This study analyzed both county‐level and hospital‐level data in a comprehensive examination of the availability sexual assault nurse examiners (SANEs) in rural areas.
Care for sexual assault victims provided by SANEs is associated with improved victim health and prosecutorial outcomes. Upon completion of SANE training, nurses can demonstrate their experience and expertise by obtaining SANE certification. The availability of nurses with SANE training or certification is often limited in rural areas, and no studies of rural certified SANEs exist. The current study first describes the geographic distribution of certified SANEs across rural and non-rural (i.e., urban or suburban) Pennsylvania counties. It then analyzes hospital‐level data from semi-structured interviews with rural hospital emergency department administrators, using qualitative content analysis. The study identified 49 certified SANEs across Pennsylvania, with 24.5 percent (n = 12) located in 8 (16.7 percent) of Pennsylvania's 48 rural counties. The remaining 37 certified SANEs (75.5 percent) were in 13 (68.4 percent) of Pennsylvania's 19 non-rural counties. Interview data were collected from 63.9 percent of all eligible rural Pennsylvania hospitals (n = 63), which indicated that 72.5 percent (n = 29) have SANEs. Of these, 20.7 percent (n = 6) have any certified SANE availability. A minority of hospitals (42.5 percent; n = 17) have continuous SANE coverage. Few SANEs in rural Pennsylvania have certification, suggesting barriers to certification may exist for rural SANEs. Although most hospitals have SANEs, the availability of SANEs was limited by inconsistent coverage. A lack of certified SANEs and inconsistent SANE coverage may place rural sexual assault victims at risk of receiving lower quality sexual assault care. (publisher abstract modified)