Meet a Forensic Nurse

by Maura Deering
Meet a Forensic Nurse

As advanced nursing practice specialists trained in both the healthcare and criminal justice systems, forensic nurses care for patients dealing with the long-term health effects of victimization or violence.

As part of their duties, forensic nurses examine patients to identify trauma, conduct investigative interviews, and collaborate with social services agencies and law enforcement. They also investigate crime scenes and present expert testimony in court.

Our guide to forensic nursing features a Q&A with forensic nurse examiner Laura Clary and provides information on how to get started in this emerging field, including projected salaries, employment outlook, and forensic nursing specializations and workplaces.

Q&A With a Forensic Nurse

Laura Clary, BSN, RN, FNE-A/P, SANE-A

Laura Clary, BSN, RN, FNE-A/P, SANE-A

Laura Clary, BSN, RN, FNE-A/P, SANE-A is a registered nurse, forensic nurse examiner and clinical program manager of the GBMC SAFE/DV Program. In 2010, she completed her forensic nursing training at Greater Baltimore Medical Center and joined the GBMC SAFE Program.

She is certified to care for patients across the lifespan that have been victims of sexual assault, rape, child physical/sexual abuse and neglect, intimate partner violence, non-fatal strangulation, and human trafficking. Clary obtained national professional certification as a sexual assault nurse examiner (SANE-A) from the International Association of Forensic Nurses in 2013.

In addition to her work with patients in the hospital, community education is very important to her. Clary lectures at high schools, colleges, and other organizations throughout Baltimore county on healthy relationships, safe dating, internet safety, and the services offered at GBMC.

She is a Board of Nursing-approved forensic nurse examiner instructor in Maryland and has taught and precepted registered nurses and physicians from all over the country. She has extensive experience in emergency and trauma nursing. She is an active member of the International Association of Forensic Nurses and the Maryland Child Abuse Medical Providers (CHAMP). Clary is also chair of the Baltimore County Sexual Assault Response team.

What does a forensic nurse do and why is this work so important?

First and foremost, a forensic nurse examiner is a registered nurse. I am a nurse. I do not work for the police. I do not work for the prosecutor. I am a nurse. As a forensic nurse, we are specially trained and certified to provide trauma informed, patient centered care and treatment to victims of sexual assault, child physical and sexual abuse, intimate partner violence, non-fatal strangulation, and human trafficking.

Forensic nursing is a tough field to work in and one with a high rate of turnover. I feel very fortunate to have a team of amazing nurses that work alongside me, support me, and provide the most compassionate and evidence-based care to patients who have been victims of violence.

On tough days, we look at each other and say, "This job is hard, but what if no one wanted to do it? What if we weren't here? Who would take care of all these patients needing help?" This work is hard; therefore, teamwork is so important. I feel the nurses who work with me are not just my co-workers; we are one big crazy family working together to make a difference in the lives of our patients and our community.

Does one need to be an RN first in order to become an FNE?

In Maryland and most states, it is required to be an RN prior to obtaining certification in forensics. Each state has different requirements and regulations, so I suggest anyone interested in this field should look at what their state requires prior to taking courses.

What drew you to the idea of helping patients in this capacity?

Ever since high school, I knew I wanted to help people. Nursing was always something I was passionate about. I also had a tremendous interest in forensics. After many years of working as an emergency room nurse in inner city Baltimore, I would encounter victims of sexual violence, and we didn't have the capacity to care for them, so we would transfer them to hospitals that had skilled and trained nurses that specialized in that type of care.

I always wondered what happened to them when they left me. I looked into forensic nursing, found out what was required, and took the course. I took the course in 2010, and I have been hooked on this incredible work since then.

When in your nursing career did you decide this was something you were interested in doing?

I became a nurse in 2008, and as soon as I heard about forensic nursing, I immediately looked into it. I learned that in Maryland you need 18 months of clinical experience prior to taking the course.

I waited the 18 months and took the course as soon as possible. Two years after graduating nursing school, I became a practicing forensic nurse.

What does a typical day look like for you?

I am one of few nurses that have the privilege of being a forensic nurse full time, but prior to that, I worked full time as an emergency nurse and picked up on-call shifts as a forensic nurse. While on call, I waited for my phone to ring, ready to respond when someone would need help. This is how most forensic nurses across the country work, on call, waiting for the phone to ring.

Doing this full time, my typical day as a forensic nurse manager involves general oversight of the SAFE & Domestic Violence Program. I ensure that we always have nurses ready to respond when someone needs them, 24/7, 365 days a year.

Additionally, I feel that managers should never lose sight of what it is like to work at the bedside, so I take the same amount of calls as the nurses on my team. I love caring for patients, and I never want to give that up.

When not working in the hospital, I do a lot of community education about what SAFE is, the services we offer, and do other related presentations in schools, community centers, police departments, and neighboring agencies.

In what unique ways are you able to help patients?

As a forensic nurse, we are trained in forensic photography, or the use of alternate light source photography, which is not something typical to nursing. We use special dyes to help visualize micro injuries that are difficult to see to the naked eye.

We collect and package biological evidence from the patient's body, and we write up an extensive report with body maps. We are trained in maintaining chain of custody of all evidence.

We say that our care does not end when we discharge our patients; we follow our patients from the bedside to the courtroom. Months, even years down the road, we may be requested to testify as expert witnesses in the care and treatment we provided to the patient.

What are some of the greatest challenges of this type of work?

As I mentioned earlier, this work is incredibly challenging emotionally. There is a high risk for vicarious trauma. Vicarious trauma refers to negative changes in the forensic nurse's view of self, others, and the world, resulting from repeated empathic engagement with patients' trauma-related treatment, emotions, and hearing about the pain and suffering they endured.

Therefore, self-care is so important. I had to find ways to de-stress after work and learn to not take my work home with me, and that is not always easy.

I also have 18 other forensic nurses that work with me. We are very close, and I know I can always call any of them if I need to vent or just need someone to hear me out about a tough case. Teamwork and camaraderie are essential, and I feel very thankful to have such an amazing group of forensic nurses working alongside me.

How does one become a forensic nurse?

Each state has different requirements to practice as a forensic nurse. I recommend looking into your state board of nursing prior to taking any courses, to ensure that they are approved.

In most states, it is required to take an accredited 40-hour didactic course, followed by a variety of clinical activities, and precepting under an experienced forensic nurse examiner. For more information, you can look at the International Association of Forensic Nurses.

What advice would you give to nurses considering this pathway?

If this is something you are interested in, please look into it. While this job is difficult, it is also so incredibly rewarding. After each shift, you leave knowing you truly made a difference in the lives of your patients. The world needs more forensic nurses.

How to Become a Forensic Nurse

The first step on the path to a career as a forensic nurse involves becoming a licensed registered nurse (RN). RNs earn associate or bachelor's degrees in nursing and pass the National Council Licensure Examination (NCLEX-RN) to obtain licensure. Nurses can then opt for board certification or a graduate degree in forensic nursing.

Many RNs pursue training and certification as sexual assault nurse examiners (SANE), a forensic nurse specialty area helping victims. In addition to an RN license, SANE programs prefer at least two years in practice conducting advanced physical assessments of patients.

Students should select a training program that meets the standards set by the International Association of Forensic Nurses. Additional requirements may vary as mandated by state boards of nursing.

Once students complete 40 hours each of classroom and clinical training and begin practicing as SANEs, they can opt to take one of two board certification exams: SANE-A to care for adults and adolescents or SANE-P to help children.

Some jurisdictions hire forensic nurses trained as death investigators. Nurses interested in this specialty should have experience in emergency or intensive care nursing and take an American Board of Medicolegal Death Investigators certification exam. Depending on local laws, forensic nurses act as medical examiners or coroners.

Salary and Job Outlook for Forensic Nurses

As an RN specialty area, forensic nursing pays a median annual salary of $73,300, according to data from the Bureau of Labor Statistics (BLS). The advanced skills required of forensic nurses, such as documentation, attention to detail, critical thinking, and communication, may affect salaries. PayScale reports the annual earning range for forensic nurses as between $59,000 and $89,000.

The BLS reports the employment rate of RNs in general should grow by a projected 7% from 2019-29. This should translate to more than 220,00 new jobs nationwide.

Salaries and job openings also vary by location. California tops the list for both salary and employment level of RNs, paying a mean annual wage of $113,240, but the state has only filled 17.42 out of every 1,000 available jobs.

A nationwide shortage of SANEs indicates the need for forensic nurses in this specialty in all areas. In Virginia, for example, only 16 of the state's 122 licensed hospitals offer forensic exams, and just 150 out of 94,000 Virginia RNs practice forensic nursing.

Other top-paying states include Hawaii, District of Columbia, Massachusetts, and Oregon, in which all RNs earn an annual mean wage that exceeds $90,000.

Forensic Nurse Specializations and Work Environments

In addition to sexual assault, forensic nurses can choose from a number of other specializations and careers, including forensic nurse examiner (FNE), legal nurse consultant, forensic psychiatric nurse, nurse death investigator (NDI), correctional nurse consultant, and forensic nurse educator.

Forensic Nurse Examiner (FNE)
Certified FNEs examine victims of violence, often as part of criminal investigations. They also provide crisis intervention, refer patients to other programs and services, and collect evidence using technology like forensic photography. They often serve as expert witnesses in criminal trials.
Legal Nurse Consultant
Legal nurse consultants work with physicians, attorneys, and their clients to advise lawyers on medical facts and evidence for ongoing cases.
Forensic Psychiatric Nurse
Forensic psychiatric nurses help patients experiencing emotional or physical trauma. NDIs perform examinations on the deceased and gather evidence and take photos at crime scenes.
Correctional Nurse Consultant
Correctional nurse consultants work with incarcerated patients, providing exams, healthcare services, and medication.
Forensic Nurse Educator
Forensic nurse educators teach classes that cover topics in forensic nursing, including crime scene evidence collection, domestic violence, and elder abuse.

General medical and surgical hospitals employ the largest numbers of RNs in the U.S., but forensic nurses can be found in a wide variety of settings. Forensic nurses work in hospital emergency rooms, urgent care centers, psychiatric facilities, prisons, community anti-violence programs, government agencies, and in offices of coroners and medical examiners.

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