Compassionate Champions: Forensic Nurse Examiners

In 2023 ChristianaCare’s Emergency departments treated more than 2,000 patients who were victims of violent crimes. In those sensitive situations, a specially trained team of nurses called forensic nurse examiners provides compassionate, trauma-informed care.

For their innovative, dedicated approach to care, this full-time team of 25 nurses received the Compassionate Champion Award in health care from Delaware Gov. John Carney on May 17. The recognition is awarded by the Family Services Cabinet Council, Trauma Matters Delaware and the Governor’s Office. It’s the latest acknowledgement for this one-of-a-kind team in the region.

Christiana Care’s internationally respected forensic nurse examiners are on duty 24 hours a day, seven days a week. Coordinator Amy Stier, BSN, RN, FNE, CEN, SANE-A, and Sarah Peluso, BSN RN CEN CPEN SANE-A, explain the vital role of forensic nurse examiners and how ChristianaCare is setting the gold standard in the field.

What is the role of a forensic nurse examiner in a hospital setting?

Forensic nurses look a little bit different at every hospital. At ChristianaCare our forensic nurses are also emergency department nurses and we have additional training in caring for adult and pediatric victims of violence.

We take a health history, do a safety assessment, identify and document injuries and collect potential evidence along with photographs and written documentation.

What does the national landscape look like for forensic nurse examiners?

There is a shortage of forensic nurses throughout the U.S. In the 200 hospitals in our region, 80% of them do not have a forensic nurse or they have a forensic nurse who is only on call. Especially in rural areas, some patients have to drive hours to find a hospital that has a sexual assault nurse examiner or a forensic nurse examiner.

What makes ChristianaCare’s forensic nurse examiner program exceptional?

Victims of crime present 24 hours a day, and we are there for them every hour of every day. We are the only forensic nurse examiners in our region that are available on site 24 hours a day, 7 days a week, 365 days a year.

I want people who need us to know that we’re ready any moment of the day to provide one-on-one compassionate, private, trauma-informed care.

We’ve made it our mission to never allow a shift to be uncovered. We all work as a team and everybody does their part to make sure if someone’s sick or an emergency happens that there’s someone there.

In our training, we initially take a 40-hour course through the International Association of Forensic Nurses specific to caring for victims of sexual assault. We have expert training in strangulation and in gunshot wounds and ballistics. We have about 125 hours of education specific to the wide variety of patient we care for, plus hands-on training. We have mandatory continuing education requirements twice a year.

We are part of the Emergency Nurses Association and the International Association of Forensic Nurses. We’ve helped train nurses from as far away as Malta, the United Arab Emirates and Australia.

How did the program begin?

We began in 1997 as sexual assault nurse examiners. Now we are a forensic team of 25 between our Newark and Wilmington campuses. We care for victims of sexual assault and we take care of patients who are victims of intimate partner violence, elder abuse or child abuse, or who experienced any kind of traumatic injury such as a gunshot wound or stabbing or strangulation.

In addition to seeing patients in the ED, we receive consults from all over Christiana and Wilmington hospitals, and respond to all of the admission floors, the Center for Women’s & Children’s Health and the Pediatric Care Center. Patients come to us from Union Hospital and from all over the region.

What is trauma-informed care?

Because we are in the emergency room, we are able to greet victims of sexual assault at triage promptly and bring them back to a quiet, isolated area away from the busyness of the emergency department. From the time we are notified that patient has arrived to the time we make face-to-face contact with them is less than 10 minutes.

ChristianaCare’s forensic nurse examiners offer education to health care professionals, community organizations, government offices, law enforcement agencies, schools and universities. To make a request, contact fnecoordinator@christianacare.org.

And we practice trauma-informed care in a safe, inclusive environment. This care model shifts the focus from “What’s wrong with you?” to “What happened to you?” We partner with our patients to get a complete picture of their life situation — past and present — so we can give them the most effective and healing health care services possible.

Trauma-informed care has been proven to improve patient engagement, treatment adherence and health outcomes, as well as provider and staff wellness.

It’s a model that helps us in our roles too. We’re seeing traumatic things and we need support from each other. We have a cohesive team – we debrief each other and provide support to each other. That is how we are able to continue helping our patients.

What happens after a patient leaves the hospital?

This is more than just treating in the moment. This is continued care to help them through the situation they’ve dealt with. They’re just starting that healing process and that road to recovery when we’re discharging them.

At discharge we partner with them on safety planning to ensure they have a safe place to go. We make referrals to the domestic violence hotline, shelter placement, counseling services, law enforcement agencies, victim advocates – really anything they may need. We want to make sure they have access to all of the different resources that are available because not every patient realizes there are so many different options.

Sometimes we’re able to follow a patient full circle through the justice system. We’re able to testify on behalf of the patient. We’re able to see them get their protection from abuse or the restraining order they need.

Patients are extremely appreciative. Knowing that we were able to provide that one-on-one care and help them in that moment is so important. When a patient says, “you changed the entire feeling of that visit” or “you made me feel safe and protected,” that feedback fuels us.