National shortage of Sexual Assault Nurse Examiners impacting cases

The U.S. is in the middle of a nurse shortage, and that includes a lack of Sexual Assault Nurse Examiners, or SANEs. These are specially trained nurses who can provide high-quality and compassionate care for sexual assault victims.

Local perspective:

Lauren Easter is a survivor. The 35-year-old mother remembers the day her partner attacked her inside their apartment while their two-year-old son sat in his crib, just a few feet away.

"Just in a split second, I remember being pushed onto our bed and him attacking me," Easter said. "Once I kind of got him off, I just remember being on the floor at one point and he started attacking me again."

Easter recalls briefly losing consciousness during the attack.

"That's where things kind of get blurry from during the attack into waking up in like the fetal position on the floor," she said. "And so I did remember having bruising and fatigue around my neck."

Easter said she and her partner had been together for a few years, but at some point, their relationship began to change for the worst.

"Things started getting pretty, pretty dark and difficult," she said. "And eventually, our relationship just kind of imploded at that point."

With the help of a friend, Easter reported the attack to police. A detective eventually took her to be examined by a SANE. These licensed professionals are trained to conduct forensic exams, or rape kits, for survivors of sexual assaults. SANEs are often the first, and the most important, step in helping victims find justice.

"I think he really wanted to prioritize getting as much evidence as possible in that moment, especially knowing that we were in a long-term relationship," Easter said. "I remember him explaining that, that this would be important for my case to get that completed."

Why you should care:

According to the International Association of Forensic Nurses, there is a shortage of SANEs nationwide.

"There's no mandatory database identifying who is a practicing Sexual Assault Nurse Examiners or forensic nurse and where are they located," said Jennifer Pierce-Weeks, CEO of the International Association of Forensic Nurses (IAFN). "So we have data based on our membership numbers... based on the data we collect inside our membership, that we know that somewhere in the neighborhood of 25% of U.S. hospitals have some form of forensic nursing program."

Pierce-Weeks said the biggest gap in coverage is in more rural areas and tribal communities across the U.S., where assault cases often go underreported.

"We do not have anywhere near the number of Native nurses doing this work that we need," she said. "We see that even more so in Alaska, right, where there are communities that literally have no provider, no provider at all."

She cites several factors for the SANE shortage— everything from the lack of training and the costs associated with it, to burnout.

"If you enter the field and you really kind of make it to the three-year mark in the field, you're much more likely to stay," Pierce-Weeks said. "We have a lot more members that have been around and a part of the association for better than 10 years than we do the members who are around for one or two years, and then they kind of disappear."

Dig deeper:

A recent report from the University of Arizona found that the total number of SANEs in the state is close to 50, with a majority of them in Maricopa County, including at HonorHealth in Scottsdale. 

Samantha Mendez-Dominguez, the forensic nurse manager there, spoke about the unique challenges of the job.

"You have those added challenges of burnout and compassion fatigue and what we call as vicarious trauma, where you're hearing and seeing trauma that other people have experienced and that can really lead to burnout on the individual," Mendez-Dominguez said.

To help mitigate the issue, HonorHealth said they provide newer SANEs with resources to help them deal with such heinous cases.

"Anytime we have a new nurse, they are paired with a mentor so that they have that added layer of support," she said. "Sometimes we have cases that are even more difficult, even more violent, and so we really encourage debriefing to be able to talk through kind of what you're feeling after that difficult case."

By the numbers:

According to the Rape, Abuse, & Incest National Network (RAINN), 60% of sexual assaults are committed by someone known to the victim. Every 74 seconds, someone in the U.S. is sexually assaulted. Every nine minutes, that someone is a child. 

There were roughly 1,500 sexual assault-related arrests in Arizona between 2018 and 2022. More than half of those cases ended in convictions, due in large part to the work of a SANE.

Local perspective:

But in Easter’s case, justice never came. She said in the months leading up to the trial, the evidence from her exam ended up getting lost.

"I remember getting the call from my advocate attorney where she told me that my evidence had been misplaced and that the prosecutor was no longer comfortable going to the trial now and was going to be offering a plea deal," Easter said. "I just remember bawling. I remember just words coming out of my mouth just being like, 'How? How does this happen? What do you mean they lost my evidence? How can you not get it back?'"

Despite the setback, Easter said her exam was a key part in helping her heal from her experience, and said she would do it all over again.

"I would never strongly try to force anybody to go through that if that's not what they wanted," she said. "Not everybody's road to healing is going through the judicial process, but if for who wants to, I do see the need and the importance of having that examination fulfilled."

What's next:

The average salary for a Sexual Assault Nurse Examiner is anywhere between $80,000 to $90,000 annually, depending on experience. But studying to become a SANE can sometimes be expensive, and experts believe that's one of the reasons for the shortage. There are less than two dozen colleges nationwide that have a dedicated SANE program, including the College of Nursing at the University of Arizona.

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