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Friday June 24th

'Compassion, fatigue and vicarious trauma': Sexual assault nurses treat the physical and the emotional

Nurse Koren Garrity in her office in the Behavioral ED near a painting of a polar bear which she displays in order to comfort her patients.
Buy Photos Nurse Koren Garrity in her office in the Behavioral ED near a painting of a polar bear which she displays in order to comfort her patients.

Koren Garrity was ready to move on.

Unsatisfied with her nursing job, Garrity came to UNC Hospitals after hearing about the program’s sexual assault nurse examiner (SANE) training, which certifies nurses to treat patients after a sexual assault.

“I wasn’t really sure what I was getting into,” Garrity said. “But from what I had heard about it, it sounded like something that I could be good at.”

UNC has become a popular place for nurses like Garrity, because it hosts two of North Carolina’s eight certified SANE programs. But that wasn’t always the case. Before the state’s first SANE training in 1997, emergency department workers like Deb Flowers relied on state-provided forensic kits they weren’t properly trained to use.

“Basically, when a patient came in because of a sexual assault, you’d read the instructions in the kit, and it’s on legal paper, and I think the font’s like 8- or 9-point font, front and back, with tons of instructions,” Flowers, who now works as a SANE educator, said. “So you did the best you could, but you really didn’t understand true forensic techniques because you didn’t have training.”

Now, Garrity is one of seven practicing SANE nurses at UNC Hospitals. Three more are about to finish up their training. Garrity’s job includes taking the swabs, samples and pictures needed to create a rape kit. SANE nurses are often the first faces a patient sees, making sensitivity a priority.

“We don’t look at it as, ‘Well, you were hanging out with a stranger and got completely drunk, what did you think would happen?’” Garrity said. “You have to provide the same care to the mom that was sexually assaulted, the homeless teenager and the sex worker.”

Bethany Wichman-Buescher, a client services director at the Orange County Rape Crisis Center, works closely with UNC’s nurses as part of the Orange County Sexual Assault Response Team. She said she’s witnessed firsthand how crucial SANE nurses are to the wellbeing of patients after a traumatic experience like sexual assault.

“They understand trauma and they understand trauma responses, so when survivors are presenting and responding in many different ways, they understand where that’s coming from,” Wichman-Buescher said. “They let the survivor know exactly what is going to happen while they’re collecting the kit and they let them know they have a choice over all of it.”

Treating a campus

Women in college are three times more likely to be raped compared to women overall, according to the Rape, Abuse & Incest National Network.

Garrity said being a nurse on a college campus means she inevitably will see more college-aged patients, so it’s hard to say whether college students are truly the most susceptible population when it comes to sexual assault. But out of all college students, she said, first-years are the most vulnerable.

Flowers said Campus Health Services offers another layer of support for students who have experienced sexual assault, but anybody with significant trauma will be sent to UNC’s emergency department. She also said many assaults occur outside of the center’s regular business hours, which means most students will be treated by SANE nurses at UNC Hospitals.

Being a SANE nurse on a college campus may also mean going through Title IX investigations if a sexual assault survivor decides to file a report.

Flowers has been involved with two Title IX investigations, one out of state, and said she felt the process was much different than a typical criminal sexual assault investigation process because information was less accessible.

According to The Journal for Nurse Practitioners, there’s no national standard for SANE nurses’ involvement in the Title IX process. Each institution can use the nurses and their medical forensic exams on an ad hoc basis.

When Garrity was involved in a Title IX investigation, she said she was unable to learn the case’s outcome.

‘Vicarious trauma’

Charnessa Ridley, the sexual assault response team coordinator at North Carolina Coalition Against Sexual Assault, said in many states, SANE nurses work in rape crisis centers or standalone facilities, only dealing with sexual assault cases.

North Carolina SANE nurses like Garrity, on the other hand, work in hospitals as emergency department nurses as well as first responders in the case of a sexual assault.

“I think that more SANE nurses should be available,” Ridley said. “For those people who are dedicating to doing it, we don’t want to contribute to their burnout because they have to work a regular shift and then come back in later to collect evidence for a case.”

Flowers said the pressure SANE nurses face trying to balance regular hospital shifts with being on call to take forensic exams has caused a high turnover rate within the profession.

Garrity said she doesn’t think people realize how emotionally taxing the job can be.

“You read articles in the newspaper and you see portrayals in movies, but when you are a part of it, it is more real and you just don’t realize how difficult it can be until you’re in it,” she said. “If you can just imagine one of the worst-case scenarios of an assault, we’ve seen it.”

Garrity said some of the worst cases she’s seen involve children, elderly and developmentally disabled patients who are abused by a caretaker.

“They rely on other people to get their needs met, and they’re so vulnerable,” she said. “It’s so hard when they come in and you see someone has taken advantage of that.”

Flowers said SANE nurses rely on each other for support. Every month, they have meetings to give each other advice, review things they can do differently in the future and, most importantly, give each other a space to express their feelings on particularly difficult cases.

“There is a kind of compassion, fatigue and vicarious trauma that you can begin to experience when you do this for a long period of time,” Flowers said. “Having someone you can pick up the phone and talk to, having a group that understands what you do is definitely advantageous.”

Garrity said having other nurses to lean on is beneficial, but her biggest encouragement on rough days comes from those she helps.

“I just remind myself that this patient needs me to give them the best care and options for care possible,” she said. “That motivates me to clear my mind and almost hyperfocus on the patient, and block out my feelings.”

“When I have had patients thank me for helping them with getting through this difficult situation, that makes everything worth it to me.”

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