When victims of sexual assault come to a hospital to be examined, they expect to be seen by a nurse with the proper training and qualifications.
But nurses with those skills aren’t readily available across the state.
According to a recent study from Stephen Weiss, senior health policy analyst for the Virginia General Assembly Joint Commission on Health Care, there is a shortage of nurses certified to perform sexual assault examinations in Virginia.
But that doesn’t mean the level of care isn’t available to patients who need the exams.
“While reports are saying there are so few certified [sexual assault nurse examiners], that doesn’t mean there aren’t other nurses that can’t care for patients dealing with sexual assault,” said Beth Cumbie, a registered nurse and director of patient care services at Sentara Williamsburg Regional Medical Center. “Certification indicates a level of competency and professionalism and ability.”
Cumbie said all SANE nurses undergo the same level of training, but to qualify to become certified, two years of experience is needed before taking the certification exam.
Forensic nursing is a specific practice where the health care and the legal system overlap, according to the study. Those nurses work in a variety of fields from sexual assault to elder abuse to death investigations.
That’s why the training can be fairly rigorous for all forensic nurses.
Cumbie said it involves 40 hours of classroom time, law enforcement ride-alongs, photography training, evidence handling, court room testimony exercises and many practice and mentored exams before a nurse can conduct a sexual assault exam independently.
At Riverside Regional Medical Center, all 10 forensic nurses have gone through the training but only half have taken the official certification test to become a SANE nurse, said Elizabeth Walters, forensic nurse examiner program coordinator.
Walters said the certification is more of a professional credential but doesn’t mean the nurses aren’t qualified to handle sexual assault examinations.
Part of the issue for getting the nurses officially certified is that they don’t make it to the end of their two-year requirement.
“There’s a high burnout rate for forensic nurses,” Cumbie said. “Imagine the patients they interact with, it’s heartbreaking…Nurses want to see justice and when you see people stuck in the cycle of violence, it can be hard.”
About 85 percent of those forensic nurses are in-house at Riverside, she said, meaning there is at least one forensic nurse on staff between Sunday morning to Friday night. There is a nurse on-call for any hours in between those times.
Walters said the main issue is in more rural areas. For example, Riverside Tappahannock Hospital doesn’t have a forensic nursing program because there aren’t typically enough cases to warrant the amount of funding it would require. Instead, hospitals in rural areas typical contract with forensic nursing programs, meaning a forensic nurse will be on-call for a particular area.
“I think we definitely have a shortage,” she said. “[These programs] need to work really well together to make sure all victims have access to the care they need and it’s worrying to hear about victims that don’t.”
Walters said she has heard stories from victims who have had to drive hours to find a hospital with a qualified forensic nurse.
But there’s more awareness being brought to the issue in recent years.
Cumbie said when she came to Sentara three years ago one of her roles was to create a more robust program for sexual assault nurse examiners. She said the hospital realized they weren’t able to provide 24/7 coverage and decided it needed to make a change.
“When [sexual assault] happens to you, you want to get the most private and convenient care,” Cumbie said. “We found we valued that level of care. It was about doing the right thing for someone who had experienced a wrong event.”
Both Cumbie and Walters said the goal is to eventually have more forensic nurses become SANE-certified, but in the meantime programs are also working on training forensic nurses in general.
“We will always continue to work on this and ensure that we can provide this [care] in the most compassionate way possible,” Cumbie said. “I can’t imagine anything that needs to be treated more delicately.”