Forensic nursing

DEFINITION: Application of forensic science techniques and nursing practice in proceedings that interface with the law.

SIGNIFICANCE: Forensic nurses help protect the legal rights of the patients for whom they care. They apply nursing science and forensic aspects of health care in public or legal proceedings related to the trauma and deaths of crime victims and to the prosecution of perpetrators of interpersonal violence.

Forensic nursing is an interdisciplinary model of care that integrates nursing science, forensic science, and criminal justice to protect the rights of crime victims as well as the rights of the victims of traumatic accidents. Forensic nursing’s scientific knowledge base is grounded in theories of nursing, forensic science, and criminal justice. Professionals in this field apply nursing-related sciences to public or legal proceedings, to scientific investigation in the area of health care, and to the treatment of victims of trauma. Forensic nurses provide care, consultation services, and testimony related to the collection, preservation, and analysis of evidence in legal cases involving interpersonal violence and other health care issues. Forensic nurses sometimes testify in legal proceedings regarding questioned death investigation processes, the adequacy of delivered healthcare services, and diagnoses of conditions related to forensic nursing practice.

The professional title “forensic nurse” was established in 1992 at a meeting of a group of sexual assault nurse examiners (SANEs) in Minneapolis, Minnesota. From that meeting, the International Association of Forensic Nurses (IAFN) was formed to promote and support forensic nursing, to educate forensic nurses, and to educate members of the nursing profession and the public concerning this subspecialty. In 1995, the American Nurses Association (ANA) officially recognized forensic nursing as a nursing subspecialty. By the 2020s, the field was growing in the United States, with the US Bureau of Labor Statistics (BLS) estimating the job outlook for forensic nursing would grow by 6 percent between 2021 and 2031.

Forensic nurses have education and clinical practice experience beyond their nursing education that enable them to obtain objective medical histories from the victims of traumatic incidents and from victims’ caregivers; they gather information from victims about the sequences of events that took place and identify and meticulously document victims’ wounds and their stages of healing as well as patterns of injury. Forensic nurses have advanced skills in the use of specialized equipment and photography for the documentation of injuries to be presented in criminal and civil court proceedings.

Roles and Activities of Forensic Nurses

The roles that forensic nurses fill vary according to practice settings. Clinical forensic nurses, for example, provide care to survivors of crimes within health care facilities and in community settings. Sexual assault nurse examiners, who work primarily in hospital emergency rooms, examine and evaluate victims of sexual trauma. SANEs may be on call to specific facilities or to multiple sites. These nurses are trained to function as members of sexual assault response teams (SARTs), which perform crisis intervention for victims of sexual assault.

Psychiatric forensic nurses specialize in psychiatric evaluation and care of individuals in mental facilities and in legal custody; in the United States, most of these nurses work for state departments of corrections (state prison systems). Psychiatric forensic nurses are often involved in counseling both victims and perpetrators of crime.

Correctional nurses specialize in the care, treatment, and rehabilitation of the incarcerated. They identify complex health issues in correctional facilities and conduct health screenings and assessments of inmates for communicable diseases, acute and chronic mental health problems, substance abuse, and risk for self-harm and suicide. They dispense medications, manage acute illnesses and injuries, and educate inmates on health topics.

Legal nurse consultants provide education and consultation regarding legal issues, injury, and liability or malpractice to criminal justice and health care professionals. Nurse attorneys specialize in health care–related legal proceedings. Nurses in both these areas of forensic nursing must have knowledge of the medical issues related to litigation so that they can interpret medical records and other documents.

Forensic nurses can also serve as death investigators, assisting medical examiners in performing autopsies and taking part in related activities, such as examining scenes of accidents and suspicious deaths, collaborating with police investigators, examining bodies for injuries, taking tissue and blood samples, photographing bodies and crime scenes, and documenting findings related to injuries. In some US states, nurse coroners initiate the investigation and certification of suspicious deaths.

Some forensic nurses serve as organ transplantation coordinators. In this capacity, they are members of teams that work with families of potential organ donors. These nurses must have excellent communication and counseling skills as well as extensive knowledge of the legal and medical issues related to organ donation, such as the criteria for brain death.

School-based forensic nurses identify, evaluate, treat, and refer abused or neglected children for appropriate followup. These nurses are instrumental in assessing and identifying young victims of violence and in educating teachers, children, and families about the issues surrounding interpersonal violence and how it can be prevented.

Forensic Nursing Education

A variety of education opportunities are available to those who want to specialize in forensic nursing. Programs in forensic nursing are offered by technical schools and on college campuses, and online programs are also available. The only educational prerequisite for admission to some forensic nursing certificate programs is that an individual be a registered nurse, whereas other programs require the previous completion of a bachelor’s degree in nursing. Some graduate schools offer master’s degrees in nursing with a specialization in forensic nursing; a bachelor’s degree in nursing is required for admission to such programs. A post-master’s degree certificate with a specialization in forensic nursing is another avenue to a specialization in forensic nursing; a master’s degree is required for admission to such certification programs.

The American College of Forensic Examiners Institute (ACFEI) is the only organization that offers an international certification program and certification in general forensic nursing practice. To receive the designation of certified forensic nurse (CFN), an individual must qualify for membership in the ACFEI and pass the ACFEI forensic nursing examination. Nondegree programs are also available that provide certification examinations for sexual assault nurse examiners, medicolegal death investigators, and legal nurse consultants. Certification in these areas—which requires specific education, skill performance, and successful completion of a certification examination—demonstrates an understanding of a specialized body of knowledge that is acknowledged by professionals in forensic science and nursing.

Bibliography

Amar, Angela F., and L. Kathleen Sekula. Forensic Nursing: Incorporating Forensic Principles into Nursing Practice. Sigma Theta Tau International, 2016.

Barsky, Allan E., and Jonathan W. Gould. Clinicians in Court: A Guide to Subpoenas, Depositions, Testifying, and Everything Else You Need to Know. Guilford, 2002.

Campbell, Rebecca, Debra Patterson, and Lauren F. Lichty. “The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs: A Review of Psychological, Medical, Legal, and Community Outcomes.” Trauma, Violence, and Abuse, vol. 6, no. 4, 2005, 313–29.

“Forensic Nurse Salary, Job Outlook and Trends.” Duquesne University, 5 Dec. 2022, onlinenursing.duq.edu/blog/forensic-nurse-salary/. Accessed 15 Aug. 2024.

Hammer, Rita M., Barbara Moynihan, and Elaine M. Pagliaro, editors. Forensic Nursing: A Handbook for Practice. Jones, 2006.

Lynch, Virginia A. Forensic Nursing. Mosby, 2006.

Price, Bonnie, and Kathleen Maguire. Core Curriculum for Forensic Nursing. Wolters Kluwer, 2016.

Pyrek, Kelly M. Forensic Nursing. CRC Press, 2006.

Stevens, Serita. Forensic Nurse: The New Role of the Nurse in Law Enforcement. Dunne, 2004.