The Investigative Specialty Of Forensic Nursing
by Sara Courson, BSN

Forensic Nursing Job Search

Quick Links:

What is Forensic Nursing

Sexual Assault Nursing Examiner

Legal Nurse Consultant

Medical Examiner Nurse Investigator

Alternative Setting for Practice

Education

Specialty Certifications

Entry Advice

Salary Ranges

Associations

Training Programs

Continuing Education Programs

References

Publications

Contacts

What is Forensic Nursing

The generic term, forensic, means, "pertaining to the law, legal" as defined in Tabor's Cyclopedic Medical Dictionary (Davis, 1997). Therefore, the use of the term forensic nursing applies to those instances where nursing professionals are interacting with the law or legal issues. According to the International Association of Forensic Nurses (IAFN, 1999),

"Forensic Nursing is the application of nursing science to public or legal proceedings; the application of the forensic aspects of health care combined with the bio-psycho-social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity and traumatic accidents."

This definition is mind boggling in the scope of activities it covers. Forensic nursing involves many subspecialties and practitioners are found in multiple roles within healthcare settings and the public sector. Nurses, with specialty training, are assisting the legal community in gathering evidence from victims and crime scenes, interviewing victims of crimes, assisting with or determining cause and time of death, and counseling individuals with criminal backgrounds or mentally disturbed offenders.

A sampling of the various arenas in which forensic nurses practice, include: sexual assault nurse examiner; forensic nurse investigator or forensic nurse death investigator, associated with the medical examiners or coroners department; forensic correctional nurse; forensic legal consultant; and forensic psychiatric nurse.

Nurses have been serving in these various roles for years, some sources (Lynch, 1999) even cite as far back as the 18th century, even though the forensic nurse designation wasn't established until the 1990's. In the article entitled, Shattering the Myths About Forensic Nursing (Nelson, 1998), Valerie Nelson states that 1992 was the first time the term forensic nursing was used, during a meeting of sexual assault nurses in Minneapolis. This led to the establishment of the IAFN, an organization formed to educate, promote and support individuals involved with the specialty of forensic nursing as well as the nursing profession and the public in general. The American Nurses Association, has recognized forensic nursing as a subspecialty since 1995, and the Scope and Standards of Forensic Nursing Practice (ANA, 1997) was established in 1997.

The following section will cover details on a few of the more familiar roles being seen today.

· Sexual Assault Nurse Examiner

A role that is quickly gaining recognition is the Sexual Assault Nurse Examiner (SANE) or Sexual Assault Forensic Examiner (SAFE), these terms are used interchangeably. This nurse is mostly employed in the emergency room setting, although can be self-employed and on-call to a specific facility or multiple sites. The SANE nurse is specially trained to be a part of the sexual assault response team, which is a community-based resource offering crises intervention, support from law enforcement agencies and healthcare programs for victims of rape. The SANE nurse would be available in the hospital setting to interview the victim (which could be male or female), collect evidence, perform physical exams, record findings, and could also serve as an expert legal witness when the case goes to court. Many programs are actually finding that there is a higher conviction rate when SANE programs are being used due to the diligence used in evidence gathering and recording findings. Also, it seems that victims are more apt to report instances of rape when they know that their community hospitals have these programs in place. The reasoning behind this stems from the fact that the victim is attended to in a compassionate, confidential, and consistent manner, which decreases the amount of stress involved in presenting to the ER after an assault.

In Pennsylvania, the use of SANE nurses and sexual assault response teams are being
vigorously advocated by the Pennsylvania Coalition Against Rape (PCAR), a non-profit organization dedicated to educating the public on issues of sexual abuse and supporting victims of violence. Many hospitals have responded by sending nurses to training programs that are sponsored by PCAR, then positioning these nurses in the emergency rooms. These nurses are then available to work with victims who present on their shift, or act as resources for their departments in the collection of evidence, the ideal way of working with the victims in the ER, and the appropriate recording of data.

· Legal Nurse Consultant

Many people wouldn't think of legal nurse consulting as a forensic specialty, but then
again, it is the combination of nursing and the law, which fits the description of nursing forensics. In any legal case where medical issues are involved, nurse consultants could be considered to be practicing forensics. For additional details, refer to the Legal Nurse Consulting article present in PSNA's Career Center.

· Medical Examiner Nurse Investigator

Nurses in this role may go by different titles, such as death investigator, forensic nurse investigator, or deputy coroner. In some counties, nurses may actually practice as coroners, depending on the county's regulations for that position, or assist the medical examiner or forensic pathologist in that jurisdiction. Nurses are highly regarded for their medical background, investigative abilities and documentation skills that they bring to this position.

Death investigators have tremendous responsibilities. If working out of the coroner's office, they typically can work scheduled time in the office as well as taking on call time. Duties include responding to the scene of an accident or suspicious death, collaborating with detectives, pronouncing death, examining the body, taking tissue/blood samples, taking pictures of the body and the scene, keeping meticulous records and arranging for the body to be taken to the morgue or coroner's office for autopsy. During autopsies, nurse investigators work side by side with the forensic pathologist in collecting evidence to send to the lab for examination.

· Alternative Settings for Practive

- Tissue and Organ Donation: In large trauma facilities, the skills of an experienced, knowledgeable forensic nurse is a significant contribution to the crisis intervention team working with families of potential donors. The nurse needs to know the specifics regarding the "legal framework of organ donation, familiarity with brain death criteria, and confident skills in required consent request…The nurse must meet the legal requirements and at the same time provide emotional support to the grieving family." (Lynch, 1995) For further information contact C.O.R.E. or the Gift of Life program, in the Associations section of this article.
- Pediatrics: Forensic nurses may specialize in the recognition, evaluation, treatment and support of young victims of abuse through various facilities and organizations. Child abuse and neglect cases can be handled by forensic nurses depending on the protocols for that facility. Each facility will have protocols which specify who may examine and counsel pediatric victims. In some cases, SAFE nurses may not have authority to work with these patients.
- Correctional: Correctional nurses have a great deal of autonomy, provide acute and chronic assessments, dispense medications, manage acute illness and injuries, perform health screenings, and educate inmates on various health related topics. Correctional facilities also reflect the society at large, therefore the incarcerated population is aging and has a wide range of health issues that need to be addressed while serving their sentence. Some facilities are privately owned and hence hire their own healthcare staff or contract with healthcare companies to supply staffing needs. There are institutions of all sizes and for many different populations and age groups.
- Psychiatric: Pennsylvania is one of the few states in the nation that have the Psychiatric Forensic Nursing Classification. Employment is usually through the state civil service system, associated with the Department of Public Welfare. Nurses working in this role are responsible for psychiatric evaluation and treatment of criminal offenders by order of the court system. The offenders are typically admitted to a state facility for a brief period of evaluation and then returned to the county jails for sentencing. This specialty is closely tied to correctional nursing.
- School Settings: In the educational environment, school nurses are in a position to observe, assess, educate and intervene in violence issues with children at all age levels. School nurses are accessible and trusted healthcare professionals who can work with students on skills such as conflict resolution, stress management, suicide/injury prevention, and relationship management.

Educational Requirements

The educational requirements for forensic nursing depend on the setting in which one intends to work. For example, the S.A.N.E. program consists of a 5-day course that grants a certificate. On the other hand, a death investigator may be trained in a program through the county police department/coroner's office or on-the-job, legal nurse consulting does not require formal training. Psychiatric forensic nurses usually have extensive clinical psychiatric nursing backgrounds. There is an ANA certification for Psychiatric Mental Health Nursing, however this is not specific to forensics.

Specialty Certifications

Forensic Nursing has just been recently acknowledged as a specialty by the ANA, therefore there is no national nursing certification process developed as of yet.

Salary Ranges

Since there are so many different roles that nurses can get involved in with forensic nursing, it is impossible to give an accurate salary range. Each specialty has it's own range. Many forensic nurses work in their role as staff nurse and therefore are still on the hospital payroll. If employment is through a county or state office, the salary can be lower than that of hospital based work but also is dependent on the level of training and responsibility.

The option for forensic nurses to work as entrepreneurs is becoming more realistic, as evidenced by Pennsylvania nurse Maureen Jones, RN, MSN, S.A.F.E. Ms. Jones, and 8 other certified S.A.F.E. nurses, have just recently formed an organization to deliver contracted services to local hospital emergency rooms for sexual assault victims. This was a hard earned success for these nurses and one that might prove the wave of the future for healthcare professional in this line of work.

Entry Advice

Entry advice, though specific to each specialty, has many common variables. Most nurses practicing in the field, recommend strong clinical backgrounds in acute care settings, an intense interest in investigative work, an ability to handle stress-both emotional and physical, and the understanding that you will not become rich from this specialty work. Individuals must understand that this is interesting but gruesome work in most cases.

To work as a S.A.N.E. nurse, a training course must to be attended to gain a certificate. Training can take place in or out of state as long as the individual then links to the community sexual assault response team where they will be practicing so that they are aware of local regulations and facility protocols that affect their practice. Some nurses practicing in the field would recommend that anyone interested in nursing forensics should attend one or two general forensic conferences or seminars in order to understand the scope of the field and the choices available before committing to a certain specialty. There are so many options and forensics also requires a certain type of personality in order to deal with the complex issues that are dealt with on a daily basis.

In the case of death investigators, nurses can be trained on the job for positions as deputy coroners. Once this title is achieved, advancement to Chief Coroner can be obtained with time, experience, continuing education and an extensive training program offered in conjunction with the state attorney general's office.

For correctional nursing in the state of Pennsylvania, nurses would need to enter into the state civil service system in order to work for a state institution. By taking the civil service exam for healthcare professionals, which is more like an application and background check, they would obtain a score and be placed on an availability list for up to 10 counties of their choice. When a position opens up in a facility then they are contacted by the civil service commission and enter into the application process for that position. Because of their autonomy, correctional nurses need to have strong clinical skills, the capability of handling emergent situations, and a non-judgmental approach to patient care.

Individuals interested in entering the psychiatric forensic specialty need to have, at very minimum, 3 years psychiatric nursing experience. It is hard to get into the state system because openings are rare. Another option in this field is to get involved, on a local or state level, with a stress management, crisis management or critical incidence response team. The psychiatric nursing background is directly applicable and needed in this area. Many hospitals and community service organizations have teams established to deal with catastrophic/traumatic events. Within the hospital, the team can be comprised of a mental health professional and peer support volunteers who help "debrief" staff members involved in an incident that has caused emotional stress and trauma. The International Critical Incident Stress Foundation listed below in the Associations section, gives information on upcoming training programs and team development protocols.

Associations

American Academy of Forensic Sciences
PO Box 669
Colorado Springs, Colorado 80901-0669
(719) 636-1100
Fax: 719-636-1993
E-mail: membship@aafs.org
http://www.aafs.org

American Board of Medicolegal Death Investigators
c/o Division of Forensic Pathology
Saint Louis University School of Medicine
1402 South Grand Boulevard
St. Louis, Missouri 63104
http://www.slu.edu/organizations/abmdi/index.shtml

American College of Forensic Examiners
2750 East Sunshine
Springfield, Missouri 65804
E-mail: memberacfe@aol.com
http://www.acfe.com

American School Health Association
PO Box 708
Kent, OH 44240
(330) 678-1601
E-mail: asha@ashaweb.org
Fax: 330-678-4526

Center for Recovery and Education (C.O.R.E.)
(For Western and Central PA)
204 Sigma
Pittsburgh, PA 15238
1-800-366-6777
E-mail: pkornick@core.org
http://www.core.org

Center for School Mental Health Association
Mr. Mark Weist, Chair of Mental Health Group
University of Maryland, Department of Psychology
(410) 706-0980
1-888-706-0980
http://csmha.umaryland.edu/home.html

Emergency Nurses Association
216 Higgins Road
Park Ridge, Illinois 60068-5736
1-800-900-9659
E-mail: enainfo@ena.org
http://www.ena.org

Gift of Life Donor Program
(For Eastern PA)
1-800-366-6771

International Association of Forensic Nurses
c/o SLACK Incorporated
6900 Grove Road
Thorofare, New Jersey 08086
(609) 848-8356
Fax: 609-848-5274
E-mail: iafn@slckinc.com
http://members.aol.com/COCFCI/index.html

International Critical Incident Stress Foundation, Inc.
10176 Baltimore National Pike, Unit 201
Ellicott City, Maryland 21042
(410) 750-9600
Fax: 410-750-9601
http://www.icisf.org

Pennsylvania Coalition Against Rape
125 North Enola Drive
Enola, Pennsylvania 17025
(800) 692-7445
Fax: 717-728-9781
E-mail: stop@pcar.org
http://www.pcar.org

State Civil Service Commission, Harrisburg
Strawberry Square Complex, 2nd Level
320 Market Street
Harrisburg, PA 17108
(717) 783-3058

State Civil Service Commission, Pittsburgh
State Office Building, Room 1503
300 Liberty Avenue
Pittsburgh, PA 15222
(412) 565-7666
http://www.scsc.state.pa.us

Forensic Nursing Listserve
Clinical Forensic Nursing
Send e-mail message to: clfornsg@LISTSERV.louisville.edu
Subject: leave this line blank
Text: SUBSCRIBE CLFORNSG YOURLASTNAME YOURFIRSTNAME

Publications

For an extensive listing of publications related to Forensic Nursing:
Forensic Nursing Resource Homepage (From the UK)
http://www.fnrh.freeserve.co.uk/index1.html

National Medical-Legal Journal
Published by Medical-Legal Consulting Institute, Inc.
2476 Bolsover Street, Suite 632
Houston, Texas 77005
(800) 880-0944
Fax: 713-942-8075
E-mail: mail@legalnurse.com
http://www.legalnurse.com

American Nurses Association. (1997). Forensic Nursing: Standards for New Specialty.
ANA. Accessed online 1/18/00, http://www.ana.org/ajn/1998/Feb/anarsrc.htm

Burgess, A.&Dowdell, E. Forensic Nursing and Violent Schoolboys. Nursing Spectrum
OnLine. Accessed online 1/18/00, http://nsweb.nursingspectrum.com/ce/ce192.htm

Dandino-Abbott, Denise.(1999). The First Year of the Lucas County/Toledo, Ohio,
SART Program. Journal of Emergency Nursing Online. (25), pg. 333-336.

Emergency Nurses Association. (1998 ). Position Statement: Forensic Evidence
Collection. Accessed online 1/11/00, http://www.ena.org/services/posistate/data/forensic.htm

Flaherty, M. (1999). Secrets of the Dead: Nurse Death Investigators Hone Their Skills in
Forensic Research. NurseWeek/HealthWeek. Accessed online 1/18/00,
http://www.nurseweek.com/features/99-2/death.html

Kent-Wilkinson, A. 1998. Forensic Nursing Handbook98
over 300 pages of definitions, assessment tools and references
E-mail Rebecca Scott in the MRC bookstore for orders.
Rebecca Scott: rscott@MtRoyal.AB.CA

Lynch, Virginia. The New Detectives: Forensic Nurses Advance Health and Justice.
NurseWeek/HealthWeek. Accessed online 8/7/99,
http://www.nurseweek.com/ce/ce1620a.html

Lynch, V.(1995). Clinical Forensic Nursing. A New Perspective in the Management of
Crime Victims from Trauma to Trial. International Association of Forensic
Nurses. Accessed online 2/10/99, http://members.aol.com/COCFCI/Vart.html

Murphy, K. RN Forensic Investigator. Nursing Spectrum Career Fitness Online.
Accessed 1/18/00, http://nsweb.nursingspectrum.com/cfforms/forensicnurse.cfm

Nelson, Valerie. (1998). Shattering the Myths About Forensic Nursing.
NurseWeek/HealthWeek . Accessed online 4/20/99,
http://www.nurseweek.com/features/98-7/forensic.html

Training Programs

Critical Incident Management
For course schedule, call the International Critical Incident Stress Foundation
(410) 750-9600, or go to their website, http://www.icisf.org

Coroner's Basic Education Course
Offered through the Coroner's Education Board
Office of Attorney General, Commonwealth of Pennsylvania
Sponsored by the Pennsylvania State Police Academy
Next Course, April 10-15, 2000 Hershey, PA
Contact: Ms. Gwendolyn C. Casey
Executive Secretary to the Special Boards
Coroner's Education Board
1600 Strawberry Square
Harrisburg, PA 17120
(717) 783-3014
Fax 717-783-5431

Sexual Assault Nurse Examiner Course
Offered by University of Pennsylvania
Next Course, April 10-14
Contact: University of Pennsylvania School of Nursing
Center for Professional Development
420 Guardian Drive
Philadelphia, PA  19104-6096
(215) 898-4522 or (215) 898-5629
E-mail nursing-continuing-ed@nursing.upenn.edu
http://www.nursing.upenn.edu/ce

Pennsylvania Coalition Against Rape, state wide S.A.F.E.project
Next course, March 27-31 at Abdington Hospital outside of Philadelphia.
Contact: Ms. Barbara Sheaffer with PCAR, E-mail: BSheaffer@pcar.org

Continuing Education Programs

Forensic Nursing Services Online
For a thorough listing of degree programs and educational offerings,
http://www.forensicnursing.com/html/events.html

Additional programs:

American Forensic Nurses
Home study courses with exam taken on the internet. CEUs offered
http://www.amrn.com/

Knowledge Solutions LLC
On-line courses with certificate
http://forensic-science.com/courses.html

References

American Nurses Association. (1997). Scope and Standards of Forensic Nursing
Practice. Waldorf, MD.: American Nurses Publishing.

IAFN. 1999. International Association of Forensic Nurses Website Homepage. Accessed
2/24/99. Available online, http://members.aol.com/COCFCI/index.html.

Lynch, V. (1995). Clinical Forensic Nursing. A New Perspective in the Management of
Crime Victims from Trauma to Trial. International Association of Forensic
Nurses. Accessed, 2/10/99. Available on-line, http://members.aol.com/COCFCI/Vart.html

Lynch, V. The New Detectives: Forensic Nurses Advance Health and Justice.
NurseWeek/HealthWeek On-line. Accessed 8/7/99. Available online,
http://www.nurseweek.com/ce/ce1620a.html

Nelson, V. (1998). Shattering the Myths About Forensic Nursing.
NurseWeek/HealthWeek On-Line. Accessed 4/20/99. Available online,
http://www.nurseweek.com/features/98-7/forensic.html

Thomas, C.L., Craven, R.H., Jr. (Eds.) (1997). Tabor's Cyclopedic Medical Dictionary.
(12th ed.). Philadelphia: F.A. Davis.

Contacts

Dr. Kathy Brown, CRNP, S.A.F.E.
University of Pennsylvania School of Nursing
Nursing Education Building
420 Guardian Drive
Philadelphia, PA 19104-6096
E-mail geskpb@nni.com

Ms. Leslie Crimy, RN, S.A.F.E.
Mercy Medical Center, Sexual Assault Nurse Examiner Program
Mercy Medical Center
301 Saint Paul Place,
Baltimore, MD 21202-2165
(410) 332-9499
E-mail: Ms. C. Kimmell, S.A.F.E. Program Coordinator, ckimmell@mercymed.com

Mr. Joseph T. Dominick, RN
Chief Deputy Coroner, County of Allegheny
Allegheny County Coroner's Office
542 4th Avenue
Pittsburgh, Pennsylvania 15219
(412) 350-4800
Fax: 412-350-4899
E-mail: jdominick@county.allegheny.pa.us

Ms. Maureen Jones, RN, MS, S.A.F.E.
Director of Forensic Nursing Services
Centre Abuse Response team
(814) 867-3303
E-mail: mmc105@psu.edu

Ms. Barbara Sheaffer, SAFE Organizer
Pennsylvania Coalition Against Rape
125 North Enola Drive
Enola, PA 17025
(800) 692-7445 ext. 32
Fax: 717-728-9781
E-mail: BSheaffer@pcar.org

Additional Sources of Information

Ms. Vicki Firth, RN, CEN, SANE
Deputy Coroner, Death Investigator

Ms. Pat Morgan, RN
Forensic Registered Nurse Supervisor

© 2000 This page was last edited: November 08, 2004