Forensic nursing is an established and growing specialty area of nursing practice in Australia. But it’s not quite like how it’s portrayed in American television shows such as CSI and SVU, writes Karen Keast.

United States’ vice president Joseph Biden once wrote - ‘Forensic nurses play an integral role in bridging the gap between law and medicine. They should be in each and every emergency room.’

Forensic nursing has been established in the United States since the 1970s and achieved recognition as a specialty nursing area, through the American Nurses Association, in 1995.

In Australia, forensic nursing is a small but established specialty area of practice that is beginning to expand, thanks to the growing number of courses being developed in Australia and the recognition of the role nurses can play in helping victims of crime and assisting in the course of justice.

Australia’s pioneer in the field of forensics nursing, Flinders University School of Nursing and Midwifery, Associate Professor Linda Starr says when people first hear about forensic nursing they often believe “it’s about dead people”.

Assoc Professor Starr says while forensic practice was historically founded in determining the cause of death, there is now a recognised world of ‘living forensics’.

“It was Dr Harry McNamara in 1986…he saw living forensics as the application of forensic medicine to trauma cases where forensic intervention is required or needed to investigate injuries that are either caused accidentally or caused intentionally,” she says.

“He got a government grant to fund places for forensic nurses to join a living forensic team. It was so successful that forensic nursing practice has just grown from that and the general area of forensic nursing practice….it’s just blossomed from there.”

Assoc Professor Starr says Virginia A. Lynch, the founder of forensic nursing practice in the United States, describes forensic nursing as ‘the application of clinical nursing practice to trauma survivors or to those whose death is pronounced in the clinical environs, involving the identification of unrecognised, unidentified injuries and the proper processing of forensic evidence’.

She says forensic nursing involves providing best clinical care, as well as medical and legal experience, through effectively identifying and preserving evidence that can be handed over to law enforcement, to be used in the investigation and prosecution of the case.

What does a forensic nurse do?

Forensic nurses work in a variety of roles, ranging from sexual assault (as Sexual Assault Nurse Examiners or SANEs) to domestic violence, child abuse and neglect, elder mistreatment, death investigation, corrections and in the aftermath of mass disasters.

According to the International Association of Forensic Nurses, most forensic nurses in the United States work in hospitals, community anti-violence programs, coroner’s and medical examiner’s offices, corrections institutions and in psychiatric hospitals.

In Australia, forensic nursing has predominantly existed in correctional nursing and forensic psychiatric nursing, where nursing staff provide for the health care needs of people held in custody.

Assoc Professor Starr, who is also the founding president of the Australian Forensic Nurses Association, says a number of forensic nurses in Australia are now working as SANEs.

“That’s where nurses are involved in the total medico-legal examination and evidence collection of a victim of a sexual assault,” she says.

“We have them established in every state and territory except South Australia. South Australia is now looking at it.”

How to become a forensic nurse?

Assoc Professor Starr advises nurses wanting to become a forensic nurse to investigate the growing number of university courses on offer in the field.

“I would suggest any courses that you can get yourself involved in - in regards to evidence collection, the legal side, understanding the law, issues around being a witness and giving evidence in court,” she says.

“Any of those that you could actually develop and get a good handle on would just give you the edge over someone who has not got any background or hasn’t put any effort into building their CV around a forensic health focus.

“A proactive person could do all of that and then contact either the major police station in large rural or metropolitan areas as well as sexual assault services that are in every state and territory and say that they’ve got an interest in forensics, this is their background, this is their CV, this is the education that they’re doing for themselves to put them in a good position to move into that career.

“That would get them known in their local area and if there’s a position available or if there’s one coming up….at least they will have the edge.”

Assoc Professor Starr says, while not essential, it also helps to have experience in emergency nursing and in mental health.

She says forensic nurses require excellent communication skills, good clinical assessment skills and also patience.

“This work is very demanding - it can be very emotionally draining and it can be quite tedious,” she says.

“It’s not like what you see on CSI or SVU, dealing with sexual assault victims where you have the whole crime that’s committed, investigated and prosecuted within an hour.

“It kind of gives you the impression that these cases, the forensic exam and everything is just done like that…and the police have got their evidence and off you go.

“Sometimes you are dealing with clients who don’t know whether they want to have a forensic exam or not and they are traumatised.

“You have to have that skill of empathy to be able to manage a traumatised person and then also to be objective because you can’t be in a position to coerce the individual into making a decision.

“You are there purely as the examiner who can give people the options and can give them advice about what is the benefit of those options and that’s really frustrating if people don’t want to take that up.”

Despite the challenges of forensics nursing, the rewards are immense.

Assoc Professor Star says the ultimate reward is knowing you have done the very best for your patient, not just clinically but also in regards to the outcome of their case.

“That’s something that only you can do…and if you don’t have those skills you can actually lose and destroy and contaminate evidence which can have a really, really negative impact on the outcome of that person’s case.

“It can be quite detrimental - it can actually mean that there is no case, depending on how badly that evidence is lost and destroyed and contaminated.”

What’s more, the work of forensic nurses also contributes to creating a safer community.

“Your role has actually helped the law enforcement people identify and prosecute someone who puts the public at risk,” Assoc Professor Star explains.

“Ultimately you are doing a great service to the community as well by being able to help people identify who these perpetrators of crime are and then deal with them effectively.”