Idaho set to train 250 sexual assault nurse examiners by the end of the year
Four years ago, Idaho had 17 locations where victims could receive sexual assault exams, and only three of them had nurses trained in sexual assault forensics.
Today, Idaho has 231 trained sexual assault nurse examiners, or SANE nurses, who can work out of 37 facilities. By the end of the year, Idaho State Police plans to increase that number to at least 250.
But there are still gaps. While the increase in trainees is substantial, those nurses serve 1.9 million people across the 83,600 square miles that make up the state of Idaho. Nearly all of those nurses have full-time nursing jobs in addition to SANE nursing.
Eighteen counties in Idaho have no facility where a person could receive a sexual assault exam by a trained SANE nurse. Those 18 counties are home to more than 198,000 people.
Sexual assault kits, commonly called rape kits, are exams done by trained nurse examiners after an assault’s occurred. The exam involves combing and swabbing the victim’s body for DNA evidence and documenting injuries, and can take about four to six hours to complete. The exam’s evidence can assist in both confirming and ruling out suspects.
In the past, emergency room physicians or nurses could perform exams by following instructions on the kit’s box, but they didn’t necessarily have a trauma-informed approach nor did an emergency room physician have the time needed to dedicate to one patient, said Deb Wetherelt, Idaho State Police forensic nurse examiner coordinator.
“It’s very, very, very, very rare for me to get a call saying, ‘Deb, a patient came to this hospital and was told they couldn’t have an exam,’ ” Wetherelt said. “So, with us being a rural state, it is impossible for hospitals to be able to provide 24/7 coverage.”
SANE nurse training requires 56 hours of education for a registered nurse. Nurses can become certified through the American Nursing Credentialing Center with 300 hours of practice and a test.
Nurses do not need to be certified to perform the exams; they only need to be trained. Wetherelt teaches the SANE nursing classes to nurses across the state, free for nurses and employers and paid through the Idaho State Police budget.
“It is probably one of the worst nursing certifications,” she said. “It has a first-time pass rate of around 60%.”
Of Idaho’s 231 trained nurses, 21 are SANE certified for adults, and four are certified for pediatric exams.
In comparison, Oregon also has 21 certified SANE nurses for its population of 4.2 million people, Wetherelt said – significantly more than Idaho’s 1.9 million.
Wetherelt said it’s important for medical staff to be trained in a trauma-informed approach when treating a recent rape victim.
“Yes, you can come in and have someone who’s not trained do the exam, but if they’re not trained in how the brain changes during trauma and therefore how that affects that patient’s behavior, how we interact or how we approach that patient needs to change based on those neurological changes,” she said. “If a nurse isn’t trained to recognize those symptoms and to know how to use a trauma-informed approach with the patient, then you actually can cause more trauma to that patient, which is going to increase the risk of serious sequelae.”
She explained that in an ER, medical staff are often in rush and trying to treat patients at a quick pace. When working with someone who was recently traumatized, the goal is to make the patient feel safe, comfortable, and to build trust, which requires the nurse to move much slower.
Wetherelt said she once treated a patient who’d recently been sexually assaulted. The patient was so shut down that it took 40 minutes for Wetherelt to approach them from across the exam room, calmly talking to them as she slowly moved.
For Amanda Cook, SANE nursing is essential to add a medical element to the judicial system. Cook is the forensic nurse examiner program director at the Domestic Violence and Sexual Assault Center in Idaho Falls. The center has eight trained SANE nurses and three more in training. Those independent nurses respond to calls at hospitals and crisis centers primarily in Bonneville, Madison, Bingham, and Jefferson counties, but will travel to other areas or have survivors brought to them for exams.
The center has a live calendar that gives law enforcement access to which nurses are available and on-call to provide the exams. The organization hasn’t needed more than one nurse at a time, but it has had four or five day stretches with no nurse on call. Cook explained that all of the nurses have full-time jobs, and serving as a SANE nurse for the center is an additional job for them.
If no one is on-call when hospitals or crisis centers request a SANE nurse, a mass text message will go out to trained nurses in the area to see if someone is available.
The worst of the worst
The hardest part of keeping SANE nurses staffed is the vicarious trauma they endure, hearing the “worst of the worst,” Cook said. She tries to prepare the nurses for the chronic traumas they will learn about in the role.
“This is a part-time job that requires a nurse at their fullest capacity,” Cook said. “You’re with that patient for six hours.”
Wetherelt agreed it’s not a job for every nurse, and she’s had nurses tell her that it isn’t for them.
“When you are exposed to someone else’s trauma over and over and you hear the horrific things that another human being is willing to do to someone, you really have to know how to take care of yourself,” Wetherelt said. “And sometimes even if you take care of yourself well, it’s like, ‘I’ve had enough, I can’t do this anymore.’ And then there’s just those personalities that aren’t cut out for this work.”
Prosecutors sometimes call SANE nurses to testify in court, adding to the stress.
“It is hard mentally,” Cook said. “To add yourself to the scrutiny of the judicial system and possibly testify is terrifying.”
With all those barriers, ISP is looking for ways to increase the number of trained SANE nurses in Idaho, as well as reduce stress for victims during the exam process.
The department has partnered with the Colorado Center for Nursing Excellence to pay for nurses’ salaries during training to avoid the hospitals having to pay double salaries – one for the nurse in training and one for the bedside nurse while the other is out.
Idaho State Police Forensic Services used more than $276,000 in grant funding to purchase supplies at sexual assault evidence collection for at least 25 different locations in Idaho, according to laboratory services director Matthew Gamette. The agency also plans to give more equipment to Blaine County and Post Falls in 2024.
Forensic Services also has grant funding available for 17 so-called “soft interview rooms” in Idaho this year at the maximum amount of $2,000 per room. Investigators use soft interview rooms to talk to victims after an assault has occurred. Those rooms are designed to look less hostile than most rooms in police stations, with couches instead of metal tables, or softer lighting rather than harsh overhead lights. The intent is to make the victim feel safe, rather than making them feel as if they’ve committed a crime.
An unexpected issue
The Idaho Legislature passed new law, effective July 1, that unintentionally prohibits minors from getting sexual assault exams, or rape kit exams, without parental consent. This becomes problematic if the perpetrator of the child’s sexual assault is a parent, family member, or close family friend, according to Wetherelt.
Senate Bill 1329 passed during the 2024 legislative session on a party-line vote in both chambers. Proponents of the bill argued that parents should be involved in their children’s medical care and have access to medical records. The bill allows for medical care without parental consent only if it’s “in order to prevent death or imminent, irreparable physical injury.”
Prior to July 1, anyone 14 or older could provide informed consent for a sexual assault exam.
The bill’s sponsor, Senate Majority Leader Kelly Anthon, R-Burley, told Idaho Reports on Aug. 2 that hindering investigations was not the intent of his bill, and he planned to contact ISP on the issue. Anthon has not responded to a follow-up call from Idaho Reports.