Interview with a Sexual Assault Nurse Examiner (SANE)
Why were you interested in becoming a SANE?
Well, I always wanted to do ER nursing but I also have always loved law enforcement so when I learned about SANE in nursing school I thought it was so cool and interesting. Laws are changing for the better in Illinois. In 2022, it’s required that a SANE or a SAFE be in the ED within 90 minutes of a patient arriving with a chief complaint of sexual assault to care for that patient.
One of the things I always loved about the ED was the independence and relationship with physicians. I really get to gain their trust. I get to conduct the anogenital exam. I get to collect the swabs. I get to discuss medications and exposure risks. A physician still does a history and physical but we collaborate and the amount of autonomy I get is phenomenal. It’s another skill to have. Nurses do not do speculum exams in any other certifications that I can think of! It’s amazing to really be there for these people. When they come in, whether it’s directly after or days later, you are there to serve them. There’s no serving judgment. There’s no “alleged”. It’s “you were assaulted and we will care for you”. My opinion of whether a crime occurred has nothing to do with me collecting evidence to the best of my ability. It’s a great community to serve.
How does a nurse become a SANE?
The training is intensive. I’ve been working on my certification for five months. It’s 40 hours of training. Then a long list of things to complete. I have to go to a felony criminal trial and observe, I have to do 15 anogenital/speculum exams. I learn specialized techniques. I specialize in forensic photography. I use toluidine blue dye to inspect for invisible injuries on the vulva and anus. I use Foley catheters/fox swabs to inspect for hymenal injuries. I educate. I’m an advocate for my patients. I’m an advocate for them with the police. These people don’t always get the detective who’s trained in interviewing. Sometimes they get the regular beat cop who just wants to get this over with.
What if patients are not ready for police action?
In Illinois, we have three options of consent. With two sub-options to option A and B. Option A is consenting- you speak to police and make a report that day. Then within that, they can consent to evidence being submitted to the crime lab or they can consent to have their evidence stored until they are ready...or never.
Option B is also a report option but it’s a healthcare provider report. The victims are exhausted and do not always want to talk to the police that day. I can report for them and tell the police what they have told me. Eventually, within the next couple of days, a detective will be in touch with them to make a formal report. They have the same suboptions here: submit evidence or hold evidence.
Option C is no report. They are able to have evidence collected and HELD. They get all the medical forensic exam done, but their kit is then stored in the crime lab. If at any point they want their kit released for evidence they can contact our local rape crisis center (at my hospital it’s NWCASA or Northwest Center Against Sexual Assault) and they can assist them in doing that.
However, there is no option for them to not speak to police and submit evidence.
Swabs are taken from all over the body, but it’s really dependent on the case. If a patient was raped anally and never vaginally penetrated? There’s really no need to swab the cervical os and posterior fornix if she is adamant that there was no penetration. The same goes for vaginal assaults. If she was raped vaginally, there may be no need to swab someone’s anus. Exams are all patient-based. They are controlled by them. On some people, we go from head to toe. On some people, we do the least invasive collections like head hair combings, oral swabs, maybe a bite mark on their arm. I also do strangulation assessments. Then move to genital swabs. I have a special light I use, it’s called an alternate light source. I can turn the lights down with the patient's permission and I put on these orange goggles and shine a special flashlight over their body. Areas the fluoresce can be blood, semen, or other secretions and I can swab those things for evidence.
But a patient can refuse any part of the exam. Maybe they only want vaginal swabs. Or maybe no vaginal swabs at all. I take photos of everything from head to toe with patient consent. In the last case I had, I took overall body photos, a photo of a scratch on her back, I even took photos of her vulva using labial separation and labial traction. Then I took photos of her cervix with the speculum and anal photos as well. I take an entire history and physical along with the doctor. Medical history, surgical history, current medications, G/P/Ab, vaccine history, pain assessments, and then collaborate with the physician to get testing done first to rule out the life-threatening things.
What are the signs of strangulation?
I have resources I use and have laminated to collaborate with my ED physicians in ordering additional testing. One of those resources is the following picture.
Have you ever been called to examine a male? have you ever had a male come to the emergency department for sexual assault?
I have not personally had a male exam but they have come to my ED. I’ve done practice male exams on standardized patients at the SIU School of Medicine.
What has been your favorite part of the process to become a SANE?
My favorite part is learning new skills. I’m really into women’s health and eventually want to become a midwife and women’s health Nurse Practitioner. I enjoy being there for these specific patients. It’s something no one wants to do and it’s tedious; I’m usually with patients alone for 6 hours straight.
And the worst?
I am really bad about not taking it home with me. I usually sit in my shower and sob after I get home.
Any self-care tips that really have helped you?
Honestly, just talking to my work friends about it. Or my mom (obviously without patient details). Crying honestly helps a lot.
What have you personally learned from this whole process of becoming a SANE?
I have learned that this can literally happen to everyone.
Any personal/patient stories that have really stuck with you?
I can remember all of my kits, like perfectly. Where they happened and what happened. I can remember my patients face when they told me everything that happened to them.
What is something you want your patients/victims to know?
There is life after this and we are here to help you.