Forensic Nursing: Part 2. Inside Forensic Nursing

Laura A. Stokowski, RN, MS

Disclosures

Medscape Nurses 

In This Article

Nurse Death Investigator

It takes a certain type of nurse to be able to deal with death and dying all day, every day. Stacey Mitchell, DNP, RN, Deputy Chief Forensic Nurse Investigator in the Harris County, Texas Medical Examiner's Office has been doing just that for nearly 6 years. "We see a lot of things that are sad and disturbing, the worst of what people can do to other people," says Dr. Mitchell.

Nurses who conduct medicolegal death investigation are known by different titles, such as death investigator, forensic nurse investigator, deputy coroner, or even coroner. Nurse death investigators (NDIs) have the authority to confirm or pronounce death, establish decedent identification, and notify next of kin.[6] Their skills enable them to perform the critical components of death investigation -- ascertaining medical and social history of the decedent, examining the body, and investigating the scene -- all with the compassion characteristic of the nursing profession. The NDI's findings assist the medical examiner or coroner to determine the cause and manner of death.

Nurse death investigators from the Harris County Medical Examiner's Office receive more than 15,000 death reports annually. On call 24 hours a day, during 2007 the office's 9 nurses responded to the scenes of more than 2000 unnatural or unexpected deaths to determine what type of investigation was indicated. At each scene, the nurse death investigator takes photographs, examines the body, and interviews family members in order to establish a preliminary manner of death.

Nurse death investigators work closely with law enforcement, social services, organ and tissue procurement agencies, and the community. A large part of their work is educating families: explaining procedures and test results and interpreting autopsy findings. "Television programs have given some people unrealistic expectations about death investigation. DNA results do not come back in an hour," notes Dr. Mitchell. Two of Mitchell's nurses exclusively conduct follow-up, tying up loose ends and notifying waiting families of final rulings.

It isn't hard to see why nurses are the ideal professionals for the role of death investigator. Nurses combine superb assessment and teaching skills with empathy, concern, and kindness and are accustomed to the hard work required of the death investigator. Nurses can understand and interpret complicated medical records and medical histories of the deceased. Harris County's NDIs come from diverse nursing backgrounds, including emergency nursing, intensive care, psychiatry, and neonatal intensive care. Dr. Mitchell was an FNE for 9 years before being recruited by Harris County to set up the forensic nursing program. Although she earned a doctorate in forensic nursing from the University of Tennessee Health Sciences Center, this level of education isn't required to become an NDI. To build her staff, Dr. Mitchell looks for strong assessment skills and a desire to work in a forensic field.

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