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Federal bill would boost sexual assault nurse training

N.C. congresswoman sponsors bipartisan legislation, credits CPP investigation for inspiring action.


Many hospitals across the state do not have a Sexual Assault Nurse Examiner on staff, Carolina Public Press’ investigation “Finding Nurses” revealed last year, but a North Carolina congresswoman is backing bipartisan legislation that could help change that. 

The national SANE nurse shortage has risen to crisis levels, said U.S. Rep. Deborah Ross, D-Raleigh.

On Tuesday, Ross and U.S. Rep. David Joyce, R-Ohio, introduced the Supporting Access to Nurse Exams Act to address the shortage, which is pronounced in rural and tribal communities.

Ross said she has high hopes for the bill due in part to its focus on rural and tribal communities.

“I am so happy that we drew the attention to SANE nurses in our amendments and that now Congress is committed to funding more nurses … and having a special focus on children who are victims of sexual assault,” Ross said. 

“I’m just thrilled that we have bipartisan consensus on it. I’m thrilled that the senators who are pushing this are so senior.”

The legislation would train more nurses in SANE methods throughout the country with an influx of $30 million in grant money per year through 2028. The grants could be used to pay nurse salaries, establish training programs throughout the country and assistance related to DNA sample collection and analysis.

A companion bill in the U.S. Senate mirrors the SANE Act and will amend the Violence Against Women Act Reauthorization Act of 2021. The companion legislation is led by U.S. Sen. Dick Durbin, D-Illinois, and Sen. John Cornyn, R-Texas.

Training programs paid for with the grant money are likely to be located in rural or tribal communities, Ross said. Nurses in far western North Carolina, for instance, could travel to eastern Tennessee to get training instead of Asheville or other points farther east.

Last year Ross authored a successful amendment to the Violence Against Women Act Reauthorization Act, which allows grant funds to be used to track where SANE nurses work. Once Ross’ first bill on SANE nurses passed, she said the Rape, Abuse & Incest National Network reached out to her and other members of Congress on improving training and funding for SANE nurses nationwide.

Identifying the need

“The work that you did at Carolina Public Press highlighted the need for SANE nurses,” Ross said of what inspired last year’s amendment. “You started it by educating us.”

For that series, CPP surveyed 130 hospitals and community programs about their SANE nurse programs in late 2020 and early 2021, and found that no state agency tracks where SANE nurses work. Victims seeking help from a SANE nurse often travel to multiple hospitals spanning several days just to find one on duty.

One nurse said a victim traveled to her Guilford County hospital from Virginia to get care. While doctors and nurses who do not have a SANE credential can and do care for assault victims and collect the evidence of their assault, the most qualified person to do so is a SANE nurse.

A SANE nurse certification requires a person to have been a nurse for at least two years, complete dozens of hours of training and clinical work, and then pass a written exam from the International Association of Forensic Nurses.

To maintain their SANE certification, nurses must complete at least 300 hours of SANE-related practice within three years, including peer review of cases, taking on-call shifts to respond to patients and providing direct patient care.

Nurses learn how the body and brain react during times of trauma, and how to interview someone who has been through such a traumatic experience. Working with other SANE nurses, they learn where to look for injuries or DNA, and how to collect evidence that might one day be used in a criminal prosecution.

A SANE nurse also treats the victim for sexually transmitted infections and can help prevent pregnancy. There is also SANE training that is specific to child assaults.

“There is a critical shortage of sexual assault nurses across the country,” said Camille Cooper, vice president of public policy for the Rape, Abuse & Incest National Network, in a statement. 

“Nurses are working up to 150 hours a week in some rural areas, and survivors are waiting as long as 12 hours to receive care.”

Changes in North Carolina

Late last year, the state General Assembly approved $125,000 for a Cumberland County pilot project for SANE nurses, with the possibility of taking a successful model statewide. 

At one point, North Carolina had the most untested rape kits in the entire country, a number now known to number more than 16,000. Two years after the state legislature passed the Survivor Act, which requires testing of kits and provides the funds to do so, prosecutors are using the DNA to convict men who assaulted their victims sometimes decades ago.

A 2019 CPP data analysis, part of the “Seeking Conviction” investigative partnership with nearly a dozen other news organizations, showed fewer than 1-in-4 people charged with a sexual assault were ever convicted of that or a similar crime. Studies have shown when a SANE nurse collects the evidence of an assault, the chances for successful prosecution increase.

“It really shows that this issue, which has been brought to light by you and RAINN and other folks, is something that is resonating and where we can make a difference for survivors and for the justice system,” Ross said. 

“Again, we want people to have somebody who is attuned and sensitive in that hospital setting, but we also want the evidence and we want it collected in the best possible way so we can have justice.”

Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.

Carolina Public Press is an independent, in-depth and investigative nonprofit news service for North Carolina.

Congress, Cumberland, SANE nurses, sexual assault, Deborah Ross