Cato Institute paper on licensure of sexual assault nurse examiners
This Cato Institute policy analysis argues that imposing mandatory licensing, certification, or training requirements for nurses to perform sexual assault forensic examinations (such as those done by Sexual Assault Nurse Examiners, or SANEs) creates harmful barriers that reduce access to care, slow evidence collection, and worsen trauma for victims. The authors describe how SANEs, whose specialty grew through voluntary certification, provide both compassionate medical care and high-quality forensic evidence, increasing prosecution rates. They contend that licensing requirements elevate the cost and burden of entering the field, discourage innovation (for example tele-SANE models), exacerbate practitioner burnout, and concentrate services in urban areas—thereby leaving many victims in underserved or rural areas without timely exams. They also criticize licensing regimes for sometimes favoring professionals (e.g. physicians) already licensed legally but lacking forensic expertise, and for failing to prevent misconduct by licensed practitioners in other contexts. In light of these concerns, the paper recommends that states avoid imposing mandatory licensing for forensic exam providers and instead rely on voluntary certification, employer credentialing, malpractice liability, and market incentives to maintain quality care and broaden access.