Episode 39: Jane Reynolds, Forensic Nurse Examiner
Jane Reynolds, Forensic Nurse Examiner
Jane Reynolds, a forensic nurse examiner and Coordinator of the Sexual Assault Response Team in Mercer County, New Jersey, speaks about the treatment and care of sexual assault victims. She defines the term SAFE, an acronym for sexual assault forensic examination kit, describes its contents and explains the examination process.
Jane Reynolds Bio
Jane Reynolds is a Registered Nurse with multiple years of experience in several areas of Nursing. She is the coordinator for the countywide (FNE) / Sexual Assault Team (SART) in Mercer County New Jersey, as well as an examiner herself.
The coordinator oversees the services of the FNE/SART program, including the training and education of nurses, law enforcement agencies, and rape care advocates. As a forensic nurse examiner, primarily conducting forensic medical examinations on patients that have reported being sexually assaulted. FNE’s collect, preserve and maintain specimens associated with sexual assault. She is consulted on medical/legal investigations, medical chart reviews, and community education and assist investigators in various other assignments where her knowledge is useful.
Jane has served as the Program Director of the FNE/SART Program for Mercer County since January 2006 and has been a Forensic Nurse Examiner since 1999. She has many years of clinical nursing experience in multiple areas. She has also been active member and volunteer in the International Association of Forensic Nurses, a member of the American Nurses Association, NJ State Nurses Association, NJ League for Nursing, American College of Forensic Examiners Institute, and a founding member of the Academy of Forensic Nurses. As the coordinator for the Mercer County Forensic Nurse Examiner Program it is her responsibility to oversee the nurses and maintain all the functions of the program on a daily basis. Part of her responsibility as the countywide coordinator is to conduct annual SART training for the county, rape crisis, and conduct SART presentations to local colleges about SART. In her downtime, Jane enjoys traveling, photography and the outdoors.
Intro Voices 0:05
Where do I go? It only happened once. I think I was singled out. The phone calls began about one month ago. What is hazing? Something happened to me when I was younger. I'm worried about my safety. He said he was sorry. Can someone help me? Where can I get help? Can someone help me?
Intro Voices 0:31
This is “You Matter”, a podcast for the NYU community developed by the Department of Public Safety.
Karen Ortman 00:37
Hi everyone and welcome back to You Matter, a podcast created to teach, inspire and motivate members of the NYU community who have been victimized in some form or fashion and to identify resources both on and off campus that can help. I am your host Karen ortman, Associate Vice President of Campus Safety Operations at the Department of Public Safety and a retired law force Professional. Today I welcome Jane Reynolds, a forensic nurse examiner and the Sexual Assault Response Team Coordinator. The acronym for the Sexual Assault Response Team is SART in Mercer County, New Jersey. Jane is going to talk about the treatment and care of sexual assault victims. She will define the term SAFE, an acronym for sexual assault forensic examination kit, describe its contents and explain the examination process. Jane, wonderful to see you and welcome to You Matter.
Jane Reynolds 01:35
Well, thanks for inviting me, Karen. I'm happy to be here.
Karen Ortman 01:38
What is your nursing background? And how did you become involved in the forensic nurse examiner Sexual Assault Response Team program?
Jane Reynolds 01:50
Well, I am a registered nurse and it is a requirement to be a registered nurse here in New Jersey with two years of experience and then we have to go through Forensic nurse examiner training, which can be a hybrid of online and in the classroom, or all online, but then there's a clinical component that goes to it. And that's more or less a continuing education program and there's a physical assessment with live gynecological teaching aids involved. It's a very extensive but not too long program. And then a nurse would go and be oriented in precepted by another experienced forensic nurse in sexual assault. So one of the ways that I became involved was that working in the hospital being in the emergency room at times, seeing how patients that were victims of sexual assault were handled in the emergency department that it could be done better, and that's what many other nurses across the country also saw. So that's how forensic nurses or sexual assault nurse examiners - most of us, I guess, began our our career in forensic nursing.
Karen Ortman 03:11
So I have to ask, you said that the sexual assault victims could be handled better. What do you mean?
Jane Reynolds 03:19
Well, not kept waiting out in the waiting room so they could be then taken back after triage to the back of the emergency department. Because sometimes they may not be wearing their own clothes, they could be wearing nothing more than a hospital gown, or the clothes maybe they have on or torn.
Karen Ortman 03:40
Can you share with our listeners the history of this program that you are a part of the Sexual Assault Response Team?
Jane Reynolds 03:49
Sure. Back in the 90s. across the United States, there were several nurses that were also had the same concerns about how patients have sexual Salt were treated and how we could do better. And they came together as a very, very small group in many in Minneapolis and that's how our association of the International Association of Forensic Nurses was born. Throughout the country, there were many nurses and many programs practicing independently and this brought most of those programs together so that nurses could learn from one another and help to develop the programs that we have today to really help care for patients and use a patient centered model.
Karen Ortman 04:41
When you speak of forensic nursing, is it always in the context of sexual assault cases?
Jane Reynolds 04:49
No, not always. We have nurses that work in many fields as forensic nurses. You can be a sexual assault nurse examiner, psychiatric nurses that work In many institutions, nurses that work as death investigators, some work in corrections. So there are many different fields and they have been developing over the years into bigger, the scopes of those practices have to get been getting larger and better. So our patients are at the center of the care that we provide. Throughout our process of the examination. In the beginning, we ask our patients after an explanation what that process might look like we ask for their consent and their permission. And throughout that process, we continually validate that consent in that permission because a patient can at any time decline any part of the exam that they're uncomfortable with or may not want to proceed with talk to the patients about, you know, what is it that has you so concerned about this part of the process or what is it that I can add to that too support you in whichever decision you make. So most of the time, it ends up to be a positive experience. And they just are unfamiliar with what we may be talking about or the language that we use. So an explanation to them most of the time resolves those concerns. And we can proceed accordingly. But we're always checking for that permission all along the way so that they're in control of the situation.
Karen Ortman 06:28
So it's fair to say that at no time is a survivor compelled to participate in this rape exam...
Jane Reynolds 06:38
Karen Ortman 06:39
...essentially, is what it is. And they're they're not compelled, and it is completely within their power to say, No, I don't want to do this.
Jane Reynolds 06:50
Karen Ortman 06:52
Can you speak to the program that you have in Mercer County and what does that look like? And, how many forensic nurses or there as part of your team? And how do you respond to calls for service? How does it work?
Jane Reynolds 07:10
In Mercer County, we have 12 nurses in our program and also myself and we have on call self-scheduling schedule that we maintain 24 hours a day, seven days a week, 365 days a year, where the nurse is scheduled to be on call at a particular time and another agency can call and activate and make a request for services through our communications in our county. That nurse who is on call then gets a call from the sheriff's office to dispatcher and she's dispatched with the information regarding the patient, how old they are, where it may have happened, the day, whatever information basically the sheriff's department gives to her. So then the other team members are also activated. We have sexual violence, confidential sexual violence advocates that come from our organization in Mercer County is called women's space. And those are volunteers. And so the nurse will call to the emergency department and speak to the emergency room staff. Generally we'd like to speak to the nurse who's caring for the patient in the emergency department to gain any other information that may be crucial to the decision about responding and examination. Sometimes we get things that people think are warrant inactivation, and they don't, and that would be like inappropriate touching, that doesn't warrant a forensic medical exam. Although it's inappropriate, it still doesn't warrant the exam.
Karen Ortman 08:51
because you can't obtain any evidence.
Jane Reynolds 08:54
Right. there would be no specimens collectiond just for a mere touching. If someone was to be touched on their buttocks or touched on their breast, that there's not anything other than reporting to law enforcement about inappropriate touching was done in that case.
Karen Ortman 09:16
Must an incident happen in your county for you to respond?
Jane Reynolds 09:22
No, it doesn't. The patient can have an incident happen anywhere. They happen in another county, another state, another country. They show up to our emergency department and that department makes the activation for our services and we respond. What does have to happen though, is it has to be reported if the patient chooses to report to law enforcement, it has to be reported in the municipality where the incident occurred.
Karen Ortman 09:53
Sure. So if it didn't happen in your county, you will respond but the police from your county cannot, in effect, respond and prosecute any likely offender if it didn't happen in that county.
Jane Reynolds 10:10
Correct. It gets reported to the police department where it occurred.
Karen Ortman 10:16
Is it fair to say that any victim can go to any hospital in this country and report a sexual assault and if there is a program such as yours, there would be a response by a forensic nurse.
Jane Reynolds 10:31
If there is a program in that hospital I would say most of the time that does happen because there is a shortage of nurses across the country and forensic nursing is no exception to that. So especially in many rural areas, you'll find that they may not have a lot of SART site hospitals and they may not have a lot of nurses to respond. So there could be a gap in time where it could occur. When some of our programs were started up right here in New Jersey, you know, we may have started out myself included with only three or four nurses to cover 24 seven, and that was a difficult task. So there could have been a delay in an examination, but now in New Jersey we do have programs in all 21 of our counties. And the majority of our hospitals participate in this SART program.
Karen Ortman 11:33
How does one know if they're listening in a different country or if they're listening in another part of the United States, how do they know if they are the victim of a sexual assault if there is such a program in their area, what would be the most direct way for them to uncover any sort of resource such as yours?
Jane Reynolds 12:00
Well, most places have a sexual assault hotline, most states have them and then there's RAINN also has a hotline as well that organization and they can provide information that would guide someone their local rape care program could help them the police. Many universities and colleges across the state and across the country have some sort of program about violence initiatives or whatever it might be within their own campus and have direction to help patients as well as their healthcare centers on their campuses as well. And lots of times you can just Google it, SART hospitals or on a particular state's website or county website on the Office of Victim Witness website. You can wade through some of that information but I think most importantly is probably the hotline within your community.
Karen Ortman 13:10
And RAINN, they are a great resources. Are there doctors that are a part of your team?
Jane Reynolds 13:18
Not in our program in Mercer County. There are physicians that are examiners in other places. We can accommodate, of course a physician would have to go through the same training that the nurse goes through, but they could be a member of our team and there are physicians on other teams that are examiners.
Karen Ortman 13:42
Does law enforcement have to be involved in order for a victim to have a rape kit examination and evidence collected?
Jane Reynolds 13:51
No, they do not. A patient can come forward and have a forensic examination and specimens collected, Here in New Jersey, we have what were we term their called five year holds where a patient can come forward and go through that process in the emergency department and we will hold the kit for five years from the date of the incident or exam or five years after their 18th birthday. But what patients do need to know is that the kit the box, the specimens that are collected, do not get any analysis from the state police crime lab. No investigation occurs because the police are not notified and that box, the integrity of that kit, is maintained in that box sits on a shelf secured at, in our case, in our prosecutor's office.
Karen Ortman 14:52
And over the course of five years is it fair to say that the contents of that kid could deteriorate over time?
Jane Reynolds 15:06
Um, I would say it's a possibility, of course, the swabs are collected and dried and maintained and, you know, not in a really volatile environment, you know, it's fairly a fairly stable environment so it's not required to be refrigerated unless of course you're collecting some biological samples which then are collected in a separate kit and they are refrigerated in the same room as the other kits so it's dry storage and they could deteriorate but most likely would not.
Karen Ortman 15:46
Okay. At this point, I would like to go over the exam in detail. So the contents of a sexual assault forensic examination or safe kit, also known as a rape kit, what is contained in that box?
Jane Reynolds 16:09
So when we receive the box, we have boxes that are standardized and that are put together for us from a company called Sirchie and they are specific to New Jersey. And those boxes, there was a collaboration for those kids between the state police crime lab and the forensic nurses and the Division of Criminal Justice here in New Jersey. And so it's a kit that sealed the boxes sealed, you have to unseal it has a top and a bottom and they're sealed together and it has demographic information on the outside that the nurse has to fill out: name, address, location, date, the nurse, that kind of information. On the inside of the box, there are envelopes that have have swabs in them which are basically long q-tips and they have envelopes and those swabs are individually wrapped inside of those envelopes, then small little boxes that they then get packaged in after they've been used and dried by the nurse and put back in that envelope and sealed back in and they go to the crime lab.
Karen Ortman 17:26
What are you using the swabs for?
Jane Reynolds 17:29
Well, based on the history that the patient provides to us, that's what guides our exam. So the swabs would be used to swab for biological evidence from the patient. If it's a female patient, we would swab. If there was oral copulation involved, we would swab the inside of her mouth. And then we would do imaginal swab on the outside of the vaginal area inside, an anal swab, rectal swab depending on the history that our patient provides. You can also do dried secretions. We're looking for biological specimens at that point.
Karen Ortman 18:14
Okay. What else is in the kit?
Jane Reynolds 18:20
Right now that's about it. Back in the beginning in the day when it was originally developed there was a comb in their for head combings, some sticks to scrape underneath the fingernails and there is a vial of sterile water to moisten the swab with if you're drawing on a dry ice swabbing on a dry surface. But those other things that I mentioned, when we went back and collaborated with the lab, those weren't of a great value those those are particular items and but sometimes are in a particular case so the nurse has the option to use the head hair combings or the pubic hair combings or the fingernail scrapings, but they weren't yielding very much so it's an optional and a part of our teaching and our nurses and their practice so those things have been removed. So it's basically just those swabs envelopes in a container sterile water.
Karen Ortman 19:29
Okay. So after you've completed the the exam, the rape kit, and you've collected the evidence in the boxe is sealed, what other evidence are you looking for during the examination?
Jane Reynolds 19:46
Okay, so I'm just going to back up just a little even though that that piece is pretty much completed. We do a head to toe skin assessment of our patient and based, like I said on the information that they provide us in the history, we're looking for injuries that may have occurred on the skin surface, anywhere on the skin surface, lacerations, abrasions, bruises, those kinds of things, missing hair from hair being pulled. We also are trained in forensic photography so the nurses receive that in their basic training and when they go out into the field, we take photographs, we use digital cameras, take photographs of the patients and the injuries that they have. So we're looking for that and any other supporting things that, you know if a patient says that they were assaulted, you know, outside in an outside area someplace in a field or whatever, you know, do they have leaves or grass in their hair or you know, maybe mud on the clothes or something to that of that nature. So we're looking for all of those things.
Karen Ortman 21:06
And really just looking for evidence that supports the information provided by the victim, I would presume to corroborate the sequence of events as they're told to you.
Jane Reynolds 21:21
To support the history that they've reported. Yeah.
Karen Ortman 21:24
Is it fair to say that the absence of injury does not indicate absence of sexual assault or rape?
Jane Reynolds 21:32
Karen Ortman 21:33
Okay. Can you explain that?
Jane Reynolds 21:36
Well, many times people are assaulted by people that they know. And so the body is also designed for a sexual encounter between two people so the tissue and the lubrication of that tissue is a natural phenomenon that happens. Sometimes there can be alcohol or drugs involved which cause a person to be much more relaxed and not to fight or struggle against someone who may be assaulting them.
Karen Ortman 22:14
And someone who they might know, as opposed to a complete stranger.
Jane Reynolds 22:18
Of course. And sometimes victims often tell us that even if it's someone that may only be an acquaintance or a possible stranger, that um, they don't consent, but they may comply because they're afraid that they could be hurt.
Karen Ortman 22:37
Let's talk about children who might have to submit to this sort of evidence collection. How is that handled differently then with adults?
Jane Reynolds 22:53
Well, we see people across the lifespan, all ages. So RPs or children population is considered zero to 12 years old. So, basically we get called for services for them through the hospital, law enforcement or our child protection agency DCPP can also call the police and make that report. We don't take a statement from the child because they go through what's called a forensic interview using a trained interviewer and finding words to ask children questions that are not leading questions or that are mainly objective in finding out what the history may be. So we get our history about what happened from maybe the non-offending parent or the law enforcement person or the DCPP person. That's what guides our examination of the child and if it's a female child, and normally there is no speculum inserted. Most of the time children don't really have any injuries either because the person who's abusing them wants to be able to continue to do that.
Karen Ortman 24:28
Must child consent to this type of examination like an adult must?
Jane Reynolds 24:33
Well, our children, um, other than an uncooperative toddler? Yes, they do. If I have a 12 year old girl or boy or an 11 year old who says, I don't want to do this and I don't want you to touch me, they're not giving me consent even though that parent, a non-offending parent may want that examination. And that's where anyone can say, no, I don't want to do this and no, I don't want you to touch me. We have to honor that.
Karen Ortman 25:09
Can you speak to your continuing training that I'm sure you must obtain throughout your career, you and your nurses, in order to stay current in forensic issues, legal issues, what's available?
Jane Reynolds 25:31
Well it changes so readily we have to keep abreast of that so research, continuing education, going to conferences, attending webinars and all of those things - yes, nurses are afforded that opportunity to attend all those things. I try to do at our staff meetings and education piece, even if it's just like learning, even if it's not formal learning, if you will, but something that someone has a topic that they'd like to talk about, or they'd like to practice taking photographs, and there are many continuing education offerings around the country that nurses can attend and should attend, including, you know, those in person conferences when we get back to that, and webinars and online learnings. There's there's a lot of them around andn all nurses should participate in those.
Karen Ortman 26:34
And I'm sure you do probably quite a bit of training yourself with law enforcement and other nurses and the whole multidisciplinary sort of team approach to handling these cases I'm sure they benefit greatly from your experience.
Jane Reynolds 26:52
Yes. We train with the nurses we turn with law enforcement, we train with our sexual violence advocates and their many councils and committees within the state that forensic nurses are team members have as well.
Karen Ortman 27:09
What resources and guidance would you give a listener who's interested in becoming a forensic nurse and maybe being part of a Sexual Assault Response Team?
Jane Reynolds 27:19
Well, that she must be a registered nurse with two years of experience and that it is a very rewarding practice in nursing. You do a lot of one on one nursing, caring for a patient one on one one at a time in a time when they've experienced such trauma. You get the opportunity to be the person that helps them begin their healing process and, and give them the opportunity to maintain some control of their environment when awful things happen is a very rewarding concept. I've been doing it since 1998 I want to say, and I still enjoy it every day.
Karen Ortman 28:08
Yeah. And I worked with you for many years during that time. Mercer County's lucky to have you
Jane Reynolds 28:18
Why thank you. Thank you very much. It was a pleasure, as always, to work with you too. I mean, you could speak to it, too. It's just one of those things tht until you do it you don't know that you missed it.
Karen Ortman 28:30
Yeah, it's important work. So is there anything else that you would like to share with our listeners before we end our discussion today?
Jane Reynolds 28:40
No, I think a lot of people now it's a little more common but when I first started my career in forensic nursing, people often would say to me, why do you want to do that?And I said, well, if it was me, I would want somebody like me to be there to do it.
Karen Ortman 28:58
Great answer. More Janes out there, for sure.
Jane Reynolds 29:03
Karen Ortman 29:04
Thank you so much. Thank you to my guest, Jane. It was great to see you today. And thank you for participating and You Matter.
Jane Reynolds 29:14
Karen Ortman 29:16
And thank you to all of our listeners for joining us for today's episode. If anything presented today was triggering or disturbing, please feel free to contact the Wellness Exchange at 212-443-9999 or NYU's Department of Public Safety and their Victim Services Unit at 212-998-2222. Please share, like and subscribe to you matter on Apple podcasts, Google Play, Tune In or Spotify.