Rural availability of sexual assault nurse examiners

For victims of sexual assault, high-quality health care provided by sexual assault nurse examiners (SANEs) is associated with improved health and prosecutorial outcomes. However, very little is known about access to SANEs.

Sheridan Miyamoto, assistant professor and SAFE-T Center principal investigator, and Elizabeth Thiede, nursing doctoral student and 2021 ENRS Student Conference Scholarship Award winner, wanted to learn more about whether rural areas in particular may have disparate access to SANEs.

"If rural areas have limited SANE availability, then rural victims of sexual assault may be at risk of receiving lower-quality care, which has implications not only for their health but also for prosecutorial outcomes," stated Thiede.

The research recently was published in the Journal of Rural Health.

To examine rural access to SANEs, Thiede and Miyamoto analyzed data from the International Association of Forensic Nurses (IAFN) as well as data collected from 43 rural Pennsylvania hospitals.

The IAFN data showed that certified SANEs—those who have met rigorous qualifications and passed a certification exam—were only present in 16.7% of rural counties. The data collected from individual hospitals confirmed that very few have certified SANEs on staff and, instead, most rely on registered nurses with varying levels of additional training in sexual assault care.

Thiede and Miyamoto also found that most of these hospitals are not able to provide continuous sexual assault care coverage. This may lead them to encourage victims to seek care elsewhere or to rely on health care providers without additional training and experience in sexual assault care when victims present to emergency rooms.

Miyamoto and Thiede suspect that the absence of certified SANEs in the majority of rural Pennsylvania counties could be indicative of barriers to meeting certification requirements for rural SANEs. The two suggested one likely barrier to certification is the difficulty obtaining the supervised practice hours required for certification eligibility.

"Rural communities face challenges in recruiting, training, and retaining SANE nurses. Creative solutions are needed to increase access to quality sexual assault care." Miyamoto stated. "The intent of the Penn State Sexual Assault Forensic Examination Telehealth (SAFE-T) program is to pair less experienced nurses working in rural areas with expert SANEs to receive examination support, precepting, and peer review via telehealth technology. Programs like this show great promise in growing and sustaining a rural SANE workforce."

To continue ensuring that rural sexual assault victims receive expert quality sexual assault care, further research is needed to better understand how hospitals make decisions related to how they will provide sexual assault care and how ecological factors, such as hospital resources, the population size of the surrounding community, organizational culture, and state-level oversight may influence this decision-making.

More information about the SAFE-T Center and their work can be found on the website.