others wouldn’t.”
Forensic nursing is “a very promising field, but the job opportunities are not there yet,” Simmons warns. However, she adds, earning a certificate in forensics can provide immediate benefits for experienced nurses who want to enhance their skills in their current jobs. For example, emergency nurses who have learned how to do evidence collection can provide additional value to the EDs that employ them.
Compared with forensic nursing master’s degree or certificate programs, sexual assault nurse examiner training is relatively short, typically a five-day, 40-contact-hour didactic course. Classroom and online SANE training programs are offered throughout the country by a variety of organizations, including nursing schools, community colleges, hospitals, and even state and local law enforcement agencies. After completing the academic course, nurses must also complete a clinical preceptorship in which they gain experience by working on several cases under the supervision of an experienced SANE.
Although SANEs do not have to be board-certified to practice their specialty, earning national certification can definitely boost their marketability. The IAFN, through its Forensic Nursing Certification Board, offers Sexual Assault Nurse Examiner-Adult/Adolescent (SANE-A) and Sexual Assault Nurse Examiner-Pediatric (SANE-P) certification exams twice a year at numerous locations around the country.
Just the Facts, Ma’am
While forensic nurses need to be culturally sensitive, they must also be scrupulously impartial. This became a key issue in the racially charged Duke University lacrosse team case in 2006. A young African American woman, hired to be a stripper at a party hosted by the team, claimed she had been gang-raped by three white members of the team.
The SANE who examined the woman wrote a report which found “diffuse edema of the vaginal walls,” but no abrasions, tearing, bleeding or DNA evidence. However, when questioned by a police detective a week later, the nurse said she found evidence of “blunt force trauma.” This became a key factor in the decision to prosecute for rape.
It turned out the case was weak and eventually the charges against all three students were dropped. A 2007 report by the North Carolina attorney general found that the nurse had based her opinions not on the evidence—or lack thereof—but on the alleged victim’s demeanor and verbal statements.
When hiring forensic nurses for her sexual assault response team, Carroll says she looks for applicants who are compassionate but impartial. She also wants candidates to have at least two years of nursing experience.
Diamond, who had a master’s degree and many years of experience as a nurse when Carroll hired her, believes it is important to create an emotional bond with patients who are victims of violence. The fact that she is an African American nurse helps make it easier for black rape victims to trust and bond with her, she says. “When I come into the room and start to speak to them, you can see they become more comfortable.”
But she also strives for objectivity, which can mean not trying to judge victims or guess their motives. When police detectives are puzzled by prostitutes making rape charges, Diamond tells them: “When you say no to someone, it means no, even if you’re a prostitute.”
While Diamond does not champion the rape victims’ cause, she also does not question their claims. “My job is not to determine whether the victim was assaulted or not,” she says. “I’m there to gather evidence.”
Although she didn’t know it then, a personal trauma in 1994 changed the course of Karen Coleman’s professional career. Coleman, an emergency room RN at the time, was raped by her then-husband, who had been barred from her home by an order of protection. “When I went to the hospital after the assault, I had a physician perform the evidence collection kit and he didn’t have any idea what he was doing. He had no clue,” she recalls. “He wasn’t sure about the process. He wasn’t familiar with collecting evidence. I had to show him how to do my own rape kit.”
Today, Coleman, who is African American, is the Sexual Assault Nurse Examiner (SANE) coordinator for Victims Assistant Services in Elmsford, N.Y. It was by chance, Coleman says, that she learned about the field of forensic nursing. Three years after surviving her assault, she came across an article about nurses being specially trained to do forensic examinations of rape victims, and she learned that a SANE program was being considered in her county.
Coleman attended several meetings about the new program, which she then was asked to coordinate. “I thought it was ideal, because I felt nurses could do these exams,” she says. “Having been a victim myself and receiving a less than optimal exam, I made it my mission in life to make sure no one else would ever have to go through that.”
Coleman is now responsible for the recruitment, hiring and retention of SANE nurses for her program, which operates in 11 of the 14 hospitals in Westchester County. Her position is full time but the nurses hired into the program work on call.
“Forensic nurses ensure that evidence is collected appropriately and can be used in a court of law,” Coleman notes. “It’s important that crime victims know about us. All you hear about are the horror stories of waiting in the hospital and having physicians like the one I had who don’t know what they’re doing, who are less than compassionate and who tend to judge the victim.”
I’ll See You in Court
Forensic nursing is a relatively new field that combines the health care profession with the judicial system. In 1995 the American Nurses Association officially recognized it as a specialty of nursing. In April 2002, the International Association of Forensic Nurses (IAFN) held the first international certification exam. The 71 nurses who passed the exam earned the international designation SANE-A (Sexual Assault Nurse Examiner-Adult and Adolescent).
Coleman plans to take the exam when it is offered again in October, following IAFN’s Tenth Annual Scientific Assembly in Minneapolis. In addition, five states–Kentucky, Maryland, New Jersey, South Carolina and Texas–have their own certification exams for sexual assault nurse examiners. Texas and Maryland offer separate certifications for adult and pediatric cases. While certification is not mandatory in order to work as a forensic nurse, Coleman believes it gives added credibility. This is important because one of the key parts of the forensic nurse’s role, in addition to performing the comprehensive exam in the hospital, is to give testimony in court.
“The legal system is beginning to recognize the expertise of forensic nurse examiners and we are beginning to be qualified as experts,” Coleman explains. “If you can say when you are giving your credentials that you have taken a state-approved training, that you have taken a state-approved or nationally approved certification exam and you passed it, then at least you are able to say that you have met the standards for this profession of nurses and that you can be considered an expert with more knowledge than the average person in the field of sexual assault.”
When testifying in court, forensic nurses can be qualified as either an expert witness, who is allowed to give his or her opinion, or a fact witness (who, as the name implies, can only state the facts). This ruling is made by the judge.
“The prosecutor will present you, knowing you will discuss your background, the number of cases you have performed, what you do and what your job is,” says Jean Epps, RN, BSN, coordinator of the Sexual Assault Nurse Examiner Program at Howard University Hospital in Washington, D.C. Epps, who is African American, is a CFNE (a forensic nurse examiner certified by the state of Maryland).
When testifying at trials, forensic nurses are there to present information in an objective way. “Even though the prosecution may call you, you are not there to speak for or against the victim or the defendant. You are just there to present the facts of the examination,” states Epps, who also plans to take the IAFN SANE–A examination in October.
What Minority SANEs Bring to the Table
Because forensic nursing is such a new and rapidly growing specialty, it offers tremendous opportunities for both recent graduates and experienced RNs looking for a career change. Moreover, there is also a strong need for better minority representation in the field.
According to Coleman, “there are just not that many of us [nurses of color] working in this area. However, approximately 50% of the victims we treat are African American. You can probably add another 20% who are Latina.”
If minority women knew that there were more forensic examiners who were also people of color, they would be even more likely to seek medical assistance, Coleman believes. “During their experience of being a victim, they are going to be coming into contact with law enforcement people who, chances are, will not look like them,” she says. “I just think it adds a level of comfort. I am not saying, however, that because I am African American I am any better able to take care of a rape victim. I just think it is helpful to see someone that kind of looks like you among all the people you are gong to have to deal with.”
This victims’ advocacy role is important to Coleman, who has become a vocal supporter of her chosen field. She often gives talks about forensic nursing and is interviewed by the media. She appeared in the Lifetime television documentary “Fear No More,” which told the stories of five women who were victims of violence. “Rape is a conspiracy of silence, and those who are able to talk about it should do so,” she insists. “There is no shame in being a victim.”
Tools, Techniques and Teams
Helping More Than Just Rape Victims
While much of the focus of forensic nursing is on the sub-specialty of sexual assault, forensic nurses are not limited to working on these types of cases. Many forensic nurses work with victims of other types of interpersonal abuse, including domestic violence, child and elder abuse/neglect and physiological/psychological abuse. Forensic nurses can examine victims of near-fatal or fatal traumas, such as shootings or stabbings. Some even work as death investigators.
Lucretia Braxton, RN, sees a wide range of patients in her role as a forensic nurse examiner in the emergency room at the Medical College of Virginia at Virginia Commonwealth University. Braxton, who is African American, trained at the Virginia State Police Academy in Fredericksburg, first as a SANE and then as a Forensic Nurse Examiner (FNE). She earned state certificates in both areas at the academy, but Virginia doesn’t certify nurses in these areas.
The emergency department where Braxton works is the leading trauma center for the state of Virginia. In a typical month, Braxton estimates that the department’s forensic nurses handle 20 sexual assault victims and ten homicide victims. The murder victims eventually go to the medical examiner’s office, but while the ER team is working to try to save the person’s life, the forensic nurse collects evidence. The nurse may even follow the victim up the operating room to complete the evidence collection. The center also sees quite a few domestic violence victims. “These victims don’t always report it, so it is hard to quantify how many there are,” she adds.
Objectivity is a key part of being a forensic nurse, Braxton believes. “You have to know when to draw the line between being an empathetic nurse and being there just to collect your evidence,” she explains.
In cases of stabbings or shootings, forensic nurses collect such things as bullets and any debris that is on the body, such as leaves that may have clung to the body from the crime scene. They are also in charge of removing the bloody clothes the victim was wearing and putting them in a special wrapping. These nurses also photograph and measure wounds. If the victim dies, the forensic nurse examiner will often collaborate with the medical examiner on the case, answering any questions he or she may have regarding what the nurse saw.
Braxton says a background in emergency nursing is helpful for nurses who want to move into the forensic field. “It gives you the experience you need in how to work with trauma victims,” she explains. “When the victims are brought into the ER, you see the very initial trauma right there. If you are trained and experienced in emergency nursing, you know how to react to what you are seeing, what you need to do, what the doctor needs, what he is going to call for.” As a forensic nurse, she adds, you are also trained to know what things not to touch, so that evidence is not accidentally destroyed.
A Ground-Floor Opportunity
Not only is forensic nursing an exciting and rewarding career, there is also a growing demand for nurses with these specialized skills. “Forensic nursing is expanding, more so than it used to be,” Braxton reports. “Forensic nurses are being incorporated into the emergency room setting now. In the past, hospitals felt that if evidence needed to be collected, any nurse could do that. Today we are finding out that the more expertise a nurse has in knowing exactly what should be collected, the better the evidence turned over to the detectives will be. And that can help lead to a better outcome in catching the perpetrator.”
Nursing schools are starting to recognize this trend as well. In September, Johns Hopkins University School of Nursing in Baltimore began offering an MSN–Clinical Nurse Specialist, Forensic Nursing Focus program. The school tapped Daniel Sheridan, RN, PhD, a forensic clinical nurse specialist at Johns Hopkins Hospital Department of Emergency Medicine, to create the new program.
“I convinced them that there was a need for it,” says Sheridan. “I have been a forensic nurse for many years, and Hopkins School of Nursing realized there is a growing need and a growing interest in this whole area.” Since the field is in its infancy, he adds, forensic nurses often have the advantage of helping to create their own positions, and even whole forensic nursing departments.
Prior to joining Johns Hopkins, Sheridan worked as a full-time employee for the state of Oregon, investigating abuse of institutionalized people who were mentally and cognitively impaired. He was the only member of the team who was a nurse. “This is a brand new area and people are still carving out new and innovative roles for the forensic nurse,” he emphasizes. “You have to really go out and be able to market yourself, to explain that you have specialized experience and training that are going to help an institution. This field really is at the ground level.”
Karen Coleman agrees, adding that the satisfaction her job brings her is amazing. People often ask her how she can work in such a difficult and traumatic field. “But once you get into this work, you know that everything you do is going to help a victimized person, and hopefully lead to a conviction in a court case,” she says.
Coleman adds, however, that helping to convict criminals is not her primary goal. “My focus is to help that victim get through that medical experience,” she maintains. “I hope that as we get better at taking care of victims, collecting evidence, providing support and linking them up with services, more victims will come forward and cooperate with law enforcement and there will be better outcomes in court.”