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When the hit Max Original medical drama The Pitt showed a detailed portrayal in February of how a woman sought care at her local hospital following a sexual assault, it brought the experience of Sexual Assault Nurse Examiners (SANEs) into the public eye.
The patient, Ilana (played by actress Tina Ivlev), underwent a thorough forensic medical exam, learned pertinent postassault information, was treated for potential sexually transmitted infections, and offered pregnancy-prevention measures from the department’s charge nurse and SANE Dana (Katherine LaNasa), assisted by recent nursing school grad Emma (Laëtitia Hollard). Chief attending physician Dr Al-Hashimi (Sepideh Moafi) also examined Ilana for injuries, and later in the multi-hour exam, an advocate from Pittsburgh Action Against Rape (Melina Paez) visited to offer support, new clothing, and related information for Ilana to process after her hospital visit.
Dana reassures Ilana throughout that she can take a break at any time, and that the experience will not define her moving forward. Dana also reiterates that it is Ilana’s choice whether to press charges and that the decision doesn’t need to be made that day.
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Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the last time we asked nurses about their emotional struggles at work in the Medscape Nurse Practitioner Burnout & Depression Report 2024, we found that:
- A quarter of nurse practitioners surveyed sought professional help for burnout and depression.
- Traditionally, female nurses find talking with a colleague about their emotional struggles helpful.
- Other coping mechanisms reported included exercise (48%), sleep (46%), and music (44%).
The storyline, which lasts over two episodes, shows the nurses’ sensitivity, precise collection protocols, and ongoing emotional support. It showcases Dana’s commitment as a SANE, as she teaches both the patient and the first-day nurse exactly how the exam should go. When Ilana, who is uncomfortable throughout, says she wants to stop, Dana, who has remained calm and professional throughout, suggests a break. Emma leads Ilana out of the exam room to search “for the good snacks.” Dana, per protocol, must maintain the chain of custody until the evidence is securely locked up or handed over to law enforcement. Once Emma and Ilana leave, Dana breaks down, her face transforms into sadness, frustration, and vulnerability.
Ultimately, Ilana returns and completes the full exam. Done at last, Dana puts the completed kit into a locked emergency room (ER) refrigerator. But she quickly erupts when she sees kits from prior exams, which are supposed to be picked up within 24 hours, still in the fridge weeks later. She calls the local police department and unloads, demanding they send a detective to pick up the kits immediately if they continue to expect rapid ER care when one of their officers needs it.
Experts say it’s impossible not to be affected by the role. “Doing this work is like thinking you can walk through water and not get wet,” said Shalotta Sharp, RN, SANE-A, SANE-P, special projects coordinator for the Mississippi Coalition Against Sexual Assault.
But working as a SANE and training other nurses to become SANEs is Sharp’s passion. She first trained as a SANE in the late 1990s and today offers SANE training to any agency or entity that serves victims of violence. “The most rewarding part in every SANE exam is the difference I see in a patient between the beginning of the exam and the end,” she said. “Almost every patient encounter has ended with me getting a hug from the patient, seeing the patient smile at the end of the exam, and reaching that patient on a personal level as a professional. It’s very rewarding.”
Showcasing how SANEs work helps raise public awareness of who they are and what they do, and The Pitt did a good job, said Kathleen Sekula, PhD, APRN, CNS-BC, who trains nurses to be SANEs at the Duquesne University School of Nursing in Pittsburgh and consulted with the show’s writers, creator Noah Wylie, and for one meeting, Katherine LaNasa herself. “I have had people call and email me to say they didn’t do things in their practice the way [the show did], and that they changed because of it. It was impressive that the show made the points they made.”
Becoming a SANE
It’s too soon to see if the show’s February 2026 episodes have affected the number of patients who come to hospitals for care following sexual assaults, or if the number of cases going to trial has increased. But the need for SANEs is enormous. According to statistics compiled by RAINN (the Rape, Abuse, & Incest National Network), nearly every minute in the US, someone is sexually assaulted, and every 9 minutes, that person is a child. An estimated 443,635 people aged 12 years or older and about 63,000 children experience sexual violence or abuse every year in the US.
To become a SANE, a nurse must take a 40-hour training course that covers trauma-informed care, forensic photography and evidence collection, performing comprehensive medical exams, understanding how to present courtroom testimony, and providing resources for patients. Further certification comes after 2-3 years as an RN, with 300 hours of clinical practice. A SANE may get certified to treat adult/adolescent patients and/or pediatric patients.
But SANE shortages exist. According to a 2025 story published on the American Nurse Journal website, a publication of the American Nurses Association, “as of 2021, only 2135 SANE certified nurses work in the United States, and only 17-20% of American hospitals have SANEs on staff.”
Other factors like burnout affect SANE availability, noted Sheridan Miyamoto, PhD, FNP, RN, SANE-P, an associate professor at Penn State’s Ross and Carol Nese College of Nursing and the creator of the SAFE-T System, a company that provides telehealth technology specifically designed for forensic nurses. Miyamoto has been a practicing SANE since 1999. “Individual programs can be robust 1 month, and then they lose two to three local SANEs, and they are back to square one, so real-time data on availability of SANEs is next to impossible,” she said. “We won’t get there until the standard of care is that all hospitals must offer SANE care.”
Location is another element, said Heidi Gilbert, MSN, RN, CEN, SANE-A, TCRN, an emergency department clinical educator and SANE program coordinator at Stillwater Medical Center in Stillwater, Oklahoma — a college town home to Oklahoma State University. She has been a nurse for nearly 30 years and a SANE for 16. She is also on the board of the Emergency Nurses Association.
“It’s not just the number of SANE programs that are available; it’s geographically where they’re located,” she said. In a large, rural state like Oklahoma, a person may need to drive 4 hours to receive SANE care.
How Virtual Visits Can Help
One way to manage the SANE shortage is with teleSANEs. Where programs are available, SANEs can connect virtually to an appointment at any time with a patient’s permission. Using specific technology, an on-call SANE can view what a local provider sees during a forensic exam. The SANE can then guide a local nurse through the full exam and offer counseling as needed. Availability varies by state. Miyamoto said the SAFE-T System provides a much-needed service. She recounted the story of a patient who sought care at a Pennsylvania hospital but a SANE was not available. Instead, she was discharged with a doctor’s note that said, ‘You shouldn’t go drinking at bars alone.’
“She was blamed for the assault…,” said Miyamoto. A day later, the patient went to a sister hospital with the SAFE-T system in place; there, the teleSANE and the local nurse involved in her case “made her feel believed and safe and told her that the assault never should have happened, and that it was not her fault.” The patient was grateful and was also able to report the first physician so there could be more education involved within that health system. The SAFE-T System is available in 24 hospitals in seven health systems in two states for adult, adolescent, and pediatric patients.
The Legal System
While The Pitt’s episodes showed that some kits hadn’t been picked up by law enforcement in weeks, Sekula noted that today’s kits used in forensic exams don’t require refrigeration or taking blood samples. Pickup delays don’t affect testing results, though they are irritating. “Depending on the evidence obtained in a kit, analysis can take anywhere from about 2 weeks to several months,” she said.
SANEs testify in court on behalf of patients and defendants when patients choose to press charges. Sharp noted that as a SANE, forensic evidence can be collected up to 120 hours after the assault, though “physical evidence that is present immediately after an assault will deteriorate as time passes; if [a patient] does not have an examination soon after the assault, the evidence will be lost,” according to UCLA Health.
“I love going to court,” said Sharp. “It’s an opportunity for me to educate everybody in the courtroom about what I do, why I do it, and about the patients.” At the same time, she admitted that even if a jury decides in a patient’s favor, “no one wins in a court setting because the victim still has to deal with all the trauma they experienced. It’s not like the victim won.”
For Gilbert, who has testified in court many times, the largest problem remains with public opinion. She said she has been part of cases where the jurors believed an accused person was guilty, “but he was a young kid, and they didn’t want to ruin his life.” Public education about sexual assault is crucial, she said. “Ultimately, we’re trying to prevent recidivism.”
While the repetitiveness of sexual assault incidents related to lack of consent has remained the same over the past 16 years Gilbert has worked as a SANE, she said she has seen progress in the legal system related to such cases. Being drunk now means a person cannot consent to sexual activity, rather than being an excuse to not believe a patient’s story. “That has completely flipped” since she began doing this work, she said, attributing the change to the #MeToo movement and other cultural factors.
The Toll on SANEs
SANEs regularly deal with job-related trauma. Peer review and support groups, including virtual forums, can provide scaffolding for SANEs to reduce stress and anxiety and to learn decompression techniques, said Sekula.
Sharp says she teaches her trainees to be aware of burnout, that there’s no shame in seeking therapy, and that nurses can call her to air concerns that can lead to deeper discussions. “You’ve got to have a friend or somebody in your circle that you feel comfortable enough to say, ‘Hey, I’m having a rough time; keep an eye on me.’”
Gilbert said she is very aware that asking SANEs to be on call for sexual assault cases is rough; she has seen SANEs in her program burn out after 3-6 years. “It’s difficult to take call because you’re giving up a lot of your private time, and the work is emotionally and mentally and spiritually draining sometimes.”
To help the situation, she checks in with her team each month and they let her know with a red, yellow, or green light if they want to be scheduled for call.
And yet, being a SANE for some is incredibly fulfilling. For Sharp, it involves taking care of a patient medically and engaging with them at their lowest point. “The ‘kit’ is only one component of the exam,” she said. The larger part is “helping a patient regain control and telling a patient that they are believed.”
Sharp reported full-time employment as a State SANE Coordinator/Special Projects Coordinator (ie, she is paid to be a SANE). She reported that no other agency, entity, or person pays her to promote SANE education or technical assistance.
Sekula reported receiving two major Department of Health and Human Services, Health Resources and Services Administration grants totaling $3,000,000 and one Pennsylvania Coalition against Crime and Delinquency grant for $50,000.
Miyamoto reported having a financial interest in SAFE-T System, LLC. This interest has been reviewed by the university in accordance with its Individual Conflict of Interest policy, for the purpose of maintaining the objectivity and the integrity of research at The Pennsylvania State University.
Gilbert reported having no financial disclosures.
Cheryl Alkon is a seasoned writer covering healthcare and medicine. She is the author of the book Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby. Find her at CherylAlkon.com.
