Expert Interview for Forensic Nurses Week: Day in the Life of a Forensic NP

The Evolving Role of Forensic NPs

Forensic NPs have been working with victims of trauma and applying the core tenets of forensic nursing to their practices for much longer than they’ve had a specific forensic nursing title. And even though Dr. Beverly Bowns received a grant at UTHSC to use NPs in primary care settings to treat victims of violence and trauma in the early 1970s, there wasn’t a widely accepted term for what they were doing until 1991, when Virginia Lynch gave the field of forensic nursing its name.

Today, forensic nursing is an advanced, wide-reaching, and critical area of practice for NPs.

“Some forensic nurses claim Florence Nightingale to be the first forensic nurse because of her work to improve the health of the most vulnerable in society,” Dr. Speck says. “When you look at forensic NPs today, they’re nursing at the borders, in the inner cities, and in emergency departments. We carry Nightingale’s light forward as forensic nurses and forensic NPs, in settings that define our practices.”

When the label of forensic nursing first entered the mainstream in the 90s, some people associated it primarily with the treatment of sexual assault victims by Sexual Assault Nurse Examiners (SANEs). While that’s an important function of forensic nursing, it’s far from the only one.

Forensic NPs, with their extensive and specialized training, can treat not only victims of trauma and violence but also a wide variety of patients from all different backgrounds; in some cases, forensic NPs continue to see certain patients for years. A forensic NP’s understanding of trauma, and appreciation of each individual’s unique response to it, weaves through every patient interaction.

“The core elements of forensic nursing have not changed,” Dr. Speck says. “But the science has progressed, the field of nursing has evolved, and our understanding of trauma has grown. Today, every aspect of nursing involves evaluating the stress levels and trauma in a person’s life, and selectively reducing that stress, to achieve better health outcomes.”

Forensic NPs have also been at the forefront of the modern trends of trauma-informed care and social determinants of health. While the official terminology has sometimes lagged behind, forensic NPs have always been astute at identifying medical and non-medical factors that influence a patient’s health, such as the built environment, cultural norms, socioeconomics, and mental health. And they’re staunch advocates for a sensitive, judgment-free approach to caring for victims and offenders alike.

“Today we use trauma-informed care to create a safe space for the patient, and then we enlist their priorities,” Dr. Speck says. “What are they wanting to accomplish to improve their health? It works better when patients drive their own destiny. What we teach in forensic nursing is to create a safe environment for all patients. Our ethics mandate that we are humble to the culture and the lived experience, without judgment.”

Forensic NPs can treat victims who report instances of sexual assault. But through the course of their NP practice, they can also identify cases of child abuse, elder abuse, benefits fraud, and human trafficking. A victim’s wounds aren’t always physical, and each patient’s situation is unique.

“Trauma, reported or not, is universal, and forensic NPs are experts at identifying it, documenting it, and treating it,” Dr. Speck says.

Documentation can be especially important, as forensic NPs will often need to interact with the criminal justice system.

“Forensic nurses know the criminal justice system,” Dr. Speck says. “In graduate forensic nursing programs, we teach NPs how to testify so that their testimony is not manipulated. We teach them how to document a patient encounter objectively. But we also teach them how to have patients participate in that documentation. When an NP finishes documenting a patient encounter, they may turn the record around and ask the patient if what’s been written is accurate, if it’s how the patient would like it to be presented. That one step can help create a safe, trusting, and transparent relationship.”

Forensic NPs often follow up with their patients for several visits, and this is particularly important in dealing with victims of trauma and violence. In some cases, it can take a number of visits before a patient feels comfortable enough to open up about a potential incident. And patients who have suffered from violence or trauma often develop other associated health concerns: they may use alcohol and tobacco to calm their vagal nerves, or their exercise and eating habits may suffer. Forensic NPs can not only spot and treat these issues, but also help patients recognize the events which trigger them and replace harmful activities with healthier ones.

“NPs bring a medical diagnostic capacity along with prescriptive authority, but there’s another layer that affects the person’s health that pills will never solve,” Dr. Speck says. “It has to do with stress, stress response, and our ability to mitigate that response with interventions that we study and plan. We want to partner with the patient, to give them the options that we know improve health, and encourage them to adopt them when they’re ready.”