Difference Makers: There is a shortage of nurses trained to conduct sexual assault victim examinations. This nurse is trying to change that

The best part of being a nurse for Jen Cantrell is returning her patients control over their own bodies.

For much of the past decade, Cantrell has provided care to patients who have been sexually assaulted. As a sexual assault nurse examiner (SANE), Cantrell is trained to properly collect evidence of assault but also address traumatized patients in a way that lets them heal.

“When I do an exam, I want to give them back the control that’s been taken from them,” she said.

Among MultiCare’s three emergency departments in the region, the hospital system completed 269 SANE examinations in 2024. However, Eastern Washington continues to have a shortage of nurses trained to complete those exams and help patients. In 2022, for example, MultiCare had 16 SANE-trained nurses across its emergency rooms. Providence Health Care had 25 in its busy ERs.

“We hear horror stories of people in Eastern Washington or Oregon that go in for an examination and have to wait for hours for a SANE-trained nurse to travel from the western side of the state,” said Washington Center for Nursing program manager Frank Kohel.

Cantrell is trying to make sure that does not happen. In recent years, she has pivoted from performing these exams to teaching other nurses how to do them. In 2025, she trained 80 nurses in the region to competently complete the exams.

With a $1.5 million grant from Health Resources & Services Administration, Cantrell has held three trainings this year across the Inland Northwest. The 40-hour training takes place in the course of a week, and an advanced 16-hour training is in the works.

The trainings are the culmination of Cantrell’s long career in medicine. Growing up in California as the daughter of a firefighter and paramedic, Cantrell wanted to be in the medical field from a young age. On Christmas, her father would use medical tape to wrap her presents. One of her favorite gifts was an expired baby blood pressure cuff, which she used to diagnose her dolls.

After initially studying sports medicine, Cantrell found her calling as an emergency room nurse.

“There is always something different happening in the ER. You’re on your toes,” she said. “I can admit the adrenaline is a big draw to that field. But what I really like most is being able to immediately help someone and seeing the impact you’re making.”

Working at ERs in California, Cantrell had “very minimal interaction” with patients who had experienced sexual assault. A specialty forensic nurse would come in from outside the ER to conduct those examinations.

In 2015, she moved to the Inland Northwest and took a step away from the bedside. She returned to school for her master’s in nurse education and later was hired to oversee continuing education for nurses in MultiCare ERs in the region.

In these roles she discovered the availability of SANE-certified or trained nurses were severely lacking in Eastern Washington. Each emergency department had at most a handful of nurses. If any nurse took it upon themselves to get the training, they had to travel to the other side of the state, often covering the costs themselves.

“It just stopped me in my tracks. It blew my mind there was not the people specifically trained in these exams. I realized we needed to do better for these patients,” she said.

In the 40-hour training nurses go through the steps of the forensic exam, how to properly collect specimens and maintain a chain of custody, and how to testify in court about the examination they conducted. Toward the end of the training, they even conduct mock SANE exams on actor patients provided by Washington State University.

But the most important part of the training is how to conduct the exam in a way that makes the vulnerable patient feel safe.

“For nurses conducting these exams, there’s a lot of fear of saying the wrong thing and retraumatizing the patient,” Cantrell said. “So a lot of the course is making sure participants have that confidence in taking care of their patient and helping that person leave the hospital feeling heard.”

The training is also useful for nurses outside of an emergency room context. Sara Welty is the nurse manager for MultiCare’s Medications for Opioid Use Disorder Resource Team. She took the SANE training because those abusing drugs also experience sexual assault at higher rates.

“There is a significant amount of crossover between substance use disorder and sexual assault. And I think it’s fair to say that those patients who are already marginalized by traumatic event like a sexual assault, who are struggling with substance abuse, are super high risk for relapsing,” Welty said.

MultiCare Valley Hospital ER nurse Joey Plumb gained a lot of confidence after he took Cantrell’s training in February.

“Communication with the patient in these exams is much different than most communication in the ER. We are often very fast and direct with patients because we’re trying to turn over as many people as we can,” Plumb said. “But with sexual assault patients you can’t go at that quick pace. You need to move with the patient at their speed.”

Plumb was first interested in taking the training, so a male nurse was available for men who have been sexually assaulted and may feel uncomfortable with a woman conducting the exam.

“I’m the only male SANE-trained nurse in our unit. And people too often don’t really think about men as sexual assault victims,” he said.

Plumb also conducts the exam for women who have experienced sexual assault but typically offers an advocate to be present if that makes the patient more comfortable.

“Doing all the things Jen taught me – being empathetic, letting them move at their own pace – helps create that trust and so far, my patients have been comfortable with me doing the exam,” he said.

While Plumb took the SANE training electively, all the other nurses in his unit will be required to receive the training next year. He hopes to take the advanced training and eventually be SANE board certified.

Cantrell hopes that soon every nurse in the Inland Northwest will receive the SANE training and every sexual assault victim can get the care they deserve.

“Seeing that shift from fear to confidence, and having the nurses report back to us that our training helped them and helped their patient means everything,” she said.