Why sexual assault care falls short in rural areas
Survivors of sexual assault in rural communities often struggle to access specialized care. New research from The University of Texas at Arlington helps explain why.
Nurses in these areas face significant hurdles in becoming certified Sexual Assault Nurse Examiners (SANE), professionals trained to provide trauma-informed care and collect critical forensic evidence.
“We have seen increased efforts over the last decade to provide accessible SANE trainings to nurses living in rural and underserved areas, but that is only the first step of the process,” said Morgan PettyJohn, an assistant professor in UT Arlington’s School of Social Work who coauthored a recent study on the topic for the Journal of Forensic Nursing. “Building a more sustainable SANE workforce in the U.S. requires supportive infrastructures for practice and mentorship opportunities once those nurses return to their communities.”
To earn SANE certification, nurses must complete at least 40 hours of classroom training, a clinical preceptorship and 300 practice hours before sitting for a certification exam.
More than a quarter of women (26.8%) and 3.8% of men will experience attempted or completed rape in their lifetimes, according to the Centers for Disease Control and Prevention.
What led you and your colleagues to focus on rural nurses and barriers to SANE certification?
PettyJohn: Accessing any type of health care in rural areas can be difficult, but it becomes even more so when you’re talking about a subspecialty like SANEs. The stigma of sexual assault can make it difficult for any victim to seek medical support, but survivors in rural areas often face additional barriers from living in insular communities where they or the person who harmed them may have personal relationships with local medical professionals or law enforcement. Having a certified SANE who is an expert in navigating these challenges, both from emotional and medico-legal perspectives, can be critical for survivors seeking out and continuing to access support.
What are the biggest challenges rural nurses face in becoming SANEs?
PettyJohn: Becoming a certified SANE takes a lot of work. They have to carve time out of their existing schedules to complete educational and clinical skills trainings, which for rural nurses may require traveling long distances and taking time away from work and family. Once their training is complete, rural SANEs return to their home communities, where there typically are limited resources. Additionally, case volume is low in rural areas, which creates challenges for completing practice hours for certification and maintaining competencies over time.
Your study points to tele-mentoring as a possible solution. Why is that approach promising?
PettyJohn: Tele-mentoring would allow for newly trained SANEs who are practicing in more remote areas to have logistical support and oversight during medical forensic exams while they are still building their skills and confidence. Texas is fortunate to have a tele-forensic remote assistance center called Tex-TRAC. Through this program, nurses at partnering hospitals in rural and underserved areas can call Tex-TRAC’s 24/7 hotline for support from an expert SANE. My hope is that other states will replicate this model.
What’s next for future research?
PettyJohn: While health care access is becoming increasingly disparate in many parts of the country, rates of sexual assault are not declining. Our research highlights the importance of developing ways to support nurses pursuing SANE certification. Future research should evaluate the effectiveness of the solutions proposed by our team and others in the field in building a more sustainable SANE workforce for the U.S.
About The University of Texas at Arlington (UTA)
Celebrating its 130th anniversary in 2025, The University of Texas at Arlington is a growing public research university in the heart of the thriving Dallas-Fort Worth metroplex. With a student body of over 42,700, UTA is the second-largest institution in the University of Texas System, offering more than 180 undergraduate and graduate degree programs. Recognized as a Carnegie R-1 university, UTA stands among the nation’s top 5% of institutions for research activity. UTA and its 280,000 alumni generate an annual economic impact of $28.8 billion for the state. The University has received the Innovation and Economic Prosperity designation from the Association of Public and Land Grant Universities and has earned recognition for its focus on student access and success, considered key drivers to economic growth and social progress for North Texas and beyond.