Sexual Assault Nurse Exams through the National TeleNursing Center
Need: Clinicians in rural areas are often unprepared to treat sexual assault victims after an assault.
Intervention: The National TeleNursing Center (NTC) in Massachusetts uses telemedicine to connect Sexual Assault Nurse Examiners to clinicians in remote areas, offering them guidance through examinations.
Results: Clinicians report that the help gives them confidence through the examination process and NTC has assisted in the care of over 300 patients.
Assault Nurse Examiner (SANE) is a national model of
nursing practice in which nurses receive specialized
training to provide trauma-informed care, including
forensic evidence collection, for victims of sexual
assault. In 1995, the Massachusetts Department of Public
Health (DPH) started the MA SANE program, deploying MA
SANEs to care for sexual assault patients in 30 hospitals
across Massachusetts. It is a challenge in many states,
including Massachusetts, to provide SANE services to all
hospitals, especially in rural locations.
In 2012, the Massachusetts DPH received funds through a
competitive solicitation from the Department of Justice
Office for Victims of
Crime (OVC) to develop and pilot the National
TeleNursing Center (NTC), the first national 24/7
sexual assault telemedicine resource for clinicians.
Through a video conferencing system, NTC links SANEs to
clinicians in rural and underserved areas in order to
provide help in the examination process of a sexual
assault victim following an assault. They also give
guidance on how to collect forensic evidence that is used
to prosecute the offenders. Their goal is to increase the
confidence and competence of rural clinicians in
performing a sexual assault examination, as well as to
give quality support to the patients.
From NTC's headquarters at Newton-Wellesley Hospital in
Massachusetts, NTC's 24-hour call schedule is covered by
21 SANE-certified nurses. Upon a remote clinic's
admission of a sexual assault victim, NTC is notified and
the nurse on call arrives at Newton-Wellesley Hospital
within the hour to provide assistance.
Through a request for proposal process from the
Massachusetts DPH, 6 remote or underserved medical sites
across the nation were chosen as NTC pilot sites. The
following sites were active from 2016 through December
2018, when the federal grant ended:
Twelve national partners have helped to establish and
continue the program. The Massachusetts administration
has recently appropriated funding to help sustain and
expand NTC teleSANE services within the state. Over the
next 18 months, 9 additional teleSANE sites will be
established in addition to the current 3 sites.
Through a Health Resource & Service Administration (HRSA)
grant, NTC is currently providing technical assistance to
East Tennessee State University for the training of new
SANE providers and the use of teleSANE guidance.
The following are services that have been provided
through the National TeleNursing Center at the launch of
the new pilot sites:
NTC staff paid a visit to offer education on their
services and conducted an assessment of the facility's
NTC provided a computer with video conferencing
capabilities, installation assistance, and continued
An information technology liaison was designated to
oversee the accurate functioning of the telemedicine
A clinical liaison was
designated to serve as coordinator with NTC and to
oversee the sexual assault care team.
A local rape crisis advocate is available to provide
emotional support to the patient.
The completed kits are then sent
to a crime lab for analysis.
Following an examination:
NTC nurses review documentation, packing of forensic
evidence specimens and chain of custody procedures with
A debriefing is offered with the clinician to review
the experience. Because these situations can be
emotionally taxing and rural clinicians may have less
experience in conducting such exams, debriefing is key.
The rape crisis advocate links patients with
aftercare and counseling services if desired.
Clinicians are offered continued education regarding
sexual assault and forensic evidence collection.
A full evaluation of the program's effectiveness is
currently being conducted; however, NTC has already seen
some positive results. Clinicians who have used their
services say that the support has helped them feel more
comfortable with the examination process. Before the
clinician can call NTC for help, the patient's permission
As of April 1st, 2019, NTC has assisted in the care of
301 patients. The consent rate of non-military patients
Additional resources explaining the importance of NTC and
Campbell, R., Patterson, D., Lichty, L. F., (October,
2005). The Effectiveness of Sexual Assault Nurse Examiner
(SANE) Programs: A Review of Psychological, Medical,
Legal, and Community Outcomes. SAGE Journals.
Clinicians at remote sites have varying levels of
experience treating sexual assault victims. Many have
either not been trained or have limited opportunities to
use their training as victims may be reluctant to come
forward. This is especially true in remote or rural
communities in which it is difficult to achieve
It is currently a national requirement that any
clinician providing telenursing or telemedicine services
become licensed in every state in which their services
are used. As part of this pilot project, the NTC nurses
were licensed in MA, CA, and AZ. Getting licensed may be
a time-consuming process and delay a nurse's start with
The baseline skill level and training of the remote
site clinicians may vary. It is important to have an
assessment of their level of experience and training when
assisting and/or supporting them.
Complex organizational processes have delayed the
implementation of NTC services in some locations.
The national scope of the program presented some
challenges. NTC is currently developing a uniform way to
provide support and training that meets multiple needs in
Start your program with a strong team and continue to
build it. Ensure that your staff is high-caliber. Be
strict in your acceptance process of SANE nurses.
Prerequisites of NTC nurses include 5 years of experience
as a practicing SANE nurse, expertise in several areas of
practice, and a recommendation from their supervising
nurse. The nurses go through an extensive interview
process, and, once hired, take training classes and
perform clinical practicums several times each year. The
nurses are also required to renew their accreditation on
a yearly basis.
Through sustainable funding sources, NTC is planning on
increasing their pilot sites in selected locations across
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.