21 Nov 2016

Meeting the Challenges of SANE Nursing in a Prison System

Authored By Masonda Wheatley, RN, CCHP, SANE Nurse Coordinator, Corizon Health


Prison rape

Rape in prison is a reality that too often goes unreported. In Missouri’s prison system, our SANE nurse program is making victims more willing to report the crime, receive the forensic exam they are entitled to under the Prison Rape Elimination Act (PREA), and get the medical and mental health attention they need.

Passed in 2003, PREA established national standards to prevent rapes of those incarcerated. The law also calls for mandatory reporting by anyone with information that a sexual assault has occurred. But in a prison setting, many victims are unwilling to come forward due to fears of stigmatization or threats of violence.

Correctional medical provider Corizon Health serves the healthcare needs of the 35,000 individuals incarcerated in the state’s adult prisons under a contract with the Missouri Department of Corrections. We learned of the positive benefits SANE nurses bring to the rape exam experience and believed such services would be valuable to our patients and our state partner. In July of 2015, I was given the assignment of working with our team to develop a statewide SANE prison program.

This proved a difficult task. I reached out to several states, but could find no similar program in a statewide prison setting to model or from which to seek guidance. Colleagues working in the Philadelphia, Pennsylvania jail system, another longtime Corizon Health partner, already had an established SANE nurse program and lent their expertise. Nevertheless, expanding to a statewide program and introducing a new approach to rape examinations required a lengthy process of program development, recruitment, staff training and inception. On September 1, 2016, more than a year after we started, our team offered our first SANE nurse examination to our patients.

In our program, a SANE-certified nurse responds to the facility where the victim is located. Prior to the program, a sexual assault patient was taken to an outside provider to receive a SANE exam. At times this meant victims sometimes waited up to 12 hours depending upon the location of the prison facility in relation to the hospital and the availability of a SANE nurse at the hospital.

Benefits of a SANE nurse prison program

On-site correctional SANE exams offer benefits to the victims of prison sexual assaults and the public. Our program is still young but it is helping those who have been sexually assaulted feel more comfortable reporting the attack. Inmates are very observant and gossip spreads fast in a prison. Prior to our SANE program, offenders would be aware of patients leaving the facility. On-site SANE exams help protect patients’ privacy, reducing the disincentive to reporting that comes with stigmatization or fears of violent reprisal.

Furthermore, our SANE nurses are also correctional nurses who work with patients in the prisons on a daily basis within their normal job duties. At times our SANE nurse will know patients through past encounters during clinic or chronic care visits. Patients may be more trusting of a familiar nurse and be more forthcoming in discussing the event than they would with strangers.

Our SANE nurses are part of a coordinated response that includes investigators, advocates, and mental health professionals. Having the entire Sexual Assault Response Team (SART) under one roof facilitates the investigation and provides better continuity of care to the victim. The SANE nurse may directly schedule appointments for follow up and STD prevention with the staff at the patient’s assigned facility.

Additional benefits for having the SANE nurse respond directly to the facility:

  • Patients may report sexual assaults without the trauma and potential embarrassment of reporting the details multiple times to multiple individuals.
  • Patients are cared for by correctional nursing professionals trained to deal with this specific population.
  • Minimizing off-site inmate transportation increases public safety.
  • Facility staffing is not impacted by transporting the patient to an outside hospital.

The challenges of maintaining a SANE program

Staffing has been one of the most significant challenges throughout developing and implementing the program. All SANE programs seem to have nurse retention issues, but they are exacerbated in the correctional setting where nursing turnover already is high. I am engaged in a continual cycle of recruitment and training.

A sustainable SANE program requires anticipating and preparing for turnover. Training a replacement may take six to twelve weeks. SANE certification is typically a 40-hour on-line self-study program followed by competency testing that the recruit must complete in addition to normal scheduled duties and outside commitments. A tool that aids in the training of new staff is the online process that was utilized from Kinetic Learning at SANE-SART.com. The online training has the added benefit that staff can complete on their own versus needing to be away from the worksite and duties for traditional classroom training.

The prison environment itself poses several challenges such as availability to supplies and access to patients. Equipment, such as syringes and flushes, are secured and counted. When working in the community, I have taken for granted the ease of obtaining supplies. In the prison environment, it can be a challenge to acquire a needed item simply because of the security measures that must be followed to retrieve supplies from another area of the facility.

In the community, patients are easily accessible. In the prison setting, patients may be in a locked cell and the correctional nurse may have to wait for custody staff to move the patient to an examination room or for an escort to a patient’s location. This may take time depending upon what is occurring at the facility or the security level of the institution, creating a delay for the nurse to complete the task at hand.

What else is required to sustain a SANE program? This is something I think about on a regular basis. Our program is only in its infancy, but I find myself thinking about its future and long term sustainability. The cost of training each nurse alone can take a large portion of budgeted funds. Requirements for length of employment prior to being accepted to the SANE nurse program can decrease the number of eligible applicants. I don’t yet know the solutions, but I am optimistic that our committed team will overcome any obstacles that arise.

Correctional nursing is challenging but highly rewarding work. Patients aren’t always cooperative or honest with staff and sometimes have ulterior motives for seeking care. Nurses must provide care while being aware of their environmental surroundings. But the reward is delivering care to appreciative patients with significant health needs who typically have had little access to care in the community. We play a vital role in turning around the lives of our patients and our SANE nurse program is a natural extension of our mission to provide quality care to our patients.

About the author

masonda-compositeMasonda Wheatley, RN, CCHP, is the SANE Nurse Coordinator for Corizon Health in its Missouri Regional Office, serving the Missouri Department of Corrections. Nurse Wheatley, who also serves as CQI Coordinator and Clinical Educator, has worked in the correctional setting since 2010, where she has served several roles including Registered Nurse, Assistant Director of Nursing and Director of Nursing. She has been in her current role since July 2015.

3 Responses

  1. Brenda Garison

    Awesome is all I can say about the work you have done toward finding a workable solution to a problem that my team has struggled with for over a decade. Our staff have been providing SANE examinations for the many prison facilities in our area while performing forensic medical examinations in a 24/7 private freestanding nonprofit facility for persons giving a history of sexual assault. With limited time and resourses, it’s been challenging to say the least! Thank you for the work you are doing

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