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The sexual assault nurse

Nurse discharging patient 
September 29, 2010 -- Tonight NBC's long-running drama Law and Order: Special Victims Unit offered a portrayal of a sexual assault forensic nurse as part of an episode intended, commendably, to highlight the nationwide backlog in analyzing rape kits. But sadly, this was a highly damaging misportrayal of nursing, with the nameless nurse presented as an insensitive technician who carefully collects evidence but utters not one word to the distraught rape victim. The plotline is reminiscent of a November 2004 SVU episode in which a SAFE nurse did get a name and a few lines, but likewise came off as an awkward assistant to the lead female detective character Olivia Benson, who provides all emotional care to the victim. The new plotline does not so strongly imply that Benson is actually directing the exam, but here the nurse character is far more callous. She gets no name and no introduction, and she goes about her work saying nothing, even when she hurts the patient--no warning, no apology, no explanation. Of course, since the show never bothers to identify her to viewers as a nurse, maybe viewers will not see her as one. In real life, it's unlikely a police detective would be present at all for this exam, but it has always been very important to the show to present Benson as the 24/7 advocate and savior of rape victims, so it's no surprise that she again usurps much of the nurse's role. The show also remains eager to portray rape exams as awful ordeals in which the victim is re-traumatized by an insensitive evidence collector, arguably associating the SAFE nurse more with the rape itself than the prosecution. In the 2004 episode, a prosecutor actually described the exam as a "sexual humiliation" comparable to the rape itself. We assume SVU's longtime show runner Neal Baer--a physician who also wrote for ER--knows better than to portray nursing this way. But he and Jonathan Greene, who wrote this episode, seem to have other priorities.

See the film clip in Quicktime at broadband or dialup speed.

It is not beyond the capacity of skilled U.S. television producers to give a fair portrayal of a SAFE nurse, even in a segment that lasts only a few minutes and that involves a heroic detective character. But doing so would require that a show take forensic nursing seriously enough to make that a priority, and not permit the profession to be sacrificed on the altar of anti-crime fury.

The episode, "Behave," tells the story of Vicki Alicia Sayers, who has been stalked and repeatedly raped by the same man over the course of 15 years. The lead New York City detective characters, including Benson, try to protect Vicki and bring the rapist to justice, more urgently when they learn that he is linked to many other rapes in cities across the nation. But a problem in pursuing him is the backlog of rape kits in many cities; thousands of these kits have never been analyzed, and the episode is intended in part to bring attention to this real problem.

As the episode opens, Vicki has just been raped again by her longtime stalker, but he has escaped, and he now seems to present a threat to her life. Benson persuades Vicki, who is very reluctant and scared, to undergo a rape exam for the attack, even though she did that in the past and it led to nothing. Benson also persuades Vicki to accompany her to the hospital the next day, explaining that since she has not changed her clothes or showered, they can still recover evidence. The hospital reference at least hints that a health worker of some kind will be involved. Vicki asks Benson to stay with her; Benson of course says she will do so for as long as it takes.

Next we see an exam room, apparently at the hospital. Vicki and Benson are there. We also see the solid blue scrub pants of a health worker, but we rarely see her face, and never straight on. We do see her patterned scrub top, another clue that she is a nurse; other hospital staff wear those, but few others with advanced training do. The apparent nurse character is mostly just forearms and hands, collecting evidence. Vicki disrobes and submits to her poking and probing.

As the apparent nurse conducts the exam without saying a word, Vicki and Benson speak. Vicki tells her history of being raped, as Benson gently asks for detail. Even when Vicki says something painful, or when she starts crying, as she does repeatedly, the nurse character says nothing. Vicki notes that when the man first raped her, she was a candy striper at a hospital. The nurse shines the ultraviolet light on her body in darkness (looking for fluids, bruises, bitemarks and skin trauma). The nurse takes photos, which at first startle Vicki, but the nurse gives no warning and no apology. The photos are presented as bright, unpleasant flashes, taken in a darkened part of the room; it's not clear why an examiner would not use the existing room lights so they would not need an annoying flash. When Vicki starts to cry, it is Benson who comforts her. The nurse collects evidence from Vicki's head, and she is presented as careful and methodical, at least.

Vicki lies on her stomach. She is describing how the rapist followed her to LA in 2000, just before she was to be married. A rape kit was collected there. As she is describing how the rapist destroyed her wedding plans, fighting back tears, with the camera only on her head, she winces and moves: 

Vicki:  Ow! Please, you're hurting me!

Benson looks up and over, perhaps at Vicki, perhaps at the nurse, as if to question whether that pain was necessary. Next we see the nurse's hands deposit some evidence on a Q-tip in what looks like a little collector thing, next to several thin boxes that say "anal" on them, presumably containing probes. But the nurse says nothing--not before, not during, and not after this obviously painful and highly invasive procedure.

Vicki goes on with her story. She is on her back, legs up, and the nurse seems to be preparing to do a vaginal exam. We actually see the nurse's face briefly as she is handling the speculum. As Vicki continues, she takes Benson's hand for comfort. Vicki describes the most recent attack, and Benson promises her the rapist will never hurt her again. Vicki nods tearfully, and the scene ends. The rape exam scene lasts about 5 1/2 minutes, perhaps one eighth of the episode.

The SAFE nurse character is credited only as "Nurse." In fairness, she is less tentative than the SAFE nurse character who appeared on the show in 2004. "Nurse" seems to know what she's doing with the collection procedures. But she is also grossly insensitive, and it's obvious the show is trying to heighten the drama. Maybe the process is inherently unpleasant and invasive, but it seems that the show wants to signal or reflect the trauma and pain of the rape itself. Of course, the heroic Benson has to be kept clear of that; she is the savior. So it falls to the nurse to inflict the pain, and Benson has further opportunities to provide comfort. You might think the memory of 15 years of getting raped would be dramatic enough, even with a sensitive nurse.

The nurse character's failure to utter a single word in a scene lasting more than five minutes is inexcusable. Maybe Vicki knows the basic exam procedure because she has done it before, but that doesn't mean she knows exactly what is coming at every second, or that she would not benefit from some comfort and the least stressful evidence collection practices. And of course, presenting a nurse character who can't or won't talk reinforces the idea that nurses are not autonomous professionals, but at best technicians who carry out procedures someone else designed. Perhaps they have developed some skill at those procedures, as "Nurse" appears to have in this segment, but the average viewer is unlikely to be very impressed. Nor does the nurse get an opportunity to redeem herself through expert, powerful court testimony; there is no opportunity for that in the episode. We're not sure we can say the character implicates the battleaxe stereotype when she does not speak and does not seem to have much power, but she does have the power to hurt rape victims, and she does not wield that power responsibly.

And there is something even worse. The show's decision to portray the SAFE nurse and her evidence collection this way--as a minor form of sexual assault--associates the nurse at least much with the rape as it does with the prosecution of the rape. And by presenting the rape exam as an echo of the rape itself, as it did explicitly in 2004, the show indirectly compares the SAFE nurse to the rapist. We're confident that was not the show's intention, but it seems to us that is the effect. Sure, if you think about it, without the SAFE nurse there would be no rape kit, but how many viewers will think about it, when Benson and her police colleagues are the ones who spend the whole episode on the rape kit issue? They are the advocates for the rape victims. "Nurse" is more like a robot with no speech function. As it happens, the rapist is also associated with health care; he sells high-end medical devices. However, he is not committing sexual assault as part of his job. SVU's approach is bad for nursing generally but particularly for SAFE nurses, whose work depends in part on gaining the trust and respect of sexual assault victims. The SAFE nurse is the victim's advocate and a key part of the law enforcement team.

It is not beyond the capacity of skilled U.S. television producers to give a fair portrayal of a SAFE nurse, even in a segment that lasts only a few minutes and that involves a heroic detective character. But doing so would require that a show take forensic nursing seriously enough to make that a priority, and not permit the profession to be sacrificed on the altar of anti-crime fury.

Please urge Law and Order:  Special Victims Unit to consider where it's aiming the righteous indignation. SAFE nurses are not part of the problem, but part of the solution.


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