Forensic nurse examining patient

Forensic nursing expands patient advocacy

Making a difference for patients, the justice system, the nursing profession and health policy
November 6, 2018

Texas A&M College of Nursing is poised to become the state and national leader in forensic nursing, making a difference in the lives of patients, on the nursing profession and on the policies that impact survivors. And, it couldn’t happen at a more opportune time.

In 2017, Texas’ violent crime rate increased, soaring to 17.3 percent above the national average. Survivors of violent crimes such as sexual assault, intimate partner violence, child abuse or other types of abuse are often aided by forensic nurses or those with some education in forensic health care.


Nursing is all about the patient, and nursing school is about preparing students to become the best nurses possible. Learning how to provide trauma-informed care is an important part of the undergraduate nursing curriculum, and it changes the course of crime victims’ lives.

“Trauma-informed care places the patient and all that they have endured at the center of treatment,” said Nancy Downing, PhD, RN, SANE-A, associate professor. “Recognizing, understanding and responding to the effects of the trauma, while providing the health care and support that the patient needs, promotes healing and facilitates physical and emotional recovery.”

Although Texas requires that all practicing nurses in an emergency department setting receive two hours of continuing nursing education on forensic evidence collection, students in the College of Nursing receive six and a half hours.

“Nurses play an important role facilitating justice for survivors of violence,” Downing said. “They integrate patient care with the evidentiary needs of justice.”

For patients who are suspected to have been victimized, nurses identify, collect, document and preserve evidence that can be used to prosecute the accused, and nurses may testify in court as factual or expert witnesses.


In 2017, there were only 447 certified sexual assault nurse examiners (SANE) practicing in Texas, and they treated almost 10,000 patients. With the upward trend in violent crimes across the state, there is a growing need to graduate more forensic nurses to become SANE certified, to provide continuing education in forensic nursing for registered nurses and to provide multidisciplinary education for nurses, law enforcement, social workers and advocates.

“Enhancing the knowledge and skills of Texas nurses to help them provide better patient care for survivors is the goal,” said Laurie Charles, MSN, RN, SANE-A, SANE-P, clinical assistant professor at the College of Nursing. “Wherever a nurse is in their career, they can benefit from courses or programs offered through the college.” College of Nursing provides various continuing education courses throughout the year and is the contracted provider for the Sexual Assault Nurse Examiner training for the state of Texas. The college also hosts regional conferences on human trafficking for multi-disciplinary forensic professionals.

The College of Nursing recently received a $1.47 million three-year grant from the United States Department of Health and Human Services to recruit and train nurses from rural and underserved areas in Texas to become certified adult SANEs, along with forensic nurses currently in practice for enhanced experimental learning or certification.

The college offers a Master of Science program in forensic nursing. Through the program, students develop the specialized skills and knowledge needed to collect evidence, consult with legal authorities and testify in court. Nurses who graduate from the program will be prepared for leadership roles in a variety of settings including clinics, hospitals, anti-violence organizations, coroners and medical examiners offices.


Forensic nursing faculty from the College of Nursing are helping to shape state and national policies through their leadership and service.

“We often provide input on legislation that involves health or justice for survivors of violent crime,” said Stacey Mitchell DNP, RN, SANE-A, SANE-P, DF-AFN, FAAN, clinical associate professor and coordinator of the Forensic Health Care Program at the college. “That may include testifying before the state legislature, or reviewing and providing comments on proposed bills.”

One example is Texas House Bill 281 from the 2017 legislative session. Charles testified before the Texas House of Representatives Committee on Criminal Jurisprudence regarding the implementation of a statewide electronic tracking system for evidence of sexual assault. That bill is now a law, requiring entities involved in handling evidence to update and track the status and location of each item of evidence through various stages of the criminal justice process, while allowing survivors of sexual assault to anonymously track or receive updates on the status of the evidence.

At the national level, Mitchell recently worked with colleagues to draft a policy brief on nursing’s response to human trafficking that was published by the American Academy of Nursing on Policy. The brief recommends a number of actions that can be taken to address the human trafficking crisis including promoting the appointment of nurses who are trained in forensics to be on each state’s human trafficking task force; funding Stop, Observe, Ask and Respond (SOAR) Training on Human Trafficking for nurse educators to integrate human trafficking into nursing curriculum; and  identifying advanced practice forensic nurse educators to serve as consultants to government and law enforcement officials to strengthen efforts to end human trafficking.

“While it is true that policy directs health care, the best practices in health care should inform policy makers,” said Mitchell. “It is important to have nurses engaged in influencing and making policy. It is an extension of nursing’s role in patient care, education and advocacy.”

— Diane L. Oswald

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