• When receiving services in hospitals by non-specialized staff, rape survivors are at risk of receiving inadequate and unethical care.  They may suffer long waiting periods in emergency rooms, and during treatment may not receive the full spectrum of treatment.  Medical providers may not be sufficiently trained in collecting forensic evidence or in providing emotional support to the survivor.

• Sexual assault nurse examiner programs are those in which nurses are specifically trained to conduct sexual assault examinations and provide care.   In general these programs are designed to emphasize quality of care for survivors. Nurses usually work from dedicated examining suites in hospitals, but some programmes cover several hospitals and thus the nurse travels and there may even be mobile examination facilities (Jewkes, 2006).

• Nurses are usually expected to provide both emergency medical care and facilitate access to on-going support services. They are specially trained through recognised and validated courses and are expected to provide comprehensive medical care. Some programmes have full-time staff and others operate with on-call systems (Jewkes, 2006).

• This model potentially has particular advantages for developing countries where doctors are often in short supply. Since the nurses give evidence in court it is essential that the legal system acknowledges the expertise of nurses and gives equal weight to this as it would to evidence of doctors (Jewkes, 2006).

Lesson Learned:  Ensuring that trained nurses have the resources and support they need, especially in settings where the may have additional responsibilities beyond forensic nursing, is critical to the success of nurse examiner programs. Managers may not recognise that the needs of sexual violence health services should take precedence over those of other aspects of health care. This has been a particular problem in some settings outside North America.