Eastern Washington nurses anxious as legislature considers funding for sexual assault exam training

SPOKANE, Wash. — Surviving a sexual assault is painful enough as it is and local nurses say the way survivors are treated at the hospital could traumatize them even more. In an effort to stop that from happening, the Washington State University College of Nursing has spent the last two and a half years pushing for a pilot program — which would be the second of its kind in the state — to train Eastern Washington nurses how to examine and care for those victims.

As it stands now in Washington, the full sexual assault nurse examiner (SANE) training course is only offered at Harborview Medical Center in Seattle. If nurses from Eastern Washington want that state-level training, they have to pay their own way there while taking time off of work.

The state legislature is currently considering a budget proviso that would change that. WSU has not been able to make its dreams of a training program a reality, because it’s been without a funding source. If legislature approves the money, more nurses from rural communities could receive SANE training.

SANE nurse Jennifer Jordan, who serves as the emergency department educator at Multicare-Deaconess Hospital, said Harborview staff does make the trip over to Eastern Washington once or twice a year, but the training is often condensed into three days, instead of the five-day course offered in Seattle.

As a SANE nurse, Jordan has 40 hours of additional training — paid for by her hospital — on how to treat survivors from the minute they walk into the hospital to the hours spent administering a rape kit.

“On a good day, if it’s a really quick one, it’s about three to four hours. I’ve spent upwards of six to eight in some cases,” Jordan said of the 15-step process. “You have somebody who has just been victimized who comes into the facility to seek care and it’s really important that we have a nurse that doesn’t re-victimize them by not having that sensitivity and understanding of what they’re going through.”

But not everyone is able to get that training — much less have it paid for by their hospital, according Wendy Williams-Gilbert, a clinical associate professor and director of the WSU College of Medicine.

“Some hospitals can’t let a nurse leave for 40 hours for a training because they don’t have nurses to back up her shifts,” she said.

A 2019 report from the state Department of Commerce found there are six Washington counties that do not have a SANE hospital, meaning they are without SANE-trained staff. Four of those counties — Lincoln, Ferry, Columbia and Garfield — are in Eastern Washington.

The report found Spokane County and Yakima County are the only two counties in the state where more than 75% of the medical staff designated to perform rape examinations do not have formal SANE training.

Jordan and Williams-Gilbert, along with other local nurses, have long advocated for the expansion of SANE training from the International Association of Forensic Nurses to Eastern Washington. Should the state legislature approve the budget proviso, a new, nationally-recognized SANE training pilot program at the WSU College of Medicine could finally get off the ground.

“If it were more readily available, more affordable and they had access closer, I think we would have a much larger pool [of SANEs],” said Jordan.

All emergency room nurses have some sort of training on how to administer a rape kit, but Jordan said without extra training, some nurses doubt their abilities.

“There’s always that chance they may go to court and this case may go to court, and there are a lot of nurses that don’t really want to sit up on the stand and defend their practice when they maybe only do one kit a year, or maybe this was their first kit ever or maybe they’ve done three in ten years,” she said.

Williams-Gilbert said some nurses are not able to get continuing training, so even if they have been trained, it could be years before they actually see a sexual assault case.

“When the nurses are saying ‘we can’t do this,’ it’s not out of malice. The nurses just care so much about their patients they don’t want to re-traumatize them by doing the kit wrong or — ‘what if I get on the stand and I mess something up and then my actions prevented a prosecution?,'” she said. “If you think about the courage it takes for somebody to just show up to the hospital, that’s huge — and then [they could] be told ‘we can’t do that.'”

Since it takes so much courage to reach out for help, Williams-Gilbert explained, sexual assault victims who are turned away to find better care at another hospital will likely avoid getting a rape kit done at all.

“The more that we tell somebody to go to another facility, the more chance that that patient won’t get served,” she said.

Jordan said that can have an impact on the survivor’s decision to move forward with prosecution, too.

Plus, forensic evidence needs to be collected as soon as possible. Research from the National Institute of Justice found evidence from a vaginal assault should be collected within five days of the assault, whereas evidence from an oral assault should be collected within a day.

The commerce report showed 45% of women and 22% of men experience sexual violence at some point in their lives. On a national scale, between the physical and mental costs, productivity losses, and criminal justice costs, it is reported that the lifetime cost of rape is $122,461 per victim.

“I think what we’re asking for is just having equal access for everybody,” said Williams-Gilbert. “I think regardless of where you live, you should have access to the best quality care. And that’s one of the things I want to ensure is that on the worst day of your life, you can go to a hospital and have a SANE nurse take care of you.”

An executive session on the budget proviso is set for Feb. 20.