A sexual assault nurse examiner opens a rape kit at the Solace Center in Raleigh. File photo by Alicia Carter / Carolina Public Press

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The best care for sexual assault victims comes from nurses trained to help victims process their trauma and collect evidence of the attack against them.

These trained nurses, called Sexual Assault Nurse Examiners, are rare in rural areas, a Carolina Public Press investigation found last year

By this fall 50 more nurses with SANE qualifications will be working in hospitals throughout the state, thanks to $2 million from the state Attorney General’s Office.

Attorney General Josh Stein said Tuesday his office asked hospitals what services would help the facilities, and training was one of them. The money comes from the state’s Sexual Assault Kit Initiative grant, which has been used to test decades-old rape kits. Half of that money can be used to test kits, and the other half can be used “in a variety of different ways,” Stein said.

Last year, Stein told CPP he wanted to see a SANE nurse in every hospital system. So far, the state legislature hasn’t moved in that direction, and Stein still wanted to address the need.

“Let’s see if we can creatively come up with ways to advance the number of SANE nurses in North Carolina,” Stein said.

Having a nurse trained not only in forensics but also how to compassionately help the victim in a dark time is critical, Stein said.

“You also want the nurse to have the emotional training necessary to deal with the person with compassion and make sure that they don’t retraumatize that person and help connect that person to support services to help that person heal over time,” he said.

The program includes 40 hours of online training through the International Association of Forensic Nurses, eight hours of N.C. Board of Nursing-approved training on sexual assault investigations and crime lab processes, and 16 hours of on-site clinical training at one of four sites around the state. The in-person training will take place at one of four locations: Fayetteville, Greenville, Elon and Asheville.

Once the nurses have completed this training, they will have met the state Board of Nursing’s minimum training requirements to practice as a SANE. They will then be well on their way to apply for the International Association of Forensic Nurses certification exam.

The Southern Regional Area Health Education Center runs the training. Increasing SANE nurses is a “critical need” across the state, “especially in the rural areas of south-central North Carolina that Southern Regional AHEC serves,” said a statement from Sheree Hays, administrator for continuing professional development at Southern Regional AHEC.

The program will “offer a comprehensive training curriculum and best practices needed to extend the resources available for victims of sexual assault within our local hospitals,” Hayes said.

Last year, a Carolina Public Press investigation found few rural hospitals have a certified SANE nurse. And few hospitals statewide had a SANE nurse available 24 hours per day, seven days per week. Victims seeking help from a SANE nurse often travel to multiple hospitals spanning several days just to find one on duty. 

No government agency was keeping track of which hospitals had these nurses on staff, so victims could not look online or call a public health agency to figure out where to go.

It’s “not an acceptable situation” and “every hospital system in North Carolina should have SANE nurses trained to deal with these types of crises to serve people in need,” Stein said then. “I think a requirement that (hospitals) have them would address the situation.”

Studies have shown that victims served by a SANE nurse received “more consistent and broad health care services,” including sexually transmitted infection treatment, than those who did not have a SANE present. In addition, 72% of those served by SANEs reported the crime to the police compared with half who did not see a SANE. 

Another study from 2006 noted that criminal cases that included evidence collected by a SANE were 3.5 times more likely to result in a conviction.

Vidant Health now has nurses in training through the program from its locations in Ahoskie, Kenansville, Nags Head, Tarboro and Washington. CPP’s reporting last year showed few SANE nurses worked at hospitals in Eastern North Carolina.

“Vidant Health is deeply appreciative of North Carolina Attorney General Josh Stein’s commitment to helping health systems train and educate SANE nurses across the state,” said spokesman Jason Lowry in a statement for Vidant Health. 

“SANE nurses play an instrumental role in providing compassionate care to sexual assault victims, and expanded access to SANE nurses will benefit those that depend on their services and expertise. 

“This initiative to establish more SANE nurses statewide will help fill an important need and serve as an immense benefit to the people of North Carolina.”

Stein said his office tried to make sure nurses were spread evenly throughout the state.

“Having a SANE nurse is such an important response to a victim of sexual assault that we’ve made it a real priority to train as many of them in North Carolina hospitals as we can,” Stein said.

Other nurses training in the state program will work in hospitals in Clyde, Clemmons, Pinehurst, Kinston and Morehead City. 

Two nurses with Novant Health who work in Clemmons will be trained by the grant, said Novant spokeswoman Megan Rivers.

“Currently, we have 17 nurses that have completed training in our largest markets with 15 more who are expected to complete their training sometime this summer,” she said.

Last year, the General Assembly approved $9 million to test the state’s decades-old backlog of rape kits, in addition to $6 million legislators approved in 2019.

In January 2019, N.C. Attorney General Josh Stein announced the details of The Survivor Act, a bill then proposed in the General Assembly to create a protocol for law enforcement agencies to follow on when and how to submit rape kits to the state crime lab. Kate Martin / Carolina Public Press

“We should have enough funds to fully test the backlog of untested sexual assault kits here in North Carolina,” Stein said. “And over half of them are either tested or in the process of being tested, or at the lab and waiting for their turn to be tested.”

At one point, North Carolina had the most untested sexual assault kits in the nation, at more than 16,000. Stein said there have so far been 63 arrests related to 91 assaults related to the old kits.

As of last year, more than 3,700 had been tested, and nearly 1,400 had eligible DNA. Of those, 41% were a match with a known person on the federal DNA database called CODIS.

Several prosecutors have already charged and convicted people with crimes committed, at times, decades ago.

The SANE nurse training program joins several other reforms and investments since CPP’s Finding Nurses series ran last year, in which 130 hospitals were asked about their SANE programs. The series found that no state agency tracks where SANE nurses work and that they largely worked in urban areas.

President Joe Biden signed a law that includes $30 million in grant money per year through 2028 to, in part, train and retain Sexual Assault Nurse Examiners nationwide and retain them in rural and tribal communities. U.S. Rep. Deborah Ross, D-Raleigh, championed the changes and said she was inspired by CPP’s reporting.

The federal legislation also allows states to use grant funds to create a database to track where SANE nurses work.

State lawmakers approved a $125,000 SANE nurse training pilot program in Cumberland County. State legislators are likely to consider other reforms once the General Assembly convenes next month.

Clarification: This article initially posted on April 7, 2022, but was updated on April 8, to provide more detail about the training and certification process for sexual assault nurse examiners.

Kate Martin

Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.

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