Supporting Survivors

Anna Brown (she/her) is an NSRH member and our new Training in Abortion Care (TAC) Program Director! Outside of NSRH, she is also a forensic nurse examiner. We chatted with her about the role of sexual assault and forensic nurse examiners, providing trauma-informed care, and how nurses can better support survivors of sexual assault. 

Note: Small edits have been made for length and clarity. 

 

Explain the primary role of a Sexual Assault Nurse Examiner. 

 

In my current role, I’m a forensic nurse examiner. That is an umbrella term, and sexual assault nurse examining is within that, but we do more broad exams for anyone who experiences violence. So that can be intimate partner violence, domestic violence, stabbings, sexual assault, or anything under this umbrella of violence. 

 

On the day to day, what does that type of care look like?

 

For me right now, our program is based within a hospital. So we are within an emergency department, but I have also worked in a free-standing clinic. Anytime someone comes to the emergency room with a complaint of something related to violence, our team is there full-time, 24-hours to provide that care. We work with the primary medical team, but our exam is completely independent. Our team has a lot of autonomy, which is great!

 

Why did you choose to go into that type of nursing care? 

When I was in college, I worked at a sexual assault survivor hotline providing emotional support and referrals. That was my introduction into survivor work. Knowing that I wanted to go to nursing school and already having exposure to what SANE nurses do really inspired me. A lot of times when you’re in nursing school you don’t get exposed to these types of careers, but I was lucky enough to have been exposed to them. I knew that this was work I could do and was really passionate about already. 

 

Did your nursing school have this curriculum or did you have to seek it out on your own?

 

No, not at all. Not even like, “Hey, this is a thing that exists,” much less any access to the curriculum. The hospital that I worked at after graduating nursing school was in partnership with our free-standing sexual assault clinic. If for any reason a patient’s care was a little bit too advanced to be seen at a free-standing clinic, this was the hospital we would go to. I already had the vague understanding of it, but it was definitely something I had to reach out for. I had to reach out to the organization, and I had to seek out the training while I was working full-time. It's a pretty expensive training, and these things are not paid.

 

What is the training like?

 

The training to be able to start working as a SANE nurse: you do a 40-hour didactic (in-class) training, and then you have a clinical requirement. That can look different by program, but everywhere I’ve been is really multifaceted. So you have to watch a certain number of exams, and you have to be supervised on a certain number of exams. But you also do things like shadow the police, shadow a district attorney, etc. All of the kinds of places that a person experiencing sexual assault might have to engage with, we have to shadow so we understand the process that a patient might be going through. 

 

How does providing care as a SANE nurse differ from other types of SRH care? 

 

I think one of the big things that I've noticed is the level of RN autonomy. A lot of nursing advancement will come from advanced degrees that give you more scope of practice. Whereas, I have found in SANE nursing, typically it is you and the patient. Your care and the type of care you provide is completely in your hands. That is something very unique, this level of autonomy in creating the patient experience and doing what you think and have been trained to do. Even while working in an emergency room that has all levels of education, the default is to come to us about anyone experiencing violence because they know we have such specific training that you just don’t get in education. Doctors and nurse practitioners will come to us because this education really isn’t anywhere unless you’ve sought it out. 

 

Then, with the actual care that is provided, there is more inter-organizational work. In a lot of SRH care that I’ve provided, it’s unique to that patient coming to whatever facility you’re in. You do the care and there's maybe some referrals, but the care is pretty limited to that experience. Whereas with forensic nursing and SANE nursing, I have found that the relationships you have with other organizations are so important. This patient is already in acute crisis, and referring them to someone who might not be supportive or who is going to ask them to recount the story but can’t follow-up with resources is doing more harm than good. So, not only am I going to be providing this one-one-one patient-nursing care, but I also need to make sure to build relationships outside of this organization. 

 

So you have to work with people outside of the hospital?

 

Yes exactly. I’m very fortunate with the program that I’m in now; our nurse leader is amazing! They do so much to advocate for patients, and it’s been the first nursing job I’ve had where the whole system is tied together. They really focus on us being involved in advocacy and involved in state legislation to make this experience better for patients. I find that there is a disconnect a lot of times in nursing. We understand that laws impact what we can and can’t do and what our patients can and can’t receive, that’s obvious. But I’ve never been somewhere where it’s so connected to a specific piece of legislation that affects our patients and our jobs.

 

What are the similarities between SANE nursing and SRH care?

 

SANE nursing is SRH care. We are providing sexual and reproductive health care and because of that autonomy, we really have the opportunity to bring in the whole health. The patient came to us, and we are engaging because of a certain instance, but we can also broaden that topic to talk about sex, healing, mental health, and isues that were going on with sex beforehand. A lot of times for people, the SANE exam is the first time they are getting a pelvic exam, and that is a big piece to navigate. It involves explaining what I’m doing and how this exam is not the same as if they were to go to see a regular nurse practitioner or women’s health provider. Because there is so much acute trauma happening, it is really important to navigate consent very explicitly-on-going and all the time. On the flip side, working in other fields of SRH you experience patients who may or may not disclose that they are survivors of sexual assault, and that can change the type of care that is provided. 

 

Someone who experienced sexual assault may also have other SRH needs, so we need to make sure that the places we refer to are trauma-informed. I could never work in SANE nursing and not support things like abortion access because they are so directly linked. My support of abortion access comes from people who have experienced trauma and pushed on to survive and thrive. It is a piece of empowerment to be able to choose how their family and their lives look after power was taken away. They all bleed together. 

 

What is the most rewarding part of your job? 

 

A piece that most people don’t know is that these exams are so long (5 or 6 hours), so you’re with this person one-on-one for a very long time in a very acute situation. Noticing how the behavior has changed at the end of the exam is always something that is most rewarding for me. It encourages me to improve my practice and provide trauma-informed care. A lot of times in this job it is really, really hard to do exams like this with so much trauma happening and then [at the end] it’s like, “OK, bye.” Our clinic does follow-ups and phone calls on all of our patients, but it is hard to be so engaged with someone in such an honest way, then it’s done, and you go to another exam. Being able to see tangibly in the moment how the care you have provided has impacted this person and has the opportunity to impact that person is definitely the most rewarding. 

 

It’s Sexual Assault Awareness month. What would you want other nurses to know about people who may have experienced sexual assault? How can nurses be better at supporting them? 

 

I wish there was more conversation in nursing about what sexual assault really can be. A lot of times it gets watered down to just being a heterosexual rape, and it’s so much more than that. To be able to provide care for people who have experienced a spectrum of violence is something I don’t see talked enough about. Groping is sexual assault. Penetration with an object is sexual assault. Finger penetration is sexual assault. When we as nurses and healthcare professionals are leading the conversation just focusing on penile to vaginal rape, it really does a disservice to our patients who have experienced other forms of sexual assault.

 

If the healthcare profession is only portraying sexual assault as one thing, are people who experience other types of sexual assault going to come in for care? Are people who are engaging in other types of sex or who are LGBTQ going to come forward and feel supported in a healthcare system that has probably not validated them already? Probably not.

 

For example, in Georgia, the only thing that will qualify as a rape charge is penile to vaginal penetration, and that is common in a lot of other states. Part of that comes from the role that healthcare providers play in portraying what rape is, although that is not the only thing that impacts the laws, of course. So the reality is, in Georgia, if someone is choosing to report, it’s important for me to have conversations like, “This is what you define it as, and this is what the law is going to define it as.” I hate having to qualify and name their experience.

 

Do you have any resources for nurses who want to learn more about providing trauma-informed care to survivors?

 

In terms of sexual assault nursing specifically, look up the programs that already exist in the state (that’s if you’re fortunate to have more than one). Most places will have at least one sexual assault organization who is already doing this type of care, and that’s pretty much the only place for someone who wants to be trained in sexual assault nursing.

 

The Academy of Forensic Nursing is a professional organization that hosts weekly webinars and focuses on nurses at all levels. That’s been the place that I’ve gotten a lot of education, and it provides a community outside of potentially the other SANEs you’re working with. It can be a pretty isolating job because it’s typically just you and that patient. So it’s nice to have a community of other people who do such a specific type of work. 

 

For those thinking about learning how to provide trauma-informed care, Beautiful Cervix is a resource that shows pictures of cervices and talks about self-speculum exams. Also, consider following organizations committed to Reproductive Justice like SisterSong, Amplify, the Feminist Women’s Health Center, Access Reproductive Care - Southeast, and your local abortion fund. Honestly, healthcare is really lacking in trauma-informed care. Seeing how communities are talking about this and providing community-based care is how I developed awareness of trauma-informed care. Then I had to translate that and seek out specific healthcare resources for how to provide that.

 

We know that the past year has been hard on everyone, especially nurses. As we enter into May, which is Nurse Appreciation Week, we want to know: what do you do to practice self-care?

 

My program offers a non-religious chaplain, and they’re available 24/7 if we ever want to talk. That’s something that I personally don’t take advantage of, but it’s really nice to have someone who is there for you to unload on. Once I moved into this new forensic job, it was really important for me to make sure my program had mechanisms for encouraging self-care and support because this job is so difficult. It’s important to me to have someone in leadership reminding us that taking care of ourselves is important.

 

I personally take care of myself with a lot of quiet time. If an exam has been really hard or is affecting me in a type of way, I immediately write that down. I’m not necessarily doing a whole three-page journal session, but just writing down immediately how I’m feeling. This is what I have found has been the most hard about taking care of myself in this work -- people don’t necessarily want to hear about my exams and the trauma. And that is totally fair, I signed up to hear about and engage with people’s trauma, but the people in my life who would normally support me didn’t. I’ve had to learn that boundary, but that doesn’t mean that I don’t still have things that are going on that I need to get out and things that are affecting me from these exams. So I have found that right after the exam, jotting down what’s coming up for me is really helpful. If I want to revisit that later, great; if not, that’s fine. It's like a purge for me, and really identifying in that moment what is happening. 

 

I also don’t think self-care has to be something that you pay for. So like: do I want tea right now or do I want to just sit and read my book and have no stimulation. That is something I have found is really important because in these exams you are feeling someone’s crisis, and that energy is very palpable. It’s sensory overload, so when I come out of it I need sensory deprivation. I need quiet time, I need calm, I need no calendar events, no internet. It’s really time in my house, by myself.

 

Do you have a story to tell? We welcome you to submit your story or blog idea to us so we can feature you in our newsletter or on our blog. Email us at [email protected] or message us on social media @NursesforSRH.

 

Share this post:

Comments on "Supporting Survivors"

Comments 0-5 of 0

Please login to comment