COLUMBUS, Ohio — The pandemic nursing shortage has impacted Ohio's everyday care at hospitals, and it exacerbated the issues in an already understaffed system within Cleveland’s healthcare. A new federal bill introduced by Congressman Dave Joyce (OH-14) would help this essential team.
Survivors of sexual assault face uphill and traumatic battles. But a lesser-known struggle is what happens to them when a medical team gathers evidence of the assault, trying to get a forensic exam.
“If a nurse isn't available for six hours – then a nurse isn't available for six hours,” Dr. Jennifer Savitski, chair of the Department of Obstetrics and Gynecology (OB-GYN) at the Cleveland Clinic said. “So, that is absolutely a problem in our state.”
Savitski is seeing the pandemic’s staffing shortage has already-reluctant survivors rethinking getting the medical care they need. Her team and University Hospitals say sexual assault exams can take up to six hours to conduct, but some survivors in rural areas are now sitting for numerous hours before they are even taken back from the waiting room.
“In the state of Ohio, we only have 28 certified pediatric sexual assault nurse examiners for the pediatric population, and we only have 71 certified and adult sexual assault nurse examining,” UH Rainbow Babies and Children’s Hospital sexual assault nurse examiner (SANE) Kathleen Hacket said.
Hackett is one of two SANE-certified pediatric nurses at the hospital. Despite Cleveland Clinic and UH being powerhouse healthcare facilities in Ohio, they each only have a handful of SANEs on their team. Cleveland Clinic Akron General has has five and UH is similar with both pediatric and adult nurses. Total, the Clinic has 14 SANEs and three pediatric SANEs.
“We just don't have the financial support to have SANE nurses full time,” the nurse said. “We are fortunate in Cleveland, but we need more.”
Most hospitals don’t even have any adult or child SANEs. Both Savitski and Hackett recall people traveling for hours to see SANE nurses. If no SANE is present and the survivor is unable to journey somewhere else, the odds are high that the sexual assault forensic exam is being done by a provider that has no training and is just a regular doctor or nurse, Savitski said.
The hospitals work together to get a survivor the best care possible, communicating with other programs to see if a SANE was working and could see a patient.
“If we're not available, we might just reroute them before they even hit our doors,” Hackett said. “I know that the other hospitals in the Cleveland area are very committed.”
There is a critical shortage of SANEs, according to a 2016 government study. The three main reasons for the lack of certified nurses are as follows: not enough training programs, limited money for training and trained nurses are leaving the profession, because of stress and low pay.
There was a 75% decrease in funding to the Cleveland Clinic SANE branch due to federal bills like the Violence Against Women Act (VAWA) not being reauthorized after expiring in 2019, Savitski said. The Clinic gets most of its funding from the Victims of Crimes Act (VOCA), but the available funding from VOCA has decreased, as more funding was going towards other programs.
However, new bipartisan legislation could pump more than $180 million in the span of five years into SANE programs.
“The SANE Act is to address the shortage and to improve the care for survivors of sexual violence here in northeastern Ohio and across the country,” Congressman Joyce said in an interview with News 5. “I know that as a former prosecutor, I know how traumatic it can be for the victims of sexual violence even report their assault, let alone did not have somebody there to help them at the hospital, get them through there. And it's also the critical stage and collection of evidence.”
The Supporting Access to Nurse Exams, or SANE, Act is a bipartisan bill introduced by Joyce and Congresswoman Deborah Ross (NC-02). The Act is an update to an existing federal grant program, but this bill is dedicated to the training, recruitment and retention of sexual assault nurse examiners, like Hackett.
“The majority of the [SANE] nurses, not only in the state of Ohio, but across the country – they have their regular job and they get called in,” Hackett said, referencing those SANE nurses are not full-time salaried RNs. “They have such commitment to have an additional job as a SANE nurse, but that's a lot.
“They're working through COVID times, they're already overworked on a regular job, and then to maintain their confidence in this, this unique field of forensic nursing. That's a lot to ask of anybody.”
These specific nurses are trained to care for the patient during a traumatic time, properly collect DNA, and take notes on testimony that can be used during a criminal case.
“To be able to have this type of funding to support having SANEs – that’s really what's key is to have these specially trained nurses available to care for this segment of our population, segments of our community,” Savitski said. “So, it would be amazing.”
It is a strenuous certification process through the International Association of Forensic Nursing. Being the co-chair of the Congressional Nursing Caucus and the co-founder of the Bipartisan Task Force to End Sexual Violence, Joyce said he is trying to fill the void that VAWA and VOCA have left on the country.
“It's important that people understand that how important this project is, it's just not another grant,” the congressman said. “It's that we're getting grants to target the problem, both in the nursing industry who are dedicated, hardworking folks, but also to caring [for] those victims of our communities, as well as helping law enforcement and prosecutors be able to do their job on a more consistent basis.”
Joyce wants to solve this problem by addressing this critical nursing shortage and making sure that the victims don't have to relive their assault again by catching their perpetrator. The 2016 study also showed victims of sexual violence who were seen by a SANEs following an assault were “significantly more likely to see their perpetrator be successfully prosecuted.”
“Having specially trained medical personnel who can address it from the moment they step through the door and give them the support that they need, that's going to give those people, the survivors, the courage to actually come to the hospital,” Savitski said. “I think it's just the perception in our society that is a huge barrier is the lack of knowledge of patients knowing, ‘where do I go? Oh my gosh, I've just been raped, what do I need to do? I don't know who to call.’”
The bipartisan legislation came as a pleasant surprise to Savitski, but she is grateful for the unity to support such an important cause.
“Well, believe it or not, every now and then – we do get things done,” Joyce said. “We do work in a bipartisan way to get those things done.
“The SANE Act, it makes so much sense. I think hopefully we can get people from both sides to understand how important it is that to expand this access to trauma-informed care for survivors of sexual violence and enable them to be able to seek justice effectively and helps prosecutors, it helps the victims and it eliminates the people in society who should be incarcerated.”
Two U.S. Senators just introduced the same bill. If passed, the act would take effect in 2023.
Savitski actually just started a program with Kent State University to educate and encourage nurses to get certified as SANEs. RNs can come back to take a course that prepares them for the state certification. The Cleveland Clinic Akron General partners with KSU for three semesters. To be certified, nurses with a minimum of two years of full-time experience must complete:
- a minimum of 40 hours of sexual assault education
- work under the supervision of a SANE
- perform enough sexual assault exams to demonstrate “clinical competency”
- successfully passed a certification test.
“It's not just about getting the money, it's about getting the people trained and getting out there,” Savitski said.
The Cleveland Rape Crisis Center is urging rape victims to come forward and seek agency resources and support by calling its Crisis and Support Hotline, call or text 216-619-6192 or 440-423-2020. Theagency websiteis also packed with a wide range of prevention, education, support, and resources.
You can also call Rape Abuse & Incest National Network (RAINN) at 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.
Great to chat with @MorganTrau about my latest bill, the SANE Act, and how it would expand access to trauma-informed care for survivors of sexual violence – care that enables them to effectively seek justice.— Dave Joyce (@RepDaveJoyce) February 16, 2022
Keep an 👁 out for her upcoming story on @WEWS pic.twitter.com/ghqt4NRWmh
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