Forensic nursing training ensures empathetic care during evidentiary exams
By GAIL APPLESON
Like many little girls, Tracy Marcotte thought she wanted to be a nurse when she grew up. Even as a child, Marcotte jumped at the chance to visit people in the hospital. "I can't remember not wanting to be a nurse. The smell of rubbing alcohol, I thought that was the greatest thing," she said.
Husband and wife Adam and Tracy Marcotte team up to train hotel staff in the Omaha area to spot and report human trafficking victims to first responders. Tracy Marcotte was instrumental in bringing Sexual Assault Nurse training to CHI Health Creighton University Medical Center. Adam Marcotte is a deputy with the Douglas County Sheriff's Office.
Photo by Andrew M. Jackson
Today, Marcotte directs maternal services, labor and delivery at CHI Health Creighton University Medical Center–Bergan Mercy in Omaha, Neb. But that's not the end of the story. Marcotte is also a SANE — short for Sexual Assault Nurse Examiner — a position she describes as her real "calling."
The International Association of Forensic Nurses, which certifies SANE clinicians, says to qualify for the credential, a registered nurse must complete course work that includes a classroom or web-based curriculum and clinical training that meets the association's guidelines.
Call to care
"I went to Catholic school and never really understood what priests and nuns meant by their 'calling.' But when I started doing the sexual assault exams, I thought 'I get it. I understand what a calling is,'" she said. "I knew I was making a difference."
Marcotte's interest in sexual assault examinations was sparked by her sister, a county prosecutor, who would discuss her experiences with these types of cases. Marcotte then began reading everything she could find on forensic nursing. This background eventually led Marcotte to help Theresa Gregg, director of emergency/trauma services at CHI Health Creighton University Medical Center, to launch the Omaha hospital's SANE team in 2014 and be among the first trained. The Bergan Mercy hospital and the university medical center are part of CHI Health of Omaha. The regional network of 14 hospitals is part of Englewood, Colo.-based Catholic Health Initiatives.
CHI Health's five metro Omaha hospitals and one freestanding emergency room, along with CHI Health St. Francis in Grand Island, Neb., have SANE programs now.
Before CHI Health's involvement, there was only one facility in Omaha with a trained SANE team. "So when sexual assault victims showed up in our emergency room we had to transfer them," Gregg said.
Although Gregg and Marcotte were both passionate about creating SANE training programs at their sister hospitals, they didn't know each other until they just happened to sit at the same table during a CHI Health leadership meeting for its Omaha-area hospitals.
They began to talk about the gap in emergency room care for sexual assault victims. This was of great concern to the women because sexual assault victims are often in a very fragile and emotional state when they first get to an emergency room, and some are reluctant to even come in for the exam.
"Sending them to yet another hospital was not what we wanted," said Marcotte. But there's also a need to collect and protect evidence as soon as possible in the event it's required for a criminal prosecution.
That chance meeting energized both women and with funds from all CHI Health emergency room department budgets, they put together the first training session in June 2014 with 25 participants.
Nurse examiners must take 40 hours of advanced training to learn how to conduct the evidentiary exams and handle rape kits. This includes being able to identify and carefully collect bodily fluids and blood stain evidence. They also must preserve the integrity of this evidence and make sure there is proper documentation. Initially the training was at CHI Health Creighton University Medical Center but now it's done online through the forensic nurse association. The clinical training is scheduled separately.
The right stuff
In addition to mastering evidence collection, SANE providers must be extremely sensitive to the needs of victims who can be emotional and often are very scared. They have been through a horrible experience and must endure a very invasive examination.
Members of the sexual assault forensic team answer SANE call in addition to their regular shifts. And, if there isn't a trained SANE nurse available, Marcotte will step in.
"I'm willing to come in any time," she said. Marcotte gets no extra pay because she is in a management position.
Although nurses tend to finish the training, some leave the SANE team after finding it both emotionally and physically draining.
"These nurses have to be very compassionate and dedicated to take on this role," Gregg said.
Marcotte said: "You have to relax and know there's no rushing through it. The victim often blames herself, and you need to realize you're not just there to collect evidence. You have to convince the victim that she did nothing wrong."
Marcotte explained that the exam and collection of evidence can take more than four hours. She recalled one case that took some six hours. After it was over, she went out to her car and broke down in tears.
Tragically, many of the victims are very young, added Marcotte. Prepubescent girls, typically under age 12, are sent to Project Harmony, a child advocacy center where nurses with pediatric forensic training conduct sexual assault exams.
"Knowing these things are happening in your community and how violent people can be, you start to see your community differently. You want to do more for these victims and when the exam is over, it's hard to send them away," she said. "When you're this up front, it can take a toll."
Stopping trafficking
Her efforts don't stop at the hospital and in fact, they overlap with those of her husband, Adam Marcotte, a deputy with the Douglas County Sheriff's Office who is often a first responder to sexual assault reports. Although the couple has not worked together on a sexual assault case, they do team up with the Omaha Coalition on Human Trafficking and help train hotel and motel staff to spot women and minors who have been lured or forced into prostitution and subjected to sexual assaults.
"A lot of big companies and organizations have conferences in Omaha, and that brings in traffickers," Tracy Marcotte said. "People don't want to believe it's happening here, but it is."
As recently as last October authorities arrested 42 people in the Omaha area as part of the FBI's crackdown on human trafficking called Operation Cross County. Nationwide, 82 sexually exploited juveniles were located and 239 people were arrested in the three-day operation. In mid-July, hospital clinicians identified a possible young trafficking victim who came to Omaha's CHI Health Immanuel for emergency care.
"Our people strongly suspected something was very wrong, beyond the medical reason she was there," said hospital spokesperson Kathy Sarantos Niver. The SANE nurse became involved. The 16-year-old was transferred to Children's Hospital & Medical Center in Omaha for specialty care.
See something, say something
Adam Marcotte said participants in the hotel trainings are taught to recognize warning flags of human trafficking. These include a much younger woman accompanied by an older man, who rents two separate rooms for a number of days and pays cash. These "guests" have little or no luggage. In addition, housekeeping staff often find sex toys, costumes and scripts in one of the rooms.
During a training session last summer, Adam Marcotte said he was approached by a hotel staff member who said he had seen these clues and believed a trafficking ring was operating right at that time in his hotel.
It turned out he was correct, and the operation was disrupted.
"We're being more proactive in the whole fight," said Adam Marcotte, who hopes teamwork by law enforcement and health care professionals can help stop trafficking before it begins. "Next we'll go into the schools to educate youth so they don't get caught up in this."