National Tribal Clearinghouse on Sexual Assault

Conversations with a Sexual Assault Nurse Examiner - Part 1

• NTCSA • Season 1 • Episode 5

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This episode provides insight on what a forensic nurse is and the important role they play in the overall service provided to survivors. 

Presenter Bio:
Tammy Scarlett serves as a Forensic Nursing Specialist, providing training and technical assistance at the International Association of Forensic Nurses. Tammy has been working as a registered nurse since 2010 and received her Master in Public Health with a concentration in Global Health in 2020. Initially receiving a position as a forensic nurse in Newport News, Virginia, providing care to patients in an on-call capacity while working in the Emergency Department. Eventually Tammy became a Principal Investigator on two research projects.

Currently she holds her certification in Sexual Assault Nurse Examiner- Adult/Adolescent (SANE-A) and Sexual Assault Nurse Examiner- Pediatric (SANE-P). She has provided training for the Colorado SANE/SAFE Project and Indian Health Services skills labs. She is a member of IAFN and the Colorado chapter. Tammy continues to practice clinically, providing care to patients and precepting forensic nurses to better care for our patient populations.

Interviewer Bio:
Blaze Bell is a lifelong Alaskan, Speaker, Singer, and Transformational Coach, who has turned her pain into her purpose. She is on a mission to help others heal, in the ways that she has, from trauma and addiction. Blaze has a popular podcast highlighting healing tools and a new video series interviewing leaders in the healing industry. She is the Board President of Victims for Justice and also frequently works with Standing Together Against Rape (STAR), a rape crisis intervention service in Anchorage, Alaska. As a certified holistic health coach and award-winning singer, Blaze combines her unique skill set to bring the world healing through mindfulness, health, music, and joy.

This project was supported by Grant No.2019-SA-AX-K001 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this presentation are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women or the International Association of Forensic Nurses. 

Speaker 1:

Hello. And welcome to today's episode. This podcast is brought to you by IAFN's, ISAAC project funded by the Office on Violence Against Women. The International Association of Forensic Nurses is the recognized authority on forensic nursing, promoting universal access to care for patients impacted by violence and trauma. The Indigenous Sexual Assault and Abuse Clearinghouse project has a mission to offer technical assistance, training and education to providers serving sexual assault survivors in tribal communities. I am your host, Blaze Bell, lifelong Alaskan dedicated to helping fellow survivors heal from trauma. Today's guest is Tammy Scarlett. She serves as a forensic nursing specialist in Colorado Springs, Colorado. Tammy has been working as a registered nurse since 2010 and received her masters in public health with a concentration in global health. In 2020, she has provided training for the Colorado SANE SAFE project and Indian Health Services, skills labs. She is a member of IAFN and the Colorado chapter. In today's episode, Tammy gives us insight on what exactly a forensic nurse does, what role they play in the overall service provided to survivors. I also share my experience with a forensic nurse. This episode is both educational and inspiring. So let's dive in. Hello. Welcome to today's episode. I am here today with Tammy Scarlett, a forensic nurse. Thank you so much for talking with us today.

Speaker 2:

Yeah, I'm happy to be here.

Speaker 1:

Yeah. Well, I'd love to just dive right in and get it right into what is a forensic nurse for all of us that don't know.

Speaker 2:

So I think there's a lot of things that entail what a forensic nurse is to kind of break it down to something a little bit more simple is a forensic nurse is a specialized nurse who has training to help anyone who's experienced any sort of violence. Um, my way of explaining it is a forensic nurse is the big umbrella term. And underneath it, you have all kinds of different categories. For example, a sexual assault nurse examiner. I'm also one of those where I specialize in adults, adolescent and pediatric patients who experience sexual assault you have for, um, forensic nurses that work in the CORs office or other disciplines as well. So that's kind of a good example.

Speaker 1:

Oh, okay. So it's not necessarily specific to sexual assault,

Speaker 2:

Correct? Yeah.

Speaker 1:

Okay. Well, see, I didn't know that<laugh>

Speaker 2:

I know, I think a lot of people don't, and it's good to kind of understand, um, that we don't just deal with sexual assault and we might see other victims of violence such as child abuse, elder abuse, intimate partner violence. Um, all those things are intertwined. Sometimes it's not just one or the other, so it's good to have as much knowledge as possible.

Speaker 1:

Yeah. Well, I would really like to hear your perspective on when you show up, like, what is the process from the time of an assault to when you come in and after you share about that, I'd be happy too, to share a little bit about my personal experience of, um, getting a rape kit and what that was like, but I'd love to hear from your point of view, like where is that in the lineup of, you know, action and how, how do you show up for survivors?

Speaker 2:

Yeah. It's not always going to go as planned. I think I always have a set process in mind and something always gets changed, but for good, because not everybody's the same and not every, um, a health is the same. So it's important to know that it can change and it can be variable. Um, but one of the things I like to talk about with patients is when you first come in, I want to kind of get to know you a little better, get you to know who I am, because that's really important. And I'm not just someone who's coming in and outta the room quickly. The most important thing for me to know is what happened during salt. So after I've gotten some more information about you, the, um, history of the, uh, assault, kind of what I like to call it is what will guide my exam. So I'm gonna understand what happened to you. So I can understand what I can do to treat you in the most appropriate and beneficial way. So if you tell me one part of the assault happened, then I know, okay, we can go down this pathway. So history is really important to gain, and those are things that are hard to talk about. Some patients want to do that in a one word sentence, uh, one sentence, and then some of them want to do that in a whole paragraph and for, to each their own that's important. And I can always ask clarifying questions. So history is important to ask. So we go from history to what I call like a physical assessment. And then we do like a detailed anal anogenital assessment. These are all dependent on what a patient wants and also dependent on what happened during the assault. But knowing that I am constantly assessing for medical concerns throughout this, I'm constantly assessing your level of alertness to make sure that you are able to give informed consent throughout this entire process. And that you're kind of capturing what I'm saying. So I know that you are all for this. When we get a history and move on to a physical assessment after we've gotten consents, and we make sure that we have discussed every single process that is coming head to toe assessment is me getting to know where injuries might have occurred. So if there was strangulation, I'll check on your neck to make sure that there's no injury there. And if I need to collect evidence or even document photos, then we can move to, you know, general assessment. And that's where if any kind of assault occurred, um, to vaginal anal area, anything down there, penile that's something where I definitely can assess, make sure there's no injury. If we can intervene medically, if we have to, that's important to know. And first and foremost, I am a nurse and I wanna make sure that your health is taken care of. So we can collect evidence. We can document any injuries if we need to with, um, a body diagram, or I can just document that and write the it down or with the body camera, which is important for documentation as well. And then after that we discuss safety planning, wraparound services. We can get an advocate involved at the beginning of the process, if we need to, if you wanna wait and hold off for them to come into the exam, or sometimes some facilities might not have an advocate available and we can do you over the phone advocacy, whatever is available in that capability to make sure the process is easy and smooth for the patient. Um, I think that's kind of a, to be honest, a simple breakdown, because there's so much more that happens in that, whether it's a detailed assessment of strangulation or of partner violence assessments, or if it's a pediatric patient, there's a lot to consider, but overall it kind of is a good flow from understanding what happened to assessing the body and then doing detailed general assessment with evidence and photography and assessing all throughout.

Speaker 1:

Yeah. Wow. That, that's an intense job. Thank you for doing it.

Speaker 2:

Yeah. I love it. It's honestly, one of the best jobs I've ever had. I feel like I get to work so closely with my patients.

Speaker 1:

Well, that's amazing. That's amazing. Oh yeah. I, so, you know, and my, my memory is not like a hundred percent, um, for the day of my cell old too was just so traumatic. But what I do remember is by the time I gotten into the hospital, you know, leading up to that, I still had so much adrenaline from just trying to survive. And it was about the time I got to the hospital when the adrenaline started to wear off, like I knew I was safe. Uh, and I started to feel all the pain in my body and, uh, and just completely broke down. I mean, I was on the floor like in a hallway, just fetal position sobbing and, and just feeling pain and all, you know, parts of my body. I didn't even know, you know, never felt pain before. And, and I was also very, um, skitish, you know, I like didn't want anybody to touch me. My parents were all just right there around me, but I didn't want them to touch me. And, uh, it was just a really, really scary experience. And, uh, but I will say the forensic nurse, I remember thinking she must be an angel. Like she was so wonderful cuz I was, I was nervous about that part. I was like, I mean, here, I was like, don't touch me. Don't don't look at me. You know? And um, and obviously she was gonna have to touch me quite intimately. And somehow she made me feel really safe and really taken care of and like it, it was gonna be okay. Um, there was also an advocate from star, which is the rape crisis center here in Anchorage, Alaska. And, uh, that was another like amazing part. You know, she really, she stood in between me and anyone else that walked in that room and that made a huge difference. Um, definitely. Yeah. So I think, you know, for anyone listening, like the advocacy part is also really, really helpful. And um, but my experience with the nurse was beautiful and you know, I'd love to see her again. Like I just, it was so powerful to me and she really made me feel like you're gonna be okay, we're gonna take care of you. You're safe. You know, you're safe here with me. And it was really, really pretty incredible. So I'm, I'm a big fan.<laugh> big fan of the work you do. It's, it's so important. Yeah.

Speaker 2:

And it's good to hear that you're a great experience. I know some people don't always have those and that is so heartbreaking to me. So any way possible to make it like your experience, where it's about you and what you need and what we can do. That's really important to me as well. And I know every forensic forensic nurse I work with,

Speaker 1:

I felt really taken care of and cared for and that I needed that in that moment. For sure. Yeah. So I'm curious, um, as far as like the, your work with other care providers, so, you know, who do you need to communicate with, who calls you to show up to do these? Um, is there, are this, there are always law enforcement involved. Like what kind of, what is your connection to the other people involved?

Speaker 2:

My connection is of course different than a lot of other people's. I know the forensic nurses in different states, um, might or different countries might have a different process. Um, for sure, especially if you're working out a child advocacy center versus a hospital that can present very different for me working outside of a hospital, I am actually working in a program that is 24 7. So we are always on site. We have patients that present by ambulance or law enforcement. They might come in through the ambulance bay and law enforcement might bring them to us. And then we up seeing them that way. Or they might come in through intake where they just present not knowing where to go, what to do. And then we will take them as our patients. At that point, I've worked as an on-call nurse as well, where I was also an emergency room nurse, but then I took on-call shifts and that's where I was at home. I had my pager, it went on off in the middle of the night or whenever. And if a patient, um, came into the hospital, they would page me or detectives might page me to say, Hey, we're bringing a patient in. They'll be in, in a few hours. It just, it just varied. But for me right now, at this point, a lot of my patients present to the hospital or from other hospitals that will be transferred to us.

Speaker 1:

Okay. So say someone's assaulted and they don't report it and maybe don't want to report it. Uh, are those the cases when they're just showing up at the hospital, can they still get care if it's not tied to a case?

Speaker 2:

I think that's an excellent question. You can come in with law enforcement or without law enforcement and due to HIPAA, which is your right to choose whether and whether or not you want your medical information released. I might not be able to say anything to law enforcement. If you present with them. If some thing happened, there's a lot of instances where I have patients whose friends reported or family members report it. Now law enforcement knows, but that doesn't mean I have to share everything with them. But on the other hand, you have patients who present in certain states where they don't wanna report. And if your state has that reporting option for anonymity or a medical report, a lot of other different names that might be out there for that. You don't have to report as long as there's nothing that falls under mandatory reporting, such as things like serious bodily injuries like breaks in your bones. Um, permanent disfigurement like here in Colorado, that would be an, uh, for an instance, um, children present, um, it's just very variable across the states. But as long as it's not one of those things, then you do not have to report some states even have that option for you to have your evidence collected, to be sent to often stored or stored within your facility, where you get that option to think about what you wanna do. And if you wanna turn it in or hold it or never do anything with it, but that gives you that opportunity to still have that choice within that timeframe of still collecting that evidence. And one nice thing about our exams, which I always try and make sure patients know upfront is that I am doing this again for you. So whatever you need, if you want to tell me, need bits and pieces enough that we can get as much medical care as we can. That is fine. If you only want to do the anogen exam, but you don't want photos or you only want to do a B, but not C, D and E. I am all for that, whatever I can do to make sure that you get the best care possible. Um, that's a part for me and that's a big part for forensic nursing. Again, healthcare comes first. So if you came to me just to receive healthcare, that's great. We don't have to report. We don't have to collect evidence.

Speaker 1:

Hmm. Oh, that's good to know. What is the timeframe for reporting or, or what's the timeframe for getting at, for getting the exam and having the proper evidence?

Speaker 2:

Again, it's tough cuz every state jurisdiction territories is different. For example, where I work, you have 120 hours to collect evidence. Sometimes that's a variable on whether a patient is taking shower or other in, um, instances, um, in other states or other places, sometimes it's only 72 hours. And that depends on the crime lab, on your jurisdiction and on your policy, your local policies like for your hospital. But everybody is about somewhere between 72 and a 20 hours for there. But again, variable that is for overall evidence collection. Now you also have things to consider such as, um, STI medication or sexually transmitted infection, medication or HIV impact to prevent someone from acquiring HIV or emergency contraception. If we wanna prevent a pregnancy, those also sometimes have timeframes or considerations around them that if you are not wanting to get evidence collected and you're not worried about that timeframe, I'm still concerned about those and I wanna address those. So it depends. And I know there are some facilities that can only work within those limits of the timeframes for evidence collection, for good reasons. They might not have enough staff. That's maybe what law enforcement is, you know, saying that's all they can handle with their evidence collection, you know, for various reasons, for some programs though, they might be able to see patients well after that evidence collection timeframe to still talk about the assault, make sure there are still no other concerns do assessments for your danger, like risk. Um, so many more things that can still be done after photographs. Um, and other programs also even do follow ups after. So we've seen you once, but let's bring you back to recess that injury or to still make sure that you're okay and you're getting the medications you need. So there's a lot of variations. Um, and I know that's kind of a tough answer sometimes, but the best idea is to call your local hospital or local law enforcement and they would probably know how to guide you as well.

Speaker 1:

Yeah. Yeah. And I understand that every case is different and there can be I'm sure. So many nuances. I can't imagine how many different, uh, you know, situations you've witnessed and yeah. Mm-hmm<affirmative> yeah, absolutely. Okay. Well here's a little bit different question. This job sounds like it would be so challenging. I know you love it and that's awesome. How do you take care of yourself? Like what's what kind of, do you have self care practices? Are you able to separate work from home or are you kind of always thinking about everyone you saw that day? Like how do you do that?

Speaker 2:

That's a hard question because I think I, I innately am always gonna be thinking about my patients. I, like we mentioned before, there was a patient before gone here, there was a patient that I was thinking about and worrying how they were doing. Um, that doesn't happen all the time. I think I can separate pretty well, just because I've learned to, I've gone to therapy, I've done a lot of talking about this, of how do you do that? Cuz I wanna take everything home and I know I can't. Um, but I have a great group of forensic nurses that I work with. They are amazing to debrief with. They will walk me through what happened, what didn't happen, what, um, my thoughts were on it and it's really helpful and really beneficial cause I trust all these nurses. So that's a big, a big plus for me. I think family time has been very important for me. So being able to get out of the city, go back and visit my family. That's kind of my, my downtime where I'm able to not have to process and not have to think about things. So for me, that's my self care. Um, I do tend to work a lot and I know that. And so I have to find those boundaries and that time and remember that I can't save the world in one shift, um, or even after my shift's over. So for me, family time is very important and that's been really helpful.

Speaker 1:

Good. Yeah. Thank you for sharing that. I know that compassion, fatigue is real and burnout with these types of jobs that are just so can be so heavy if you're not able to compartmentalize and have your own way to process. So, you know, I'm so happy to hear that you've utilized therapy to work through that. And I love hearing that like you and the other nurses can support each other because only they understand exactly what you're going through. And that's awesome.

Speaker 2:

Yes. It's a very true, they're an amazing group of people. Yeah.

Speaker 1:

Well, do you have any just kind of final words about forensic nursing, maybe for a survivor listening who's considering, um, seeing a nurse or even other care providers on how they can support you as well?

Speaker 2:

I think one thing I would like to say to other care providers is this is hard. Our patients sometimes get dismissed easily in the sense that, oh, the forensic nurse will handle them or law enforcement will handle them, but we need to remember that these are healthcare problems as well. And these patients deserve every single amount of our attention as any other patient, like a trauma or a broke. These are very important and a lot of things are time sensitive as well. So if we change our view as practitioners on how we view these patients as humans and as our responsibility, I think that's a really important piece of the puzzle to help kind of navigate through how these patients present to hospitals and how they are treated and how they feel when they get to the hospital, but also encourage patients and survivors to remember they can voice opinions to us and they can say, Hey, I'm not comfortable with this because I know sometimes that seems a little taboo and not appropriate or someone doesn't make you feel like you can. It is a, is a hundred percent allowed to say how you are feeling and no, wait, hold on one second, give me a break or can I eat something first? Cause I haven't eaten all day. I think we forget those things as nurses sometimes. And um, it's important that, you know, we wanna hear from you, we want to hear what is happening in your mind because I'm here for you. So speak up and let us know. Although I know that's hard, um, if it doesn't happen and it's okay too, we'll probably just help process help you process through the entire thing. But if you want to, we are there for you.

Speaker 1:

Beautiful. Thank you. You. Yeah. Well, thank you so much, Tammy, for sharing so much. I think this is really helpful for people to get a much greater understanding of your role and how you can support the people that need you and the moment of crisis. And I, I love hearing that you love your job. I think that's just so incredible. So thank you so much. And I'll talk to you soon. Yes,

Speaker 2:

Please. I really appreciate it. And if anyone ever wants to reach out to me or anyone on the team at I a N more than happy to answer any questions, um, I really appreciate your taking time today to let me talk. Thank you so much. Thank

Speaker 1:

You. This podcast is made possible by funding from the Office on Violence Against Women. The opinions, findings, conclusions, and recommendations expressed in the presentation are those of the authors and do not necessarily reflect the views of the Department of Justice, the Office on Violence Against Women or the International Association of Forensic Nurses. If you would like to connect with an advocate after listening to this episode, please call 800-656-HOPE that's 800-656-4673. To be routed to an advocate in your area 24/7, or go to rainn.org, R A I N N.org for more info or live chat.