Sydney Morning Herald: "Doctors resist forensic role for nurses"

December 13, 2004 -- Today the Sydney Morning Herald ran a piece by Ruth Pollard about the "turf war" between physicians and the New South Wales (NSW) government over a plan to train nurses to collect and present forensic evidence from sexual assault victims. Pollard's article follows one by Miranda Wood the day before, "Nurses to train as sexual assault experts," which provides more detail as to the reasons for the government's initiative. Both pieces also provide an interesting look at some unsupported physician attitudes about the quality of nursing care.

Wood's piece reports that next year the NSW government will introduce a program to train Sexual Assault Nurse Examiners (SANE) to perform forensic examinations and provide evidence in court, in response to an increase in sexual assaults and an apparent lack of interest among physicians in performing the work, especially in rural areas. Queensland and South Australia are considering similar moves. The piece notes that NSW Health Violence Protection Unit manager Jo Spangaro recently toured the U.S., where nurses have provided evidence in rape cases for 30 years, to study the work of forensic nurses there. (Actually, many U.S. forensic nurses are looking to replace the potentially problematic "SANE" name with "Forensic Nurse Examiner.") Spangaro reportedly found that "prosecutors and police [in the U.S.] were strong supporters of the nurses because of the quality of their evidence and availability to attend court compared with doctors." Spangaro noted that juries "responded more positively to the evidence of nurses;" readers would have benefited from data, or at least possible reasons, supporting that assertion. She was also quoted as saying that nurses are "more readily available than medical officers and often have more time available to provide the type of holistic care that a traumatised person needs in these circumstances."

The piece notes that the Australian Medical Association's (AMA's) NSW branch has voiced "concern about nurses giving evidence as expert witnesses," called for a detailed review of the plan, and argued that the government should be encouraging physicians to provide sexual assault services. The piece does not report anyone saying that the government is having a hard time persuading nurses to provide the services.

Pollard's followup piece focuses in more detail on physician objections to the NSW forensic nurse plan, comparing the situation to the "bitter wrangling over the introduction of nurse practitioner positions in NSW hospitals several years ago." The article reports that the AMA's NSW branch has criticized the government for "failing to maintain properly trained and resourced doctors in sexual assault services." Choong-Siew Yong, "chairman of the AMA's medical practice committee," is reportedly concerned about inadequate resources provided to physicians who work in sexual assault services. He argues that these physicians are actually eager to expand their work, and is quoting as saying that "we have been a bit disappointed [at the] emphasis of putting nurses into what is a very important public duty." It's nice that nurses don't have to wonder what this physician really thinks of them, but we would direct him to Ms. Wood's piece of the preceding day, which presented the view of law enforcement professionals as to the competence of nurses to perform this "important public duty."

Indeed, Pollard's piece itself includes remarks from Sydney physician Jean Edwards, "one of [Australia's] most respected doctors in the field," who believes that many nurses have the experience to take on the examiner's position. Edwards is quoted as follows: "I am not suggesting that we do not need doctors ... but I think it is at least possible for a component of work to be done by forensically trained nurses, who are not any less competent than [a] doctor who only does this occasionally." Perhaps this very measured endorsement is designed to soothe ruffled feathers among physician colleagues. Unfortunately, it implies that though highly trained forensic nurses are no less competent at the relevant tasks than physicians who do it only occasionally, they are less competent than physicians who do the work more than occasionally. Edwards cites no evidence for that view, and we are aware of none. As NSW Nurses Association general secretary Brett Holmes, also quoted in the prior piece, noted: "That nurses can undertake some of the roles that doctors have traditionally seen as their own is a reality that everyone in the health field has to recognise."

Both pieces provide a fairly balanced look at the issues surrounding the introduction of these forensic nurses in NSW, including a good deal of information about the valuable contributions of forensic nurses. The Center commends Ms. Pollard, Ms. Wood and the Sydney Morning Herald.