How To Care For Sexual Assault and Human Trafficking Victims as a Nurse

Trigger warning: The following article discusses sexual assault and violence.

Leah Helmbrecht BSN, RN (@offtheclocknurse) discusses her expertise as a forensic nursing examiner (FNE) and sexual assault nurse examiner (SANE).

Not all nurses know what to do in that situation, especially in rural settings, but sexual assault is so common — it occurs every 68 seconds — so it is important that nurses educate themselves so they know what to do if a patient is sexually assaulted.

In this podcast, Leah explained exactly that, along with her 14-year journey as a nurse, where she has done everything from work in the OR to travel nursing to even serving as a nurse recruiter, but now she feels she has found her nursing “home” as an FNE and SANE.

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>>Listen To The Vital Role Of Nurses in Combating Human Trafficking with Leah Helmbrecht, Forensic Nurse Examiner

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Helmbrecht admitted that her journey into nursing started more by happen-stance than feeling a strong call to the profession.

“My dad was a physician and, he would take me to the hospital to make rounds with him sometimes,” she recalled. “And if an emergency came up, he had had me sit at the nurse’s station. For the longest time, I thought nurses just played games and ate candy because that’s what they would do with me while my dad was in with this other emergency,” she laughed.

Once she got into college and it came time to choose a major, she settled on nursing. “I had absolutely no idea what I was in for,” she admitted. “But it’s probably one of the most flexible and just great careers that I could have chosen. So I was just very lucky that way that it’s something that I happened to fall into.”

What Does a Forensic Nurse Examiner and Sexual Assault Nurse Examiner Do?

Helmbrecht discussed her role as a forensic nurse examiner and a sexual assault nurse examiner. She explained that she works with patients who have been affected by domestic violence, strangulation, sexual assault, and human sex trafficking. If someone has come into the ER looking for help or medical attention and that individual meets certain criteria, Helmbrecht is called in to do her evaluation.

Once in the ER, she does all of the evidence collection on the patient including,

Listens to what happened and what was done to these patients, and then from there
Once she has an understanding of the situation, Leah tailors her exam in order to find potential DNA
Following her exam, she provides any prophylactic medications that the patient might need, such as those for pregnancy prevention, HIV prevention, and STI prophylaxis. (She clarified that there are standing orders for these types of medications and scenarios)
In addition to medications, a FNE/SANE also provides post-trauma resources. “We know that the trauma doesn’t just stop there right after getting this exam done,” Helmbrecht explained. “There’s a whole road ahead of them.”
She ends her time with a patient ensuring that they know their reporting options because she explains that a SA exam done in the ER is not the same as filing a police report. The patient is able to decide if they would like to continue on with a police report and the FNE or SANE will help walk them through that process.

“Just to have one of these exams done does not mean that you have to talk to the police if you are not ready to because there’s only a certain time limit to where you can collect evidence as opposed to a time limit to when you can report to police,” Helmbrecht said.

As mentioned earlier, it can be a challenge for nurses to know what to do if they have a patient who is sexually assaulted (SA) and do not have access to resources, like a dedicated SANE on staff or nearby.

Here are some steps you can take if you have a patient who has been SAd,

Look for a local crisis center near you. If there is a FNE/SANE associated with the center, they may be able to come directly to your patient to do evidence collection.
If there is not someone locally available, nurses can call the National Sexual Assault Hotline at 1.800.656.HOPE(4673) or call 202.544.3064 to reach the RAINN business office for assistance. In some situations, the nurse may have to collect evidence themselves and because it is a detailed process with specific ways evidence must be collected, RAINN can help with that process.
Nurses can also educate themselves on some common terms surrounding sexual assault and find other resources on the RAINN website.

If you’re a nurse who is interested in forensic nursing and particularly becoming a sexual assault nurse examiner, Nurse.org has a few career guides to reference:

Nurses who are interested in becoming a FNE/SANE can first turn to their state SANE program, many of which are government-funded and offer free training to all RNs. It is important to do your state program because each state has different laws and procedures about reporting and collection options.

Leah took her training through her home state of Colorado says that the program was “really great.” It was an online, self-paced didactic, followed by a 2-day in-person clinical. The clinical prepares you to start working towards your certificate and then you take a national exam.

She also recommended checking with the Academy of Forensic Nursing and the International Association of Forensic Nurses. “Both can be helpful in helping you find a program in your area that also includes clinicals because that’s gonna be the tough part,” Leah noted.

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“They’re really great too because every Wednesday they have a webinar that also includes CEUs, continuing education, which you’ll need in order to sit for a national exam,” Helmbrecht added. “They have so many different educational options and opportunities, so that’s a place to start.”

Leah also shares the somewhat difficult topic of how to best approach SA from a nurse’s perspective by having the right mindset from the beginning.

“I think the biggest issue and the biggest obstacle that we have in healthcare is just getting over our own biases,” she said.

“I think most of it is just putting our own judgments in front of healthcare, right?” Helmbrecht went on. She provided an example of a patient who had been drinking and doing drugs and also happened to be SAd—if a nurse can take the approach right away to focus on the fact that someone assaulted the patient and that’s the problem, it can help frame the situation correctly.

“Because it really doesn’t matter if they were drunk, if they were high, what they were wearing, what time of day or night—it’s never okay to sexually assault somebody,” she pointed out. “And that’s why we say it’s always good to start by believing, right? As in healthcare, our judgments on this, our opinions on what we think happened to them mean nothing. It doesn’t,” she added.

She continued by encouraging nurses to go in “believing” the patient and being supportive, not only because it’s the right thing to do but also because it can help encourage the patient to come forward and get the help they need.

“We want people to come forward and get help,” she said. “And this doesn’t always end up with a guilty sentence in court. We’re not the police, we’re not investigators.”

“What it does, what our main goal is as healthcare workers, is to make sure that they are getting the proper healthcare. So that’s getting those prophylactic medications, that’s getting those trauma resources,” she continued.

Leah ended the difficult conversation by discussing the reality of human trafficking and how nurses can take steps in identifying and helping victims. Leah explained that the Academy of Forensic Nursing is working to start providing education as early as middle school about human trafficking because of how prevalent it is.

She also pointed out the misconception that many people have about human trafficking, picturing a Liam Neeson in Taken type of scene when that’s not the reality at all.

Instead, 41% of traffickers are actually going to be a family member of the child being trafficked.

“So they’re going to be people that we know, they’re going to be boyfriends, they’re going to be friends of the family, they’re going to be the uncle… someone within the family,” said Helmbrecht.

That means that people coming into the ER who are being trafficked may be difficult to not only identify, but to get help. “They’re not going to fall out, come right out and say that they’re in trafficking,” said Helmbrecht, especially because they’re going to be with their trafficker.

4 Signs A Patient May Be a Human Trafficing Victim:

They’re always with their trafficker
They’re never allowed to be alone ever
They won’t have access to their own identification
Whenever you ask them a question, their trafficker speaks for them

Unfortunately, Helmbrecht also explained that even if you as the nurse are able to get the trafficked victim alone, very few will admit that they are being trafficked or accept help because of the extreme abuse, isolation, and brainwashing their trafficker has had on them. She suggests simply offering a resource like a human trafficking hotline number on a card and giving it to the suspected victim telling them that you are offering resources to everyone and if they know of anyone who needs help to call that number.

What To Do If a Human Trafficking Victim Asks For Help

If a patient does ask for help — and Helmbrecht is clear that you should only take action if a patient asks for help, because otherwise, it can endanger the individual — then you should contact your local police department and notify hospital security.

There will be a hospital lockdown for security and the nurses can contact the local human trafficking hotline to see if they can send an advocate out. “There’s a ton of things that can get the ball rolling with that,” Helmbrecht says, but “The number one thing is to get that person away from their trafficker and in a safe location.”

Clearly, there is a lot of information and winning the fight against sexual assault and human trafficking is not something one nurse alone can do, but Helmbrecht encourages anyone interested in learning more about how to get involved to check out the Academy of Forensic Nursing website. It offers plenty of resources such as guides on learning how to talk to potential abused victims — even something as simple as using the right language can help.