How a lack of sexual assault nurse examiners is affecting Oregon’s North Coast

There are no certified sexual assault nurse examiners based on Oregon’s North Coast. Currently, there is one certified nurse who is based in Portland and works intermittently in Astoria. This means for those who choose to report their assault, they will likely need to travel to Portland for an examination when this nurse is unavailable. Survivors are often told to wait for several hours until a certified or trained nurse is available and are also instructed not to shower or change clothes during this waiting period, discouraging many from continuing the process. Abbey McDonald is a reporter for The Astorian. She joins us to share more on her reporting and how the lack of these specialized nurses are affecting Oregon’s North Coast.

Note: The following transcript was created by a computer and edited by a volunteer.

Geoff Norcross:  I’m Geoff Norcross in for Dave Miller. There’s a critical gap in care for survivors of sexual assault on the North Oregon coast. Reporting by The Astorian shows that most people who are sexually assaulted do not seek the care they are entitled to. And the reason is often because there are usually no nurses who are qualified to administer that care on the entire North Oregon coast. And survivors don’t want to or they can’t take a full day to get that care in Portland. Here to talk more about this is Abbey McDonald, reporter with The Astorian. In the best case scenario when a sexual assault victim goes to a hospital, what is supposed to happen? What kind of care are they supposed to get?

Abbey McDonald:  Well, I think what people expect when they come in is to be treated promptly and to get an exam that will help them if they choose to build a case in the future. But at the very least people want to take steps to prevent pregnancy, prevent STDs and just get themselves checked out.

Norcross:  And so who is supposed to provide all those levels of care? Is it one person? Is it several people? What happens?

McDonald:  So in Oregon, it’s required that someone with sexual assault forensic training does this exam and this is someone called a SANE nurse, sexual assault burse examiner. And we don’t have enough of those on the Coast. We have several people who have this training and can do part of the exam. They can come in when time allows. But sometimes they cannot.

Norcross:  What does it take to get certified as a SANE nurse in Oregon?

McDonald:  Certification requires a lot of steps. Part of this is taking a week-long course, doing a lot of observations, doing exams alongside someone who is certified, working with law enforcement, doing observations and courts. It involves understanding the entire process of sexual assault.

Norcross:  What kind of care can a sexual assault nurse examiner give that victims can’t get in, say, just an emergency room situation? I mean, what kind of extra care can they give?

McDonald:  These nurses are specifically trained in something called trauma informed care, which means they’re aware of what kind of secondary trauma inadequate medical care can [result in]. So they know to approach someone slowly, to ask their permission for every step along the way and let them know that every part of the exam is optional. They don’t have to get a swab in a certain place if they don’t want to. It’s about giving them the power and the control back during the medical exam to limit that trauma.

Norcross:  So it’s almost like they’re acting in a sort of advocacy way. They are with these victims every step of the way through the care process?

McDonald:  Yeah, yeah. And then a big part of the exam is just a lengthy conversation. The first few hours of what is a 3-4 hour exam is just talking with someone and finding what areas actually need to be looked at and giving them recommendations for what kind of services they need.

Norcross:  How many victims will a sexual assault nurse examiner normally see in a day?

McDonald:  It really depends. So on the North coast we have a very low reporting rate. This is for a variety of reasons that I think exists everywhere. But part of it is, you know, shame, embarrassment, anxiety. 83% of people who are sexually assaulted don’t even seek medical care in the first place. So around here, I would say that one nurse I spoke with has seen two people this year, and she was called in a third time but the survivor left before she could get to the hospital.

Norcross:  So what are some of the reasons for the scarcity of these nurses on the North Oregon coast?

McDonald:  From what I found, it comes down to a labor issue. That’s typical in the healthcare field at this time. So it’s burnout. It’s a lack of training opportunities. But I think burnout is the main issue. This is a very tough job for people to do and when they don’t have a network of other nurses to talk to and debrief about what they’re seeing, it can be exhausting.

Norcross:  You said that things are really tough in these times and the pandemic has had a lot of ill effects on everybody in the medical field. Does the pandemic have something to do with it too?

McDonald:  Yeah. From what I’ve talked to … I talked to the emergency department director at our local hospital and she says that’s the main issue, on top of risking your own safety to go into work, you’re now dealing with very emotionally traumatizing stories. And these nurses are happy to do it, but it’s tough when you feel like there’s not a support network there.

Norcross:  Are hospitals on the North Oregon coast running afoul of any kind of state or federal law by not having these trained nurses on staff or readily available?

McDonald:  Yeah. So they do have some of these nurses who are trained. So in lieu of having certified nurses, they are permitted to have these nurses who have the training to do it. But that’s why they send people to Portland. So if they call one of these nurses in and they’re not available, which is more often the case, that’s when they’re required to provide transportation for someone to go to Portland.

Norcross:  Okay. And if the victim has to do that - has to go to Portland to get this post assault care - what kind of day is it going to be like?

McDonald:  It might be a several hour wait in the hospital and then they will be told to go to Portland and sometimes that transportation is a reason people decide not to go in. There was at least one case this year where someone opted to go to Portland but then could not organize the transportation. So it’s, it’s gonna be a long day and it’s going to be a day where they might be sitting in the same clothes they were assaulted in.

Norcross:  And do some victims run the risk of being retraumatized by the experience?

McDonald:  Yes. Just based on who I’ve been talking with advocates wise, that’s one of the main discouraging factors as people want it to be over with as quickly as possible.

Norcross:  Abbey, do you have any specific numbers about victims who will seek out this care that they’re entitled to on the North Coast? How many victims are we talking about?

McDonald:  We know that the vast majority of people do not seek medical care in the first place. But yeah, it’s hard to get these kinds of numbers really. But I would say very few opt to go to Portland. Usually I would say over half refer to Portland and often people just say never mind.

Norcross:  What about the law enforcement part of this? How does the lack of access to this level of care affect any of the investigating police on the coast may want to do?

McDonald:  So when you have a SANE nurse readily available, it can help someone’s case because these nurses are trained in asking people questions in the most effective way to build a court case. And also these kits that they collect, which are called SAFE kits, sexual assault forensic exam kits, are what will be used to get DNA evidence and things like that. So it does improve someone’s chances of a case leading to conviction. So this is something that law enforcement also is dealing with, the shortage.

Norcross:  This isn’t a new problem. It’s been on your radar there at The Astorian since 2014. Can you talk about what happened then?

McDonald:  In 2014, The Astorian first reported on this because a 10 year old girl was assaulted and had to drive to Portland because of it.

Norcross:  Do you know what happened to her?

McDonald:  I do not. This was before my time here. But what I do know is there’s still no one on the North coast, at least in our region, who’s certified to take care of people under 15. So anybody who is assaulted who is a minor will be asked to drive to Portland, even if it’s hours away from your 15th birthday, which a detective told me has happened.

Norcross:  What are hospitals, and for that matter advocacy organizations, there on the North coast doing about this problem?

McDonald:  So hospitals have several nurses that they are training to get the certification with the hopes of becoming certified. And those nurses can come in and do the majority of the exam. They can’t do things like the pelvic exam, but they can do the asking and treating for STDs and things like that. We have The Harbor here, which is our domestic violence shelter. And they have recently applied for a federal grant. They’re hoping to train some of the midwives who work at our local birthing center to expand this outside of hospitals.

Norcross: This is not just the North coast problem. You noted that Jackson County had a similar issue a couple of decades ago. What happened there?

McDonald:  Yeah. So I was interested in including Jackson County just as kind of a perspective of someone who’s in a similar situation to the North Coast and [has] addressed the situation. So there are two women down there. In the early 2000′s, one formerly worked at a rape crisis center and one was the SANE nurse. They set up a non-profit which trains these nurses and then contracts them out to hospitals. And the interesting distinction for me was that they were completely on a call that she said was very important to preventing burnout - making sure people are paid and making sure that there’s always going to be someone available within a 30-minute response window.

Norcross:  Pay and support, that seems to be the keys to helping other people avoid burnout, regardless of their profession. What prompted you to look into this in the first place?

McDonald:  I was doing some reporting on looking back on the past few years of the pandemic and seeing how it impacted domestic violence survivors. And expectedly, there has been an increase of domestic violence incidents on the coast and these incidents are becoming more violent. But just talking to people and asking, what the impact was - a visual situation that’s showing our lack of resources for marginalized communities. This is on the forefront of a lot of people’s minds.

Norcross:  You touched on this earlier, but there’s already a whole universe of stigma around sexual assault. People who are victimized already feel shame and they already feel hesitancy to talk to anyone about it, even under the best of circumstances. I’m wondering if you have some insight into how the lack of care in certain parts of the state can make that worse?

McDonald:  Yeah, I mean, just from talking to advocates it just seems like it feels like further discouragement from seeking help. It’s already a difficult enough decision to seek help. And then when you’re told, you know, you have to wait several hours or you have to go to Portland or help’s not here for you right now, it might feel like you made a mistake. And what a lot of advocates were really wanting to to push forward is that there’s people here who want to help you and people are working on improving the resources. But I mean, people are aware of this. It can be super discouraging.

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