How to Become a SANE Forensic Nurse

The most prominent type of forensic nurse is the SANE nurse, an acronym that doesn’t refer to the mental state of the nurse but to his or her role as a Sexual Assault Nurse Examiner. These are forensic nurses who specialize in working with the victims, both child and adult, of sexual assault and other forms of sexual abuse. This is an especially important form of forensic nursing because victims of sexual assault are in an unusual position, both physically affected (and often violently so) by the crime and emotionally affected as well, often because they feel shame about the crime that has been perpetrated on them. SANE nurses know that such victims must be treated gently, with emotional understanding and support, even while they gather evidence to prove that the crime has indeed occurred.

But how does one get to be a SANE? Generally, a SANE nurse will begin with the same training as other nurse practitioners, often obtaining a degree or certificate in standard nursing practice before moving on to forensic nursing. However, there is training available specifically for SANE nursing practices and most schools that offer degrees in forensic nursing will incorporate this training into their curricula. If you are already a nurse, on the other hand, you can take courses that will rapidly bring you up to speed on this field. The International Association of Forensic Nurses (IAFN) recommends that you study their publication “Sexual Assault Nurse Examiner Adult and Pediatric Guidelines” (available for purchase at this address: http://www.iafn.org/storelistitem.cfm?itemnumber=7) for a clear outline of the body of knowledge that you will need for working in this field. They also recommend a training course that covers the specific type of person that you plan to be working with, either adolescents and adults or children, or a 64-hour course that will deal with both groups.

Once you’ve studied the necessary body of information for a sexual assault nurse examiner, you can begin to consider certification. The nationally recognized certifying body for SANEs is the Forensic Nursing Certification Board (FNCB), which offers two types of certification. These are:

SANE-A — This is a Sexual Assault Nurse Examiner-Adult/Adolescent. The SANE-A works with patients who have undergone some form of sexual assault or abuse and are of at least adolescent age.
SANE-P — This is a Sexual Assault Nurse Examiner-Pediatric. The SANE-P works with patients who have undergone some form of sexual assault or abuse and are too young to be treated by a SANE-A.
The International Association of Forensic Nurses makes its Sexual Assault Nurse Examiner Examination Candidate Handbook available online at this address:
http://www.iafn.org/associations/8556/files/SANE%20candidate%20handbook_2011.pdf.

Before you can take the FNCB certification exam you must already hold a current unrestricted license as a registered nurse or the equivalent outside the United States. You must also have completed a training course and have practiced sexual assault nursing under supervision for two or three years, the exact nature of the course and duration of the experience varying according to whether you are applying for SANE-A certification or SANE-P certification. (The handbook at the above address contains details.) You must submit an application for the exam along with a $50 processing fee, supplying contact information for a physician or nurse who can verify your experience in the field as well as evidence of current licensure.
The fee for the exam, payable to the International Federation of Forensic Nurses (IAFN), is $275 for IAFN members, $400 for non-members and $450 for testing outside the United States or at military bases (including those inside the U.S.). There is a $75 late fee for applying after the test deadline. You may join the IAFN at the time of registration by including $115 in dues with your application. You can have your fee refunded (minus a $50 processing fee) if you cancel at least two weeks before the exam and, if you fail to pass, you may retest for a fee of $200 within one year.

Preparing for the SANE Forensic Nurse Exam

Now that you’ve decided that you want to become a Sexual Assault Nurse Examiner (SANE) and have applied (and been accepted) for either the SANE-A or SANE-P certification exam, what do you do to get ready?
First of all, don’t panic. You’ve already done much of your preparation. You’re already a registered nurse (this is one of the qualifications for taking the exam) and you’ve taken a course appropriate to the exam you’ve registered for (this is also a qualification for taking the exam). But you may still feel that you aren’t quite ready to embark on this new adventure in your life, especially when it requires taking a rather difficult exam prepared by people who know the field well and want to make sure that only the best people are allowed to practice in it. So you may feel that you need some kind of extra edge. After all, this is an exam that costs several hundred dollars to take — and at least two hundred more to retake. You want to get it right the first time and get on with the rest of your career.

Well, the International Association of Forensic Nurses (IAFN) has some suggestions. Go to their Web site at www.castleworldwide.com/tds_v5/asp/home.asp and take a practice test. No, these are not practice tests specifically for the SANE exams, but they demonstrate the methods that the Castle testing firm uses in its computer-administered tests and will give you some idea of what to expect when you sit down to take the test for real. IAFN also explains that the test will consist of 175 questions and you will have four hours in which to complete it.
The IAFN also provides a list of reference books and articles that can be studied that will contain most of the information covered by the exam. You can find this reference list on page 12 of the publication “Sexual Assault Nurse Examiner Examination Candidate Handbook,” which you can find online at this address:
http://www.iafn.org/associations/8556/files/SANE%20candidate%20handbook_2011.pdf. Among the reference works for the SANE-A exam are some articles that may be available to read or to order on line, such as the “Sexual assault nurse examiner education guidelines” from the IAFN itself and the U.S. Department of Justice Office on Violence Against Women publication “A National Protocol on Sexual Assault Medical Forensic Examinations: Adults/Adolescents.” For the SANE-P exam, the IAFN recommends “Nursing approach to the evaluation of child maltreatment” from GW Medical Publishing and “Evaluation of the sexually abused child” from Oxford University Press.

And, if the books and articles recommended by the IAFN don’t make you feel confident that you can pass the certification exams for either the SANE-A or SANE-P, we seriously recommend obtaining a study guide. Such guides are available in bookstores and online and come in a number of forms, including book form, flashcards, CDs, DVDs, and software. Such a guide is in many ways more valuable than any of the other forms of study that we’ve listed for the SANE-A and SANE-P exams because they’ll talk not just about the general subject of the sexual assault nurse examiner profession but will directly address the test that you are going to take. Study guides should be available for both the SANE-A and SANE-P and even for both combined. A good study guide will contain sample questions, much like the ones that will actually be on the exam, where you can test your knowledge and find out where you need to do additional studying. They will tell you exactly what subjects will be on the test and how much they will count toward a passing grade. Most of all, they will calm any pre-exam nerves from which you may be suffering by letting you know exactly what to expect when you arrive at the examination site on the day of your test appointment and sit down at the computer to take the exam.

Contents of the SANE Forensic Nurse Exam

Do you want to know what questions are going to be on the SANE-A and SANE-P certification exams> Well, come over and we’ll show you exactly what…okay, we’re just kidding. We can’t show you the questions that you’re actually going to be asked. For one thing, it wouldn’t be legal. For another, we don’t have a copy of the test. The actual questions that will be on these two certification exams are known only to a few people in the International Association of Forensic Nurses (IAFN) and are subject to change at any time. So the best we can do is tell you what subjects the questions are going to be about, because this is information that the IAFN makes available in advance. This will let you know what areas you should concentrate your studies in and is a great deal better than not knowing anything about the exam in advance.

Let’s start with the SANE-A exam. It consists of 175 questions and is divided into five content areas, as follows:

  • Assessment of the Sexual Assault Patient (40 percent of the exam). In this section, you’ll need to know how to assess the patient’s psychological reaction to the assault; name the symptoms of peri-traumatic and post-traumatic stress disorder (PTSD); identify urgent medical problems that require immediate treatment; document the patient’s health history and any history of sexual assault and abuse; demonstrate that you can perform a full body physical assessment; adapt your approach to the patient’s needs; identify damage to anatomy as opposed to normal anatomical variation; determine what bodily orifices were involved in the assault; examine the patient for signs that they have been administered drugs by the assailant; assure the patient’s safety during the exam; assess the patient’s risk of HIV infection; verify the patient’s hepatitis B immunization status; check the possibility of pregnancy resulting from the assault; and find out what physical problems the patient has been immunized for.
  • Evidence Collection and Documentation (16 percent of the exam). In this section, you’ll need to know how to collect forensic evidence; protect the chain of custody for the evidence; collect trace evidence from orifices and other areas of contact; collect samples that may contain identifying DNA; document the condition of the patient’s clothing; and describe your findings through written descriptions and body diagrams.
  • Management of the Sexual Assault Patient (23 percent of the exam). In this section, you’ll need to know how to provide information to a patient while getting information back from them; obtain the patient’s consent for the examination; provide crisis intervention and guidance to family members or caregivers; bridge any linguistic communication gaps with the patient; offer testing for STDs; and counsel the patient on safe sex; consult with other health care providers about the patient’s medical problems and refer the patient for follow-up counseling and support.
  • Interact Throughout the Judicial Process (11 percent of the exam). In this section, you’ll need to know how to testify as a fact witness or an expert witness, either for the prosecution or the defense; testify about the integrity of the chain of custody of the evidence; respond to subpoenas and other court orders; and respond effectively to aggressive questioning at trial.
  • Professional Practice Issues (10 percent of the exam). In this section you’ll need to know how to provide for the safety of the SANE nurse during the evaluation, employ principles of confidentiality and informed consent; and evaluate evidence-based practices in your field.

The SANE-P exam is divided into the same sections as the SANE-A exam. The major differences are in the first section, where you must apply your knowledge to the special needs of sexually abused children. This will require somewhat different methods of questioning the patient and evaluating the patient’s psychological condition, which is why the training requirements for the SANE-P are somewhat different than those for the SANE-A.

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