Forensic nursing: Overview of a growing profession By Julie L. Valentine, PhD, RN, CNE, SANE-A Career Sphere AmericanNurseToday.com December 2018 American Nurse Today 43 As forensic nursing grows, subspecialties will advance to meet healthcare and societal needs. (See Forensic nursing subspecialties.) But regardless of the subspecialty, forensic nurses focus on improving patient and legal system outcomes. They address the bio-psycho-socialspiritual needs of patients affected by violence and trauma to promote physical and psychological health and recovery. Additionally, forensic nurses use proper evidence documentation, collection, and preservation practices to ensure optimal analysis findings. Only RNs can take specialized forensic nursing education, but forensic nurses come from a variety of educational backgrounds—from associate to doctoral degrees. Many forensic nurses have experience in emergency departments, intensive care units, women’s health, medicalsurgical units, or mental health/psychiatric units. SANEs make up the largest group of forensic nurses in the United States. In fact, about 72% of the International Association of Forensic Nursing (IAFN) members are SANEs. IAFN provides online education for SANE training and sponsors the certification examinations for both adolescent and adult SANEs (SANE-A) and pediatric SANEs (SANE-P) as recognized by the American Nurses Credentialing Center’s Magnet Recognition Program®. Nurses must meet the eligibility requirements before taking the credentialing examination. In some parts of the United States, the SANE role has expanded to include providing nursing care and examinations for patients affected by interpersonal violence, strangulation, torture, physical child abuse, child neglect, and elder abuse. They also care for the suspects of violent crimes. Employment settings Forensic nurses work in a variety of healthcare settings: hospitals, emergency departments, clinics, correctional health centers, and medical examiners’ or coroners’ offices. (See Forensic nursing care settings.) Many forensic nurses work on-call, ready to respond when a patient needs their specialized care, while others are employed as full-time forensic nurses. States, jurisdictions, and healthcare facilities vary on their payment structure for forensic nursing services, providing oncall, case-by-case, hourly, or salaried wages. Educational options Forensic nursing education is holistic, ranging from learning about assessment of the psychological impact of trauma to documenting physical injuries and preserving evidence. As forensic nurses intersect with the criminal justice system, education also is provided on expert testimony. A variety of online forensic nursing education programs are available through IAFN. Several universities offer courses specific for SANEs or death investigators, and graduate forensic nursing programs range from master’s to doctoral degrees. When exploring SANE education opportunities, look for programs that meet IAFN guidelines. And keep in mind that to practice as a forensic nurse, you need both classroom education and clinical experience. Key forensic nursing concepts RNs already practice many forensic nursing concepts, including compassionate, patient-centered, objective, culturally sensitive, and evidence-based care. However, forensics’ education expands on these key concepts to incorporate a thorough understanding of trauma-informed care, including knowledge of the neurobiology of trauma and interventions to promote healing and restore power and control to patients who’ve experienced violence and other trauma. Objectivity Objectivity is critical to forensic nursing, both in terms of nonjudgmental care when documenting findings and facts and in interactions with the legal system when serving as an expert witness or consulting for prosecuting and defense attorneys. Cultural sensitivity Culturally sensitive forensic nursing care involves an awareness of cultural and societal influences on violence, abuse, and trauma. It also requires a commitment to social justice and access to care. Evidence All aspects of forensic nursing care—from patient assessment to evidence collection and documentation of injuries—must be based on research and best practice guidelines. Violence prevention Violence prevention is also a foundational concept within forensic nursing. Under IAFN’s Vision of Ethical Practice, the scope of forensic nursing practice includes a responsibility to address violence prevenCurrently in the United States, forensic nurses can specialize in any of these areas: • sexual assault • interpersonal violence • intimate partner violence • child abuse and neglect • elder abuse and neglect • human trafficking • death investigation • incarceration • refugees with torture victimization history • mass and natural disasters. Forensic nursing subspecialties