Empowering victims: Banner Health's forensic nurse examiners provide choices with one-on-one care

May 27—Care by a forensic nurse examiner differs from other types of medical intervention in that patients are empowered to have total control of their hospital visits.

People who fall victim to interpersonal violence — domestic violence, strangulation, sexual assault, human trafficking or child, elder and at-risk adult abuse — can find comprehensive, compassionate and, when requested, confidential care at northern Colorado'sBanner Health hospitals.

Forensic nurse examiners are a highly trained, specialized nurses who collect evidence, document injuries and provide courtroom testimony.

Northern Colorado's Banner Health has 10 forensic nurse examiners, led by forensic program manager Julie Rojas, providing 24/7, on-call care at Banner's emergency departments.

The Blue Bench, a sexual assault prevention and survivor support center in Denver, reported 1 in 3 women and 1 in 6 men in Colorado will experience sexual assault in their lifetime. Nearly 70% of all reported sexual assaults occur to children ages 17 and under, according to the Four Corners Child Advocacy Center.

Nurse examiners provide medical exams involving head-to-toe assessments and reviewing medical histories. The nurses also conduct a detailed examination assessing victims for trauma such as injuries on the body surface.

In cases of sexual assault or strangulation, forensic nurse examiners can collect evidence from victims' bodies such as collecting body swabs and clothing. Documenting evidence through photographs is also common.

Patients have a choice

In Colorado, depending on the circumstances, patients over 18 and under 70 have the right to reject law enforcement involvement, Rojas said.

"Depending on their desire and what we're held to legally, we don't report everything," Rojas said.

Forensic nurse examiners, however, are required to adhere to specific mandatory reporting criteria, such as notifying police if a person is underage.

Although forensic nurse examiners are mandatory reporters for juveniles, children of all ages can undergo a sex assault exam without parental permission. Since the police are notified, forensic nurse examiners can help facilitate conversations between patients and their parents.

When it comes to involving law enforcement, Rojas said the Banner Health team takes the time to educate all patients about what it means to alert or not alert law enforcement, as well as provide them with any options available to them.

Even if nurses are required to report an incident, patients aren't required to cooperate with the police unless they want to.

Any photographs taken are kept on file for patients indefinitely and confidentially, with or without law enforcement involvement. Even in mandatory report situations, photos are only shared with the police if nurses are granted consent from victims.

"Banner Health provides people a safe place to keep incidents documented that they might not feel safe telling the police," Rojas said.

But evidence collection is never the primary concern for Rojas when a victim walks through her door. Safety is of the utmost importance to forensic nurse examiners.

"How can I give this person who maybe has had control taken from them in one way or the other, give them space to be in control and help plan for their safety?" Rojas asked.

One of the reasons Rojas, who worked as a nurse before the Banner program's introduction in 2012, became a forensic nurse examiner is because of how unique the role is compared to other nursing jobs. As a forensic nurse examiner, Rojas can prioritize individual care with no rush.

Each forensic nurse examiner has one patient at a time and can be there with a victim for however long they desire, from a few minutes to a few hours.

"It's truly the only time in nursing that I've ever been able to be one-on-one with a patient who wanted me there for as long as they needed me there," Rojas said.

A patient under a forensic nurse examiner's care is also in charge of the whole situation, according to Rojas. When a nurse meets with a victim, Rojas said the team will first make it very clear that victims have the choice to refuse or accept the care.

"You could tell me to go home, go back to bed and get out of here," she said. "You're not going to hurt my feelings. This is all up to you."

Next, the team will explain steps victims can take to help them feel safe and in charge — a challenge at times depending on the level or history of trauma, Rojas said.

The ultimate goal is for victims to leave with resources that keep themselves safe past the initial emergency department visit as well. Luckily, Rojas and her team know about resources in the community thanks to networking and working closely with other agencies to provide the best coverage possible for the patient.

Rojas also does outreach with the University of Northern Colorado students and high school students who are interested in a career in the medical field.

Increasing need

Rojas said the need for forensic nurse examiners is on the rise in northern Colorado. Back in 2012, the first year of the program, 64 victims came in with incidents of interpersonal violence. In 2022, Banner Health forensic nurse examiners saw 300 victims.

Rojas' theories for the rise in victims include increased outreach education and expanding forensic nurse examiner practices statewide.

Forensic examiners like Rojas said outreach to students, law enforcement, paramedics and other community members is bringing in more victims to find support. In the past decade, Rojas has attested to seeing the Greeley Police Department improve in the way officers present themselves to a patient who's been in that situation due to education and awareness efforts.

In addition, within the past couple of years, most hospitals across the state expanded coverage to all types of interpersonal violence. Prior to the program, only sexual assault nurse examiners could complete sex assault exams at hospitals.

Rojas noted there are also upticks in patients during warmer weather months, when college students return back to school in August and during holidays.

Taking the first step

During a time when people are experiencing trauma and are left feeling powerless, seeking care is the first step when taking back control, Rojas said.

Along with the goal of empowering victims when they feel powerless, Rojas and her team notify people of the benefits that can come from taking control of one's health, especially when there are potential risks involved.

During an ER visit, forensic nurse examiners check vaccination statuses and provide vaccination updates such as for tetanus and hepatitis when people are exposed. The team can also potentially help treat sexually transmitted infections and offer emergency contraception options — services that are confidential.

"I think taking control of your health is the one thing people can still do, even though they've been through some terrible trauma related to being assaulted," Rojas said. "It empowers people to start their healing."

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