“In the future, we’d like to see an advanced practice forensic nurse in every clinical setting, so that every hospital has at least one advanced practice forensic nurse who can be called upon to help any of the staff or professionals through a case.”
Dr. L. Kathleen Sekula, Professor and the Noble J. Dick Endowed Chair in Academic Leadership at Duquesne University School of Nursing
Forensic nurses combine the nursing, forensic, and legal sciences to bring safety, medical treatment, and justice to their patients. Initially focused on victims of domestic violence and sexual assault, forensic nursing has grown to incorporate a wide variety of roles across the healthcare spectrum.
Forensic nurses can work in correctional facilities, psychiatric hospitals, women’s health clinics, medical examiner’s offices, universities, and anti-violence organizations. They’re called upon in community crises, mass disasters, death investigations, and cases of domestic violence, child abuse, elder abuse, and human trafficking. They also collect evidence, provide testimony, and consult with legal authorities. Regardless of the setting, forensic nurses maintain a careful balance between the medical, mental, and legal concerns of their patients.
Forensic nursing is still a relatively young specialty. The US Surgeon General didn’t identify violence as a healthcare issue in 1985 and the International Association of Forensic Nurses (IAFN) was formed in 1992. But the last three decades have been a period of rapid growth for forensic nurses, with a renewed, nationwide focus on trauma-informed care reinforcing their importance.
This year’s Forensic Nurses Week takes place from November 8-12, 2021. It’s a time to raise awareness around the role of the forensic nurse, and also an opportunity to appreciate the expertise and dedication of today’s forensic nurses.
To learn more about the work and advocacy of forensic nurses, read on.
L. Kathleen Sekula, PhD, PMHCNS, FAAN
Dr. L. Kathleen Sekula is a Professor and the Noble J. Dick Endowed Chair in Academic Leadership at Duquesne University School of Nursing. She received her MSN and PhD from the University of Pittsburgh, and her certificate in forensic science and law from the Cyril H. Wecht Institute for Forensic Science and Law at Duquesne University School of Law.
Dr. Sekula’s research interests include care of the patient who has been sexually assaulted, trauma-informed care, and other forensic areas.
Dr. Sekula developed one of the first master’s of science programs offering a specialty in forensic nursing. Subsequently, Dr. Sekula applied for and received two program grants from the Department of Health and Human Services, which helped make the forensic graduate programs among the most popular programs throughout the forensic nursing community. The graduate MSN forensic programs have grown to include DNP and PhD programs that encompass forensic research at a higher level.
Dr. Sekula has been honored as a pioneer in forensic nursing by the International Association of Forensic Nurses (IAFN) Virginia Lynch Award, served as president of the Forensic Nurse Certification Board (FNCB), served as president and as a member of the International Journal of Forensic Nursing editorial board, and a member of the IAFN Board of Directors. She was inducted as a Fellow in the American Academy of Nursing in 2011.
Karin A. Wickwire, DNP, CRNP, SANE-A, SANE-P
Dr. Karin A. Wickwire is a nurse practitioner at UPMC Hamot, where works within critical care medicine and is the forensic nursing clinical coordinator. She also is an NP in the Erie CARE Clinic, a satellite office of the UPMC Children’s Hospital Children’s Advocacy Clinic. She earned her BS in biology from Allegheny College, her BSN from Gannon University, and her DNP from the University of Pittsburgh.
Dr. Wickwire is an adjunct professor at Gannon University and works with the Duquesne University Sexual Assault Nurse Examiner (SANE) Grant Program. She is also a member of the International Association of Forensic Nurses (IAFN) Research Committee and currently serves as the president of the Pennsylvania IAFN Chapter. Dr. Wickwire has co-authored a chapter in a SANE certification review guide and her research has been published in the Journal of Forensic Nursing.
“Forensic nursing is still relatively new as a clinical practice area for nurses,” Dr. Sekula says. “It’s been an interesting journey, and it’s been quite exciting to work on expanding the practice with more and more forensically-prepared nurses involved.”
Up until the early 1990s, the clinical staff member of most hospitals were not well-equipped to treat victims of sexual assault. If a victim had been coerced or restrained, for example, then they might not have had physical wounds for the staff to treat. The staff also didn’t have training in how to properly collect evidence, conduct interviews, and interface with the legal system. A group of nurses, recognizing this gap in care, went on to form the International Association of Forensic Nurses (IAFN) and with it, the role of the Sexual Assault Nurse Examiner (SANE).
“For a long time, if you asked people what forensic nursing was, they would tell you it was the SANE,” Dr. Sekula says. “But that’s just a small part of what forensic nursing is now.”
Forensic nurses operate at the intersection of the legal, forensic, and nursing sciences, which applies to much more than just victims of sexual assault. Today’s forensic nurses work in a wide variety of roles across a number of different settings. The wounds they treat aren’t always physical, and each patient’s situation is unique. A growing awareness of trauma-informed care across the healthcare spectrum has increased the need for forensic nurses who can properly assess, treat, and document victims of violence and trauma.
“In the last five years, trauma-informed care has really come to the forefront,” Dr. Sekula says. “Research tells us that we each respond differently to trauma, based on our unique physiology, personality, and background. It’s been a real move forward in all types of nursing, but particularly in caring for victims of violence.”
“As a forensic nurse, something people either love or struggle with is how autonomously you’re functioning,” Dr. Wickwire says. “In the case of a sexual assault, you’re doing pretty much everything: conducting a head-to-toe exam, talking with the patient, coming up with a plan, and going back and talking to the physician or NP about what medications you think the patient needs. You’re really making a lot of decisions completely based on your judgment. It can be a bit of a reality check, but it’s a great opportunity to work to the highest level of your license.”
Operating with a large amount of autonomy also carries with it a great deal of responsibility. Especially since forensic nurses will need to interface with the legal system, their actions can sometimes come under scrutiny in the courtroom. Forensics nurses need to be adept at documenting their processes in an objective and legally sound manner, but they also need to be able to balance that with consideration for the patient’s medical and mental health.
“The medical and mental health piece is the most important,” Dr. Wickwire says. “But this is such a collaborative area of practice. You have law enforcement, attorneys, victim services, and medical staff—and everybody has their own focus that they want to prioritize. We try to make sure everyone is on board in understanding that the medical and mental health pieces are the most important.”
Reporting an instance of sexual assault or domestic violence is never easy, but forensic nurses have the benefit of belonging to the broader field of nursing, which has been America’s most trusted profession for 19 years running. This puts them in the unique position of being able to simultaneously perform an exam, collect evidence, and also elicit a larger story around what a patient has been through. Contrasted with the sometimes rigid processes of law enforcement officers, forensic nurses are able to provide a safe, welcoming, and transparent environment to patients, and empathetically present them with their options going forward.
“Sometimes a patient comes in, and they don’t want evidence collection,” Dr. Wickwire says. “They just want to make sure they’re okay. It’s up to us to explain that there’s a limited timeframe where we can collect DNA evidence, so the time to get it is while we’re performing our checkup. We want to be very clear, but also, if the patient declines, we will respect that.”
Working as a forensic nurse can mean exposure to uncomfortable topics, difficult decisions, and extremely emotional situations. So as much as forensic nurses need to be attuned to their patients’ traumas, they also need to attend to their own mental well-being.
“You have to know yourself, and you have to know what your triggers are,” Dr. Wickwire says. “We really stress the importance of peer-review, of sitting down with a colleague or colleagues after the fact and going over a difficult patient encounter. You have this huge group of support from other people who are also doing this job and totally understand everything you’re seeing and experiencing.”
Forensic nurses are engaged in advocacy at the professional level, the policy level, and the patient level. But an overarching theme is lobbying for more support and better care for victims of violence and trauma. Even in the modern age, a very small percentage of sexual assault victims report their assault, and those who do may still be subject to revictimization: the conscious or unconscious shifting of blame back onto the victim.
“Through research, we know that many sexual assault victims don’t come forward because they’ve heard horror stories of what it’s like to be blamed for what’s happened to them,” Dr. Sekula says. “It still happens. We’re trying to prevent that.”
At the policy level, forensic nurses advocate for further expansion and improved access to forensic nursing services. One of the ways this can be achieved is through grants, particularly ones which are awarded through the Health Resources and Services Administration (HRSA) to support nurses who practice in rural and underserved areas. Dr. Sekula’s SANE program at Duquesne University was a recipient of two such HRSA grants.
“The increase in the number of SANEs has been exponential since the first grant was awarded,” Dr. Sekula says. “We expect that to get even better as we go into these next three years.”
In August 2021, Senator Lisa Murkowski and Senator John Hickenlooper introduced the Ensuring Forensic Care for All Victims Act. If passed, the act would authorize grants to provide an evidence-based and trauma-informed care approach to a broad range of service providers, including NPs, RNs, physicians, and other health practitioners.
“In the future, we’d like to see an advanced practice forensic nurse in every clinical setting, so that every hospital has at least one advanced practice forensic nurse who can be called upon to help any of the staff or professionals through a case,” Dr. Sekula says.
Forensic nursing may be a relatively young specialty, but it’s growing quickly. As the field continues to mature, more research is being conducted by forensic nurses, and on longer timeframes. The role of the forensic nurse has expanded far beyond treating sexual assault and can be a critical resource in caring for victims of domestic violence, intimate partner violence, child abuse, elder abuse, and many other traumatic scenarios.
“We’re still struggling with educating people on what can be done and that takes time,” Dr. Sekula says. “But soon I think more people will fully understand all that a forensic nurse can do. We have outstanding graduates from our program and graduates from other forensic master’s programs, who are making a difference. And researchers are showing people through their publications more of what is going on in the forensic community.”
As the role of the forensic nurse is evolving, so are the science and technology surrounding it. Advances in touch DNA could make it easier to identify perpetrators. Telehealth is making it easier for every facility to have a forensic nurse on call, either physically or virtually. And research into the long-term outcomes for victims is helping to provide forensic nurses with toolkits and data they need to progress our collective understanding of trauma and survivorship. To be a forensic nurse today is to be part of an essential, patient-centered, and forward-thinking movement that improves care for victims of trauma and violence.
“I get to help people in some of the worst moments of their lives,” Dr. Wickwire says. “It’s very rewarding.”
To learn more about emerging issues related to forensic nursing, check out some of the resources below.
Matt Zbrog is a writer and freelancer who has been living abroad since 2016. His nonfiction has been published by Euromaidan Press, Cirrus Gallery, and Our Thursday. Both his writing and his experience abroad are shaped by seeking out alternative lifestyles and counterculture movements, especially in developing nations. You can follow his travels through Eastern Europe and Central Asia on Instagram at @weirdviewmirror. He’s recently finished his second novel, and is in no hurry to publish it.