This story was originally published by MinnPost.
Before Iron Range nurse Sarah Junek was properly trained to treat victims of sexual assault, she felt ill-equipped to handle the severity of such situations.
“I just always felt horrible that I was so nervous trying to figure out the legal aspect of the (sexual assault) kit, that I couldn't be there for the patient,” said Junek, a nurse at Essentia Health in Virginia. “It was difficult for a lot of us to try and be there for the patient emotionally, as well as trying to focus on doing the exam and focusing on what we needed to get for legal aspects.”
Indeed, while Sexual Assault Nurse Examiners — known as SANE nurses — are a critical part of the experience for victims who report their assault or go to a hospital, many rural areas lack examiners and other resources that can support victims.
Efforts are underway, however, to expand SANE training for rural caregivers, giving more sexual assault victims access to a higher level of care.
This map shows sexual assault nurse exam availability and advocacy locations across the state of Minnesota. It was made in collaboration between Professor Carolyn Porta at the University of Minnesota, the Re LAB team with U-Spatial and the Minnesota Coalition Against Sexual Violence (MNCASA).
A demand for training
To get SANE-certified, Junek came to the Twin Cities for a course in best practices while working with sexual assault patients, conducted the exam and interacted with law enforcement, among other activities.
In the Twin Cities, there are designated forensic nurse programs that send nurses to various hospitals in the region.
In smaller rural hospitals, meanwhile, its common for nurses to finish their shifts and then to be asked to help a sexual assault victim, said Linda Walther, clinical coordinator for the Statewide Medical Forensic Policy Program.
The responsibility for doing sexual assault exams typically falls on the nurses who are present and working that shift, Walther said. “There's not any, like, formalized system in those critical access hospitals around the state,” she said.
There’s been an increase in SANE training, with class sizes now including between 25-30 nurses, with the help of funding from the federal Health Resources and Services Administration that has allowed nurses from rural areas to travel and stay in the Twin Cities, according to Walther, who facilitates many trainings.
“It’s really expensive for somebody to take all that time off work and then also pay for the training, pay mileage and pay for the hotel,” she said. “When there's funding, it's sort of like when you build it, they'll come.”
She also conducts trainings at smaller hospitals, just to teach some of the basics so that people can have a general understanding of how to work with sexual assault patients. Those people don’t get certified, but they are able to help patients throughout the process since Minnesota doesn't require certification.
She wishes these skills were intertwined with nursing school.
“People generally get out of school without knowing very much about intimate partner violence,” she said. “That's one of the problems. I think it is rarely even brought up during their nursing education.”
Using the skills in rural areas
Rural hospitals see fewer sexual assault cases than those in more populated areas. But despite that, nurses like Junek feel it's just as important to have people on staff who are equipped to support a sexual assault victim.
“I just want to be able to be there for the patient from start to finish,” she said. “That way they have one main person that they can go to and they don't have a bunch of fingers involved in telling their experience to a whole bunch of people.”
The training also taught her how to provide resources to patients and how to offer support like aftercare, medications, STI coverage and contraceptives.
Since completing her training in March, she’s seen four sexual assault patients. Many times, patients will come from smaller surrounding towns, such as Ely in the region where she lives, because their hospitals don’t have SANE-trained nurses.
“I just always felt horrible that I was so nervous trying to figure out the legal aspect of the (sexual assault) kit, that I couldn't be there for the patient,” said Sarah Junek, a nurse at Essentia Health in Virginia. Those distances can be barriers for patients who are already reluctant to share what happened to them. Many people also don’t know what services are free — so while support may be available, they may not pursue them, said Jessie Blanchard, a nurse who is the medical surgical pediatric floor manager at Alomere Health in Alexandria.
She added: “There are times where they will decline having an exam just because they don't want to travel, they don't want to take that extra time because they just want it to be over. Some people just want to move on with their lives.”
Blanchard said Alomere Health previously had nurse practitioners who also worked as SANE nurses, but they were quickly overworked. She’s been a SANE since 2017. She said the job takes a heavy emotional toll but has been very fulfilling.
“Your SANE hat is always kind of on, and you need to be ready to answer the phone and show up at whatever time of day it might be, and it's usually not at one o'clock in the afternoon,” she said. "Our ultimate goal is to make sure people feel safe.”
A statewide coordinator?
Blanchard said her hospital in Alexandria doesn’t have a shortage of SANE nurses because it may see around 20 patients a year. For the staff to keep their skills, it helps to see enough patients a year.
Walther, who facilitates trainings around the state, said the number of patients increased after the #MeToo movement. But when COVID hit, there was a decrease. She said the number of reported incidents are picking up again now.
“I just want to be able to be there for the patient from start to finish. That way they have one main person that they can go to and they don't have a bunch of fingers involved in telling their experience to a whole bunch of people.”Sarah Junek, nurse
Through word of mouth, Blanchard said more people are coming to hospitals after assaults. If more people knew more about the process and that it was free, she thinks more people would come in.
In surrounding hospitals, there is still a need for staff with SANE skills, she said, whether they are certified or not. She teaches in Alexandria Technical and Community College’s nursing program about assault and response.
There have been improvements to the way Minnesota handles sexual assault cases, like the option for victims to now track where their exam kits are and their ability to change their minds if they want to pursue legal action against a perpetrator.
An initiative called Re LAB also works to increase the numbers and capacity of SANE examiners throughout Minnesota and the United States with a focus on rural and underserved areas, through clinical skills workshops.
Walther said the creation of a statewide coordinator — similar to the role she plays in supporting SANE nurses at and after training — is one of the next steps the state should take to improve sexual assault care in Minnesota.
“It would make a huge difference for small hospitals if there was that ongoing support, that ongoing technical assistance, if we had someone who could create some statewide protocols on timeframes for evidence collection because there's nothing like that,” she said. “We don't have a statewide protocol for how to respond to sexual assault.”
This article first appeared on MinnPost and is republished here under a Creative Commons license.