What Are Forensic Nurses and Why Are They So Critical to Your Cases?

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Most law enforcement professionals have worked a sexual assault case that involved a medical forensic examination. Far fewer have a clear picture of what actually happens during that exam, what the examiner is trained to do, or how much the quality of that relationship shapes the strength of a case.

Forensic nurses are among the most valuable partners in a sexual assault investigation. Here is what they do and why it matters.

Who They Are

A medical forensic examination is ideally conducted by a licensed healthcare provider with specialized training, commonly referred to as a Sexual Assault Nurse Examiner (SANE) or, more broadly, a Sexual Assault Forensic Examiner (SAFE), depending on their specific training and certification. Forensic nursing is a recognized specialty, with its own body of practice standards and certification pathways.

One point is worth stating plainly: this exam is not conducted by law enforcement. That distinction is not a technicality. It is the source of much of the exam’s value, both to the patient and to the case.

Where the Exam Happens

Exam facilities vary considerably. Many are located within hospitals. Others are freestanding, or housed within an advocacy agency or another community organization. Jurisdictions also differ widely in capacity; many communities have only one exam facility, while others have several.

If you respond to sexual assault calls, know in advance which facilities serve your jurisdiction, what their hours and callout procedures are, and who to contact. That is not information to be figuring out at 2 a.m. with a victim waiting for answers.

What Actually Happens During the Exam

Based on local protocols and with the patient’s consent, a medical forensic exam typically includes:

• Obtaining informed consent
• Taking a medical and assault history
• Performing a head-to-toe physical and anogenital examination
• Documenting injuries with written notes, body maps, and photographs
• Collecting biological and trace evidence, such as swabs, clothing, or debris
• Providing medical care and treatment, sexually transmitted infection prophylaxis, emergency contraception, and referrals for follow-up care and advocacy

The examiner determines the specific scope of the exam, including the nature of any internal examination and which reference samples to collect, based on the patient’s account and clinical judgment. These are medical decisions, made case by case, with the patient’s consent.

It Is Healthcare First

This is where the exam is most commonly misunderstood, including by victims deciding whether to have one.

There is no cost to the victim for the forensic evidence collection components of the exam; those costs are covered by governmental entities, though the specific arrangements vary by jurisdiction. However, medical services provided as part of the exam (treatment of injuries, preventative treatment for pregnancy or STIs) often are not covered the same way. Victims may be able to apply to their state or territory crime victim compensation program for reimbursement, though in most states that is only available to victims who report and participate in the criminal justice process. Advocates can usually help with that paperwork.

Victims are generally not required to report to law enforcement or participate in the criminal justice process in order to have an exam. The exception is where state or territory law mandates a report (for example, based on the victim’s age, certain disabilities, or dependent status). These requirements vary significantly; know yours.

Victims who go through a forensic nurse also tend to get faster access to specialized care than they would in a general emergency department, and are more likely to have advocacy support available during the exam.

Why This Matters to Your Case

Exam documentation and evidence can do three things for an investigation:

1. Corroborate a victim’s — or a suspect’s — account of events
2. Identify or exclude suspects through forensic analysis
3. Strengthen the overall quality and defensibility of the investigation

The DNA point deserves particular emphasis. Research on previously unsubmitted sexual assault kits has repeatedly demonstrated that testing identifies serial offenders. Campbell and colleagues’ work on the Detroit Sexual Assault Kit Action Research Project and Lovell and colleagues’ research in Cleveland both found substantial numbers of suspected serial offenders surfacing through kits that had never been tested. A kit is not only about the case in front of you.

There is also evidence that these programs change outcomes. The National Institute of Justice’s CrimeSolutions rates the multisite SANE program evaluation as Promising, finding that sexual assault cases prosecuted after SANE implementation had a statistically significant greater likelihood of resulting in a guilty plea or conviction.

And there is a factor that does not appear in any statistic: A forensic nurse is a trained professional witness. Their documentation is thorough, their language is clinically neutral, their chain of custody is defensible, and they can explain findings to a jury in terms a layperson understands.

What Absent Findings Do and Do Not Mean

This may be the single most important thing a forensic nurse can teach an investigator.

Most sexual assaults do not produce visible genital injury. Absence of injury is not evidence that an assault did not occur, and presence of injury does not by itself establish non-consent.

A negative toxicology screen does not rule out a drug-facilitated assault. The drugs commonly used by offenders to incapacitate victims metabolize quickly and may have dissipated, or dropped below detectable levels, by the time a sample is collected. The absence of laboratory findings should never be interpreted as evidence that the assault was not committed.

A good forensic nurse will say exactly this in a debrief, in a report, and on the stand.

How to Work Well With Your Forensic Nurse

Coordination is most of the job. Before and during:

• Briefly explain the purpose, benefits, costs, logistics, and options of an exam so the victim can decide whether they want one.
• If the victim has eaten, drunk, urinated, or showered, reassure them that they have done nothing wrong. Valuable evidence is still likely available.
• Advise the victim to bring a clean change of clothing, since clothing may be collected as evidence, or let them know that replacement clothing is available on site, if that is true. If they have already changed, arrange to retrieve the clothing they were wearing.
• In suspected alcohol- or drug-facilitated cases, request and appropriately preserve a urine sample per agency policy.
• Arrange transport, accounting for any equipment or service animals that also need to travel.
• If forensic evidence will be collected from the suspect, do not take the suspect to the same facility. If that cannot be avoided, ensure there is no contact.
• Alert the exam facility of the pending arrival, and alert the advocacy program so an advocate can meet the victim there.
• Give the examiner as much information about the incident as you can, so it can inform their evidence collection and documentation.

Two boundaries matter a great deal:

Do not ask investigative questions while the healthcare provider is in the room, and do not be present while the provider takes the medical history. Victims need to feel free to discuss any aspect of their physical and emotional health without law enforcement present. And having a healthcare provider present while you ask investigative questions compromises their professional role, which can create real evidentiary problems down the road.

Do not pressure the victim for details before or during the exam. If you are scheduling a follow-up interview, remember that the mind and body need time to rest and recover afterward.

Afterward, debrief with the examiner about their findings if at all possible, and follow agency policy for evidence kit pickup and storage.

If Your Community Doesn’t Have an Examiner

Many communities — especially rural, remote, and tribal ones — have no local forensic examiner, and victims may travel hours for an exam. If that describes your jurisdiction, EVAWI’s SAMFE Virtual Practicum was built specifically to expand access to sexual assault medical forensic examiner training.

Learn More

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