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The primary responsibility of forensic nurses is to provide nursing care to both the victims and perpetrators of crime, while at the same time collecting biological and other physical evidence that law enforcement, prosecutors, defenders, and other members of the legal system can use in criminal proceedings. Forensic nursing skills include:
- Identifying patient injuries and evaluating their nature and scope
- Documenting the patient’s incident and collecting and properly storing biological and physical evidence
- Dealing sensitively with people who have experienced crime and violence
- Working with law enforcement officials and attorneys
- Giving expert testimony in both criminal and civil court cases
Forensic nurses work in various settings, including emergency rooms, acute care centers, adult protective services units, psychiatric forensic treatment and evaluation units, correctional facilities, as well as on scene with death investigation teams.
According to the International Association of Forensic Nurses (IAFC), the most common type of forensic nurse in the U.S. is the sexual assault examiner. In fact, the term “forensic nursing” first came into use in 1992 at a convention for sexual assault examination nurses. These nurses go by various titles:
- Sexual Assault Nurse Examiner (SANE)
- Sexual Assault Examiner (SAE)
- Sexual Assault Forensic Examiner (SAFE)
- Sexual Assault Nurse Clinician (SANC)
- Forensic Nurse Examiner (FNE) (This title may also refer to nurses who examine victims of crime other than sexual assault)
Although these various titles are still used by some practitioners, in 1996, the annual meeting of the IAFC voted to make SANE the preferred, standardized title. In order for RNs to become sexual assault nurse examiners, they must take a sexual assault examiner class that includes 40 hours of classroom training, plus an average of another 40 hours of clinical training.
Another common role for forensic nurses is medicolegal death investigator. These investigators are medical personnel who collect evidence at the location a death took place in an effort to determine the cause. Other titles for nurses in this role include death investigator, medical examiner nurse investigator, forensic nurse investigator, or deputy coroner. In some jurisdictions, nurses may serve as coroners, depending on local regulations. Forensic nurses in this role are also involved in identifying bodies after natural disasters and accidents that result in mass casualties. Becoming a medicolegal death investigator requires the completion of a forensic nursing program in medicolegal death investigation.
Another role is that of forensic psychiatric nurse. These nurses work with both victims of crime, as well as offenders, helping them deal with the psychological consequences of violent crime, which commonly manifest as depression, acute stress disorder, post traumatic stress disorder, anxiety, and substance abuse.
An Interpersonal Violence Specialist might choose to work in a number of different specialties, including geriatric forensic nursing (elder mistreatment), pediatric forensic nursing (child abuse and other violence against children), and domestic violence. In addition to caring for patients, these forensic nurses may develop psychological treatment programs for children affected by abuse and trauma, as well as community-based programs that address domestic violence.
Other roles assumed by forensic nurses include medical-legal consulting, public health and safety, and forensic nurse education.
Forensic Nursing Education
In addition to specific types of educational programs, such as SANE or medicolegal death investigation training, more general education is also available for RNs who want to become involved in forensics. Typically, the focus of forensic nursing education is on the legal system, collecting and preserving evidence, providing testimony, and caring for victims and perpetrators of crimes.
For nurses with an undergraduate degree who don’t want to attend a full graduate program, forensic nursing certificate programs are available.
Master’s degree options include:
- Master of Science in Forensic Nursing
- Master of Science in Nursing with a Forensic Track, Forensic Specialty, or Forensic Science Minor
- Clinical Nurse Specialist: Forensic Nursing Focus
- Master of Science in Forensic Medicine
- Master of Science in Forensic Science with a Forensic Nursing Option
Post-master’s programs are available for nurses who already have a master’s degree. A number of DNP programs also offer a forensic focus, including the Dual Family Nurse Practitioner and Advanced Forensic Nursing option.
Sexual Assault Nurse Certification
The Forensic Nursing Certification Board (FNCB) offers SANE-A and SANE-P certification. Both SANE-A (Sexual Assault Nurse Examiner – Adult/Adolescent) and SANE-P (Sexual Assault Nurse Examiner – Pediatric) applicants must have an active, unrestricted RN license in the United States, or have a license as a first-level general nurse outside the U.S.
Further requirements to take the SANE-A exam include:
- At least two years of RN or first-level general nursing in the country where licensed
- Successful completion of a sexual assault program that grants nursing continuing education hours or academic credit from an accredited school. The program can be either an adult/adolescent sexual assault nursing program with at least 40 hours of class work or a combined program in adult/adolescent and pediatric sexual assault that offers at least 64 hours of class work.
- Completion of supervised practice within the past three years that validates competency as a sexual assault nurse examiner
Further requirements to take the SANE-P exam include:
- At least three years of RN or first-level general nursing experience in the country where licensed
- Successful completion of a sexual assault program that grants nursing continuing education hours or academic credit from an accredited school. The training can be either in a pediatric sexual assault nursing program with at least 40 hours of class work or in a nursing education program that combines pediatric and adult/adolescent sexual assault training and offers at least 64 hours of class work.
- Completion of supervised practice within the three years immediately prior to application that validates competency as a sexual assault nurse examiner (nurses who already have a current SANE-A credential don’t have to meet this requirement).
Note: All educational programs must follow the content outline contained in the Sexual Assault Nurse Examiner Education Guidelines published by the International Association of Forensic Nurses.
FNCB administers the SANE exams two times a year, in May and October, at both U.S. and international locations. Each four-hour exam contains 175 questions. The SANE-A exam content is broken down as follows:
- Assessment of the Sexual Assault Patient (40%)
- Evidence Collection and Documentation (16%)
- Management of the Sexual Assault Patient (23%)
- Interact Throughout the Judicial Process (11%)
- Professional Practice Issues (10%)
The SANE-P exam content is:
- Assessment of the Sexual Assault/Abuse Patient (46%)
- Evidence Collection and Documentation (16%)
- Management of the Sexual Assault Patient (21%)
- Interact Throughout the Judicial Process (6%)
- Professional Practice Issues (11%)
Certifications are valid for three years. SANEs can renew certification either through meeting continuing education requirements or by taking the exam again.
Other Forensic Nursing Certifications
The American College of Forensic Examiners International (ACFEI) offers a Certified Forensic Nurse (CFN) program. Taking the exam requires the following:
- Being a member of ACFEI
- Having a current, unrestricted RN license in the U.S. or a first-level general nurse license in the country/jurisdiction of current practice
- Having at least three years of nursing experience as an RN or first-level general nurse
- Completing at least 40 contact hours of education in the core areas of forensic nursing
- Validating current forensic nurse competency by providing supporting documentation signed by an appropriate clinical authority
To maintain the CFN credential, nurses need to complete 15 hours of forensic-related continuing education each year.
The International Commission of Health Care Certification (ICHCC) offers certification as a Forensic Nurse Certified Consultant (FNCC). To apply for the certification, nurses must be licensed RNs and have 80 hours of forensic science training for nurses or related forensics training. The exam can be taken either online or on site. Recertification is every five years and requires 80 hours of approved continuing education.
The American Institute of Health Care Professionals offers the credential of Certified Specialist in Forensic Nursing (FN-CSp.). Becoming certified requires completion of a 250-hour certification program.
Forensic nurse death investigators can become certified through the American Board of Medicolegal Death Investigators.
Forensic Nursing Associations
The goals of the International Association of Forensic Nurses (IAFN) include establishing and improving evidence-based standards in forensic nursing, incorporating violence prevention strategies, encouraging the exchange of ideas and knowledge, establishing ethical standards for forensic nurses, and providing educational opportunities. The IAFN publishes, in cooperation with the American Nursing Association, the Forensic Nurse Scope and Standards.
The Academy of Forensic Nursing Science (AFNS) is an international professional organization that represents all forensic nursing specialties.
The American Board of Forensic Nursing (ABFN) is an advisory board under the ACFEI.
The Forensic Psychiatric Nurses Council is a part of the American Psychiatric Nurses Association (APNA), a network and resource for members who work in forensic psychiatric nursing.
Nurses working in death investigation may be interested in the Society of Medicolegal Death Investigators.