Working the Frontlines

By: Jeff Nazzaro

As the COVID-19 pandemic, bolstered by the delta variant, drags on into its second year, most people are acutely aware of the severe stresses it has put on the elderly, those with compromised immune systems and other preexisting conditions, and the front-line workers in the healthcare industry charged with caring for them. Less visible to the public eye, but facing many of the same COVID-related challenges and concerns, are forensic nurses and the at-risk populations who depend on them.

According to the International Association of Forensic Nurses (IAFN) website (forensicnurses.org), “a forensic nurse is a Registered or Advanced Practice nurse who has received specific education and training.” Within the specialty, which, with origins in research conducted at the University of Texas at Arlington in 1990, is still young, nurses may work in one of several fields, such as domestic violence, elder abuse, corrections, child abuse and neglect, and sexual assault. They deal with injury, wrongful death, and other medico-legal cases. This work takes place in a variety of settings, most often hospitals, coroner’s and medical examiners offices, psychiatric clinics, prisons, and within community anti-violence programs, according to the IAFN. Forensic nurses may also be summoned in community crisis situations or following natural disasters.

Despite its relative youth as a specialty, Stacey A. Mitchell, director of the Center of Excellence in Forensic Nursing at Texas A&M, stresses in the foreword to 2010’s Forensic Nursing: A Concise Manual, that “forensic nursing is not a fad. It is the missing piece in health care that allows us to provide holistic care not only to individual patients but also to entire communities.

“Forensic nurses are practicing in hospitals and out in the community, making a difference in people’s lives,” writes Stacey. “They identify issues that will have a legal impact on society. They document injuries and pull communities together to address issues such as domestic violence, sexual assault, and child abuse. They work with grieving family members when death comes unexpectedly. They care for inmates and those in the psychiatric facilities who are unable to understand the consequences of their actions. Forensic nurses contribute to disaster planning and response. They are also entrepreneurs and consult on legal cases, assisting attorneys to understand the intricate medical terminology and how care is provided to the community. Anywhere there is an injury or potential for injury, there is a role for the forensic nurse.”

Rakesh K. Gorea details in the Journal of Nursing and Patient Safety some of the ways in which COVID-19 has disrupted the practice of forensic nursing and the education of future forensic nurses around the world.

“It has put fears in the mind of the patients and the clients coming to the forensic nurses,” Rakesh says. “With the death of many health workers, additional burden has been put in the minds of forensic nurses, too.”

These fears, of course, couldn’t come at a worse time, as the conditions causing them are also increasing the need for forensic nursing. In an editorial for the IAFN’s Journal of Forensic Nursing, Cindy Peternelj-Taylor grapples with as much.

“As forensic nurses, we know that the patients and clients whom we care for under ‘normal’ circumstances are at an increased risk because of the measures that have been implemented to prevent the spread of this deadly virus,” she writes. “We understand intuitively that too much time together, and increased social isolation, places many vulnerable members of our communities at an increased risk for sexual abuse, intimate partner violence, elder abuse, and child abuse. We also know that criminal justice involved persons, refugees, and homeless persons are also at an increased risk of contracting the virus, given the overcrowding commonly found in jails, prisons, processing centers, shelters, and other forms of temporary housing, where social distancing (among other precautions) is impossible to adhere to.”

And these remain challenging times. United Nations statistics show as high as 30 percent increases in domestic violence reports globally. And a UCLA study has found a 42 percent rise in “excess deaths” related to all causes, not just COVID-19, in Florida prisons. Nationally, incarcerated individuals face a higher risk of both contracting and dying from the virus, according to the Prison Policy Initiative. On multiple fronts, COVID-19 continues to push demand for forensic nurses even as it hampers the supply of qualified professionals ready and able to meet these vital challenges.

Technology does offer clinicians and their clients and instructors and their students obvious ways around the close contact that continues to stoke fears, even in this time of universally free and available COVID vaccines. Non-life-threatening services can be conducted via Zoom or telephone, rather than in emergency rooms, for example, and educational programs can be shifted online. UCR University Extension currently offers its 16-unit Professional Certificate in Forensic Nursing for RNs, LVNs/LPNs, and other already-licensed medical professionals, like nurse practitioners, physician’s assistants, and paramedics, in a 100 percent online format.

“Regardless of the area of forensic nursing one aligns with,” Cindy states, “forensic nurses are among the unsung heroes, assuming leadership in caring for the most vulnerable members of society.”