In the fall of 2022, a sexual assault victim (survivor) was sent home from a Fredericton emergency room (ER) and instructed not to wash until a forensic nurse was available. The lack of urgency to appropriately care for this person during this incident, and the request for them to remain “as is” after they were sexually exploited, is blatantly traumatizing.
This incident is the result of a lack of trauma informed staff in the ER. Registered nurses in the ER must have trauma-informed care (TIC) training to be able to care for clients safely and competently.
Sexual assault is not a rare occurrence. The Government of New Brunswick reports that every single day an act of sexual violence is committed in the province. The survivors of these crimes will enter our ERs in very delicate situations, requiring and deserving a nurse with a trauma-informed approach to provide safe, affirming, and empowering care.
Trauma-informed nurses are equipped with a holistic lens that guides them to recognize the prevalence of trauma in survivors, to address trauma, understand the diverse manifestations caused by trauma, and to empower sexual assault survivors.
When nurses lack this holistic, trauma-informed lens, survivors are subjected to traumatizing barriers when they access the ER. A few of these barriers are victim blaming, pressure to speak to authorities, skepticism of their experience, and being rushed through examinations and explanations, and like the survivor who went to the Fredericton ER, some are turned away.
Survivors of sexual assault are already at a high risk for depression, anxiety, post-traumatic stress disorder, substance use disorder, suicide attempts, and other psychological and physical diagnoses. If ER nurses are not trauma-informed, traumatizing interactions with ER nurses will only intensify these choking odds for survivors.
Another consequence of non-trauma-informed care in the ER is acquired mistrust of the health care system, and of nurses. ER nurses are often the first point of contact for survivors, and all it takes is one action, one comment, or “gut” feeling to cause a survivor to lose trust in the health care system, and in turn to develop a hesitancy or aversion to seeking any care at all. This is concerning because survivors who are turned away from the ER or fear accessing it may be returning to dangerous situations or the lethal hands of an abuser.
As a student nurse at the University of New Brunswick in Fredericton, I have been exposed to the trauma-informed approach in multiple courses. It sounds great on paper; new nurses are graduating with an understanding of TIC to implement in their practice. However, it is apparent that in ER settings, like in Fredericton, many nurses currently practicing are not well informed of this approach, and patients are being left traumatized or retraumatized during and after care.
Horizon Health Network, one of two health authorities in New Brunswick, has only one TIC e-learning module available on its online employee platform called Skyline. And for ER nurses, it is not mandatory or suggested in job postings that TIC training is an asset to possess for an ER position.
Educating nursing students is not enough. All practicing ER nurses should be educated in TIC to make a difference in the care provided to survivors of sexual assault. Horizon Health must require ER nurses to complete this TIC e-learning module, and must provide ER nurses with mandatory follow up and debriefing sessions of their experiences caring for survivors of sexual assault, to ensure adequate implementation of the approach.
Some may say nurses in New Brunswick are too understaffed for Horizon Health to implement mandatory TIC training. Yet the problem with not implementing this training is that even the most basic care tasks such as greeting patients in the ER or washing them up, can be laced with traumatizing actions. Without TIC, nurses will worsen trauma stemming from violent sexual encounters and amplify long-lasting impacts on survivors’ health.
The trauma-informed education in place at the University of New Brunswick for student nurses, and the single (optional) e-learning module offered by Horizon Health is not nearly enough to stop survivors from being traumatized. To stop the traumatization of survivors, Horizon Health Network must mandate TIC training for nurses in the ER and implement follow up with employees who have cared for sexual assault survivors.
With the high incidence of sexual assault in the province, and the known corresponding psychological trauma and health impacts for survivors when they do not receive proper care, it is critical to implement TIC training for ER nurses now more than ever.
Meagan Strickland is a nursing student at The University of New Brunswick in Fredericton.
