How I became a forensic nurse

By Sheila Early, President, International Association of Forensic Nurses

One of the most wonderful things about life is that it happens while you make other plans.  I started my professional nursing career in obstetrics. It was my first love and I was fortunate enough to obtain a teaching position in the field in 1969. Then a car crash happened and I could not return to my teaching role for several months. Back then there was no such thing as sick leave.  You had to work or did not have position.  When I was able to return to work, my former obstetrics instructor asked me to come and work for her in emergency.  That began my 30 plus years in three Emergency Departments.  Over those years I worked as an emergency staff nurse, team leader, nursing instructor, nurse clinician/educator and nurse manager.  I loved the fast pace emergency and the fact that you do not know what is coming in the door environment next. Yes, I was an adrenalin junkie!  I loved trauma cases especially as all my nursing skill and experience were refined to make a difference in that patient’s life.  The team work of emergency also was a huge factor, a whole medical team: Physicians, nurses, respiratory techs, lab techs, radiology techs, specialists all doing their very best each and every day and night for the best outcomes possible for emergency patients. Sad times of course, losing a child to any illness or injury takes a toll on your spirit. In emergency, you either learn to live with vicarious trauma or you will not survive.

In 1992, my professional life took an unexpected turn. I was the nurse educator in emergency when the manager asked me to follow-up on a letter we had received from an RCMP officer who had brought a patient for examination post sexual assault. So I looked into the matter to see if the clinical practice was appropriate and if there were any changes in our procedure that could improve care for this group of patients.  As an educator, I started with statistics.   I found that we had actually had only 12 patients present for care post sexual assault. With a population of about 250, 000 at the time I knew something was wrong.  In my previous Emergency Department, serving a population of 60, 000 we averaged 50 to 60 such cases a year.  I knew this because working night shift, I frequently was the caregiver in what was known as “rape” cases.  I discovered that patients from our catchment area were actually going an hour away to another hospital to a specialized service with female physicians doing the examinations.  The service saw many patients per year from our area.  So it was clear that we were not providing the services our population needed.  I investigated the options for improving care at our facility.  The options included:

1. Develop a specialized service with female physicians providing the examinations at our facility.
2. Educate all the emergency nurses to better assist the emergency physicians in the care of this patient population.
3. Look at developing an innovative service for not only our province but our country: that of the Sexual Assault Nurse Examiner which I had found literature on and was deeply interested in as it expanded the nurse into advanced practice.

So long story short is that option 1 was not viable as we could only find 3 female physicians interested and we needed at least 6 to build a roster.  Option 2 was not viable as there simply were too many nurses in the department as we were the largest volume Emergency Department in Western Canada. Keeping the staff skilled in the care of the sexually assaulted patient was simply impractical.  So my manager and I looked at option 3.  We did a funding proposal, I did the research and looked at policy development and guidelines and in June 1993 we received funding for a 1 year pilot project to develop the first Sexual Assault Nurse Examiner Program.  By this time, I was totally intrigued by the forensic sciences involved, the linking with legal entities and the ability for nurses to utilize all their skills in this advanced practice role. In other words, I wanted to BE a nurse examiner.   I also went back in my nursing history to two patients that had long been part of my “patients you never forget“ file.   Every nurse has such a file whether they admit it or not.  My file had two patients whom I had cared for post sexual assault. My very first one was a 22-year-old university student who came to my department in the middle of the night and the physician and I cared for her, both of us having never cared for such a patient in our professional lives (this was in 1970).  The second one was a 19-year-old young woman sexually assaulted by her employer at a Christmas party. I realized in 1992, the health care being provided by professionals was pretty much the same as I did in 1970. Nothing had changed!! I was shocked and dismayed that in 22 years we had not made any changes to lessen the trauma to those who have been sexually assaulted.  So I became a Nurse Examiner and did my first examination in 1994 as the first nurse examiner to perform an examination in my province.   I loved the work; it provided me with the opportunity to use every skill I had as a nurse to focus on this one individual who presented with not only health care needs but forensic care needs as well. The more skilled I became at this new role, the more I realized that health care was not responding to the forensic needs of many other groups of patients, such as children being abused, intimate partner violence, car crashes, workplace injuries, death by crime, elder abuse.  I found my skills were applicable to approximately 70% of the patients presenting to emergency.  For a period of 6 years I actually held two positions,  full-time Nurse Educator in Emergency, on call Nurse Examiner as well as doing all the education for the SANE Program.  In 2000, we were fortunate to receive funding for a full-time Coordinator (me) and I continued in that role until 2006.

Since 2006, I have been the primary Forensic Nursing Educator in my province developing the first classroom delivered Forensic Health Sciences Certificate.

My motivation has always been to provide the best possible nursing care for my patients, first as a bedside nurse and then as an educator ensuring nurses had the education and skills to provide the highest quality patient care possible.

 The devastation of violence and trauma on individuals, families, communities and society was clear to me from the beginning of my career in emergency. Forensic nursing which I discovered through the International Association of Forensic Nurses in 1995 when I attended my first Association conference, only led to reinforce that health care was not addressing the forensic needs of patients both in the  acute and community medical settings.

Forensic nurses work with individuals across the lifespan, from a child who is born drug addicted to the elderly person who is being financially abused by a family member. And they are the last advocate for the deceased as death investigators or coroners.  The forensic nurse of this decade is becoming the game changer in health care when it comes to violence and trauma responses. That makes this specialty such a unique and exciting.