The evolution and outlook of forensic nursing

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Forensic nursing is a specialist area of healthcare delivery that is ever-evolving and flexing to accommodate changes in society and the law. It’s a much-needed profession, providing valuable support to victims of crime as well as to those accused of or charged with crimes.

Because the role relies on understanding and awareness of developments in society, the law, and scientific techniques, it’s a highly-valued one and makes an attractive prospect for nurses looking for a challenging area in which they may practice.

We’re going to take a look at this fascinating role in this article, examining the history and development of forensic nursing and understanding how it has responded to changes in society and the law. We’ll also understand the roles and responsibilities of the forensic nurse and the training pathway that takes healthcare professionals to this position.

Once you’ve reached the end of the article, you’ll have an insight into a world where healthcare delivery and understanding of the law meet — and why the role of forensic nurse is an excellent choice for healthcare professionals.

What is a forensic nurse?

A forensic nurse is a highly-trained registered or advanced practice nurse who provides care to victims of crime – whether children, adults, or inmates in correctional facilities. Forensic nurses work in a variety of settings including hospitals, community programs to help the victims of domestic crime, psychiatric units, and correctional facilities. They are most commonly associated with caring for victims of crimes such as sexual assault, domestic or other violence, child abuse and neglect, and human trafficking.

In this role, they fulfill a number of functions. These include:

  • Assessing patients to understand the trauma they have suffered, caring for their immediate health needs, and referring to other professionals as appropriate.
  • Collecting evidence that may be used in a court of law – for example, writing reports detailing the victim’s injuries.
  • Supporting the victim and their family members and signposting them to appropriate services.
  • Liaising with law enforcement authorities and sometimes testifying in court.

There are several sub-specialties of forensic nursing, so you may also come across other roles such as forensic mental health nurses who use their specialist psychiatric knowledge to assess the mental state of those accused of crimes.

Meanwhile, correctional forensic nurses provide care to inmates in jails (designed for pre-sentence inmates or those serving a sentence of less than two years), prisons (accommodating individuals convicted of a crime), and juvenile detention centers.

In these settings, they may assess an inmate on arrival at the correctional facility to determine their short- and long-term health needs, including suicide potential. They may then deliver care themselves or refer the inmate to a doctor or other healthcare professional. The type of care they offer and health conditions they treat may vary considerably and present specific challenges.

In short-term facilities, inmates may be experiencing drug and/or alcohol addiction or have acute medical or psychiatric needs. Communicable diseases may also be an issue in these types of environments. In prisons, where inmates are accommodated for longer periods of time, forensic nurses will also provide care for chronic or long-term health conditions.

Another area that forensic nurses may be involved in is death investigation, working with a coroner or medical examiner to examine a body with the aim of determining the cause of death.

This means that they may collect evidence from crime scenes and the victim’s body and their clothing and assist at autopsies.

The role of a forensic nurse is a complex one, since they will not only need to deal with their patients – who in many instances may be traumatized – but will also need to understand how to collect evidence and communicate with legal professionals too. It’s without doubt a multi-skilled position that requires nurses to draw on many personal attributes as well as diverse aspects of their training and experience.

Forensic nursing and changing social needs

As society shifts, the role of forensic nursing is growing and changing to accommodate the changing needs of the community. The first forensic nursing programs were developed in the 1990s in recognition of the need to provide targeted care to victims of and perpetrators of crime.

Since then, the field of forensic nursing has grown and become more popular as the need for a specific role that addresses both healthcare and legal issues at the same time is increasingly recognized. While it’s hard to say with certainty that we are living in more dangerous, violent times, the ease with which we can access local and worldwide news brings with it the perception that crime is more prevalent today.

This means that there is a heightened public awareness of crime, so forensic nursing and other similar roles are seen as more of a priority than ever before. In response, the government has increased funding for the education of nurses dealing with the victims of crime; as a result, more educational establishments have created programs and pathways for nurses to specialize in forensic nursing.

There have also been changes in society’s perception of the roles and scope of healthcare professionals. It used to be that doctors were considered the only professionals who could take on certain roles and responsibilities. But society’s expectations are constantly evolving. In today’s healthcare landscape there are many roles performed by nurses with increased responsibility and scope – for example, the nurse practitioner (NP) role.

NPs can perform a wide variety of tasks that traditionally would only be carried out by physicians – for example assessing and diagnosing patients, creating treatment plans, and prescribing medication. Similarly, the sexual assault nurse examiner (SANE) role developed in the 1970s sought to improve the scope and standards of care to victims of sexual assault. The role was recognized as a sub-specialization of nursing by the American Nurses Association in 1995. 

Then, in 1997 the Office for Victims of Crime (OVC) publicly recognized research that found that SANE programs translated into better care for victims of sexual assault as well as higher standards of evidence collection. This in turn led to the OVC championing the first SANE Development and Operation Guide, giving this area of expertise more kudos than ever before.

These shifts in recognition of the rights and needs of victims of sexual assault, and the demand for highly-trained nursing professionals to help and administer them, have been crucial in pushing forensic nursing to the fore.

Forensic nursing and legal developments

The development of forensic nursing has also been informed by changes in the fields of evidence collection and law. Let’s start with evidence collection. It’s clear that developments in techniques of evidence collection and the methods to analyze it have directly affected the role of forensic nurses.

Take DNA science, which has now been refined to such a degree that only the smallest samples can help convict a criminal. One of the key parts of a forensic nurse’s role is to collect DNA evidence to a standard that means it would be admissible in a court of law.

This evidence can make or break a case, which means that forensic nurses must be steadfast in their understanding of the latest DNA collection techniques and apply them meticulously.

They must be willing to undergo continuing professional development and training to keep up with the latest theory and techniques in DNA evidence. In addition, forensic nurses must always bear in mind their part of the law enforcement process when carrying out these tasks, with an awareness of the appropriate legal developments and implications. 

A forensic nurse must also be ever-mindful of changes in the legal system, on top of their commitment to understanding the latest medical research and techniques that affect the execution of their role. For example, on December 1, 2023, amendments to three of the Federal Rules of Evidence are set to come into force. While it’s not the forensic nurse’s main role to understand all the complexities of the legal system, they should have an awareness of how changes to the law such as these may affect them if they are called to give their testimony in court.

These proposed amendments affect Rule 702, which is about the admissibility of expert testimony and sets the required standards for it. The changes will clarify the standard of the expert witnesses and put a focus on a judge’s remit to allow or disallow such a witness to testify.

One of the implications of the proposed change is that standards of evidence provided by expert witnesses could be set to become ever more stringent. For forensic nursing, this could be interpreted as a positive since driving standards higher can only result in better results for the victims of crime and for the reputation of this branch of nursing.

The planned changes to Rule 702 are just one example of where forensic nurses must keep an awareness of developments in the legal world that could have implications for their day-to-day practice.

The outlook for forensic nursing

As we’ve seen, societal changes and attitudes mean that increasing value is being accorded to roles that allow nurses to specialize in diverse fields and practice autonomously and to the highest standards. This is especially true of the role of forensic nurse.

Meanwhile, changes to the legal system are driving standards of admissible evidence and expert testimony ever higher. While this represents a challenge to anyone working in the field of evidence collection, such as forensic nurses, it also means that the high quality of their work is recognized and appreciated.

Increased recognition of specialized nursing roles to deliver high-quality healthcare services means that there is a bright future for forensic nursing, with many opportunities for growth to meet the demands of today’s society.

The U.S. Bureau of Labor Statistics has predicted that nurse practitioners – whose role is equivalent to the forensic nurse in terms of skill level, education, and responsibility – is set to become the fastest-growing occupation in the United States in the decade 2021 to 2031.This means that new positions in this role will open up, making it an attractive option for registered nurses looking to specialize in an area of care that brings together the medical and legal worlds.

The role of senior nurse is also attractive in terms of salary awarded. As of May 2022, the U.S. Bureau of Labor Statistics quotes a mean annual wage of $124,700 for nurse practitioners, with the top earners receiving $165,200. This reflects the value placed on these types of roles, where highly-trained professionals such as forensic nurses are rewarded fairly for their skills and dedication. They can expect a long and fruitful career, enjoying the recognition that they truly deserve in this demanding but incredibly-rewarding career pathway.

A career as a forensic nurse

As we’ve seen, forensic nursing offers a highly-challenging yet fulfilling career. It requires a high level of autonomy, excellent assessment and communication skills, and the ability to work under pressure. While it’s possible to transition from a previous nursing role into forensic nursing, additional training is recommended to prepare the candidate for this demanding role. Employers are also more likely to hire nurses into forensic positions if they can demonstrate an understanding of the medico-legal setting and its demands.

So, if you’ve ever wondered, “what does a forensic nurse do?; or if you have a desire to specialize in a much-needed area of nursing, you may wish to build on your existing skills by embarking on a training program in forensic nursing. One route to gaining forensic nursing skills is via an online training program, offering students the ability to study at their own pace and from a location of their choice. The Online Master of Science in Nursing – Forensic Nursing program offered by Cleveland State University, for example, prepares candidates for forensic nursing roles, with instruction in topics including evidence-based practice, crisis response, holistic nursing practice, forensics methodologies and the legal system. Coursework is delivered 100% online, and no on-campus residencies are required, meaning it’s perfect if you are aiming to study alongside your existing commitments. You’ll also get the chance to gain real-world experience through learning hours in your community. You can complete the course in two years part-time, so gaining the skills, experience, and confidence to enter the world of forensic nursing could come sooner than you think.

A role that brings rich rewards

Keeping up with changes in technology, social needs, the legal system, and healthcare delivery brings many challenges to the forensic nurse. But for many, these are challenges worth rising to as this role brings such rich rewards. The career of a forensic nurse is a fascinating one, requiring a deep understanding of two different worlds: healthcare and the criminal justice system.

Forensic nurses can enjoy the satisfaction of supporting victims of crime and their families and helping bring criminals to justice.  And working in correctional facilities can also bring its own unique rewards. Here, forensic nurses may also make a difference to people’s lives thanks to their professionalism and compassionate approach.

Since the role of forensic nurse is poised to become more recognized and in-demand than ever before, it makes an excellent choice for any nurse looking to specialize in a growing sector of their profession. Gaining the skills and expertise to do this through an online Master of Science program, such as the one offered by Cleveland State University, means that a career in forensic nursing is more accessible than ever before.

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