One of Sierra Roman’s first cases as an emergency room nurse at Kittanning Hospital — and one she’ll never forget — involved a victim of a sexual assault.
Roman, who started at the hospital in August 2023, needed to perform a rape kit on her patient.
“I’m nervous, because I’ve never done this before,” said Roman, 25 of Wayne Township, Armstrong County. “That really made me want to dive a little bit deeper.”
The following year, Roman completed a sexual assault nurse examiner course available at Pennsylvania Western University’s Clarion campus. The course consists of two 10-week classes that emphasize trauma-informed care, crisis intervention and evidence collection, medical forensic photography and collaboration with community and law enforcement agencies.
“Their work is hard,” said Randilyn Lewis, SANE course instructor and a nurse at UPMC Northwest hospital in Venango County. “It’s emotionally taxing, but it’s a calling. They’re needed. Trauma is not uncommon.”
Sexual assault nurse examiners and the work they do were highlighted in the last two episodes of “The Pitt,” a popular HBO series portraying life in a Pittsburgh hospital’s emergency room.
In the show, the hospital received Ilana, a young woman who is the victim of sexual assault. Charge nurse Dana was the only SANE-trained nurse on shift, and guided Ilana through the forensic exam process.
“It was trauma informed and completely accurate. It was moving and inspirational,” Lewis said. “That’s what we train for.”
The exam in the show walks the viewer through appropriate gown handling and screenings. Lewis was particularly impressed with the patient-led pauses throughout the exam process.
“They put a focus on the patient, the process and supporting the survivor instead of making it dramatic,” she said. “It was beautifully portrayed.”
Grant for training
In 2024, PennWest’s nursing department was awarded a $1.18 million grant to train registered nurses as sexual assault nurse examiners. PennWest was the only higher education institution in Western Pennsylvania that received the three-year grant from the federal Health Resources and Services Administration, said university spokeswoman Wendy Mackall.
Skills learned during training include forensic interviewing, anatomy and injury assessment and documentation, speculum exams and specimen collecting.
“They specialize in trauma-informed care,” Lewis said. “They’re the intersection between medical health care and collaboration with the law.”
Roman was part of the first group to take the class, and graduated from it last spring.
“When I took the class at Clarion, it’s humbling,” she said. “My mindset changed. Every patient I have now, I treat them like a family member.”
Training was eye-opening, Roman said.
“I was more confident,” she said. “I could explain to the patient more, and explain what I’m doing.”
The need for more certified experts
There is a need for SANE training, said Lewis. Lewis trained at UPMC with Dr. Karin Wickwire, and she is currently in the forensic nursing program at Duquesne University. According to the International Association of Forensic Nurses, roughly one in five American hospitals have a sexual assault nurse examiner on staff.
The Rape, Abuse and Incest National Network reports that, on average, roughly 463,600 people aged 12 or older experience rape and sexual assault each year in the United States.
“Especially in rural areas, there’s a complete lack (of SANEs),” Lewis said. “There’s areas of complete deserts of certified SANEs.”
There are 180 adolescent-trained SANEs in the UPMC system, Lewis said. Thirteen students completed PennWest’s first class last year, Lewis said. She anticipates 15 students in the second class.
Lewis acknowledges the work is taxing.
“We talk about it,” Lewis said. “We talk about taking on that emotional toll. Nurses are innately advocates. We talk about self-care and that they debrief so that they can continue caring for others.”
Roman hopes the accurate portrayal of SANEs on “The Pitt” can better inform the public of available resources to sexual assault victims.
“A lot of people don’t know that there are SANE nurses out there,” she said. “We’re out there, and it’s available.”
Lewis agreed.
“My hope is that, as a survivor, or any patient, that they know if they report to an ER, there is a SANE that is going to care for them,” she said. “They are never alone.”
