Forensic Nurses Specialize to Make a Difference After Patient Trauma

Through trauma-informed care, nurses help patients reclaim their future

Forensic nursing

As a full-time firefighter and an emergency department nurse, Scott Sharp, RN, understands what it means to be called to service. Sharp regards his work in forensic nurse as a calling within a calling – a realm of caregiving that offers a unique opportunity to help during a particularly difficult time in his patients’ lives.

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“This is very individualized care,” Sharp says. “Your whole focus is on taking care of that one patient, and it feels like you really did help them.”

Sharp is part of a team of five full-time nurses and 40 PRNs in Cleveland Clinic’s Forensic Nursing Department, which provides care for individuals who have experienced sexual assault, domestic violence, human trafficking, elder abuse, child abuse and neglect. Care includes treating the patients’ medical concerns first, then documenting injuries and the collecting forensic evidence that may help bring justice through legal channels.

The larger goal of the forensic nursing team, however, is to holistically support patients who have experienced abuse.

“We are also called in when doctors or nurses have concerns that a patient is at risk for exploitation based on knowing and understanding the red flags for abuse and or trafficking,” says Michele Reali-Sorrell, DNP, RN, manager of the Cleveland Clinic Forensic Nursing Program. “Maybe there’s a disclosure, maybe not, but our goal is to plant that seed that we are here to help.”

Forensic nursing started in the 1980s and was introduced at Cleveland Clinic in 2003, Dr. Reali-Sorrell says. In 2020, the program cared for more than 700 patients, 380 of whom had been sexually assaulted.

The needs around forensic nurses continues to grow, says Dr. Reali-Sorrell, especially in less populous regions, which may have no access to nurses with the specialized training.

“The bigger cities tend to have robust programs, but the rural areas tend not to have them available,” says Dr. Reali-Sorrell. “There just are not enough forensic nurses to cover the need.”

Historically, patients who have experienced abuse or assault have sometimes been asked to travel to a hospital that has a team better trained to collect forensic evidence. That’s far from ideal for a person who has just been through a life-changing trauma. “That’s just very old-school thinking,” Dr. Reali-Sorrell says.

Forensic care requires knowledge and a deep sensitivity to what the patient has experienced, she says. It also takes time that ED teams don’t typically have.

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“The forensic exam can average between two to six hours, based on the patients’ medical and emotional needs,” Dr. Reali-Sorrell says. “The forensic nurse will provide patient-centered, trauma-informed, one-to-one care that includes medical care, documentation of all injuries, including photo documentation as appropriate, as well as blood work and offering  prophylactic treatment for sexually transmitted infections.”

At Cleveland Clinic, forensic nurses work with local agencies such as the Cleveland Rape Crisis Center and help connect adult patients with law enforcement if needed. “As mandated reports, we report to child protective services and law enforcement for anyone under the age of 18,” Dr. Reali-Sorrell says. “It’s also important that we do safety planning and make sure that we get people home or that they have a safe place to go if they can’t go home. With this model, where a forensic nurse comes in and really has expertise in the field, we have better outcomes.” Within the field of forensic nursing, there is simply a need for more, she says: more nurses trained and certified to serve patients in all areas of the country; more support from hospital systems to put programs in place; and a greater awareness within the healthcare community about what forensic nurses bring to the table.

A place for nurses of all kinds

At Cleveland Clinic, the program has two main hubs, Fairview Hospital on the West Side, and Hillcrest Hospital on the East Side. There is a forensic nurse on call at all times covering 12 hospitals and free-standing EDs in five counties.

The work – frequently pursued as a second job – calls to nurses with a variety of skill sets and from a variety of backgrounds. Like nursing itself, it tends to draw more women, but Dr. Reali-Sorrell notes that the two men on the Cleveland Clinic team excel at the work. Patients, the majority of whom are women, respond to the professionalism and understanding they bring to their care.

“The teaching methods in the forensic nursing training are really focused on trauma-informed care,” says Cody Morrison, RN.

Morrison says that the certification training, developed by the International Association of Forensic Nursing, grounded him in trauma-informed care, a style of caregiving that considers the impact of trauma, including long-past or ongoing experiences.

“Our patients are coming out of an acute trauma, and we really bring an understanding of what that involves,” Morrison says. “We are able to start helping them through the recovery process.”

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Morrison became interested in forensic nursing because he saw it as a way to have a more integrated role with patients and to acquire expertise and greater autonomy. He also brings a passion for caring for vulnerable populations, and is also pursuing a Doctorate of Nursing Practice in Adult Gerontology Acute Critical Care. The most rewarding part of his work in forensic nursing, Morrison says, is “to walk into a room with someone who has experienced a life-changing event and be able, in a very short time, to establish trust, to preserve their dignity, and then to establish that foreground for recovery.”

Care that spans the patient experience

In 2020, Cleveland Clinic opened its Forensic Follow-Up Clinic at Lakewood Family Health Center, where patients meet with a nurse practitioner and can connect with a victim advocate.  So far this year, 111 patients have scheduled follow-up appointments.

“Some survivors of violence may have a primary care doctor and some may not,” Dr. Reali-Sorrell says. “There are also some who don’t want their primary care physician to be the one who checks up. It’s not uncommon for people to want to separate their care when something like this is going on, depending on circumstances.”

At the follow-up clinic, patients can have an hour-long meeting with Ursula Jackson, FNP, and meet with a forensic nurse who acts as the care coordinator, helps with education, and assists with the medical examination. Victim advocates provide guidance in communicating with law enforcement, applying for victims of crime compensation, safety planning, and other services that patients may require.    “It’s a one-stop program that starts them on their way to recovery,” says Dr. Reali-Sorrell. “It’s eight visits a day, and we really work hard to make sure that this is a program that focuses on their physical and mental wellbeing to help them in their journey to healing, both physically and emotionally.”