Focus on Forensics

Forensic Nursing
An Aid to Law Enforcement
By Joseph R. Yost and Tod W. Burke, Ph.D.
© Digital Stock

T he unidentified male is rushed to the hospi-

tal via ambulance. He is unconscious, with
a gunshot wound to his chest. The trauma team
has been alerted prior to his arrival. While each
forensic nurses provide a needed link between
medicine and the law. In 1992, 70 nurses gathered
in Minneapolis, Minnesota, for the first national
convention of sexual assault nurses, which led to
team member has a role in the immediate care the formation of the International Association of
of the victim, the forensic nurse cuts off his Forensic Nurses (IAFN).3 Three years later, the
clothes, careful to avoid the bloody hole where the American Nurses Association officially recog-
bullet pierced his shirt. The nurse puts each article nized forensic nursing.4 As of 2004, the IAFN has
of clothing in a separate container, places brown over 2,400 members.5 As a result, forensic nursing
bags over the patient’s hands, and searches his has become one of the fastest growing specialties
pockets for anything that could identify the young in the field of nursing.
man.1 Forensic nurses must be a registered nurse
Gunshot wounds, drug overdoses, sexual as- (RN),6 a trained medical professional licensed by a
saults, and stabbings constitute just a few cases state authority.7 Once they have earned an RN
that involve forensic nurses who administer medi- license, nurses who desire to specialize can take
cal attention to individuals with traumatic injuries selected courses in the field of forensic science that
and those involved in catastrophic accidents, as would cover such topics as collection and preser-
well as provide assessment and care to both vation of physical evidence, wound identification,
victims and perpetrators of crime and to their law enforcement investigation, documentation
families.2 A relatively new field in the criminal procedures and chain of custody, and preparation
justice arena, forensic nursing originated in the for court testimony.8 Various universities across
early 1990s. While not lawyers or police officers, the nation provide education and training for those

February 2006 / 7
seeking a career as a forensic nurse, presenting often offering a sympathetic ear. SANEs operate
them with classroom lectures and discussions, on the belief that victims should receive thorough
laboratory experience, and internships at local medical evaluations, treatment by skilled profes-
hospitals. One forensic nurse indicated that sionals, and knowledgeable support.14
she first became an RN and later decided to be- All SANEs have to be certified through a com-
come a forensic nurse. She successfully completed prehensive, usually 40-hour, training program that
the required courses, including evidence preserva- includes gathering medical histories from victims,
tion and collection, photography, and wound conducting physical exams, identifying wounds
identification. She also observed the functions of and patterned injuries, and collecting evidence, as
law enforcement by riding with a police officer well as learning some interview techniques and
for a specified number of hours basic forensic photography. This
and learned about the court- training also may prove valuable
room process by witnessing trial to law enforcement officers in-
procedures.9
THE LAW ENFORCEMENT
ASSOCIATION
“ Forensic correctional
nurses provide
vestigating cases of assault.15
Forensic Correctional Nurses
Forensic correctional nurses
medical attention to
The general term forensic individuals charged provide medical attention to in-
nurse encompasses several areas and convicted dividuals charged and convicted
of expertise that RNs can of a crime. of a crime. They often are em-
specialize in to aid law enforce- ployed in prisons, jails, and juve-
ment officers in many ways.
These include sexual assault
nurse examiners, forensic cor- ” nile detention centers.16 Their
responsibilities include giving
prescribed medications to in-
rectional nurses, forensic geriatric nurses, forensic mates, running the correctional facility’s hospital,
legal nurse consultants, forensic nurse investiga- and treating the victims of inmate fights. Forensic
tors, forensic pediatric nurses, and forensic psychi- correctional nurses also serve as potential negotia-
atric nurses. tors. For example, an inmate barricaded himself in
his room and, using a mop ringer as a weapon,
Sexual Assault Nurse Examiners threatened to kill the first person who attempted to
The sexual assault nurse examiner (SANE)10 intervene. Officials called in a forensic correc-
specializes in providing care and treatment to tional nurse who told the prisoner that police offi-
sexual assault victims.11 The duties of the SANE cers were en route, and, if he did not immediately
include assessing injury, objectively documenting calm down, they would take corrective action. The
the health history of the victim, recording informa- inmate, known to tear through restraints, broke
tion about the crime, screening for sexually trans- down and submitted without incident.17
mitted diseases, collecting and preserving forensic
evidence, and aiding the victim.12 Forensic Geriatric Nurses
Because SANEs frequently work closely with Forensic geriatric nurses care for aging indi-
assault victims, most possess some education and viduals and often handle the human rights issues of
knowledge in the field of victimology, the study of abuse, neglect, or exploitation.18 Nursing home
victims and crime.13 Most SANEs follow the facilities or retirement communities usually em-
victim through the entire criminal justice system, ploy these nurses who also can have their own

8 / FBI Law Enforcement Bulletin

independent practices.19 They use their knowledge Forensic Nursing Programs
and skills most often in cases of elder abuse or in the United States
neglect. In one incident, an elderly woman arrived
General Forensic Nursing
in the emergency room of a hospital with a swollen
right eye, bruises on her arms, and severe dehydra- Beth-El College of Nursing,
tion. The forensic geriatric nurse on staff took Colorado Springs, CO
pictures of the injuries as they appeared to be Bossier Parish, North Bossier City, LA
possible signs of elder abuse. When the elderly
woman became coherent 2 days later, she ex- University of Pennsylvania,
plained that her son had become frustrated with her Philadelphia, PA
declining health. She stated that he would tell her University of Scranton, Scranton, PA
that she needed to try harder. If she failed to do so,
he would strike her. The intervention of the forensic Graduate Level
geriatric nurse prevented the woman from be- Duquesne University, Pittsburgh, PA
ing released her back to her son. Instead, she was
immediately assigned to an assisted living center Gonzaga University, Spokane, WA
where she would have minimal contact with her John Hopkins University,
son.20 School of Nursing, Baltimore, MD
Monmouth University,
Forensic Legal Nurse Consultants
West Long Branch, NJ
Forensic legal nurse consultants use their clini-
cal knowledge to assist attorneys in cases where
law and medicine overlap.21 They often use their Source: http://www.iafn.org/resources/
knowledge in civil, rather than criminal, cases.22 educational.html
These nurses typically have their own practices or
work for major law or insurance firms. Their duties
can include verifying malpractice and negligence
claims, preparing and analyzing records, providing
legal assistance, and serving as expert witnesses.23 Forensic Nurse Investigators
While law enforcement officers focus on criminal Employed by medical examiners, forensic
law, they also may have to testify in civil litigations nurse investigators conduct scientific investiga-
(tort actions), such as automobile accidents and tions of the crime scene and the circumstances
assaults. The forensic legal nurse consultant could surrounding the victim’s death.25 For instance, a 6-
aid officers in understanding the components of month-old baby was found dead in his crib, and the
civil actions. For example, in a malpractice case forensic nurse investigator was called to investi-
where a man died as a result of a farming accident, gate the death. Upon arrival at the scene, she was
a forensic legal nurse consultant reviewed the file told that there was no history of disease or abuse.
information and testified that the doctor was When the nurse entered the child’s room, she no-
negligent when allowing the patient to be air trans- ticed a distinct odor of vomit. She asked the mother
ported to the hospital before he was stable.24 If if the baby had been sick. The forensic nurse inves-
police officers had arrived on the scene to assist the tigator learned that while the baby had shown no
victim or to investigate the incident, they most signs of previous illness, his older brother had
likely would have been named in the lawsuit. complained of stomach problems for several days.

February 2006 / 9
The nurse observed green paint peeling off the nurse to determine the competency of a subject
steam radiator pipe that snaked across the apart- who had brutally murdered his mother. After con-
ment. She lifted the dead infant’s lip and observed ducting an extensive interview with the son, the
a thin, bluish lead line on the baby’s gums. She forensic psychiatric nurse determined that he ex-
then instructed the mother to have herself and her hibited signs of mental illness and required hospi-
children tested for lead poisoning. The test verified talization and, therefore, was not competent to
the nurse’s suspicions. The entire family had con- stand trial.31
tracted lead poisoning from the paint flaking off
the pipe.26 THE EVIDENCE CONNECTION
Documentation of evidence proves critical
Forensic Pediatric Nurses to any investigation, including ones where forensic
Forensic pediatric nurses care for children and nurses have become part of the effort. These
often encounter the human rights issues of abuse, nurses should adhere to all evidence collection and
neglect, or exploitation.27 These preservation techniques without
nurses often are in independent exception and maintain the chain

“
practices or work in the pediatric of custody to ensure that no
department of hospitals.28 In one evidence is ruled inadmissible in
case, an 8-year-old girl was Forensic nurses a court of law.
brought into the hospital one may prove invaluable
night complaining of pain in her to investigators, Collecting Evidence
pelvic region. The forensic pedi- particularly when a Forensic nurses may prove
atric nurse on staff performed a victim is transported invaluable to investigators, par-
pelvic exam on the youngster to an emergency ticularly when a victim is trans-
and discovered several abrasions room. ported to an emergency room.
and bruises. Further investiga-
tion revealed that the father had
sexually abused her. As a result
of the forensic pediatric nurse’s examination, the victim,
”including
In that setting, forensic nurses
on staff should document all
proceedings pertaining to the
a complete medical report that
physical evidence collected, and the testimony of covers all treatment administered and the location
the child, authorities arrested the father and of any bruises, cuts, scrapes, or lacerations.32 Pho-
charged him with molestation. tographs of all of the victim’s injuries also are
essential for proper documentation and should in-
Forensic Psychiatric Nurses clude close-up, mid-range, and full-body images.33
Forensic psychiatric nurses handle offenders When practical, they should contain a photo-
who are mentally ill. They often work in forensic graphic scale or ruler for comparison.34
psychiatric practices, state hospitals, and psychiat- When collecting physical evidence, forensic
29
ric facilities within correctional institutions. nurses should wear gloves to minimize contamina-
One of their major roles involves determining the tion and follow basic techniques and procedures.
competency of offenders. These nurses must have Law enforcement investigators attempting to
a thorough understanding of the criminal justice collect evidence from victims may seek assistance
system, as well as the necessary elements for from forensic nurses who could swab for saliva or
competency.30 Forensic psychiatric nurses often semen, collect bullets and gunshot residue from
testify in court regarding competency issues. In the body, and bag the victim’s clothing for future
one instance, a judge asked a forensic psychiatric analysis.35

10 / FBI Law Enforcement Bulletin

Handling Evidence custody and cause the court to rule the evidence
Once they have collected the evidence, foren- inadmissible.
sic nurses should place each sample in a separate In addition to maintaining a proper chain of
container and seal it to prevent contamination. The custody, forensic nurses must be careful in han-
victim’s name, date, time, and case number should dling evidence. For example, a victim with a single
appear on the label accompanying the evidence, gunshot to the head arrived at a hospital. In the
along with the forensic nurse’s name, identifica- emergency room, the forensic nurse removed the
tion number (if any), and location where the evi- bandages from the victim’s head that the emer-
dence was recovered. It would prove helpful to law gency medical technicians had applied at the scene
enforcement officers to assist in training forensic of the shooting. Unknown to the forensic nurse, the
nurses, particularly when requesting forensic evi- bullet had dislodged into the bandages. While the
dence and adhering to the proper chain of custody. projectile was later discovered in the trash, the
Failure to maintain proper evidence and chain of evidence was inadmissible because it could not be
custody may jeopardize a case. In a hypothetical traced to the victim.36
situation, a forensic nurse collected evidence, but,
Testifying in Court
in a rush to treat another victim arriving in the
emergency room, failed to include the date and Forensic nurses also may serve as expert wit-
time. This type of action would break the chain of nesses in court. Sometimes, this poses problems.

Specialties in Forensic Nursing

• Sexual assault nurse examiners (SANE) are specially trained to treat and care for victims
of sexual assault.
• Forensic correctional nurses provide medical attention for individuals charged with and
convicted of a crime.
• Forensic geriatric nurses care for aging individuals with an emphasis on the human
rights issues of abuse, neglect, or exploitation.
• Forensic legal nurse consultants use clinical knowledge to help attorneys in cases where
the law and medicine overlap.
• Forensic nurse investigators, employed by medical examiners, conduct scientific
investigation of the crime scene and the circumstances surrounding the death of a victim.
• Forensic pediatric nurses care for children, with an emphasis on human rights issues
of abuse, neglect, or exploitation.
• Forensic psychiatric nurses administer aid to offenders with mental abnormalities.

Source: http://www.forensiceducation.com/specialties.html

February 2006 / 11
When a doctor and forensic nurse provide contra- 3
Valerie Nelson, “Shattering the Myths About Forensic
dicting information, attorneys can use this to their Nursing,” Nurseweek/Healthweek; retrieved on March 2, 2005,
from http://www.nurseweek.com/features/98-7/forensic.html.
advantage. If a nurse and doctor provide conflict- 4
Javacia N. Harris, “Forensic Nursing: Fast-Growing Field,”
ing information, the testimony of the doctor most Seattle Times, 4th edition, July 5, 2004; retrieved on March 22,
likely will be believed over that of the nurse. For 2005, from http://www.archives.seattletimes.nwsource.com.
example, a SANE had performed an examination 5
Ibid.
6
on a sexual assault victim. The doctor on call “Forensic Files: FAQs”; retrieved on April 17, 2005, from
http://www.forensiceducation.com/forensic_files/faq.htm.
deemed it necessary that he be there to sign off on 7
New Standard Encyclopedia, 1963 ed., s.v. “nursing.”
the case, even though he did not conduct the ex- 8
American Forensic Nurses; retrieved on April 17, 2005,
amination. As both the doctor and the forensic from http://www.amrn.com.
9
nurse were present during the examination, 10
Interview by author, April 13, 2005.
both were subpoenaed to court. When providing Serita Stevens, Forensic Nurse: The New Role of the Nurse
in Law Enforcement (New York, NY: St. Martin’s Press, 2004),
their testimony, both the doctor and the SANE 44.
identified the same injuries but in different loca- 11
Supra note 2.
tions on the body. The judge considered the 12
Supra note 10, 45.
13
doctor’s testimony, which later proved incorrect, 14
Supra note 10, 48.
as more accurate. The defense counsel noticed the Supra note 10, 48.
15
Supra note 10, 48.
discrepancy in the two testimonies and used it to 16
Supra note 6.
win the case.37 17
Supra note 10, 206.
18
Supra note 2.
CONCLUSION 19
Supra note 6.
20
While a relatively new profession, forensic Supra note 10, 183-184.
21
Supra note 2.
nursing already has successfully helped bridge the 22
Sue E. Meiner, “The Legal Nurse Consultant,” Geriatric
gap between the two fields of law and medicine. Nursing 26, no. 1 (January/February 2005): 34-36.
The high demand for forensic nurses will likely 23
Ibid.
continue as doctors and law enforcement officials 24
Supra note 10, 148-149.
25
recognize the need for their valuable expertise. Supra note 2.
26
Supra note 10, 157-158.
Those not currently employing forensic nurses can 27
Supra note 2.
contact their local hospital or the nearest forensic 28
Supra note 6.
nurse program by accessing the International As- 29
Supra note 2.
sociation of Forensic Nurses’ Web site at http:// 30
Supra note 10, 212.
31
www.iafn.org/resources/default.html. Bringing Supra note 10, 210-211.
32
Serita Stevens, “Cracking the Case: Your Role in
the two worlds of medicine and law enforcement Nursing,” Nursing 2005 34, no. 11 (November 2004): 54-56.
together can help both fulfill their different, yet 33
Ibid.
complementary, missions. 34
Ibid.
35
Ibid.
36
Supra note 10, 22-23.
Endnotes 37
Supra note 10, 130-131.
1
Karla A. Knight, “The Real CSI: Forensic Nursing in the
ED,” Nursing Spectrum, September 20, 2004; retrieved on May
Mr. Yost is an honor’s undergraduate senior at Radford
11, 2005, from http://www.community.nursingspectrum.com/
University in Radford, Virginia.
MagazineArticles/article.cfm?AID=12758.
2
“Forensic Specialties”; retrieved on September 27, 2005, Dr. Burke, a former police officer, is a professor of criminal
from http://www.forensiceducation.com/forensic_files/ justice at Radford University in Radford, Virginia.
specialties.htm.

12 / FBI Law Enforcement Bulletin