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0:00:08.6 Jackie Strohm: Welcome to PA Centered, a podcast designed to help listeners be a part of the solution to end sexual harassment, abuse and assault. Each episode, we will take on a topic or current event to help spark conversation and break down barriers to building communities free from sexual violence.

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0:00:32.5 JS: Hi, I'm Jackie Strohm, the Prevention and Resource Coordinator at the Pennsylvania Coalition Against Rape. I'll be your host today as we're joined by forensic nursing specialist, Angelita Olowu from the International Association of Forensic Nurses, or IAFN, to hear about her experience as a Black sexual assault nurse examiner, or SANE, in the anti-sexual violence movement. Welcome, Angelita.

0:00:58.7 Angelita Olowu: Hi Jackie, thank you for having me.

0:01:00.0 JS: We're so excited to have you here, and I thought you could start by telling us a little bit about yourself.

0:01:07.0 AO: Yeah, so I am a forensic nurse. I'm located in Cleveland, Ohio. It's not chilly out today, thankfully. The sun is shining and it's warming up. So I have been a nurse since 2008, and I have been doing forensic nursing since 2010. So, yeah.

0:01:31.6 JS: Awesome. I'm not sure how many people are familiar, but for those that might not know, can you share with us about the role of a forensic nurse and how you became one? 

0:01:42.8 AO: Yeah, absolutely. So my story starts, typical to some, but not typical as many, oftentimes you will hear that forensic nurses end up becoming a forensic nurse based off the patients that they see, or better yet, the, for lack of better words, the mis-care of patients that they're seeing in the ERs. My background is ER trauma, and I worked in trauma hospitals pretty much all of my ER years. So how I came about it was really by someone else kind of pointing out to me that they thought that I did really well with our domestic violence patients, and they appreciated the time that I spent with the patients, and I was kind of being told over and over again that, "You'll be really good as a SANE nurse," SANE nurse is like you said, is the sexual assault nurse examiner. And it wasn't that I didn't necessarily wanna do it, it just wasn't something I ever thought of doing, so I kinda wasn't like jumping right on that like, "No, I'm good, I'm okay doing what I do." And so after a little while of hearing it for so long, I just say to myself, "Well, you know what, no matter what it's education, and they can do nothing but benefit the patients that I do care for."

0:03:00.3 AO: And we were beginning to see a lot more patients present, and it wasn't necessarily about the care that wasn't being provided because there was actually a SANE program in the ER that I was in, but more about, how can I make sure that I'm learning what I need to learn? So, long story short is I did go ahead and take that training, and I'm telling you, probably after day one and the day one, I said, "Yeah, absolutely, this is for me, I don't know what I was thinking." So I sat through that session, that whole week-long session and got hooked up with a different program, not the program that was in my ER, but got hooked up with a different program, and the more I learned, the more that I loved it. I initially was trained to do adult and adolescent patients, and two years later, I did take the training for pediatrics, and I was a little nervous about that, but I was comfortable with pediatrics from my own background, so it was helpful to have that and I felt really good. Again, same exact thing I felt with the first time I took the training for adult and adolescent, I felt the same exact way when I took the pediatric training.

0:04:07.7 AO: So I knew that that was gonna be something that would've been meaningful for me. So that's kind of how my story started. So a lot of times forensic nurses start out as SANE nurses, and they're oftentimes in positions where they're on-call, depending on where you're at, there may be either no opportunity or very few opportunities to be a full-time forensic nurse. And so somewhere along the way, I did get the opportunity to become a full-time forensic nurse, and when it came up, I had to try and see if I could get it and I did. And from there, I just kinda continued on. And so yeah, being able to not just practice but also work in the hospital setting, and also help other staff members that are not trained to work with this patient population, help them to understand the population better and help them to understand the most appropriate care and the most appropriate resources has always been beneficial, and then to move on and be able to do it full-time, and then on top of that, be able to provide education and assist other nurses to become forensic nurses or SANE nurses has been very, very meaningful to me.

0:05:21.3 JS: That's really cool. I guess I didn't realize what kind of training was involved to become a SANE nurse, and that there were different courses you had to take for different ages and populations.

0:05:31.5 AO: Yeah, so to become SANE-trained, so let me just clarify, just in case there are people who are listening that don't really know the world, about forensic nursing, I should say, I won't say know the world, but a forensic nurse is a nurse that has specialized training to deal with patients or to work with patients, care for patients that have had some intersection with the legal system and medical care. And so it's not just the sexual assault patient, so a patient that could be considered a forensic patient population, could be a human trafficking patient, an intimate partner violence, or a domestic violence patient, human trafficking, I said that, child abuse, elder abuse, all of those things kind of fall under the same gamut umbrella. And so when we talk about the SANE nurse, the SANE nurse is specifically trained to do a sexual assault medical forensic examination. And so for a lot of nurses, this is where it starts, and then they continue to get some of that additional education, so they'll work really hard to get education around intimate partner violence, around domestic violence, and how we need to care for these patients, and human trafficking, just continue to pile that information on.

0:06:50.1 AO: And how the practice is reflected also depends on what the program looks like that they are practicing out of, and what's offered within their community for them to be able to practice in that level. So specifically, you had said, "What does the education look for the SANE nurse?" So for the SANE nurse, you have a 40-hour didactic, and so it's 40... 40-plus hours, I should say, 'cause there's a little bit additional. But there's the didactic, which is like the classroom component of the training, and then there is the clinical piece of it. So if you were taking... If you wanted to be a pediatric and you wanted to treat adults and adolescent, you would have to take that training for your adolescent adult, and then you would have to take a separating training specific to pediatrics.

0:07:41.9 AO: Some places have a combined, which is usually 63 to 64 hours, but most people have two separate ones that they have to take, and then for each one, you would have to do a clinical component for whichever population that you're planning to practice under. So if I'm only practicing adult adolescent, there will be a clinical component, and what that looks like is either a preceptorship is usually what people work with, but sometimes you have the ability to do multiple clinical skills labs, whereas you may have access to a clinical skills lab and you can go in and they'll have simulated or live gynecological technical assistance available. And so that would be like working with a live patient and you get to have interaction with them, ask them questions, a lot of them respond, give feedback, as well as doing actual physical examination of the body and the genitalia. So it's super helpful. Beyond that, you have to have your actual clinical component within the program that you're gonna be working with, on whatever program that may be, so whether it's a hospital-based or whether it's community-based, or whether it's a program that's based out of rape crisis center, there has to be something to help that nurse, to guide that nurse on what practice looks like in that environment specific to that program.

0:09:01.4 JS: Thank you for explaining all of that. I know I just learned a whole lot about what that looks like. So I hope others did too. So unfortunately, forensic nursing isn't a very diverse profession, so can you share with us what it's been like being a Black SANE? 

0:09:19.3 AO: Sure, sure. So I would say that, yeah, it's not a very diverse population. I would say, depending on where you live, you may see a little bit more diversity in some places than others. There have been plenty of places that I've taught in where no one there had any color, and I'm not just talking about brown skin like mine, it could have been any color to their skin, or they're all white. So that can be a little bit sometimes maybe intimidating, may be a good word, it just depends on what's happening. So I think that we really have to think about it from the standpoint of the patients that we're caring for. We want our patients to be comfortable and open up to us to the best of their ability, because it's a scary situation that they're dealing with all by itself. And then to walk into a facility where there may be all kinds of layers of scariness associated with the facility, and then to have care provided to you and never get to see anyone that looks like you, it can be a little bit overwhelming, I guess would be a good way to say it.

0:10:31.4 AO: But the same thing goes for practice as well, it can be overwhelming sometimes when you're always the only person in the room of color, because the expectation may look a little bit different, and your responses are definitely looked at very differently, if even paid attention to. So it can be tough sometimes. It can be tough. Okay, Jackie, so I have shared with you some of the difficult parts of working as a SANE, as a Black woman. I think I would like to also give you a little bit of perspective of some of the positives that comes along with it, for me, at least, for sure. So one of the things that has truly been a positive for me is to be able to do community outreach and reach out to communities of all age. So when I say community outreach, I have had the opportunity to make presentations or to educate people across the lifespan, and it's made a difference not just in the community, but also in my own heart and how I look at things.

0:11:42.4 AO: And one of my favorite things that I have been able to do over the years is to go into high schools and present in high schools and I've had the opportunity to do some of this education on inner city, as well as in suburban communities. And they look really different, but the one thing that has always come out is the reaction of the students and the openness to ask questions and really absorb what I'm there to provide them. That has been super good to me. That's been one of my favorite pieces of it. And I guess part of the reason for that is because, first of all, they're not expecting me to be a Black person walking in there to have this conversation with them, let alone for me to be a Black nurse to have this conversation. So it's really helpful for them to be able to see that anybody can do this job, no matter what you look like, and no matter where you come from, that everyone has an opportunity and that it's there. So that's one of the positives that has kind of been a big piece of my heart.

0:12:52.3 AO: The other one is really around some of the barriers that actually present when providing care. So I'll give you an example of a barrier that you may not necessarily automatically think would exist. Sometimes we feel like because someone looks like someone else that they automatically are gonna be the right person, and that's not necessarily the case. You have to actually get to know your patient and allow your patient to get to know you, build rapport with them, essentially. So an example of this is I actually had an African-American patient, female patient, and I was actually precepting a nurse who was a white nurse, and this patient automatically assumed that I actually was the one being precepted and didn't know. So she automatically had a level of comfort with this white nurse, and it could be simply that's what she was used to, she's used to going into the hospitals, or she's used to going into doctors and that's the care, that's who's providing care to her.

0:13:58.7 AO: So what I had to do is just kind of let her get to a space of understanding who I was, what my role was, and helping her to understand that we're working together, but at the same time, this nurse is learning from me. And once we got to that point, there was a nice little shift there. She was totally acceptive of me. But what we do have to really clearly understand is that those barriers exist no matter what you look like. Like a patient may not be comfortable with me caring for them, if they're white, but a patient may not be comfortable with me caring for them because they're Black either. They may also feel like I'm not competent enough to provide them care. So I may actually have to work a little bit harder to actually provide the care that they're hoping to get. And I'm fine with that. I'm fine with that. I will work hard for any patient because that's my job. That's my job as a nurse, to provide the best care to each and every patient that I care for.

0:14:51.0 AO: So that's not a problem. But it is something that we have to recognize as clinicians, that we all come with different levels of bias. We all come with different levels of bias, and we also carry multiple barriers that either present to us from the patients that we're working with, or from our own perspectives of what we're able to provide them, but we have to be kind of self-reflective on that and meet ourselves and meet the patients as well, where we're at and where they're at. So the positive with that really was about breaking down those barriers, so acknowledging them and figuring out the way to break those barriers down when you do recognize them. And that's the challenge that I actually love, and that I'm grateful, I guess, with my skin, to be able to do that, 'cause I see that every day.

0:15:41.6 JS: Thank you for sharing that. I think it's always really helpful when we can reflect on the fact that we all do have biases and that we need to think about that in all of our jobs. But I really love what you said about working hard to build that rapport, no matter who that person is, because I think that also shows me what kind of amazing nurse that you are, that you put that much effort, even if somebody's not giving you the time of day, that you will make sure that they are taken care of, and I think that's something, from any of the other SANEs that I've met, feels like a really special thing. Do they teach you about that kind of stuff in school though? I guess I'm thinking about like, this is such a traumatic time in their lives, and so we know everyone responds to trauma really differently. So do they talk about that when you're getting trained about how some patients may react just differently than they would on a normal day? 

0:16:43.4 AO: Well you do get education on the neurobiology of trauma and how to... You can't say what to expect. You can't say what to expect, but better understand the fact that everybody responds differently, and the same person may respond differently no matter how many times you see them for the same thing. But I think that is important for nurses to not just hear it, but to understand it. And one of the ways that it's helpful for that to actually work is to not just take that into your practice of seeing them... Of thinking that when you're working with your sexual assault patient, but take that into your practice with every patient that you walk into the door with. So we are seeing a patient for sexual assault or domestic violence because that's what brought them to us, but that same patient may come to another provider for something totally different, that doesn't mean that those things don't exist anymore, or they're not there, they are.

0:17:37.8 AO: So what happens if we have a patient, so I'm gonna take myself back to my ER setting. What happens if I get a patient in that's intoxicated and obnoxious and mean and just not nice? Am I gonna be like, "Well, you're just drunk, or you're whatever, you're high," that's not like, "I don't have time to deal with you." No, I'm not, I'm gonna acknowledge that whoever this patient is, they're here for a reason, in some kind of way, they have something that they're sick with it, they have an injury or they have an illness, or they have something that's causing them to need my assistance. They wouldn't be there if they weren't. So no matter how much I like how they're behaving or not... Like how much I care about what nasty words come out of their mouth or not, they're still my patient and I still have to accept that they're here because something is going on and they need my help. So it's my job as a nurse, no matter what my role is, is to acknowledge that and take a step back and say, "Okay, where is this patient at? What's going on with them? How can I help them?" First and foremost. That does not mean they're gonna be nice to me. They might not be nice to me until it's time to go home. That's okay. At least I'm there and I'm gonna do my job and I'm gonna get them the care that they need. It doesn't mean my job is gonna be easy, but to me, that's the role of a nurse.

0:19:00.6 JS: Yes, a special shoutout to all the nurses, I think you all do such amazing work. And thanks again for sharing that particular story about your time back in the trauma ER, about... [chuckle] Yeah, I'm sure you've experienced quite a bit in the different settings that you've worked in.

0:19:20.7 AO: I have, yeah. Especially with intoxicated mental health patients, you get a lot of nice things said to you that aren't so nice after all.

0:19:30.7 JS: Right, yeah. But that focus on the care is so important.

0:19:35.2 AO: Yeah, yeah, yeah. And just kinda understanding where they're at, so if I saw them on the street tomorrow, are they gonna act the same way? Probably not, probably not. Am I gonna be mad at them for how they behave when they were intoxicated? No. Why? What's the point? So we all are human. Every single person that we encounter, as far as I know, are human, and we need to treat each other with that human dignity and respect, that's so essential, in every case, in every patient that we care for and everybody that we work with, so that even crosses the borders to the people that you work with. Having that level of respect and the ability to communicate properly and treat each other properly, it helps the environment altogether, even on the days when you have that tough day and everything seems like it's going bad, or you have the worst patients, whether you're doing SANE, or whether you're doing ER or L&D, because everybody has those days where it's just not a good day all around, so having somebody that you can communicate with support you through it. That's essential.

0:20:40.8 JS: Absolutely. So speaking of support, do you have suggestions or ideas about how to diversify the field and support people of color who become forensic nurses? 

0:20:52.0 AO: Yes, I do, I do. So again, I'm gonna even push a little further and say, "Where are you at? Where does your community look like?" You can even just say, "What does your facility that you currently work in looks like?" So you look around, do you see anybody of color, and so not just black people, people of color, and then look at your population that you are actually seeing as your patient, what is the patient population that you're seeing? Do you have people that look like that? Do you have, especially if you're in a community that speaks a second language other than English, like do you have any representation there where people actually will feel comfortable coming there for whatever care you're able to provide them, and if not, then there needs to be a conversation as to why not. Is it why not because no one has thought it was a good idea, no one look for anyone in that way and just didn't think about it, or is it why not because maybe there's not administrative support? It really needs to be assessed why it's not that way, and how can you get it that way, if that's case.

0:22:07.7 AO: One of the conversations that we hear a lot is that nursing is not a very diverse field, and I can say that, yeah, we are lacking in the nursing world, but I can say that forensic nursing is lacking even more. So if you have a forensic nursing program and you know that you're seeing a great deal of patients that are patients of color, and you know that you have nurses within your facility or within your community that you might personally know or know other nurses that know, maybe having conversations that help them first of all understand who you are as a SANE nurse, as a forensic nurse, what you do, and why it may be beneficial for them, first of all, to learn more about it. So it never hurts, like I said, it never hurts to get that education, because that education can take them further than we can imagine. It doesn't mean that they have to necessarily practice, but maybe they can be a champion on their floors or maybe within their facility to actually give voice to those patients that come in that don't wanna talk to anybody else about what happened, it doesn't mean they have to do the exam, but at least they hear from someone else that says, "Hey, I know these great nurses that do this great job specifically around what you're dealing with, can I connect you?" Or if they're connecting you to community resources that are appropriate for that particular culture, that's really good to know.

0:23:32.3 AO: So the point there was to look at what you got and how do you access that? If you can recruit them, that would be even better, but recruiting and training also requires support, so if I hire and train or train and not hire, a million nurses, but don't give them jobs or don't give them jobs where they have the ability to leverage out, they're not gonna stay there. It's not meaningful. So if you're going to go to the extent of actually going that far of training the nurses, and going that far and ask them to join your team, let their voice be heard. Allow them to make a difference because they have something to bring, just like everybody else on that team, every single voice on every single team matters, and I think as managers and coordinators or how our programs are run in that particular area, we have to understand that and be willing to work to make it a little bit better. You can't just say, "Now that I have the space that this is the end of it." No, there has to be additional that goes with it, and I'm not gonna say that's always easy 'cause sometimes it's not. Sometimes that's what the programs want to happen.

0:24:50.3 AO: Sometimes it's higher administration that doesn't necessarily want that to happen, but sometimes maybe you need a little bit extra, so does that mean that maybe you look at your start. So do you look at your sexual assault response teams or your multi-disciplinary teams to talk about what's happening in your communities and what the survivors are talking about when they go to the outpatient services or to the victim services and say, "This is what I experienced," like we have to be able to communicate that. And then take that and say, "How can we do better?" If we don't acknowledge it, if we don't assess it, then we can't change it.

0:25:30.2 JS: Absolutely. Are there other concrete ways you think that we can be more supportive of people of color who are forensic nurses or just nurses in general? 

0:25:44.9 AO: I think really to keep them engaged and to let them know that you're interested in what they have to share. Encourage them to participate. Sometimes, some nurses, it doesn't bother them to be the only black person or the only person of color in a room, but for some nurses it does and it's a lot to be that person. So yeah, it's a lot to be that person, no matter which person or color you are. So here's an example, and I sure hope my colleague doesn't mind me switching it up, I think she would be okay with this, but, here's a way to kind of put it in perspective. How does it feel when you are the only white person in a room of people of color? So I'm gonna put that out there because my colleague and I traveled, we travel a lot, and so one trip we were on in particular, she shared a story with me about how she was in the area, and it wasn't that she didn't feel safe, but she looked up and she realized that she was the only white person there. And she felt a bit of a panic. But nothing bad was happening, she didn't think anything was wrong, but it was like a panicky feeling, and she just remembered that that's the first time she ever recognized that she felt that feeling.

0:27:08.1 AO: And so we joke about it, but I said, "Well, that's 'cause you're the only white person there. I feel that all the time." So we laughed about it, but really take a minute and think about that, like what does it feel like to be that only person? So what if you're the only person in your whole hospital system like that, or your whole hospital, right? So how do we make that feel better, and it doesn't mean you have to go overboard, but it does mean that you do have to be there for support for that person and maybe ask them what do they need. What do you need for me to be successful? Because each person is gonna be a little bit different. So they may not be looking and maybe they just wanna have a voice to somebody to open up to after a case, right? Maybe they want resources to another black nurse, and you may not have that, but maybe you do, maybe you can always reach out to somebody else and say, "Hey, I have a colleague that really just wants to know how the rest of the world is dealing with what's going on."

0:28:05.2 AO: Sometimes we just have to think outside of the box. And sometimes it's okay to ask, and then letting that person know that, yeah, I would love to support you. But don't say it, if you don't mean it. Everyone knows what those empty promises mean. So if your intention is really, "I wanna hear what you have to say, but it may not go anywhere," be okay saying that. So that's better than saying, "Yeah, yeah, tell me, tell me please, I wanna make a difference," and then do nothing because if there's nothing you can do, but you want to give that person the opportunity to voice their concern and voice their opinion, then allow them to do that, but be clear when you are doing that.

0:28:50.9 JS: That's so important, just having that level of transparency in any conversation, but especially if you're in a position of power where you get to make decisions about what happens, not making those empty promises. So thanks for raising that.

0:29:09.2 AO: Yeah. So yeah, I think that what I was just thinking that the other thing that can be done is just really thinking about what culturally specific organizations are within a community, specifically your community, your surrounding communities as healthcare providers. Especially if you are a healthcare provider that is a SANE or forensic nurse, or you have one within your healthcare system, you have a program within your healthcare system, and I just wanted to explain some of the benefits of that. So getting to know those culturally specific programs and the people that run those programs opens the doors for a lot of things, it opens up the doors for the opportunity for you to build relationships that really make a difference, and so I don't wanna make it seem like if you're not doing a culturally specific organization that it doesn't make a difference, because they all make a difference, but if you get to know them and they have an understanding of you and your healthcare system and what you're offering, this is something that they spread within their community. And so I'm talking culture-specific, but it doesn't necessarily mean race culturally specific, this could be your LGBTQ community, this could be your deaf community.

0:30:27.5 AO: If you have the ability to show that we have a connection, that I care about this community. That I want to do things with this community, I wanna learn more about this community, they're gonna have a different perception of you, of the program that you're representing, as well as the hospital system that you're representing. So specifically, if you are a healthcare provider in general. That organization may be able to say to a client that comes to them, "Hey, you know what? I know someone who provides care, they do really good care," maybe they have even decided to come to your facility themselves, they can kind of attest to if you are doing a good job, or if you're not doing a good job. So there you've built rapport, you opened the door for new clients to come in that you may not have, and they also are saying, "Hey, I support you as well," and you're also supporting them. So I just wanted to throw that out there as a reminder or a food for thought for us, because sometimes we don't always think about why that's important.

0:31:30.0 JS: Angelita, thank you so much for joining us to talk about your experience as a SANE and sharing suggestions on how to support a more diverse field of SANEs.

0:31:40.8 AO: Thank you for having me, I totally appreciate it.

0:31:44.4 JS: That is unfortunately all the time we have today, but thank you for listening to this episode of PA Centered. You can learn more about IAFN at forensicnurses.org.

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0:32:02.8 JS: If you or a loved one needs help, a local sexual assault center is available 24/7. Call 1-888-772-7227 for more information, or find your local center online at pcar.org. Together, we can end sexual violence. Any views or opinions expressed on PA Centered by staff or their guests are solely their own and do not necessarily reflect the opinions of PCAR or PCAR's funders.