#MeToo movement brings sexual assault nurse examiners to forefront

The scores of people who have shared their stories of sexual assault and harassment in the now-viral #MeToo social media movement are staggering – and disturbing. But sadly, not shocking to sexual assault nurse examiners (SANE) at HealthONE’s The Medical Center of Aurora in Colorado.

In just one year, SANE nurses at the HCA Healthcare affiliate hospital have treated an estimated 40 patients per month and more than 300 patients overall who have been victims of sexual assault.

“People are in denial about the prevalence of sexual assault. Those of us who have dedicated our lives to working with and caring for survivors understand the frequency of incidents and the importance of having an open and honest discourse on the subject,” said Colleen Kampa, a registered nurse and one of seven SANE nurses at The Medical Center of Aurora.

“The #MeToo movement has provided a valuable opportunity for a nationwide conversation about sexual assault, and for us, as caregivers, to talk about the type of medical programs that are available to victims,” Kampa continued.

Kampa believes that the social media campaign raised awareness about sexual violence – the hashtag was used more than 1.7 million times on Twitter and, in less than 24 hours, 4.7 million people engaged in the conversation on Facebook – and potentially, triggered survivors of assault who have never disclosed the crime to anyone.

“I hope, if nothing else, the #MeToo movement has shown survivors that they don’t have to live in fear or shame and that they are not alone,” she said.

Kampa candidly talks about being a SANE nurse, the training involved and how they are “healthcare’s first line of defense for victims of violence.”

Many people may not be aware that sexual assault nurse examiners (SANE) exist. What does that mean to the average person?

SANE nurses are a subset of the broader specialty of forensic nurses – a nurse who provides specialized care for patients who are victims of trauma. Our primary job is to provide trauma-informed emergency medical care to survivors of sexual assault, including prophylactic, or preventative, medications to prevent the spread of sexually transmitted infections, HIV, and prevent pregnancy. Our secondary job, if the patient consents, is to collect evidence of the crime that took place including injury documentation, DNA evidence collection, and photography of the injury.

What is a SANE nurse to you?

We are the medical community’s first responders to survivors of sexual assault.  In treating sexual assault patients, and by telling them that they are in control of their exam, in control of everything that happens to them during the exam, we are able to give them back some of the power and autonomy that were taken from them during the assault.

How common is it for a hospital to have a SANE program?

I can only speak for Colorado where there are 20 hospital-based SANE programs, including The Medical Center of Aurora, out of approximately 110 hospitals in the state. What’s unique about our program is that we work on an on-call schedule to ensure traumatized victims can get the care that they need 24/7. Unfortunately, not all 20 of Colorado’s SANE hospital programs have around-the-clock coverage available. We also know that rural areas are disproportionally represented compared to urban areas. According to the National Institute of Justice, there are more than 600 SANE programs in the United States and Canada.

Why did you want to become a SANE nurse?

For me, I attended the United States Air Force Academy in the early 2000s during a sexual assault scandal that led to several female cadets appearing on The Oprah Winfrey Show to discuss the attacks. After that happened, we had many briefings detailing what to do if an assault occurred, including information on the local hospital where we would be taken and where the “special nurses” would do a “rape kit.”  At that time, I was interested in becoming a nurse and I remember thinking that was the type of job that I could do. I recognized even then that it would provide both care and empowerment to survivors of assault.  Some SANE nurses were motivated by personal experiences with assault or experiences of close friends or family.  What we ALL share in common is the desire to provide compassionate care to survivors of assault who seek help.

Why do you consider SANE nurses the first line of defense for sexual assault victims?

Often times, victims of violence are reluctant to report to law enforcement but are willing to seek medical attention. Patients know they can come to the emergency room for help.  When patients report a sexual assault, our emergency room staff inform them of the services that a SANE nurse can provide and ask if they are interested in seeing the SANE nurse.  We then can collect evidence without requiring that victim to speak to law enforcement. We become the first line of care that this victim receives and also the point-person for informing them about their options to report to law enforcement and the availability of community resources.

What type of training does one have to undergo to become a SANE nurse?

SANE nurses typically come from either the emergency room or women’s health (labor and delivery, etc.) backgrounds. Being “certified” is a bit of a misnomer. A nurse can practice as a SANE nurse without the SANE-A® (adult-adolescent) or SANE-P® (pediatric) certification from the International Association of Forensic Nurses. In fact, a nurse must practice before certification. In order to sit for the certification exam, a SANE nurse is required to have a minimum of 300 hours of SANE practice. Other requirements include:

• at least 2 years of registered nurse experience
• a 64-hour didactic, or theoretical, course requirement
• a clinical skills training component to get comfortable with skills necessary to perform SANE evaluations including advanced anogenital assessments: pelvic examination, speculum exams, etc.
• a preceptorship with an experienced SANE nurse to receive training on:
  • assessment
  • evidence collection
  • forensic photography
  • providing trauma-informed care
  • forensic charting
  • law enforcement responsibilities, such as maintaining evidence chain of custody of medical forensic kits and other evidence.

We also attend training courses sponsored by the District Attorney’s office on courtroom testimony and attend trials where one of our nurses testifies to gain courtroom experience.

The number of exams necessary to come off of orientation varies from SANE trainee to trainee. Typically, we expect a trainee to perform approximately 10 exams before dropping off orientation. Only when a new SANE nurse feels comfortable will they begin taking call shifts.

There may be people that just think SANE nurses process rape kits and nothing more. What else would you want people to know about what you do?

The medical forensic kit is just a very small portion of our job as SANE nurses.  First and foremost, we do not work for law enforcement, and we do not work for the prosecution; we work solely for the patient.  Our primary job is to treat any emergent medical or mental health needs the patient has.

Throughout the medical forensic exam, the patient is completely in control of everything that happens. If there is any part of the exam with which they are uncomfortable, we do not conduct that portion.  We start the examination with a forensic interview where the patient describes what took place during the assault.  This interview guides our medical forensic examination and informs us where we may potentially find injuries or DNA evidence. It also lets us know if the patient thinks that they were drugged in conjunction with the assault. If so, we can collect blood and urine as part of a Drug Facilitated Sexual Assault (DFSA) test.  We document and photograph injury (if the patient consents) and swab for DNA evidence if indicated.  Once the examination is complete, we ensure that the patient has the follow-up resources that they need, are in contact with an advocacy organization if they do not already have an advocate present, and have a safe place to go.

We also have a private bathroom available so the patient can shower and clean up if they choose.  If we collected the patient’s clothing as evidence, we have new sweatsuits available in multiple sizes and colors that we can provide to them so they have something comfortable to wear home.

Throughout the entire process, which can sometimes take several hours, we allow the patient to do whatever they need in order to feel comfortable and safe. If they are nauseous, we can get them anti-nausea medication; if they are hungry, we will get them a snack. If they need to stop and take a break, we can.  If they need to stop the exam and just talk, we absolutely will stop and listen.  Our job is to provide whatever the survivor needs at that point in time, within our capabilities, whether that be emergency medical care, medications, advocacy, just someone to listen, or a competent forensic evaluation and evidence collection. We are there to meet their needs post-trauma in any way that we can.

What keeps you going after the challenging work of being a sexual assault nurse examiner?

Taking care of patients and having a small part to play in giving a vulnerable patient some of their power and autonomy back, is incredibly meaningful work.  I was told when I initially began SANE training: “Don’t do this job to ‘put bad guys in jail.’ We don’t do that.”  And that is true.  We know the statistics on the prosecution of criminals who perpetrate sexual violence are abysmal.  None of us do this job to “help catch bad guys.”  Contrarily, we do this job knowing that out of an estimated 1,000 rapes, 994 perpetrators never see jail time.  However, knowing that if the case does enter the criminal justice system, the victim has a much greater chance of achieving a successful prosecution if a medical forensic exam is conducted by a trained SANE, does inspire us to act meticulously.  Knowing that our charting, photography, education, training, and entire careers are at the mercy of being scrutinized in court, challenges us to perform at a high level and hold our colleagues to a similar standard.  As for my SANE colleagues, the mutual respect we have for each other to successfully accomplish the difficult work that we do is what keeps me going.  I am humbled to work with the nurses within this program.  I could not ask for more compassionate, intelligent, skilled, or dedicated colleagues.  It is inspiring to work with coworkers who care equally about what we do and the quality of care we provide.

Why is this type of program important?

This type of program is crucial so that victims can have a place where their emergency medical needs, as well as mental and emotional health needs, can be attended to and evidence can be collected in a professional and timely fashion.  We have had patients present to our emergency room for SANE services who have visited at least three or four other hospitals before finally being put in touch with us for our SANE services.  It is absurd that patients are still being shuffled from facility to facility trying to find a place that has this service available.

What do you want victims of sexual assault to know about the SANE program at The Medical Center of Aurora?

In Colorado, we want victims of sexual assault to know that they can come to The Medical Center of Aurora for care by a trained SANE nurse 24 hours a day, 7 days a week. They can do this and have evidence collected even if they do not want to speak to law enforcement at the time. If they DO want to speak to law enforcement, we can facilitate that as well.  We want victims of sexual assault to know that they will not be revictimized by the system if they come to us for care.  We will treat any emergency medical conditions they have, provide prophylactic, or preventative medications, connect them with advocacy and community resources, perform evidence collection, and provide them with professional, compassionate, trauma-informed care.  We want them to know that they are not alone, that what happened WAS a crime, that the assault was NOT their fault, and that they do not need to be scared or ashamed to come forward.

Colleen Kampa is a registered nurse and sexual assault nurse examiner at The Medical Center of Aurora, part of the HealthONE network of hospitals in the Denver metro area. She was featured on local NBC affiliate to talk more about the program.   

The SANE program is located within the emergency department at The Medical Center of Aurora. Please visit here for more information on sexual violence from the Centers for Disease Control.