The initial Forensic Nurse Examiner training, averaging 32-54 classroom hours, whether for adult or child, is only the beginning. After that, comes the 40 hours of clinical observation and training, followed by observing, then doing a certain amount of exams, prior to being allowed to work independently.
Those clinical rotation experiences, which must be signed off by each department representative, or individual, include, but are not limited to the following:
- Police ride - along (s)
- Clinical time with detectives
- Courtroom Observation
- Child Advocacy Center
- Meet with staff
- Spend time with therapist
- Watch an interview
- Observe or assist in case review
5. Forensic Interviewing of Children
6. Child Protective Services
7. Prosecutor's Office
8. Emergency Room Clinical Hours & exams
9. SAFE Unit clinical hours & exams - observation followed by practice
All this must be done according to the state Board of Nursing requirements. All must be signed off by each dept, turned in to the unit coordinator, then presented to the state Board of Nursing for certification and licensure. Certifications must be renewed each year.
In order for licenses to be renewed, each FNE/SANE must complete a specified number of on call hours, number of exams, and the required number of CEU's, which may include: on line or off line CEU's, job related classroom/college courses, published works, giving or attending conferences and seminars, etc.
After that, each exam record is usually gone over by the unit coordinator, or ED supervisor, in which empty blanks on the form, or other problems are addressed and corrected, then signed off by a physician. If anything needs to be corrected, there is only one correct, legal way to do that:
The current date/time must be noted, along with the word Addendum; followed by a note addressing the correction, or the empty blank is corrected, either or both then followed with that nurse's initials.
FNE/SANE Certifications
Based on what my fellow blogger, and others, wrote, there seems to be some confusion as to the FNE/SANE certifications.
First, there is the state certification which has to be renewed each year.
Then, there is the IAFN SANE -A or SANE P certification. The IAFN, or International Association of Forensic Examiners, administers an exam for these certifications. Those who pass receive the appropriate international certification. It's desirable but not mandatory.
It may help in court but doesn't determine whether someone is to be qualified as an expert. That's up to the prosecutor to submit the witness as an expert, and for the judge to decide if that witness will be admitted as an expert.
Most FNE's I know have not sat for the exam, myself included, for various reasons. The expense of taking it and renewing each year is a hindrance for many.
* Forensic Training Class Schedule Overview
This is an example of the type of initial forensic nursing examiner training Sharon Anderson would have received:
Standards of Clinical Nursing Practice
Standards of Care
Standards of professional Performance
ANA Approved Forensic Nursing as a Specialty
Scope & Standards of Practice
ANA Standards of Care:
Standard I: Assessment
Standard II Diagnosis
Standard III Outcome Identification
Standard IV: Planning
Standard V Implementation
Standard VI Evaluation
Sexual Violence/Assault: Definitions
Overview of FNE
Overview of Child Sexual Assault
Physical Indicators of Concern
Behavioral Indicators of Concern
Stages of growth & Development
Obtaining The History
Child medical/Forensic Sexual Assault Exam
Head to Toe Assessment & Injury Documentation
Role of the Pediatric Nurse Examiner:
Complete exam when requested by law enforcement
Maintain privacy & identity
Medical Intervention
Assessment
Collection of Evidence, photography
Documentation, Diagrams
Be an educator
Testify as an expert or fact witness
Day II
Head to Toe Assessment & Injury Documentation
Genital Examination and position Techniques
STD Identification & Interpretation in Children
Pre-pubescent Genital Interpretation
Hymen Variation
Profile of Child Sex Offenders
DAY III
Documentation/Maintain the Chart
How to Document the Physical Findings
How to Formulate the Impression
Identify the Necessity of protecting the Chart
Child Protective Services
The Child Abuse Center
Resumes & Credential Building
Anal/Penile Evaluation
DAY IV
Courtroom Testimony
Defining The Expertise of The FNE
Ten Rules of Testimony
Fact Witness - "A witness who can testify only to what is seen, heard, smelled, tasted, felt."
Expert Witness - " A witness who may give an opinion based upon knowledge, skill, training, experience outside the realm of the normal person that will assist the trier of fact"
" Expertise does not equate with payment!"
Be able to testify about the basis of your experience:
Education
Employment
Board Certifications/Licenses - what is involved, who needs it?
Specialized training conferences
Presentations taught
Continuing Education
Awards
Publications
Prior Court testimony as an expert
Meet With Prosecutor
Be a Prepared Professional Keep it Simple
Use Visual Aides as needed
Don't Argue With the Defense
Listen Carefully & answer only what is asked. Be accurate & concise
Don't be a Puppet
Don't Become a Target
Debrief With Prosecutor
The Judicial System and Laws
Mock Courtroom Testimony
Clinical Requirements
Sample Questions In Court
Name & business
Occupation
Employment? Position held? How long? Special Certifications?
Licensing procedures for state?
What licenses have you obtained?
Education? Degrees?
Special training?
Seminars, conferences attended?
How many days/hours were the trainings?
Special training regarding pediatrics?
What is your work experience in this area?
How many SAFE exams?
Have you been published?
Have you taught others?
What organizations do you belong to?
What publications do you subscribe to?
Have you been qualified as an expert before?
Explain how to do a SAFE exam
Anything used to assist the exam or collect evidence?
What is the difference between an adult and child exam?
Do you find physical trauma in every exam? Why or why not?
Would you expect to find sperm in every case of assault or abuse?
What is a hymen
What do you look for when examining the hymen?
How is he hymen of the adolescent different from that of a child?
For what purpose was this exam done?
Was anyone else present?
Dis anyone assist you?
Did you obtain a history from the child?
For what purpose did you obtain a history?
Was the history critical to the diagnosis/treatment in this case?
What was he general appearance of the child before the exam?
Did you conduct a physical exam? Were there any findings?
Any other tests or procedures?
Does you hospital have a standard procedure for the evaluation of victims of sexual assault?
Were those standards followed here?
Did you prepare a report?
Photographs? diagrams?
Are your findings consistent with the history given by the child? Why or why not?
Would you always expect to find injuries if a child was sexually assaulted or abused?
Let's Examine The Background Questions Asked of Sharon Anderson (as reported):
1."During cross examination Craft's defense attorney, Dr. Demosthenes Lorandos, questioned Anderson's credentials and ability to make judgments about what is "normal," physically, for a young girl.
Lorandos asked Anderson if she knew what the U.S. statistics were for young girls with genitals that are considered "normal" or "abnormal," and Anderson answered she did not know.
Lorandos repeatedly asked Anderson to define "normal" and "suspicious," and Anderson replied she knew what a young girl should look like in the genital area based on years of examinations."
Answer: Defense attorney questioned Ms. Anderson regarding her credentials:
1. As you read above, we expect to be questioned about our background training, education, and experience. No problem there. That's standard procedure.
However, the way some of the news media & bloggers wrote of it, you'd have thought there was some big, ugly secret they had on Ms. Anderson.
2. And, of course, Let's not forget, all that media, blogger, and forum member rage over the fact that Ms. Anderson had only a two year degree. If you missed my discussion and clarification of state requirements, well in her favor, please see the previous post.
3. Hmmm. Let me see, since Dr. Lorandos is obviously an excellent attorney, I would expect that he did indeed question Ms. Anderson further. Especially, since I know that, during Discovery, he was entitled to receive a copy of her Curriculum Vitae.
So, he would have known her whole educational, training, and work background, before he even came into that courtroom. If not, I would have to ask, why not?
And if he did, then I have to question: Why didn't the bloggers and news media publish that information too?
As I stated above, in order to re-certify each year, Ms. Anderson would have had to meet certain continued education/training, etc.. Otherwise, she couldn't have renewed her license.
4. "During cross examination, Dr. Lorandos waved copies of books in the air written by people he considers to be "experts" in the field of child sex abuse, and asked if Anderson was familiar with them.
Anderson said she was familiar with one of the books, which she said she kept in her practice as a reference and guide."
In the last section in my own CV, I list my organization membership. That's pretty standard. I would expect that Ms. Anderson did the same. It's a pretty good clue what periodicals we subscribe to just by what organization we're a member of.
Like most other FNE's, my own list is very short, and sometimes changes. Membership dues & subscriptions are very expensive.
Since I could access certain periodicals at work, I preferred to subscribe to other forensic periodicals which I knew wouldn't be at work.
For example, I'm a member of the Association of Certified Fraud Examiners and subscribe to their own magazine on fraud.
I also subscribe to an archeology magazine due to my interest in forensic anthropology. And, like many others, I also buy books off of Amazon for my private library. But, of course, those wouldn't show up in court.
Many do not subscribe on their own. Rather, they utilize the periodicals which are located in the office at work. And, like me, many have their own personal library of books.
That's why Ms. Anderson was familiar with them, although she didn't personally subscribe. That's perfectly acceptable. It's what most of us do.
I'm surprised (or maybe not) that the defense attorney, having many years of experience, and, presumably, a copy of her CV, didn't ask Ms. Anderson that question.
Instead, choosing to ask Ms.Anderson about membership in an organization he had to have known was for physicians only.
And another question regarding a position in which you have to have been nominated by the Governor.
3. The next question had to do with the defense attorney asking Ms. Anderson about statistics.
Answer: I doubt too many FNE's could have answered that off the top of their heads. However, it's a good idea to look up that fact before going into court. It wouldn't have changed anything but it's good to know.
4. Does Ms. Anderson research?
Answer: She answered "No". That would be typical of many, if not most, forensic nurses, unless they are working on a special research project at work, or are planning to get published. I know many nurse managers who don't research either.
I'm one who is different, as I live to research. I've been researching a variety of different aspects of forensics for years now.
5. "defense atrorney [sic] asks so if there's no sign, does that mean there is sexual abuse."
Answer: Perfectly acceptable question. We expect to be asked this. And, Ms. Anderson answered it appropriately. Whether it's an adult exam or a pediatric exam, the answer is the same: Just because there are no injuries, doesn't mean that no assault or abuse has occurred.
In fact, when it comes to pediatric exams, there usually are no injuries found. That's because examinations are rarely performed immediately after abuse. Most children are too afraid to report sexual abuse and, even as adults, later carry that awful secret to their graves.
Years ago, our paralegal instructor taught us what every attorney knows when it comes to asking the witness questions: Never ask a question for which you don't already know the answer.
She was admitted as an expert witness without objection by defense counsel. That should have said something to the bloggers & news media. However, apparently they missed that part.
The Pediatric Child Sexual Abuse Exam To be continued in Part III
* From the Carroll County Hospital Pediatric FNE Training Manual, 2005, for educational purposes only.
Recent Comments