National Tribal Clearinghouse on Sexual Assault
These podcast episodes are being brought to you by the National Tribal Clearinghouse on Sexual Assault (NTCSA). Visit supportingourcircle.org to learn more. Through a partnership between the International Association of Forensic Nurses (IAFN) and Minnesota Indian Women’s Sexual Assault Coalition (MIWSAC), NTCSA offers technical assistance, training, and education on issues related to sexual assault and abuse against American Indian and Alaska Native (AI/AN) populations. NTCSA addresses cultural and traditional needs of AI/AN victims and survivors while strengthening training to improve the response to sexual violence within these communities. This project is supported by grant number 15JOVW-23-GK-03969-INDI, awarded by the Office of Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendation expressed in this podcast are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Justice.
National Tribal Clearinghouse on Sexual Assault
Conversations with a Sexual Assault Nurse Examiner - Part 2
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In this episode, Kim Day shares moments from her career that give us insight to how we can better serve our patients and our community.
Presenter Bio:
Kim Day, RN, SANE-A, SANE-P, retired as the Forensic Nursing Director at the International Association of Forensic Nurses (IAFN) in 2021. In this position, she provided oversight of Forensic Nursing content experts, provided technical assistance, and education around the U.S. Department of Justice’s National SAFE Protocol for adults and adolescents. She holds dual certification as a SANE-A and SANE-P by the IAFN. Ms. Day coordinated hospital SANE program and the county wide Sexual Assault Response Team (SART) for 8 years before beginning her current position. She has been a SANE, caring for victims across the lifespan for 21 years and a registered nurse specializing in critical care and emergency care for over 41 years.
Interviewer Bio:
Blaze Bell is a lifelong Alaskan, Speaker, Singer, and Transformational Coach, who has turned her pain into her purpose. She is on a mission to help others heal, in the ways that she has, from trauma and addiction. Blaze has a popular podcast highlighting healing tools and a new video series interviewing leaders in the healing industry. She is the Board President of Victims for Justice and also frequently works with Standing Together Against Rape (STAR), a rape crisis intervention service in Anchorage, Alaska. As a certified holistic health coach and award-winning singer, Blaze combines her unique skill set to bring the world healing through mindfulness, health, music, and joy.
This project was supported by Grant No.2019-SA-AX-K001 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this presentation are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women or the International Association of Forensic Nurses.
Hello. And welcome to today's episode. This podcast is brought to you by IAFN's, ISAAC project funded by the Office on Violence Against Women. The International Association of Forensic Nurses is the recognized authority on forensic nursing, promoting universal access to care for patients impacted by violence and trauma. The indigenous sexual assault and abuse clearinghouse project has a mission to offer technical assistance, training and education to providers serving sexual assault survivors in tribal communities. I am your host Blaze Bell, lifelong Alaskan dedicated to helping fellow survivors heal from trauma. Today's guest is Kim Day. Before retiring in may of 2021, Kim was the forensic nursing director for IAFN. She began her nursing career in 1998 and has accumulated incredible accolades. Over the years, Kim has worked all over the nation as a speaker trainer and an integral part of national projects. In today's episode, she shares moments from her career that give us insight into how we can better serve our patients and our community. Let's dive in.
Speaker 2:Hello and welcome to this week's episode. I am here today with Kim Day, who as an incredible career as a forensic nurse, uh, and forensic nursing director. So thank you so much for being willing to just share parts of your career and your journey with us.
Speaker 3:Happy to do that Blaze.
Speaker 2:Yeah. So as a forensic nursing director, I'd love to hear kind of what your role was and when it came to the journey of a survivor, where did you fit into the picture?
Speaker 3:Sure. Um, my role as a forensic nursing director was with the international association of forensic nurses. And in that role, I supervised other nurses that were giving what we call technical assistance or help to people who are working in the field. So that was kind of my direct director position until I retired.
Speaker 2:Okay. And then before that, would you share a little bit about your career leading up to that point?
Speaker 3:Sure. I started in 1998 as a sexual assault nurse examiner. Um, in my local community hospital, we started a program there and I took care of the, um, oversight of the program and also saw patients. And then in 2006, I came to IAFN to work providing training and technical assistance or training and, and help to other nurses, um, on the national protocol for sexual assault, medical, forensic exams. And in that role, I, um, helped other nurses who were seeing patients directly to understand what the, um, what the protocol was about and how they could use that to implement change and programs in their own communities.
Speaker 2:Okay. Yeah. Excellent. Well, what do you think? I know IAFN works quite a bit with, um, rural communities as well, um, as urban. And so I'd like to hear if you have any, you know, stories about this or recollections just for, throughout your career, working in different with different communities, what kind of differences did you see, or maybe different ways you had to train people based on if they were in a big populous urban area versus a very small rural community. Were there differences in what you all did?
Speaker 3:There may have been differences in the response pattern and I'm thinking particularly like of communities and rural Alaska, or even anywhere in rural Appalachia or anywhere in the United States. That's very rural, may not have access to the tools that a larger urban program might have. They also interact generally with less, um, multidisciplinary team members. For instance, there may only be one law enforcement officer, or as you probably know in Alaska, not even even one, but a village public safety official to, to work with post assault. Um, but the most important thing that I have found and that I've taught and that's really solidified over the years is the, is the understanding the at a patient is a patient, no matter where they are. Um, the things that the nurse has to do are, are pretty much the same. You take, you're taking care of a patient and, and that means the same, no matter where you are, you may have limited resources for referrals. You may or may not have advocacy in a, we would say in a smaller, really rural area, but even in some of the urban areas, there's lack of patient, um, or victim advocates, and are such a critical piece of, of kind of the team, which I'm saying the nurse advocate patient team that, um, it it's really important that they are involved at all levels also. And I always, um, one of the things that I always remember from what I was when I was practicing was the PA we, we would ask the patient if they'd want advocacy with them. And I, they barely, if ever declined, they even declined after the advocate got to the hospital. So, um, when, when they didn't have a victim advocate and they left after the exam, they were kind of lost. They didn't know what to do next or where to go next. And then they often would call the hospital cuz I was in a hospital based program to find out what to do next. And definitely that's not the role. That's one of the role of the nurse is to take care of the pace. And there may be, um, there may be a need to testify later years, weeks, months, mostly years after the acute assault, but we don't walk with them. We walk them to the door and they should have the advocate holding their hand when they walk further. So that's one really important piece. And we may think that it's only in the rural areas, not unfortunately there is that same, um, especially over the last several years, there's been limited advocacy because, because of COVID
Speaker 2:Sure
Speaker 3:Programs we're doing, uh, trying to do some really, um, unique responses, like, um, doing, tell a response like this on a computer, but, but we know that that's not the same as being able to sit with somebody during the exam be changed and then impacted by COVID.
Speaker 2:Yeah. And I feel like, uh, at least in my community, you know, we have a rape crisis center and they have incredible advocates, but there's only so many. And I feel like, uh, you know, there's also all that follow up time and I've started working as a peer mentor, which I thought could be a great way to kind of fill in some of that time when the advocates have to go from crisis to crisis and they are amazing with the follow up. But again, it also seems to be one of those jobs that is so strenuous and emotionally stressful and physically stressful. A lot of them are on call frequently and I feel like they need a lot of breaks or people burn out and there's turnover. And you know, I just, that's, it's a big job. It's just, it's a lot.
Speaker 3:It does. And, and similarly on the, on the nursing or the healthcare side, it's, it's very much the same. If you have a limited number of people that can even respond to call, then you have, it's exactly the same. You have the, the impact on the health and wellbeing of the nurse of the advocate as well as a patient. And it can be a vicious circle. And a lot of people give up, which is not good and programs close, and we try to make support materials for them through the projects of IAFN, which include that, um, sexual assault program, um, technical assistance, the technical assistance for the nurse, or even an advocate or any member of the team to be able to develop their own protocols, own policies. And we, we have a lot of different, um, at IAFN I'm saying we,
Speaker 2:Yeah,
Speaker 3:We developed a lot of materials and resources to be able to give people. And there are times when we would, they would even need us to go on site to be able to help. Um, and that's, we've done that multiple times also.
Speaker 2:And when you're talking about these resources, are the resources for nurses or are the resources for clients or whom
Speaker 3:They are for, um, professionals that are providing care to patients. So be advocates, victim advocates, nurses, physicians, um, law enforcement officers, also campus, um, professionals,
Speaker 2:Okay.
Speaker 3:One that's it's and, and specifically we're not, um, we're not providing victim care, but we're, we can victims for care. And that, that actually does happen where somebody will call and say, they don't wanna, for instance, I remember one, um, instance where a victim called and wanted to go had been assaulted and needed to go find a healthcare facility that would take care of them. They didn't know where that facility would be. And that's easy enough for us to look up. We do have a, um, nurses in all states and all, and even some that are outside of the United States and we could look up the hospital, but the patient was, um, actually needed the reassurance that they would be treated well when they went to that facility because they had had a history of not being treated well. Mm. And, um, but we were able to find the facility and call, I called the facility and found and spoke to the nurses in the program and found out the name of the nurse on call. And I could give that to the patient that I had permit to tell the patient when they went to the emergency room, they could ask for this particular nurse, they didn't that way. They didn't even have to say what happened to them. Um, the program, the people that worked in the program were able to have that nurse ready at the facility when the patient and came in. That was an example of really kind of, although we're not taking care of the patient, we still were able to facilitate getting that person in.
Speaker 2:Oh yeah. I love that. And I love that you had the resources to communicate that and take some of that stress off of the victim in that moment. That's, that's pretty amazing.
Speaker 3:Yeah. It's helpful. I think it was really, you know, there are very few examples of, I think that we can go down to the level of an actual victim having service at a bedside, but in that case we could.
Speaker 2:Yeah. So one thing that comes up a lot in a, all these different for all these different care providers that are in the journey of a victim from law enforcement, nurses, advocates, compassion, fatigue seems to be big. And we've already talked about this, the turnover of the stress, it's a, you know, traumatizing kind of world to be in. And I'm so grateful for, or everyone who chooses to do this even for some period of time in their life. Um, but I would love to hear what personally, and just with the people you've worked with over the years, what have you seen as far as self care? Like how did you take care of yourself when you were seeing crisis day in and day out and maybe be some other things you saw other people doing, and then maybe on the flip side, like what were some of the struggles that you repeatedly saw or experienced?
Speaker 3:Well, I'll start with the good things that we, uh, managed to do. And if you're a program of only one nurse, this doesn't necessarily work, but you usually had, we always had a, um, a whole team that included what you were talking about, advocates, law enforcement nurses, and, and nurse and other people that worked within the system after a victim was assaulted. And one thing that we did was we had meetings and to try and garner support of the, the fellow people that are in that team, we would every year have a, um, usually at the end of the year, like towards the end of the year, we would have a, a meet and greet and dinner, like appetizers at a local restaurant. And we'd bring everybody together to celebrate, really celebrate the year before. And I, we found that was really a positive thing to do. It made nurses feel really good about what they were doing. It made it, it was it was a good time to talk, not particularly about a case in particular, but to talk about the team and where we were going. And, you know, if we had had any issues that we thought needed to be smoothed out without, um, without, um, damaging any, um, privacy of the patient. Sure. So that was, that was a one good way. Uh, I think it also helps if we had, have, if you are, um, a program to be able to allow, to be able to allow people this either step aside or step back, if they're at that point of compassion, fatigue that you are, you see people that go into the work into this work as a nurse, it is an additional job. It's not, it's an addition to something else that they do. So that makes added stress. And people may not realize that they're burned out. They just sometimes don't have that capacity to be able to see that in. So, and it's really helpful if we can make a safe place, to be able to tell someone, if we think they're doing something that might be indicative of the fact that there need a break and a break can be anything from, you know, as long as they need. And it may end up being that that person doesn't come back when they stop, but the support should still be there. For instance, if somebody was, um, I can think of a nurse that we had, that we don't ask a, why did you, why you questions to a, um, survivor? Just not, not the right time or place and we're, we're not, um, being judgment over them. So if have I, we have had a nurse in one in the program that I ran, um, not at IFN, but in the local hospital, um, we had a nurse who asked, why did you do that? And it was not the first time that we had heard her make a remark that actually was, um, not appropriate to make. Hmm. We had to say, do you, do you feel like it's time for you to step aside or step back or take a break? How about taking a call? Don't do call for a month. And we were, we were actually really blessed to be able to have enough staff at that time to be able to do that. Um, the problem is the nurses are usually really, they give up their time and they're really devoted to providing that care. So sometimes it can be difficult for them to step away. Also know of another nurse that we had in our program, who was excellent. And she, she realized that she needed some time away after a very severe illness in one of her children. So she took off, um, several months, but she also was bilingual. And she, even though she was on leave, she still came in. If we had a, we, I can remember one day when I had a, um, a parent bring a child in and they didn't speak English. And we did use interpreters in the facility, but was this nurse actually came in to take care of this family. And it was really helpful because just because she knew the language to use, to be able to talk to the parents and tell them what was gonna happen, they still had an advocate and they had a nurse taking care of them, but they also had this other nurse that was a additionally. And you could see that her heart was so devoted to this, that she was willing to come in and do that. Yeah.
Speaker 2:Oh, that's beautiful.
Speaker 3:Yeah, it was, it was, I think in general, you find that most of the people that are doing this work have really, um, it's part driven. It really is.
Speaker 2:Yeah. I'm sure. I'm sure. And I felt that when I had, uh, you know, I've worked with a nurse and I had my own case and assault, and I just remember thinking, like she was an angel, I just thought, I mean, I could still picture her. She had this very long mermaid hair. She was very kind and, uh, clearly knew what she was doing, had a very specific job. Um, and also like you talked a lot about the victim advocate and that was my first experience with an advocate. And they were like, almost like the gatekeeper between me and everyone else. And they were so good at anticipating my needs and in ways that I couldn't, I was so distraught and I didn't want anyone to touch me. I didn't, you know, and, and they knew that, and they just stood right there and wouldn't let anyone get by. And, uh, you know, that was a pretty powerful that the combination of the nurse and that advocate, um, and really helped soften into having to interact with law enforcement, which, you know, definitely has a different energy they're, they're there, you know, and, uh, they have an important part to play as well. Uh, but it was a lot and it, I think it probably went the best it could have in that circumstance. Um, so that's good. Yeah.
Speaker 3:That's what we'd like to hear.
Speaker 2:Yeah. Well, I'm so grateful that you're sharing with us today. Um, I won't keep you too much longer, but I would love to hear, you know, know since, you know, so much about I a N and, you know, I'm sure we have quite a few listeners who are other nurses, maybe people even considering this field, um, other care providers, can you just talk a little bit more about the resources that are available and again, who they're geared towards kind of what they're there for, um, just to make sure that the people listening know that they have additional resources cause you, you actually know a lot more than I do about all of everything that exists on these epic websites, just full of information.
Speaker 3:Yeah. IAFN has multiple websites. One of which is the forensicnurses.org site. And that's where, um, a lot of the membership materials are housed as well as the organization's physician papers on things and there's documents on there that are related to all the forensic nursing. So even if you're a death medical death investigator nurse, or you're a sexual assault nurse, or a child abuse nurse or pH, a lot of the materials are located on that site. Another site that we have is the, um, SAFEta.org, which is the technical assistance site, specifically with resources and materials related to sexual assault and abuse across a lifespan. Um, there's all kinds, all kinds of materials there, um, related to the national protocols, um, documents that have been created specifically for taking care of, say for instance, um, victims in prison, um, all kinds of materials that are located on that site. If you can't find what you're looking for, sometimes they may have been filed by somebody that thinks differently than you do, um, technical assistance providers who can, who can provide you and provide materials for you to help. And we also can, um, through that safe TA site also, when you're working with one of the providers, one of the nurse TA providers, um, if there's a need for us to go on site, now this is more in years past, but, um, with COVID, we didn't, weren't able to do go on site until just recently, but we, but in the past, we have been able to, for instance, one in the community where, um, the law enforcement officers didn't were not trusting that the new nurses that had taken training, um, were able to see their client, their victims. And they were transporting them like two hours away when they had a facility that was ready and willing and nurses that were ready and willing to take care of patients. And they were still taking them two hours away. So I talked to the nurses and were able to send, um, a nurse from IAFN who was a, a member along with, um, um, about what we call gynecological teaching associates or somebody to be able to go with her. The two of them went down and worked with the nurses and basically deemed them competent or said, you know, met the law enforcement officers to say that, um, they're perfect. They're capable of seeing your victims. And it can be really hard. It takes trust on the part of the police officers, but they looked, um, to the person that we sent from IAFN, they looked to them as being an expert. And it was then that they was be, feel comfort enough to start bringing patients to them. And that actually persisted for a couple years, we, we would go down every, every so often because there's a turnover in the staff and it worked out really nicely. And we also have the, uh, Indigenous Sexual Assault and Abuse Clearinghouse, or the ISAAC program, which, um, is a newly, um, created, I'd say newly, but it's really a couple of years old now for people specifically working in tribal communities. And that's the focus of that website being Alaska native American, Indian communities.
Speaker 2:Yeah. Amazing. Well, and, and I'll make sure too, that everyone has, um, links to all these different sites and I can attest I've been on the sites. And I mean, if you have, if you have any questions, there are answers there. There's so much information. And I appreciate too, that you said, if, if you can't find what you're looking for, reach, shout, someone will help you.
Speaker 3:Absolutely someone will know, someone will know, and the organization itself has become much larger than it was when I started. It was just myself and the director of the organization that was doing everything. And now it's much more expansive. And we have nurses working that are living all over the country and are able to respond and starting to slowly get back to being able to do things in person.
Speaker 2:Thank goodness. Yeah. Well, Kim, thank you so much. I really appreciate you taking the time and sharing with us. And I also just really grateful that you chose to have this career. And I just know that you really helped so many people, not just the survivors, but by training nurses and making sure everyone is trauma informed and skilled. And, uh, I just really appreciate you choosing to do this type of work.
Speaker 3:Thank you.
Speaker 2:Welcome.
Speaker 1:This podcast is made possible by funding from the Office on Violence Against Women. The opinions finding conclusions and recommendations expressed in the presentation are those of the authors and do not necessarily reflect the views of the Department of Justice, the Office on Violence Against Women or the International Association of Forensic Nurses. If you would like to connect with an advocate after listening to this episode, please call 1-800-656-HOPE that's 1-800-656-4673. To be routed to an advocate in your area 24/7, or go to rainn.org, RAINN.org for more info or live chat.