Credentialing for Death Investigation Still Lags, Nurses Say
By Kelly M. Pyrek
Part one of two articles.
 Talk to just about any forensic nurse and you’ll
discover what they tend to crave most is respect from their colleagues in the
forensic science and criminal justice communities, especially when it comes to
their pursuit of advanced training, specialized education and the widely
recognized, professional credentials and certifications that designate them as
bona fide members of the medico-legal elite.
Even without their detractors, forensic nurses face numerous challenges.
While the specialty has been formally recognized by the American Nurses
Association, forensic nursing is still a conundrum to industry, healthcare and
science in general. The number of forensic nurses also is still relatively
small, although nursing is increasingly beginning to recognize that all nurses
instinctively have and must continue to cultivate their forensic sensibilities.
Internet chat rooms are still filled with dozens and dozens of new and veteran
nurses who are intrigued by forensic nursing but haven’t any idea of the
responsibilities that come with the role or a proper understanding of the
concept of the living forensic patient vs. a forensic nurse’s contributions to
death investigation.
Just ask Meliss Vessier-Batchen, RN, MSN, SANE, assistant professor at the
Charity School of Nursing at Delgado Community College in Louisiana. She
frequently does death investigation as a reservist for the St. Tammany parish
coroner’s office, and says breaking into this specialty can be extremely
challenging. Vessier-Batchen adds that she encountered difficulties when she
approached other parishes about doing ride-alongs with investigators.
“Jefferson Parish has an excellent forensic center but its senior
investigator was not very receptive to nurses because of some past problematic
encounters. I think I have made headway in changing his mind about what
(forensic nurses) can do and how we can help, but only time will tell. There are
rarely many death investigation positions available, even in large parishes. I have been told that most of the investigators leave only when forced to
retire or ‘die out of the position.’ I was fascinated with the fact that
these people are so committed to their work. They go to work sick or well, tired
or not.’
Vessier-Batchen says the reservist program has its challenges because
of low pay and politics. “The reservist program is totally voluntary, with no
pay, and the reservist rides with a regular investigator. I was hired in September as a contract investigator, which means that I carry
a badge and get paid.”
Since enrolling in a doctoral program at Louisiana State University Health
Sciences Center (LSUHSC) with the goal of teaching more nurses about forensic
science, Vessier-Batchen says she has witnessed encouraging change in the
system. “Since my doctoral studies have begun and I’ve shared many of my thoughts
and ideas about investigators, training, education, and registry, the office has
begun looking at those very topics. The senior investigators are very interested
in making the office more cohesive and ensuring consistency across the board for
investigators, regular and reservist alike. The office is now looking at the
American Board of Medicolegal Death Investigators (ABMDI) registry for all
investigators. There is now a response team used by the office to attend scenes
of suicides to help in the coping responses of survivors. I have spoken with the
head of this team and she has expressed excitement in having a nurse in the
death investigation role, so there is much in the works. In an informal survey I
conduct every time I have the chance, death investigators across the country are
not well recognized and are definitely not paid as though they do an important
job. There are some exceptions, but even in the offices specifically using
forensic nurse death investigators (FNDIs), pay is well below bedside salaries.
This may deter many nurses from pursuing full-time employment in the field.
There are also political implications, at least in the coroner systems. This hinders raising the level of professionalism and minimal requirements
for investigators. This trend is disturbing to me, but I am working through many
avenues to change the way it’s done.”
Vessier-Batchen says her knowledge of death investigation was key to helping
her attain her SANE credential, a process she acknowledges is different from
most forensic nurses. “My death investigation experiences actually helped me
with the SANE training, and this may be backward for most. I’ve been told I’m
very unique. I do not see forensic nursing as a branching out of SANE/SART
roles. The roles of forensic nurses are very distinct and although knowledge may
be similar in some aspects (evidence collection, interviews, etc.) many of the
SANEs I know say they could never cross over to my area of interest and
practice. By the same token, my legal nurse consultants have no desire to either
do sexual assault examinations or death investigation. The FNDIs I’ve spoken
with have no desire to practice SANE. I took the route of SANE training to
answer a need in the community and because of the academic area I was trying to
establish. We have no programs in Louisiana that teach forensic nursing. I am
the first here at a doctoral level as far as I know. I felt I needed a more
diverse understanding of other roles in forensic nursing but my true focus and
interest has always been death investigation.”
Bobbi Jo O’Neal, RN, BSN, SANE, F-ABMDI, deputy coroner in Charleston,
S.C., says that in her experience, being a nurse was an advantage. “However, the coroner with whom I needed to network was a nurse. I did not
have to try to convince anyone that as a nurse, I could do a good job. In
coroner systems, if a nurse will run for the elected office, I think (he or she)
will have a distinct advantage. The public values and respects nurses. The public also understands that it is important to have someone with medical
knowledge in the coroner’s office and that the coroner should have a medical
background. Therefore, in our jurisdiction, the nurse, running against police
officers, had a distinct advantage with the public. It was not necessarily a ‘political
advantage,’ however, the nurse was the underdog and did not receive the
support from other ‘political entities’ as did the criminal justice
opponents. The public made the right choice, however. In cases where the coroner
is not a nurse, then I think nurses are at a great disadvantage in trying
to gain a position as a death investigator. Nurses have a reputation as being
caregivers, not as investigators.”
“Being a nurse is definitely an advantage,” says Nancy Cabelus, MSN, RN,
DABFN, a death investigator with the Connecticut State Police. “Having been a
registered nurse and having been an operating room nurse, it was easy to get
used to workplace environments such as an autopsy room or a death scene.
Politically, the medical examiners in my state are very receptive to nurses. I
think they prefer a nurse to a non-nurse because nurses are already trained
medically and they learn very quickly.”
O’Neal says the coroner and ME systems are not created equal and forensic
nurses are discovering that the welcome mat is not always unfurled for them.
“In ME systems, I think nurses are at great disadvantage. Not only do they
need to convince physicians, but also law enforcement. Death investigators have traditionally been persons with law enforcement or
investigative backgrounds. Many offices use criminal justice or forensic
technicians, ‘just because they always have.’ Again, nurses have a difficult
time overcoming that ‘caregiver’ image. Although the public respects and
values nurses, they don’t have an understanding of what nurses are capable of
doing, what their skills are and the many different nursing specialties. We have
a perception of ‘doing what the doctor orders’ and that we don’t really
assess patients ourselves and make decisions.”
In a similar vein, Cabelus says members of law enforcement can be
territorial. “They will not let people into the crime scene that they do not
feel are competent or qualified to be there. Forensic nurses need to get
acquainted with the law enforcement agency that they will be working with. They
should have an introductory meeting or send letters out to the officers who work
off-shifts so that everyone can be advised that there is a new member to the
team. It’s best to know the team players before the game begins; that way,
there is less resistance at the scene if everyone knows who everybody is and
what their role and capabilities are. Once the law enforcement officers know what the forensic nurse can bring to
the table, the confrontational attitudes should diminish and the role will be
respected.”
Like Vessier-Batchen, O’Neal believes nurses have a long road ahead of
them.
“I think we do have a long way to go in order to earn the respect of
forensic pathologists and law enforcement,” she says. “Again it is that
perception of nurses; however, we as nurses have to earn their respect and at
the same time respect them. I see way too many nurses try to enter this field
with a chip on their shoulder and try approaching pathologists and law
enforcement with an attitude that they can’t survive without them. In fact,
these professionals have been functioning for years and years without nurses. We are not going to change that overnight. We have to approach this with a
humble attitude. Nurses do not investigate better than law enforcement. We do it
differently, and by blending the two professions we are able to, as a team, do a
thorough investigation using the skills that each brings to the investigation. I
think in many cases, nurses may be their own worst enemies. As a profession,
nursing is not very good at networking and lobbying. We need to change others’
perceptions of us but we also must change ourselves and learn how to interact
politically with these other professions.”
Knowing that small pockets of support exist, forensic nurses wanting to break
into death investigation are ready to push for the jobs they want.
“I think there are adequate career opportunities out there in the area of death investigation,” O’Neal observes. “The job description may not be written for a nurse, but there are
opportunities out there. It is up to the nurse to open those doors. As with any new specialty, we are plowing new ground, and this is going to be
a long, tedious process. There are many areas of the country where nurses can run for elected office.
The problem is that very few are willing to take that step. Instead, they want
someone to open the door for them. When plowing new ground you sometimes have to open the door for yourself.
However, there are many who would disagree with my last statement. In the areas
where the opportunities are not available, meaning the ME, state or whoever,
will not even consider using nurses as death investigators, then obviously the
opportunities are not readily available. That is where nurses need to use their
networking skills, become creative and start thinking outside the box. If we are
going to practice in a different setting we need to also start thinking
differently.”
“There are a lot of career opportunities out there but the forensic nurse
must learn to network appropriately and market the role effectively,” Cabelus emphasizes. “This is a new field for nurses. A new forensic nurse
will have to design her own blueprint. If the nurse does not exude
self-confidence and does not promote herself for the job effectively, no one
will do it for her. I strongly recommend that my forensic nursing students
polish up their CV and that they have a plan. Never go into a job interview
unprepared. Set your sites on the desired job and, if asked, state your price.
Don’t undersell yourself or underestimate your self-worth. Keep in mind that
most government- related jobs have an established salary scale. If possible,
research this before the interview.”
Vessier-Batchen’s persistence has paid off. “The senior investigator in
Jefferson Parish (who was unsure about forensic nurses) has softened his stance
and has become my cheerleader in taking and passing registry. And I do believe
that prevailing attitudes such as this do impede our entry into and development
of forensic nursing roles in ME/coroner systems. I preach that there must be
some standardization of education and requirements for the role. I see this as
the only way to raise the level of practice. Nurses need to know their stuff.
The only way this will happen is to learn what needs to be learned to function
in the role and through clinical practice, practicum, and doing the ride-alongs.
I always recommend to nursing students asking about my role that they do a real
ride. For some, death investigation is not what they really want to do. For
others, bedside was not what they were meant for. Perseverance is one of the
most necessary characteristics needed by forensic nurses. We will have to
continue to prove what we know, that we can learn more, and that we can apply
what we know. We have some very special skills through nursing and applied to
death investigation, and can continue to use critical thinking, legal charting
and communication, and interaction with people.”
Concurs O’Neal, “Those nurses who practice full time in death
investigation need to continue to plow ground, speak, write and share their
success stories with these other professionals.”
To a forensic pathologist or a death investigator, a forensic nurse’s
education, training and credentialing are areas warranting particular scrutiny,
but there is still a tremendous lack of comprehensive, national standards and
credentialing systems for forensic nurses who wish to work in specialties
outside the realm of traditional nursing. Besides an encouraging number of new
undergraduate and graduate classroom and online programs, there are a few ways
that forensic nurses can gain the knowledge and experience required to work as a
death investigator, one of the more popular career options, especially among
younger nurses.
The ABMDI, a national, not-for-profit, independent professional certification
board, has been established to promote standards of practice for medico-legal
death investigators. It voluntarily certifies individuals demonstrating proven
knowledge and skills necessary to perform medico-legal death investigations as
established in 1999 by the National Institutes of Justice. Earning diplomate or
fellow status with ABMDI and becoming a registered medico-legal death
investigator shows that a forensic nurse has submitted to examination, proves
that he or she adheres to high ethical standards and have attained the knowledge
and skills necessary to perform quality death investigations. Most importantly,
this certification can assist the courts and public in evaluating a forensic
nurse’s competence, especially in the performance of practical application of
knowledge in specialized, technical tasks, including initial body examination at
the scene.
The good news is that the ABDMI openly welcomes forensic nurses and
recognizes that their varied backgrounds can contribute to their success as a
RMDI. Upcoming exams are slated for April 30, 2004 and Oct. 8, 2004 in St.
Louis. (For details, visit www.slu.edu/organizations/abmdi.)
Forensic nurses can
also enroll in the Certified Medical Investigator (CMI) program offered by the
American College of Forensic Examiners International (ACFE). The CMI credential
allows forensic nurses to meet the demand for medico-legal investigation,
including crime scene investigations and preservation of evidence, homicide
investigation, authenticating and presenting evidence, and expert testimony at
trial. (For more details, visit www.acfei.com.) Exam dates are March 12-13, 2004
and May 21-22, 2004.)
Membership and representation in respected forensic
science and criminal justice organizations also can be critical to a forensic
nurse’s professional success. According to Jim Hurley, development director
for the American Academy of Forensic Science (AAFS) the academy currently has
approximately 49 forensic nurses within its General Section (the academy does
not yet have a forensic nursing section). AAFS membership records show that
forensic nurse representation breaks down into 10 students, eight trainee
affiliates, 23 provisional members, two members and six fellows. Having worked
hard to get there are forensic nurses Virginia Lynch, Sharon Crowley, Catherine
Dougherty, Patricia Dunn, Janet Barber Duval, Diana Faugno, Jamie Ferrell,
Constance Hoyt and Georgia Pasqualone, among others.
“I don’t think enough nurses are represented in other forensic
organizations,” O’Neal says. “I think this goes back to nursing as a profession not
supporting itself. Nurses, for the most part, do not get involved; they want to do their job and
go home. When you compare the number of nurses that are members of the ANA, as
compared to the number of physicians who are members of the AMA, it is apparent.”
O’Neal isn’t necessarily advocating that forensic nurses storm the
castle. “I am not sure we should ‘challenge the old guard’ unless the
organization will not let nurses be members. If we challenge them too much, we
will just get a bad name that is associated with a bad attitude. That will get
more doors slammed shut than doors opened wide. Instead, we need to be team
players, explain the skills that nurses have, how a nursing assessment can be
beneficial, and how by using our skills and their skills we can better serve the
public.”
Cabelus acknowledges that a few forensic nurses belong to the AAFS, ACFE and
International Association for Identification (IAI) but adds, “Perhaps they are
not aware of these organizations or how they can assist them in networking,
learning more about the field, receiving specialized training and gaining
awareness of job opportunities. It is not that nurses are not welcome into these
groups, it’s that nurses have not sought them out.
What organization is going to refuse membership dues? Personally, I belong to
11 professional organizations, and annual dues payments add up to over $600 per
year. Many people cannot afford to be as aggressive as I am with professional
memberships and I don’t recommend that nurses join organizations without
getting involved — that would be a waste of money. I have donated my time and
services to the organizations that I belong to by serving on a committee,
writing an article, volunteering, giving a presentation or attending the
meetings. In return, I get three-fold what I put into them.”
O’Neal says she is dissatisfied with the training and credentialing offered
to nurses but adds, “From a credentialing standpoint, death investigation as a
whole is just beginning to certify investigators. This is a great step. The
specialty of death investigation is moving in the right direction. This
credentialing is not required yet, but again, it is a good beginning. It all
begins with baby steps. In the same light, training is not adequate. Most people
‘learn while doing.’ Although there are some good courses out there,
hands-on training is extremely valuable and needed, for nurse and non-nurse
death investigators.”
It becomes more difficult to track representation by forensic nurses in other
professional organizations due to imprecise record-keeping or the sheer volume
of membership. The National Association of Medical Examiners (NAME) cannot
report how many forensic nurses are working in ME offices around the country,
but NAME president Michael Bell, MD, says forensic nurses are often put off by
the demanding hours and relatively lower pay that death investigation involves.
Julie Howe, a representative at Saint Louis University, recognizes “a definite
trend for nurses entering the field of medico-legal death investigation” and says forensic nurses show interest in the university’s popular
Medicolegal Death Investigator’s Course held three times annually. (For
details, visit: http://medschool.slu.edu/mldi.) So what happens when a forensic
nurse does manage to gain a foothold?
“The first thing nurses need to do if they have attained a position is to
do a good job,” O’Neal says. “These nurses need to be aware that they are
paving the way. If they get lazy, have bad attitudes, or are difficult to work
with, that will leave a bad taste in the mouths of those they work with and will
shine a bad light on all nurses. Just as with our internship, we check everyone
before they are accepted into the program. We want to be proud of those
individuals that we teach. I don’t want them going back to their home state,
getting a job and doing a terrible job.
That sheds a bad light on us and on nurses, which will only make it more
difficult for those following behind them. Those in death investigation
positions need to also continue to teach, write and speak. It is only through
our experiences that we share with our profession that will allow others in the
profession be able to learn and grow. By hoarding our information we are not
helping our profession at all, in fact we are hindering it.”
The sentiment that classroom curriculum is no substitute for hands-on
experience is frequently heard among forensic nurses discussing training and
education needs for new nurses and even veteran nurses wishing to change a
career course. O’Neal says that despite the overwhelming popularity of
Charleston County’s hands-on death investigation internship, it has not been
expanded to include more nurses’ participation due to strained resources.
“We wish we could; however, we can only accommodate so many nurses each
year and still provide the quality of service that our constituents deserve,”
O’Neal adds. “We hope that more nurses will fill these roles and can begin teaching as
well. We do have a long list of nurses interested in the internship, with more
calls and e-mails coming in each week. We have been asked to partner with one
graduate forensic nursing program to assist them in providing hands-on
opportunities for their students. It is important that nurses seeking a master’s
degree in forensic nursing complete programs with hands-on experience. Right
now, that experience is limited. The advanced education is a starting point,
however we must remember that this traditionally a criminal justice specialty,
where hands-on investigative experience is valued just as much if not more than
advanced degrees.”
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