Sexual Assault Nurse Examiner Career Overview

What Is a Sexual Assault Nurse Examiner?

Sexual assault nurse examiners (SANEs) report to emergency rooms and urgent care facilities when a patient reports a sexual assault. As a part of the Sexual Assault Response Team (SART), SANEs interview victims, gather physical evidence, and create detailed documentation of the event itself and the evidence-gathering procedures.

SANEs are specially trained to work with victims of sexual assault, which can include date rape, domestic abuse, or incest. A type of forensic nurse, SANEs learn how to speak to assault survivors with compassion, collecting verbal statements and physical evidence without traumatizing their patients further.

Where Do Sexual Assault Nurse Examiners Work?

Nurses who work as sexual assault nurse examiners typically work in emergency rooms and urgent care facilities. Sometimes, these health facilities have SANEs available around the clock, but most positions are on-call. While on-call, nurses are paid a small amount hourly, but if they are brought in to see a patient, that rate goes up to normal.

Some SANEs work in mobile clinics, bringing care to communities that may not otherwise seek it out. Other nurses in this specialty may find work in research, academia, and non-profit organizations. Local law enforcement or government agencies may employ SANEs to work with their victims, although many rely on hospital-provided nurses.

What Does a Sexual Assault Nurse Examiner Do?

SANEs see their patients when they arrive at the hospital or urgent care. At the time of their assessment, the patient has likely already given statements to the police and may be feeling exhausted, traumatized, and frustrated.

When the SANE enters the room, they must comfort their patient and put them at ease, while also clearly explaining the next steps. Rape examinations can be humiliating and uncomfortable, and SANEs help their patients by explaining the specifics of what is being done and why.

Different local governments have their own requirements and laws surrounding sexual assault examinations, and SANEs must be familiar with these practice expectations. Once a SANE meets their patient, they:

• Offer emotional support
• Perform medical triage and a forensic evaluation
• Assess the need for further mental health treatment and referral
• Provide referrals to other providers and support groups

As a part of a post-assault forensic evaluation, SANEs may do the following:

• Give prophylactic medication and offer emergency contraception
• Report abuse to appropriate authorities if not already done
• Perform a complete physical assessment
• Take photos of all injuries to the body or genitalia
• Document bruising, bite marks, and scratches

An important part of an assault investigation is the physical evidence. SANEs assist bedside nurses in the following:

• Collecting urine and blood samples from the victim
• Swabbing the patient’s mouth, rectum, penis or cervix, and vagina
• Removing head and pubic hairs to compare against other hairs found
• Swabbing the patient’s mouth
• Taking a DNA sample from the patient for comparison

All of these procedures can be upsetting for a victim of sexual assault, especially in the immediate aftermath of the event. A SANE must remember to keep all patient information confidential at all times and continually reassure and comfort their patients.

SANEs are often called up to testify in court. Under oath, they share their findings on the day and attest to the protocols followed as evidence was gathered. Unfortunately, many sexual assaults go unreported, according to the U.S. Department of Justice. Additionally, the Rape, Abuse & Incest National Network (RAINN) reports only 25% of perpetrators receive convictions.

With this in mind, SANEs may conduct a sexual assault exam even if the patient does not want to report it to the police. The evidence collected can be held for several months in case the victim changes their mind about pursuing charges.

How Do I Become a Sexual Assault Nurse Examiner?

Prospective sexual assault nurse examiners must first complete an accredited nursing program to earn either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN). The ADN typically requires two years of study, whereas the BSN typically necessitates four years. However, some nursing programs provide an accelerated option that can be completed in as little as a year. After graduation, nurses are eligible to apply for nursing positions as graduate nurses (GNs).

Before nurses can work as sexual assault nurse examiners, they must get some experience in areas that require advanced skills in critical care medicine. Emergency, critical care, and obstetrics can offer good sources of experience for aspiring SANEs.

Wherever SANEs decide to earn experience, they can begin as GNs on their unit. Working under nurse preceptors, they learn valuable nursing skills and prepare to take the National Council Licensure Examination (NCLEX-RN), their state licensing exam. Once they pass the NCLEX, GNs become registered nurses (RNs) and, after their orientation period, can practice nursing on their own.

Advanced practice nurses can also become SANE certified. Nurses can become advanced practice nurses (APRNs) by earning a Master of Science in Nursing (MSN). It’s possible to graduate with an MSN in two years, but it may take longer to complete this degree while working full-time.

After nurses have gained enough experience at the bedside, they can apply for examination through the International Association of Forensic Nurses (IAFN). The IAFN offers two different types of SANE certifications:

• The Sexual Assault Nurse Examiner-Adult/Adolescent (SANE-A)
• The Sexual Assault Nurse Examiner-Pediatric (SANE-P)

Both credentials have the same eligibility requirements:

• Current RN or advanced practice nursing degree
• Completed an approved SANE training course
• Minimum of 40 hours of didactic SANE training
• Completed an approved SANE preceptorship

How Much Does a Sexual Assault Nurse Examiner Make Per Year?

The annual salaries for sexual assault nurse examiners are comparable to those of registered nurses, who earn an average of $94,480 per year, according to the U.S. Bureau of Labor Statistics (BLS). Salaries can vary based on location and experience, from a low-end average of $63,720 to a high-end of $132,680. Depending on your workplace, your employer may be able to offer higher or lower compensation:

• General Medical and Surgical Hospitals: $96,830
• Offices of Physicians: $83,110
• Outpatient Care Centers: $102,640
• Government: $99,840

Salaries also vary depending on which state a SANE practices. The West Coast, New England states, and Alaska pay their nurses the best, but the cost of living in these areas can also be high. The lowest-paying states are in the Midwest and some Southeastern states.

The top-paying cities for sexual assault nurse examiners include:

• San Francisco-Oakland-Hayward, CA: $174,370
• Vallejo-Fairfield, CA: $171,620
• San Jose-Sunnyvale-Santa Clara, CA: $170,780
• Napa, CA: $166,180
• Sacramento–Roseville–Arden-Arcade, CA: $154,510
• Santa Rosa, CA: $152,930
• Modesto, CA: $145,190
• Santa Cruz-Watsonville, CA: $140,880
• San Luis Obispo–Paso Robles–Arroyo Grande, CA: $140,560
• Stockton-Lodi, CA: $138,420

Are Sexual Assault Nurse Examiners in High Demand?

In 2022, RAINN partnered with bipartisan members of Congress to address the shortage of SANEs in the United States, especially in rural areas, where victims may have to travel hours to see a SANE after an assault. The International Association of Forensic Nurses reports that only 17-20% of U.S. hospitals employ SANEs.

The Supporting Survivors Access to Nurse Exams (SANE) Act included:

• $30 million in federal grant funding for SANE salaries for underserved communities
• Regional training centers to provide critical clinical experience for SANEs
• Funding to increase pediatric nurse availability
• Funding for mobile SANE units

The SANE Act was signed into law on March 15, 2022, and any nurse wishing to pursue a career as a SANE should have ample opportunity to do so.

Additional Resources for Sexual Assault Nurse Examiners

To learn more about becoming a sexual assault nurse examiner, these additional resources may help:

• Academy of Forensic Nursing
• American Academy of Forensic Sciences
• American Nurses Association (ANA)
• International Association of Forensic Nurses
• Journal of Forensic Nursing
• RAINN (Rape, Abuse & Incest National Network)
• SAFEta.org