Our Multidisciplinary Roots— Member Perspective from Virginia Lynch, Forensic Nurse
In 2022, the General Section Historical Committee interviewed Virginia Lynch, MSN, RN, Forensic Nurse, on her start 40 years ago, becoming an AAFS member, and her drive to create the newest Section in AAFS. Read more of Ms. Lynch's story in the interview below.
How did your discipline get started?
Forensic nursing, as a discipline, did not exist when I was introduced to the forensic sciences. Throughout my undergraduate nursing program in the 1980's, there was not a focus on victims of violence and death or the legal issues pertaining to evidence, documentation, or reporting. I became curious about the patients referred to as victims of violence or forensic patients and this emergent science evolved in response to the consequences of global human violence. Meanwhile, my focus became emergency trauma and surgery. I noted that trauma patients were often accompanied by police officers; however, they were not afforded special treatment and vital medical-legal issues were often ignored. Some cases were not recognized as having forensic elements and, therefore, essential assessments, documentation, and reporting did not occur, compromising subsequent legal investigation.
As an emergency/trauma nurse I realized the importance of the legal issues and associated documentation required for law enforcement and judicial authorities. Later, as a surgical nurse I became more aware of the patients who died during surgery and was curious about the reasons that some survived and others succumbed. I asked permission to accompany the decedents to the clinical autopsies and became more interested in issues related to death and dying as a critical component of healthcare. I wanted to understand more about the fascinating issues of both natural and traumatic deaths. I learned that traumatic and questioned deaths were in the jurisdiction of the medical examiner and began to study under the direction of Dr. Charles Petty, Chief Medical Examiner (CME) and Dr. Patrick Besant- Matthews, Deputy Chief Medical (DCME), at the Dallas County (Texas) Office of the Chief Medical Examiner.
Two years later, I was appointed to serve as a Duly Authorized Deputy of the CME in medical death investigations for the Tarrant-Parker County Medical Examiner District in Ft. Worth, Texas. This role became the most intellectually stimulating component of my career.
Although I had a Bachelor of Science degree in Nursing (BSN), death investigation was not a recognized nursing role at that time. After working in the scientific investigation of death, I was committed to the forensic sciences in the area of health and justice. I wanted to learn more regarding the essential subjects that unite health care and the law; the living and the dead.
To find a program offering a combination of both nursing and forensic science, I realized that I had to design and propose a graduate education program for myself based on what I had learned about this discipline, and adapt it to the primary field of nursing. I developed hybrid curricula which included forensic courses, expanding the existing options for the graduate program. I submitted a draft to the University of Texas, College of Nursing, Arlington. Dr. Samuel Hughes, Graduate Dean of Nursing, embraced the forensic curricula concept that I was proposing, and advised me that the proposal would have to be approved by the university's Curriculum Committee and the Board of Regents.
Dean Hughes questioned if forensic science would be approved as an extension of the traditional graduate nursing options. My professors doubted if anyone would register for such novel courses which were considered revolutionary. Despite the wary and those who doubted, my proposal was approved. Forensic nursing became a new graduate option: A Master of Science in Nursing with a Clinical Specialization of Forensic Nursing. It was not only a new venture at the University of Texas at Arlington, but a spark that would ignite the movement for forensic nursing science as a designated nursing specialty.
I was first introduced to the role of the nurse death investigators by Dr. John Butts, Chief Medical Examiner of Alberta, Canada. Dr. Butts had been exploring the concept of which professional discipline was most appropriate to serve as a medical death investigator. After a 5-year study considering various professionals, he concluded that it was the licensed Registered Nurse with specialized forensic training who would be the optimum choice. He recognized that nurses provided the most incisive documentation; understood trauma, medications, and natural disease processes; and appropriately represented him at the scene of death. He further stated that nurse investigators were his best representatives in communicating with families and law enforcement.
Dr. Butts' concept motivated me to apply for a position in this field and I became a medical death investigator in 1984 and then became a member of the American Academy of Forensic Sciences.
Tell me how you became involved in your discipline?
At the time I first became involved, I was a Registered Nurse with a background in surgery and emergency nursing. This was an opportunity to link both fields of practice to the scientific investigation of death as both areas work with forensic patients, many of whom die.
I understood that mistakes in the medicolegal management of trauma and death could result in serious legal consequences. Cases of human violence, sexual assault, child and elder abuse, catastrophic disasters, or other categories of crime-related trauma required specific skills to prevent the mismanagement of significant forensic tasks by physicians, nurses, or first-responders. I envisioned the inclusion of a forensic specialist in nursing could improve the forensic management of evidence, e.g., clothing, drugs, or projectiles, that were recurrently discarded or destroyed due to the lack of knowledge or disregard of forensic issues.
I had discussed the concept of a forensic specialist in nursing with my professor, Dr. Irving Stone, Director of the Southwestern Institute of Forensic Sciences, Dallas, Texas. Dr. Stone had written a letter of reference for me to become a member of the AAFS, not because I was a nurse, but because I was a medical death investigator. Dr. Stone considered the idea for a moment, and then asked me what I would call it — I replied "Forensic Nursing." His approval was a vital factor which instilled the confidence I needed to pursue my goal.
After presenting the proposal for a master's degree program, it was accepted as a new formal graduate option and I became the first graduate student in this first Master of Nursing Science degree in the Clinical Specialization of Forensic Nursing. This program recognized the intricate role nurses can fill between healthcare and the law.
I realized that serious mistakes occurred in the clinical practice of healthcare and I was determined to learn why. However, there was not a resource available for nurses to address the intricate relationship between healthcare and the law. I began to appreciate the complexities and I wanted to know more. It was obvious to me that I would have to learn on my own and discovered it was a greater challenge than expected. As I began to search for programs offering forensic courses within nursing education, I was disillusioned to learn they did not exist, and began searching for various forensic agencies and institutions which might be willing to endorse the idea of a forensic nursing degree program.
Once accepted by the University of Texas Arlington, it became the genesis of forensic nursing science. Currently, there are over 90 formal programs in U.S. universities and colleges offering forensic nursing at various levels. There are certificate programs and unique curricula for both undergraduate and graduate students, encompassing baccalaureate, masters, and doctoral students. Beyond the U.S., forensic nursing educational programs have been established rapidly in an expanding number of countries, including South Africa, Ireland, Iran, Japan, Australia, Brazil, the 11 Balkan States, and the Republic of India, among others.
During my tenure as a medical death investigator, I was taught that death is first a medical concern and secondly a legal concern. To achieve the mutual objectives of both, there is a need for more qualified death investigators. Licensed professional nurses, educated in the science of forensic nursing, are skilled in recognizing the various traumas associated with violence, abuse, death, infectious disease, medication overdose, and liability-related situations.
Nurses are well prepared to manage these cases appropriately, reducing the caseload of the physician. The responding investigator is expected to anticipate the unexpected and recognize obscure medical conditions. There are many findings known to mimic signs and symptoms of natural illness, trauma or infectious disease processes which may be overlooked or confused with suspicious or self-inflicted loss of life.
The Forensic Nurse Death Investigator (FNDI) serves as one member of the Multidisciplinary Forensic Investigative Unit. Death investigation is a complex process, one that involves accurate data collection, communication, and documentation. As a science dealing in an objective assessment of death, the investigative process requires a degree of knowledge in human anatomy and physiology, psychology, basic chemistry, and physics. A variety of disciplines are essential in order to accurately assess, interpret and correlate the various elements involved in decedent identification, cause and manner of death, support and encouragement to survivors and to maintain channels of communication with additional investigative personnel.
Members of the multidisciplinary death investigative team have routinely included law enforcement agencies, crime laboratory personnel, and medical examiner and/or coroner (ME/C) investigators. Additional team members include those specializing in forensic engineering, odontology, anthropology, and the behavioral sciences.
FNDIs have become valued members of death investigative systems and their numbers are increasing in many ME/C jurisdictions.
Medical death investigators must also consider their capacity to deliver highly-sensitive communications when making a notification of death. It is essential to recognize the psychological trauma of death inflicted on an individual experiencing the loss of a significant other, evaluate the extent of emotional distress experienced, and consider if medical interventions are needed. The legal aspects of death are the responsibility of the responding legal agency, thus requiring a multidisciplinary team approach. Forensic nurses are not criminal investigators, but rather clinical investigators of trauma and death in both the living and the dead.
Tell me about how you became involved in your discipline?
I became interested in why patients may die during surgical procedures. Determining the medical cause of clinical death significantly intrigued me. I requested permission to observe the decedent's clinical autopsy. I became further interested in traumatic deaths which were medical examiner cases. Once I stepped into the world of the forensic medical sciences as a nurse, I realized this is what I was meant to do in an affiliate role.
Did something happen in your life that made you realize what your career path should be?
Undeniably, something unexpected happened that redirected my life and my future. After spending 27 years raising a family, I embarked on my first college educational quest in the same year my oldest daughter entered college.
As a teenager I was influenced by a series of experiences responsible for my desire to become involved in healthcare. These experiences
exposed me to operating room observations through a local physician who was Chief of Surgery in a rural community hospital. Knowing of my interest in his work, he arranged for me to witness a wide variety of surgical procedures; I developed an intense interest in surgery and wanted to learn more about the human body and medical interventions.
Was there a certification process within your discipline when you entered?
No certification for death investigators existed at that time. Educational requirements to hold this position were limited in the 1980s. These roles were primarily held by retired homicide detectives with law enforcement backgrounds. Position descriptions were based on their experience with crime-related deaths and no degree or medical education was required. On-the-job training and the completion of the 40-hour Medicolegal Death Investigation Training Program at St. Louis University School of Medicine was an accepted qualification for Texas; I completed this course in 1985.
As trends in medical death investigation were being initiated in various areas of the globe, nurses were working as death investigators in Canada, Australia, Singapore, England, South Africa, Sweden, and several states within the United States. The concept of professionals with a medical-related background who could represent the CME or other officiator at the scene and provide the medical component of the investigation was realized. Common responsibilities included notification of death, and/or providing assistance to police, when necessary, in regard to the body and/or the decedent's family.
The forensic nurse death investigator position was designed to work in partnership with law enforcement officers whose responsibility is the crime scene and the recovery of criminal evidence. The medical investigator's primary responsibility pertains to the body and medical evidence on or around the body as related to the cause of death. The FNDI is not involved in criminal investigation, but rather in the medical component of death and does not usurp the role of other officials in law or medicine. At that time, the posted job description defined by the CME addressed this role as a Duly Authorized Deputy of the CME. The requirements included the following criterion:
- Unrelated to law enforcement responsibilities,
- Basic medical knowledge,
- Background in fundamental psychology, and
- Familiarity with the forensic sciences.
Based on these criteria, I was appointed as a licensed Registered Nurse experienced in trauma and death-related experience, becoming the first nurse field investigator in my rural county of residence.
When did you become a member of AAFS?
I attended my first AAFS meeting in 1985 and became an associate member in 1986, advancing to Fellow in 1995. I have attended every annual meeting, with the exception of 2, throughout my 35 years of membership. I was awarded the 2014 AAFS Kenneth S. Field Award of Appreciation for Outstanding Service, the 2016 John R. Hunt Award for sustained contributions within the General Section, and the AAFS 2018 Distinguished Fellow Award for Meritorious Service by the Academy at large. I am currently a Retired Fellow.
Were education / training a priority in the Academy at that time?
A Bachelor of Science degree was required for membership in the General Section. Advanced education was a personal priority as I sought to increase forensic knowledge provided by the Academy's various section disciplines in the broad field of forensic sciences, independent studies in death investigation, graduate studies in sexual assault examination, employment in medicolegal investigation, designing and implementing the first Master of Science in Nursing degree with a clinical specialization of Forensic Nursing at the University of Texas at Arlington.
How did your education help you succeed in the AAFS?
The above educational experience and achievements have provided me with credibility as an expert in the forensic health and justice systems, which has helped me to advance through the General Section and to achieve recognition in this field and honor within the expansive Academy. My AAFS membership has enabled me to introduce and champion this new science throughout the various forensic disciplines within the Academy each year since 1985. [By selecting me as] a Distinguished Fellow (2018), the AAFS has helped to raise the image and profile of the forensic nurse in countries worldwide.
How did you realize that forensic nursing / training and education should be a discipline/priority within the AAFS?
Having been an active AAFS member since 1986, I was familiar with the various disciplines and the role of the Academy. I did recognize that components of each section were applicable to the various subspecialties of the forensic nursing discipline. However, at that time nurses were not eligible to become Academy members of any associated sections.
By 1991, the Academy's General Section recognized the related aspects of forensic science in nursing and requested that I introduce and define the discipline of forensic nursing at the 45th AAFS annual meeting in Anaheim, California, submitting a request to the membership committee to recognize the science of forensic nursing as an eligible scientific discipline. The officers of the General Section approved this recommendation and forensic nursing became a scientific discipline eligible for membership in the Academy.
The proceedings of this meeting announced this achievement as stated:
In 1991, Virginia Lynch was invited to introduce and define the discipline of forensic nursing at the 43rd annual meeting of the American Academy of Forensic Sciences (AAFS) in Anaheim, California. Forensic nursing was formally recognized as a scientific discipline eligible for membership in the AAFS General Section. Their pronouncement stated (in part) "it is proposed that the body of knowledge recognized as the science of forensic nursing consists of a synthesis, reorganization, and or extension of concepts drawn from the basic or other applied sciences that in their reformulation, tend to become new concepts.
The following year, based on the principles and philosophies of the forensic and nursing sciences, the International Association of Forensic Nurses was founded. In 1995, the American Nurses Association Congress of Nursing Practice bestowed the official status of a nursing specialty upon the science of forensic nursing. This recognition as a specialty status is an important achievement within the profession of nursing.
Were you faced with support and how did AAFS help?
As any new concept initiates a major paradigm shift, there are always obstacles to change. We had the support of the General Section and the encouragement and approval of prominent Academy leaders who helped to overcome resistance to this concept that has proved itself with time. Chief amid this support was Dr. Thomas Noguchi, Dr. Michael Baden, Dr. Henry Lee, Dr. John Kenney, Dr. Douglas Ubelaker, Dr. William Smock, Dr. Joseph Davis, and Dr. Zug Standing Bear, among others.
Conversely, there were those who did not understand or accept the role and the benefits of the forensic nurse, or the void it would come to fill. As other forensic nurses joined and presented their specialty roles, advanced educational qualifications, and scientific research within the associated sections, I strongly believe we have established our presence with respect and acceptance as the forensic nurse membership of the General Section continued to expand. Forensic nurse scientists are committed to the application of the greater forensic sciences within the practice of forensic nursing.
What are the advantages and disadvantages of your specialty developing into its own AAFS section?
I believe this recognition would raise the image and profile of forensic nursing science globally. It would encourage the application of forensic nursing in countries where organizations related to forensic health care and human rights seek new solutions for greater public health and safety in conflict areas where humanity is degraded by interpersonal, structural, and government-sanctioned violence.
A disadvantage is that nurses will be somewhat deprived of the constant challenges, interchanges and mutual support stemming from non-nurse colleagues of a forensic nursing section; the members of this new section would primarily consist of the same forensic nurses belonging to the seminal International Association of Forensic Nurses, the Academy of Forensic Nursing and other international forensic nurse organizations. At the same time, I believe it will provide a resource to Academy members from all sections, nationally and internationally, who continue to request information on the role of the forensic nurse in their areas of forensic science. This specialty is increasingly being sought by countries worldwide.
How did your work on discipline-irrelevant AAFS committees affect your progress through the AAFS?
My non-nursing committees in the AAFS have helped to provide progress and achievements outside of the Academy through participation in and contributions of the International Affairs Committee (IAC), the Humanitarian and Human Rights Resource Committee (HHRRC), and the AAFS Awards Committee. Currently, I am a contributor by request to the General Section Historical Committee.
These committees have been beneficial in my progress through the AAFS by providing member association with many forensic specialists throughout the years. The Academy-wide recognition of my specialty within the International Affairs Committee has provided a means to obtain a closer understanding of the scientific systems and methods of countries outside of the United States.
It has introduced me to colleagues worldwide who are AAFS members and non-members where personal, professional, and collegial relationships have developed. Attending scientific paper sessions presented by our international attendees has developed essential, foundational impressions that have broadened my perspective of trauma-related medical/forensic issues. It has prepared me for being awarded the first Fulbright Scholar in Forensic Nursing and Global Health related to scientific concerns, and violations of human rights beyond our national boundaries.
What are your thoughts on how to keep advancing the field?
The increase in specialty education is directly related to the quality of forensic nursing services. Currently, there is a shortage of educators skilled in the forensic aspects of nursing. This is an area that the AAFS can promote and encourage to the forensic medical community, criminalists, crime laboratory analysts, hospital administrators, and public health and safety services to employ a team of forensic nurse specialists.
How has the AAFS helped your specialty?
Indeed, the AAFS has contributed extensively to the specialty of forensic nursing as a scientific discipline with the acceptance, recognition and respect associated with the American Academy of Forensic Sciences. My AAFS membership has been an influencing factor in the development of this specialty, which has helped me to mentor others across the U.S. and internationally. It inspired me and my writing partner, Janet Barber Duval, to develop the first comprehensive textbook on "Forensic Nursing Science" (Lynch, V., Duval, J. B., 2006, 2011) which is a hallmark throughout the globe.
This publication has guided and shaped the curricula of nursing education and serves as a vital reference for practicing forensic nurses.
Most significantly, the Academy introduced me to my husband of 35 years, Dr. Zug Standing Bear, Fellow; he was the Chair of the General Section in 1986 at the 38th annual AAFS meeting in New Orleans, Louisiana where I presented the first AAFS paper on the forensic nurse in death investigation. Since that time, he has helped me to design, deliver, and promote a paradigm that is changing the manner in which victims and criminal offenders are processed through the health and justice systems. This fortuitous meeting of two forensic minds has created an incredible marriage and evolved into a forensic partnership embracing health, justice, and ethics, thus enhancing both of our lives.
The forensic nurses' partnership with the AAFS has been mutually beneficial. As the Academy has provided credibility and respect to forensic nursing and recognized it as a unique scientific discipline, forensic nursing has contributed to the goals of the AAFS. Examples below represent a portion of the benefits contributed to the AAFS by increasing and improving court testimony, reducing and preventing gender-based crime, and contributing to the workforce of scientific investigation while developing standards for other scientific bodies.
- 2002 - U.S. State of Virginia Supreme Court affirmed the SANE [Sexual Assault Nurse Examiner] expert witness testimony in criminal and civil litigation on the foundation of extensive clinical forensic qualifications.
- 2014 -U.S. Congress and President Obama signed into law a provision SANEs work with military physicians to reduce and prevent sexual assault in the U.S. armed forces.
- 2014 - National Institute of Standards and Technology (NIST) developed the Organization of Scientific Area Committees (OSAC) for Forensic Science to facilitate the development of sound technical forensic science standards and encourage their adoption across the forensic science community.
- 2021 - OSAC launched a forensic nursing subcommittee to draft standards for the evaluation and intervention of all categories of forensic patients. These standards define minimum requirements, best practices, standard protocols, and other guidance to help ensure that the results of forensic analyses are reliable and reproducible.
As we celebrate achievements of the past, we must understand that it is the next 30 years and beyond that will determine the legacy of forensic nurses within the AAFS.
The views and opinions expressed in the articles contained in the Academy News are those of the identified authors and do not necessarily reflect the official policy or position of the Academy.