collected during forensic medical exams have not yielded a full DNA profile of the assailant. The most recent victim of the suspected assailant reports actions that are associated with an opportunity to collect samples with high probative value (i.e., the ability to obtain a DNA profile to potentially identify the assailant). However, the patient declines the forensic medical exam. Patient encounters such as this scenario can create significant distress for forensic nurses as they balance respect for the patient’s wishes with a strong desire to protect members of the community from further harm, including potentially their own children. Additional questions related to the implications of developing moral distress and disengagement include the subsequent effects on forensic nursing practice, decision-making processes, and the health and wellbeing of the forensic nurse. 27 Conclusion Forensic nursing must reconcile the various duties associated with this specialized, integrated nursing specialty practice. Supporting “nurses first” language may exacerbate both internal and external role confusion and conflict. This confusion and conflict may adversely affect patient care, job performance, turnover and the overall well-being of forensic nurses. Until this role confusion in forensic nursing is resolved, internal role expectations of forensic nurses will continue to be in conflict with the forensic and legal expectations of other professionals and with the healthcare expectations of patients. Several questions remain unanswered and unexplored in this paper regarding role conflict and role confusion, perceived or actual dual roles and competing loyalties, and conflicting interests in forensic nursing practice. For example, what are the philosophical underpinnings for forensic nursing practice that may be in conflict? What are the implications for the patient, forensic nurse, other professionals, and society when these conflicts arise? What benefits are derived from the “I’m a nurse first” statements for forensic nurses? Forensic nursing is a young profession that is making a difference in the lives of populations affected by violence, intentional/unintentional injury, and nature or human caused disasters. Forensic nursing exists in a unique space, much like public health nursing, of having both individual and public health interests. With role clarification, forensic nursing will be able to clarify what has been identified as potentially conflicting loyalties. Forensic nurses, as with all nurses, have a social contract with society and at the center of this contract is their patient. To fully meet the needs of their patients, forensic nursing must engage in new dialogues and analyze ethical issues arising from the interface of forensic nursing, healthcare, and the law. What is likely to emerge from these discussions is a more nuanced view of the role of the forensic nurse, 28 a view embracing rather than protesting the complexity of the ethical discernment required to provide forensic nursing services to those affected by violence. For over a decade experts have highlighted that, depending on the type of contact involved in a sexual assault offense, samples collected from the suspect’s body may carry greater probative value (i.e., useful to prove guilt or innocence in a legal case) than samples collected from the victim’s body (Archambault, 2007). Consider, for example, a victim reporting vaginal digital penetration – the assailant’s fingers may actually be the best source for collecting samples with probative value, especially samples collected from under the person’s fingernails and around his/her cuticles (Flanagan and McAlister, 2010). Similarly, in a report of penetration of the oral cavity by an assailant’s penis, samples collected from the assailant’s penis and scrotum may be a better source for cellular findings than the victim’s mouth. Collecting samples from objects containing materials transferred during a sexual offense is critical to the investigation of the case (Apostolov et al., 2009). However, to date, many jurisdictions do not have protocols for what should be included in the examination of someone accused of a violent act (commonly referred to as suspect examination) hence such examinations are often ad hoc at best (Archambault, 2007; Faugno, 2014; Newton, 2013). Existing protocols for suspect examinations vary widely. For example, who conducts the examination includes evidence techs, law enforcement officers, or forensic nurses. In addition, there are no agreed upon standards for identifying anatomical locations for sample collection with known, unknown or conflicting histories; written and photographic documentation; or for the contents of sample collection kits. Suspect sample collection kits range from a small 6x9 envelope labeled “Penile Swabbing Evidence Kit” or an envelope called “Buccal Swab Kit” for collecting the suspect or accused’s DNA sample, to using the same kits that are used for collecting samples from victims during examinations. The lack of standards for sexual assault 33 suspect examinations is so well recognized that it was an agenda topic for the Evidence Collection Subcommittee of the National Institute of Justice SAFER Act workgroup at meetings held in 2015 and 2016. Continuing discourse on professional discussion boards and at national conferences highlights persistent variations in exam