In response to the negative and inefficient treatment of rape victims by emergency room personnel, the first Sexual Assault Nurse Examiner (SANE) programs began in the late 1970s. While SANEs, doctors, rape victim advocates, police officers and prosecutors work together to ensure the most comprehensive and sensitive care of rape victims, they all have very different roles and objectives. This research explores SANEs' perceptions of their relationships with other professionals who treat or interact with rape victims. Data from interviews with 39 Sexual Assault Nurse Examiners from four East Coast states indicate positive relationships are marked by open communication, respect shown towards SANEs as well as rape victims, and a sense of appreciation among SANEs. On the contrary, negative relationships result when SANEs believe police treat victims poorly, when advocates overstep boundaries and question SANEs about evidence collection or the exam, and when prosecutors fail to properly prepare them to testify during a trial.

While Sexual Assault Nurse Examiner programs have improved the treatment of rape victims by offering more compassionate and thorough treatment, SANEs believe victims continue to face revictimization by the medical, criminal justice and legal systems. The purpose of this research is to explore SANEs' perceptions of the revictimization of rape victims by the police, legal system and medical system. Data from interviews with 39 Sexual Assault Nurse Examiners from four East Coast states reveal that most SANEs believe that the medical, criminal justice, and legal systems wield the power to revictimize rape victims. SANEs were more likely to cite the criminal justice system as a source of revictimization, followed by the medical system and legal system. According to SANEs, police contribute to victims' distress through failure to ask questions in a sensitive manner, failure to proceed with investigations, and by asking victim-blaming questions. Revictimization by the legal system results when charges are never filed, cases are postponed or dropped, plea bargains are unsatisfactory, and victims' character and credibility are questioned. Revictimization by the medical system is marked by long waits for medical attention.

Although research has indicated that counselors, advocates and social workers who assist rape victims experience vicarious trauma or psychological consequences as a result of their exposure to victims' traumatic experiences, little is known about Sexual Assault Nurse Examiners' (SANEs') experiences. This qualitative research explores SANEs' experiences of vicarious trauma and burnout as a result of treating rape victims, and the coping strategies they implement to reduce both. Data from interviews with 39 SANEs reveal that when asked about their difficulties as a SANE and the hardest part of their job, the majority (67%) discussed vicarious trauma, the emotional demands associated with the job, worrying about victims after they leave the hospital, and burnout. More than half (51%) of SANEs interviewed specifically indicated that they have experienced vicarious trauma as a result of treating rape victims, and 46% indicated they have experienced burnout at least to some degree. All SANEs, regardless of whether they believe they have experienced vicarious trauma or burnout, have ways to cope after hard cases. These coping mechanisms include talking to family members, calling or reaching out to other SANEs, program coordinators or rape victim advocates and detectives, participating in meetings with other SANEs where the focus is on problems after difficult cases, and finding relaxing activities.

This study explores rape victim advocates' perceptions of the revictimization of rape victims by the police and medical system. Most of the previous research on revictimization focuses on either victims or members of the criminal justice, legal, medical, or mental health systems. The current study provides a more complete picture of victims' possible revictimization by the police and medical system through in-depth interviews with 47 rape victim advocates in four states who had direct experience with police or medical professionals. Rape victim advocates describe the power wielded by the police and medical system to revictimize rape victims and their own role in attempting to mitigate this revictimization.

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