The How and Why of SANE Education for RNs and APRNs

From hospital emergency departments and urgent care centers to physicians’ offices and college health centers, sexual assault nurse examiners (SANE) provide specialized care for survivors of sexual assault.

Teresa Devitt-Lynch, MSN, RN, AFN-BC, SANE A, author of Elite Learning’s comprehensive adult and adolescent SANE core course, explains SANE education and its profound impact on the care provided to survivors.

Q: What requirements must a nurse fulfill to work as a SANE, specifically for adults and adolescents?

A: The International Association of Forensic Nurses (IAFN) sets the gold standard for SANE education. To work as a SANE, nurses must successfully complete 40 hours of IAFN-approved didactic education and fulfill 16 hours of clinical experience caring for adult and adolescent sexual assault survivors.

Elite Learning’s approved SANE course explores topics such as trauma-informed and patient-centered care, injury identification and documentation, evidence collection and handling, and legal issues and testimony.

Q: Do the same requirements apply to SANE education for pediatric survivors of sexual assault?

A: The requirements for SANE education for pediatric patients are also set by IAFN, but those requirements differ from the didactic education for the care of adults and adolescents. The organization’s educational guidelines for pediatric SANE practice are available at

Q: Who should consider becoming an adult and adolescent SANE?

A: Any nurse who has a desire to help people who have survived the significant physical, emotional, and psychological trauma associated with sexual assault will benefit from SANE education, as will nurses interested in forensics.

Historically, many SANEs started out as emergency care or critical care RNs, but that experience isn’t a prerequisite. For example, I am certified as a SANE for adult and adolescent populations, but for the last 10 years, my primary background has been in medical/surgical nursing and ambulatory surgery.

However, it is recommended that RNs who want to work as SANE gain a couple years’ experience to hone their assessment, critical-thinking, and patient-relationship skills specific to survivors of sexual assault. While these skills are the cornerstones of any nursing specialty, they are especially vital to a SANE’s work, since the evidence SANEs collect and the records they document may be used in legal proceedings.

Q: What is the current need for SANEs?

A: There is a critical shortage of SANEs. The National Crime Victimization Survey, commissioned by the U.S. Department of Justice, estimates that more than 700,000 sexual assaults occur in this country each year.

While some survivors of sexual assault do not seek healthcare services, there is still a significant gap between the availability of SANE services and the unique needs of those who do seek health care, especially in rural and tribal areas.

Because of the shortage of SANEs, survivors might be turned away from facilities that are not equipped to handle their needs. In many cases, survivors wait long hours for care, or they drive long distances in search of a forensic nurse who can effectively execute a comprehensive assault examination and an evidence collection kit. Properly collected and preserved evidence of sexual assault can make a difference in the successful prosecution of perpetrators, should survivors decide to pursue a criminal court case.

Far too often, healthcare providers without the necessary forensic knowledge, or knowledge of trauma-informed care, are left to rely solely on the instructions provided in a sexual assault kit when treating survivors. In these cases, the evidence may not be properly collected and preserved, and survivors may not receive the quality services they need.

Q: What outcomes are associated with care provided by SANEs?

A: When caring for survivors of sexual trauma, SANEs are uniquely qualified to provide the trauma-informed and patient-centered care needed to help them begin the healing process. SANEs are frequently the conduit to survivors accessing immediate crisis services and long-term care. The lack of nurses educated as SANE has been linked to increased rates of post-assault PTSD and chronic physical and mental health issues among survivors.

It has also been shown that when cared for by a trained SANE, patients are more likely to participate in the investigative and legal processes, which has led to increased prosecution rates.

There’s no escaping the fact that the examination of a sexual assault survivor is invasive, and it can retraumatize the survivor. The last thing anyone caring for these individuals wants is to have them endure a long and intimate examination, only to have the evidence excluded from court because of improper collection and handling techniques. With the education SANEs receive, evidence is more likely to be properly collected and catalogued, which increases the likelihood that the evidence will stand up in court.

Q: Can RNs and APRNs be certified as SANE?

A: Yes, and as with any nursing specialty, certification is encouraged because it confers expert status.

To become certified as an adult and adolescent SANE, nurses must meet several criteria set by the IAFN. They must have an active, unrestricted license and at least 2 years’ experience in RN practice. They must complete an approved 40-hour didactic education program from an accredited provider, but also a SANE clinical preceptorship.

In addition, before RNs and APRNs can sit for a certification exam, they must practice as a SANE for a minimum of 300 hours within the preceding three years. Certified SANEs must apply for recertification every 3 years.

The full requirements are available from the IAFN at

Q: What advice would you give to RNs and APRNs who pursue SANE education?

A: As in any other nursing specialty, nurses must have an interest in and a passion for this work. SANEs encounter patients at incredibly vulnerable moments after the most intimate of crimes. It’s important work, but not for the faint of heart.

A facility might not see large numbers of sexual assault survivors, but providing these services to even one patient a month or perhaps a year can make a significant impact on the survivors’ healing process.

Also, nurses who work as SANE need to take care of themselves. Taking on others’ trauma can be emotionally and psychologically draining, and self-care is imperative in this field.

Elite Learning’s Sexual Assault Nurse Examiner Adult and Adolescent Core Course has been reviewed and approved by the International Association of Forensic Nurses (IAFN) as meeting IAFN SANE education guidelines (2018). Elite Learning is an accredited provider of nursing continuing professional development by the American Nurse Credentialing Center’s Commission on Accreditation.

In addition to the didactic education required to become a SANE, Elite Learning’s SANE core course for adults and adolescents includes extensive certification preparation materials.

To learn more about SANE education and practice, as well as enroll in the course, please visit

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