Expanding Forensic Nursing Practice

The need to provide health care solutions to victims of interpersonal violence goes beyond care for the sexual assault survivor. Many SANE programs are recognizing the need to use their unique abilities to evaluate and treat trauma by providing care for other populations. This chapter will explore how to expand your SANE program to provide care to other patients who are victims of violence or other forms of trauma. 

SANEs typically have skills that would be useful when working with other populations and in other health care settings. These skills include the ability to document injury, including photo documentation, collecting and preserving forensic evidence, testifying with regard to the injury and evidence collected, providing trauma-informed care, and working collaboratively with community partners such as advocacy and criminal justice practitioners. Having these skills make SANEs the ideal providers to deal with many types of patients beyond sexual assault patients. 

Before looking at expansion, there are several factors to consider:

1. Is someone else already providing the service successfully? Duplication of services may not be necessary. It is important to collaborate with community partners and others who may offer similar services.
2. Does adequate staffing exist to expand the program? If your program cannot provide SANE coverage 24/7 now, expansion may harm your existing services or may not be possible.
3. Do the nurses and other program staff support expansion? If the nurses are not prepared to take on other patient populations, staff turmoil may result. In addition, input from the nurses may identify potential benefits or obstacles to expansion.
4. Is there a source of reimbursement for the expanded services?
5. Are medical staff with the appropriate skills readily available to provide consultation for more medically challenging or complicated patients? For instance, if the program is planning to see victims of strangulation, there must be appropriate diagnostic testing and interpretation services available. 
6. Do the resources exist to provide the necessary additional nursing education, supplies, and other expenses that will be needed to expand the practice? Providing additional education may have significant costs both in providing didactic as well as clinical training for onboarding of staff. Prior to expansion, consider the following for each type of forensic patient: development of an educational curriculum, clinical practice guidelines, review of legal issues related to that specific population, and preparing for potentially new forms of testimony.
7. If expansion results in increased court time, will the expenses and time away from patient care be covered?
8. Will there be additional equipment needs based on an increase in patient volume and diversity? 
9. How will you prioritize forensic patients when you have two or more at the same time? 

10.1. Expanding Your Program To Include Intimate Partner Violence
10.2. Expanding Your Program To Include Strangulation
10.3. Child Maltreatment
10.4. Injuries (Major Trauma, Non-Accidental and Accidental, Occupational)
10.5. Iatrogenic Injuries/Risk Management
10.6. Human Trafficking
10.7. Suspect Examinations