What it's Like To Work as a Sexual Assault Nurse Examiner (SANE)

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Disclaimer: The following stories contains references to sexual assault, domestic violence, and child abuse. 

Leah Helmbrecht, BSN, RN, who is currently studying to sit for the Sexual Assult Nurse Examiner (SANE) A Certification exam and works at a Level 1 Trauma Center in Colorado, left an 11-year career as an OR nurse—7 of those spent as a travel nurse—to become a travel nurse recruiter shortly before the pandemic began. 

It was during her time as a recruiter that she first saw the acronym SANE on another nurses’ resume—and although she may not have realized it at the time, those four letters would go on to change her life. 

“I always assumed those who were sexually assaulted had to go to the police station and they did their own evidence collection,” she tells Nurse.org. “I had a great conversation with this nurse who explained all the aspects of the job and at the time I just thought it was an interesting role.” 

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Journey to SANE

Only 5 months into her new career as a recruiter, Helmbrecht admits that she “felt a great deal of guilt” for not utilizing her nursing license and that she often cried a lot, being forced to tell nurses their contracts were canceled or their rates were dropping without any control over it. She decided to go back to nursing, but due to having multiple medical conditions and being cautious about working directly with COVID patients, she found a job working at a nurse advice hotline as a triage nurse. 

During one shift, she took a call from an individual who had attended a small get-together with some acquaintances she knew through a friend—the woman had only consumed 2 beers, but somehow woke up in her own place with her clothing ripped and no memory of what had happened. 

“She didn't know what to do and was scared to go to the ER because of COVID,” Helmbrecht remembers. 

That experience, along with that early introduction to SANE through recruiting, prompted her to want to learn more. She found a free course through the UCHealth Memorial Hospital SANE/SAFE Program. This program is a 64-hr online didactic that was self-paced and free to nurses. After finishing the entire online course, she then decided to do the next step of going to Colorado Springs to complete two days of in-person clinicals.

Upon finishing the program, she looked online at her current hospital's job board and happened to see a SANE position open. She applied, interviewed, and began working as a SANE only two weeks later. 

“I feel like everything happens for a reason,” says Helmbrecht. “While I know being a recruiter was not meant to be, I feel like it's the path I was supposed to take to find out that this career exists. I feel like I finally found a job that I'm super passionate about and truly feel like I'm making a difference in my patient's lives.”

Challenges to Being a SANE

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While Helmbrecht has undoubtedly witnessed difficult things in her job as a SANE, she challenges the idea that what she sees in victims as being the worst part of her work. 

“Many people think the hardest part of this job is having to listen to all these horrendous acts of violence a perpetrator inflicted on their victim,” she says. “It's not. The most challenging thing about being a SANE is the frustration of seeing our system fail these victims time and time again.”

She explains that there is so much more to this kind of violence that is not known to the general public, law enforcement, or even to our judges. “It's just not taught,” she adds. According to Helmbrecht, there have been cases of judges giving probations to first-time sex offenders, medication to lower their libido, or offer the opportunity to join the military rather than face prison time. 

“There's a huge misconception that sexual assault and domestic violence have to do with sex and anger management issues and that there's an easy fix to ensure safety to the general population,” she points out. “In reality, both have to do with power and control over another person. This is why we see so many abusers in high profile jobs like politicians, judges, law enforcement, CEOs, the entertainment business, sports, etc.”

On top of the injustices she sees for victims, Helmbrecht adds that she struggles with battling common assumptions the general public has about sexual assault and domestic violence. For instance, comments like, “Why don’t they just leave if the abuse is so bad?” blame the victim and overlook the reality that the most dangerous time for a victim of intimate partner violence is when a decision has been made to leave. 

“This is when they are at highest risk of being murdered and this risk continues to be heightened up to a year after they leave,” she explains. “If the victim ends up murdering their abuser to keep from being murdered themselves, many will end up in prison.” 

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Misconceptions About Being a SANE

Helmbrecht shares that in her journey to become a SANE, she has had many of the misconceptions about the role shattered. Here’s how they break down: 

Assumption: We can test to see if someone was drugged.

Reality: “Most drugs used in sexual assault (SA) either leave the system before the victim ever makes it to the ER, the hospital doesn't actually have the ability to test for most of the drugs used in SA, and the number one drug used in SA is actually alcohol,” she notes. 

Assumption: A SANE can determine if someone was sexually assaulted. 

Reality: “Most of the time there isn't any trauma,” Helmbrecht explains. “When you think about it, the vagina in particular was created to go through trauma (such as during childbirth). So just because there isn't visible trauma does NOT mean we don't believe the victim and does NOT mean the victim is lying about being sexually assaulted. 

Assumption: Anyone can be a SANE.

Reality: Many positions require you to have between 2-5 years RN experience (preferably L&D or ER, but not always mandatory), says Helmbrecht. “Also, it can take its toll emotionally and mentally,” she adds. “It can become really easy to self isolate and turn away from romantic relationships after listening to so many terrible first-hand statements of what happened during these assaults. Make sure you are ready to not take on the trauma these patients have experienced, but also not put your past trauma on your patient.”

Assumption: You are going to get these patients justice for what happened to them. 

Reality: “Only about 2% of SA cases get a conviction,” Helmbrecht notes. “It's one of the hardest crimes to convict and why it's also one of the top crimes that go under-reported. What we will actually do for these patients is: Make sure they are medically cleared, provide prophylactic medications, give post-trauma resources, and most importantly, in a society where we blame and shame victims of SA, sometimes a SANE is going to be the only person who listens to these patients without judgment and tells them they BELIEVE them when the victim says they were SA. So while most will never get the justice they deserve, we could make all the difference in their healing process and make sure they feel comfortable coming forward if they were to be SA again.”

Assumption: A victim of intimate partner violence (IPV) will always take your advice.

Reality: “You are there to give your patient back the power and control that was taken from them during the assault,” she says. “While you have an understanding of risks in relation to being revictimized by their assailant, you are not there to convince them to leave their abuser. Your job is to listen, educate, and offer resources for when they are ready to leave. The risk of homicide increases drastically when the victim decides to leave. Simply telling a victim to ‘just leave’ does not always guarantee safety. They must make this decision for themselves knowing all the risks of staying or leaving.”

 

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 What Nurses Need to Know About Sexual Assault

The area of sexual assault nursing is one that Helmbrecht says will have a high need for additional workers in the years to come. She notes that in the U.S. alone, someone is sexually assaulted every 68 seconds and every 9 minutes, that individual is a child.

“We know these numbers are wildly under-reported,” she says. “There is already such a high need for SANEs, but unfortunately they are not seen in every hospital since it is not a job that brings in any revenue to the hospital.”

Helmbrecht adds that she believes that SANEs will be needed more than ever due to new anti-abortion laws in states like Idaho, Tennesse, and Texas that hold no exceptions for rape or incest, but allow for family members of the rapist to sue the doctor if an abortion is performed for $10K-$20K/each. Helmbrecht believes these types of laws will actually increase cases of rapes and incest because of the opportunity for financial profit. 

“Remember, only 2% of rapists are actually convicted,” she points out. “So even if there were exceptions for rape or incest, the majority of impregnated victims would still be forced to carry their rapist's fetus.”

She also sees the end result being more children in foster care, which places them at a higher risk for sexual assault as well—children living without a parent are 10X more likely to be sexually assaulted than children living with both parents. An estimated 36% of females who were victims as children were raped again as adults and 45% of males who were sexually assaulted as youths were victimized again as adults.

Despite the desperate need for more awareness, advocacy, and SANE workers, Helmbrecht is an advocate for all healthcare workers to learn more about sexual assault and how to best help victims, no matter what area of healthcare they work in. 

“I was surprised to see how uneducated the majority of people in healthcare are about sexual assault and domestic violence, myself included,” she says. “I learned so much from taking the University of Colorado SANE/SAFE program that I encourage anyone to sign up.”

For instance, she points out that education about the neurobiology of trauma and why victims act the way they do after experiencing trauma is crucial. “I was surprised by how often our judicial system fails these victims and our communities by allowing these perpetrators to walk free,” she says. “I was surprised at how slow the courts move and how backed up the crime labs are at processing evidence kits.”  

And if you’re considering becoming a SANE nurse, Helmbrecht does have some tips for you:

• Get the right experience. “Get your RN experience first and build your confidence speaking with people in authority roles,” Helmbrecht says. Typically, SANE nurses need at least 2-5 years of RN experience—preferably in L&D or ER—- to be considered for the role. “Advocacy is a huge part of this and you need to be able to speak with clear and concise facts in order to educate rather than emotions.”  
• Get the right certification. After getting 2-5 years experience as a nurse, you’ll need to complete an International Association of Forensic Nurses (IAFN) approved SANE program. Then, if you want to become SANE-A or SANE-P Certified, you’ll need an additional 300 hours working as a SANE with 200 out of 300 hours working with Adolescent/Adult population (post-pubescent) to sit for SANE-A exam and 200 out of 300 hours working with Pediatric Population (pre-pubescent) to sit for SANE-P exam. 
• Have a good support team. Along with a great manager, Helmbrecht shares that surrounding yourself with positive things in your life is key. “Right now I only work four on-call shifts/month, but can choose to pick up more if I want to,” she says. “I make sure to make my schedule so I have some time off to get out and do the things I enjoy, like hiking or meeting up with friends. Take time off of social media and just read a book that has nothing to do with work-related education. Have great friends who can call me out when they notice I'm slipping into an isolation pattern and drag me out to socialize.” 
• Get a therapist. “It is very easy to become isolated and have a severe distrust of anyone around you,” Helmbrecht notes. “While the work is important, you cannot let it consume your outside life.” 
• Don’t go into the field for the money. “One thing is for sure, you do not go into this field for the money,” she says. Helmbrecht explains that every SANE job location has a different way of paying their SANEs, whether it be hourly, call back pay, or a set amount per kit, but since it is not a field that makes money, it is not a field that pays well. However, she does add that there are other opportunities to work as an Independent Expert Witness and be paid to read over depositions and testify as someone who is proficient in the field of SA/DV/Strangulation. To do this, it is recommended that you have previous trial experience (i.e being subpoenaed to testify in cases you had been a part of as a SANE, have your SANE-A and/or SANE-P Certification, and while not mandatory, a higher education in Forensic Nursing (Masters or Doctorate).
• Become an advocate. “Take the pledge to start believing those who come forward, get rid of all your assumptions and judgments you have, and correct the behavior of those around you when you see or hear something that is ignorant or harmful,” she says. “Reach out to your representatives who voted against the Violence Against Women's Act that covers the cost of rape kits for all victims of SA and ask them why. Donate to your local advocacy groups or volunteer as an advocate.”

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Most of all, Helmbrecht hopes that all nurses and healthcare workers realize that whether they know it or not, every single person knows someone who has been affected by sexual assault or domestic violence. 

And while she points out that sexual assault or domestic violence shouldn’t have to personally affect you in order for it to matter to you, she encourages you to know what to do if someone does disclose to you that they were assaulted: acknowledge it, let them know how sorry you are that someone did that to them, and make sure they know it wasn't their fault because it doesn't matter what someone was wearing, drinking, or what time of the day or night it was—no one has the right to assault another person. 

“It can happen to anyone of any gender identity, age, socioeconomic class, or sexual orientation,” Helmbrecht says. “Anyone.” 

To Find Out More Information

According to the IAFN, there are currently only 2,154 certified SANE in the country. If you are interested in learning more about this role, check out the following pages:

• Academy of Forensic Nursing
• American Academy of Forensic Sciences
• American Nurses Association (ANA)
• Canadian Forensic Nurses Association
• How to Become A Sexual Assault Nurse Examiner
• How to Become a Forensic Nurse
• International Association of Forensic Nurses
• Journal of Forensic Nursing
• RAINN (Rape, Abuse & Incest National Network)
• The Ultimate Source for Sexual Assault Forensic Examiner