Forensic nursing combines crime, healthcare

Psychiatric nurse practitioner and PhD student Lisa Daly ’10, MS ’13, regularly works with parole and probation officers, and conducts psychiatric evaluations of inmates. This overlap of nursing and the law makes Daly a forensic nurse, and she’s not alone.

“There isn’t a nurse today whose practice doesn’t intersect with the legal system,” says Associate Professor Mary Muscari, a forensic psychiatric nurse and criminologist who also coordinates Decker’s forensic health and psychiatric nurse practitioner programs. “Every nurse practices some form of forensic nursing.”

According to the International Association of Forensic Nurses (IAFN), forensic nursing is the fastest-growing specialty within nursing. In 2017, the group reported representing 3,700-plus forensic nurses in more than 24 countries.

Forensic nurses experience a high degree of diversity with respect to the populations they serve, the services they provide and the settings in which they deliver those services. You’ll find forensic nurses working in fields such as sexual assault, domestic violence, child abuse and neglect, elder mistreatment, death investigation, corrections and in the aftermath of mass disasters. They also work as legal nurse consultants and nurse lawyers with district attorney offices, law firms, insurance companies and governmental agencies.

“Forensic nursing practice settings are evolving and increasing in number and variety,” reports the IAFN.

Some forensic nurses even open their own consultative businesses. Decker doctoral student Jacqui Callari-Robinson is one of them.

Sane and committed

An internationally recognized expert in sexual abuse medical-forensic evaluation and training, she runs Callari-Robinson Consulting LLC and works with clients around the world to implement sexual assault nurse-examiner (SANE) programs in their organizations. A SANE is a registered nurse with advanced training in caring for and gathering evidence from survivors of sexual assault, as well as providing testimony to bring sexual assault cases through the legal system.

Callari-Robinson has been a SANE since the 1990s.

“When I became a nurse in New York City in the 1980s I was working in an emergency department, following instructions for victims of sexual violence, and I was bumbling through it, making colossal mistakes with evidence collection,” she says. “How we treated the victims through the entire process was horrifying.”

Today, Callari-Robinson is on the IAFN board of directors, working to standardize protocols and educational requirements across forensic nursing while also educating the public about the field. But helping victims of violence remains her passion.

“I’ve dedicated my life to this work because I believe every person who experi-ences violence needs to have a trained, informed, compassionate nurse taking care of them,” she says. “That’s my goal.”

Decker Clinical Assistant Professor Rosemary Collier ’09, MS ’13, PhD ’16, agrees. Collier, who also works as a registered nurse in the emergency department at UHS Binghamton General Hospital, became a SANE in 2011 after being called upon to help with forensic examinations of survivors of sexual assault who arrived at the hospital when a SANE wasn’t available.

“I had taken Dr. Muscari’s forensic health courses as an undergraduate student, so I had an idea about forensic nursing,” Collier says. “Becoming a SANE wasn’t an overarching goal for me, but I knew if I was going to do the exams, I wanted to be qualified.”

Collier, like most certified SANEs, went through a 40-plus-hour training program that covered topics such as caring for victims of sexual assault without retraumatizing them, interview techniques, identifying wounds and patterned injuries, medication protocols, evidence collec-tion, courtroom testimony, DNA testing, retaining objectivity and proper documentation of the patient examinations.

Despite the challenges of conducting such a difficult and lengthy examination (four hours on average), Collier and Callari-Robinson encourage nurses to pursue this subspecialty.

“There is a great need for SANEs, and it’s nothing but beneficial for the victims to have someone there who specializes in that care and has received that advanced training,” Collier says.

“I go out there with optimism every day,” adds Callari-Robinson, “because of the look on patients’ faces when I care for them and the way I feel after a case or after I’ve trained a group of nurses and they tell me I’ve touched their lives.”

Caring for the dead

Sometimes, the lives touched by forensic nurses don’t belong to patients, but to the loved ones they leave behind. That’s the case with forensic nurses who work as death investigators or nurse coroners, determining manner and cause of death.

“Nurses have a unique educational background that transfers quite well into what death investigators are required to do on a daily basis,” says Matt Lunn, a board-certified medical investigator and criminologist. Lunn, who has been appointed to multiple federal initiatives related to death investigation, teaches Decker’s course on the subject.

Having worked with death investigators from a variety of backgrounds, Lunn says nurses’ knowledge of disease processes, combined with their skills of observation and experience interacting with and educating people, make them ideally suited to this role.

“Nurses are uniquely qualified to identify issues of trauma or natural disease at the scene,” he says. “They are also trained to speak intelligently and thoroughly with healthcare providers who previously treated the decedent and [talk] compassionately with family members.”

While Lunn says more nurses are filling roles as death investigators, he still sees a great deficit in proper death investigations in rural communities, and he believes rural nurses are the solution.

“Nurses who work in rural settings could easily transition into these roles on an ‘as-needed’ basis,” he says. “We could teach them how to do a proper death investigation.”

Crime and punishment

Before she was a psychiatric nurse practitioner in Susquehanna, Pa., Lisa Daly worked in the forensic subspecialty of correctional nursing.

As a registered nurse at the Broome County Jail, Daly was responsible for 500–600 male and female inmates. And, while there were typically two to three nurses on shift at any time, frequently she was the only registered nurse within the facility.

“A lot of the time I was by myself, and I liked the autonomy,” Daly says.

She’s quick to explain that “by herself” doesn’t mean she was alone with an inmate, but that she was the only medical professional. A corrections officer was always nearby to ensure her safety. “Not for one single minute did I ever feel unsafe,” Daly says.

Correctional nurses at the Broome County Jail care for inmates in the jail’s two medical units. They also distribute medications in each housing unit three times a day, as well as see inmates who submit “sick call” requests. In addition, nurses screen all incoming inmates, attempting to get their medical and mental health histories, and learn about any drugs or medications they may be taking. Nurses also respond to emergencies throughout the facility.

While correctional nursing had its unique challenges (heavy workload, the need for situational awareness and working within a limited formulary), Daly found the job rewarding.

“These aren’t people who are coming into a walk-in or making a regular doctor’s appointment. They’re more likely to have mental illnesses, to be homeless or to be gang affiliated,” she says. “Society doesn’t even really see that inmates exist. They’re like another layer of society that no one really knows how to care for.”

To teach new generations of nurses how to care for those who are incarcerated, Daly worked with Muscari to develop Decker’s course on correctional healthcare.

Popular science

On the undergraduate level, Decker offers a minor and a certificate in forensic health; graduate students may complete an advanced certificate in forensic health. Courses are delivered online, are open to students throughout the University and are extremely popular.

“Our forensic health program is growing by leaps and bounds,” says Muscari. “In 2007, we had one course and now we have six. You have to sign up for our courses quickly or they’ll be filled.”

A nurse practitioner and clinical nurse specialist, Muscari has held different forensic nursing roles since the 1980s, when she worked primarily with delinquents. Today, her practice focuses on evaluating sex offenders. Muscari brings her experience and expertise in both nursing and criminology to the Decker School.

“Our program is focused on practice, on what you need to know if you’re going out there to work in forensics, and I think we do a good job preparing students,” she says. “We go into the nitty gritty of what people go through if they’re victimized, but we also talk about offenders. I don’t think you can really understand victimization without seeing the whole package.”

Muscari says understanding how offenders think is difficult for students to master. For the public, it’s tough to understand what forensic nursing is and why she would spend her life in that field.

“Delinquents are a population that nobody was lining up to work with, and I enjoyed that,” she says. “What I do now is also challenging, but I like the people I work with and I feel as though I’m making a contribution.”