Rachal Clark, RN, SANE-A, was in nursing school when she learned the alarming statistics about sexual violence in the United States.
About 1 in 5 women and 1 in 13 men are victims of sexual violence in their lifetime. That’s according to the National Intimate Partner and Sexual Violence Survey. Physical and sexual violence affects millions of women, men, and children each year nationwide.
Rachal made it her life’s work to help victims.
Soon after joining the emergency department at UPMC Williamsport in 2020, Rachal trained to become a sexual assault nurse examiner (SANE). In 2021, she became the forensic nursing coordinator for UPMC Williamsport, UPMC Muncy, and UPMC Lock Haven.
Under her leadership, the forensic nursing team has grown from two nurses to about 20. The team treats victims of sexual violence, intimate partner violence, child abuse, elder abuse, and more.
“You are making such a huge difference in what could very easily be the worst day of their life,” Rachal says. “Giving them some of the power back, giving them some control back, being able to help them get through that, it’s very empowering.”
‘It’s Something That We Should Be Talking About’
Growing up, Rachal wanted to help people, and she also had an interest in law enforcement. Her father is a retired Pennsylvania State Police trooper, and her grandfather worked for the Texas Highway Patrol.
She initially took classes with the thought of becoming a paralegal but decided it wasn’t for her. After taking time off to be a stay-at-home mom, she decided to pursue nursing school.
Rachal initially had an interest in women’s health and thought about becoming a labor and delivery nurse. But that quickly changed.
“(I had) some very personal, private conversations with other students that I’d gotten close with,” she says. “(It helped me realize) the prevalence of sexual assault within our society and just within the circle of friends that I had personally and how much it impacted people.”
Those conversations sparked an interest in forensic nursing, a branch of nursing that connects law enforcement and nursing. Forensic nurses care for victims, collect evidence, and even testify in cases that go to trial.
“You don’t learn about forensic nursing in nursing school,” Rachal says. “That’s not something they teach you. It’s not something that is really out there, and I think that’s probably because it’s such a taboo topic.
“People don’t like to think about it. They don’t like to hear about it. But it’s so prevalent in our society, and it’s something that we should be talking about.”
Rachal researched forensic nursing on her own. The more she learned, the more she wanted to do it.
“I decided that as soon as I graduated, this was something that I wanted to pursue,” she says.
‘Every Type of Assault Matters’
Rachal accepted a job in the emergency department at UPMC Williamsport in 2020. Soon afterward, she completed her SANE training, enabling her to perform sexual assault exams.
In 2021, UPMC Williamsport’s forensic nursing coordinator left. Although she was still a young nurse at that point, Rachal took over the role.
“The program needed some revamping at that point,” Rachal says. “We had gone from a handful of nurses on call for Williamsport and Lock Haven to, at one point, there were only two of us on call for Williamsport, Muncy, and Lock Haven.
“I was taking between 400 and 500 hours of call time a month to try and make sure we had coverage. It was pretty rough at first.”
At first, she went to all new hires in the emergency department to gauge their interest in joining the team. Over time, she honed her approach, going to nurses that she thought had the right qualities.
“It went from, ‘Throw it at everybody and hope it sticks,’ to now it’s a more targeted approach of who I think would be a good fit for the team,” she says. “I think that has worked out really well for me. The current people on the team are all very dedicated and have a significant interest.”
In the three years since Rachal took over, the forensic nursing team has grown to about 20 nurses.
“I think Rachal is phenomenal at what she does,” says Michael Gerst, DO, emergency medicine physician and chief medical officer, Emergency Services, UPMC in North Central Pa. “A program like this doesn’t come without great sacrifice. That means time away from her family, time away from friends, and time away from doing things that she may truly love and want to do.
“But she’s taken a very passionate approach to this and built a program that is the top program that I’ve ever worked with.”
The forensic nursing team’s scope of care also has increased. Initially, the team only saw sexual assault victims. Now, they care for victims of all types of violence.
“Every type of assault matters,” Rachal says. “Every patient that is a victim of violence matters on the same level. We should be providing the same quality of care and making the same commitment to all of them.”
‘Everything We Do Impacts Us’
Forensic nursing can be a difficult job on both practical and emotional levels, Rachal says.
To become a forensic nurse requires over 100 hours of training to treat victims of many types of violence.
The nurses on Rachal’s team also go through a clinical preceptorship. They complete a minimum of three cases under a SANE-trained nurse before seeing any patients alone. That way, they have hands-on experience when they handle their first case.
After their training is complete, Rachal’s nurses are responsible for 48 on-call hours a month to handle forensic cases.
“This is above and beyond your full-time job,” Rachal says. “I’m the only full-time nurse we have as a forensic nurse for our region. Everybody else that’s doing this, they’re volunteering their time above and beyond their full-time hours. It’s a really heavy ask.”
Beyond that, caring for victims of violence can take an emotional toll. Forensic nurses first see victims after their injuries have been medically cleared. They then can spend hours with them — documenting injuries, taking photos, and collecting evidence for law enforcement. And they do it all while providing comfort and support.
“Everything we do impacts us,” Rachal says. “The first pediatric case I ever had, I didn’t sleep for months afterward because that kid was the same age as my kid.”
Rachal says empathy and compassion are two critical qualities for forensic nurses. Every person’s trauma response is different, and it’s important to meet patients where they are.
“The more important aspect of this team is really taking that empathetic, sympathetic approach to patient care,” Dr. Gerst says. “(It’s) being with them and helping them through that unfortunate circumstance.”
In addition to providing immediate care, Rachal’s team connects patients with social workers and community resources. That way, patients get any additional help that they need.
Down the line, forensic nurses may testify in cases they were involved with that go to trial. Rachal testified in several cases in 2024.
“For me personally, getting to see the follow-through and the outcomes of cases has helped me significantly to get over the internal trauma from hearing about all these things and seeing all of these injuries,” she says. “In a way, it’s cathartic. You get to see it from start to finish, and you know that what you did mattered.”
‘We’re Making a Difference. We’re Helping’
Addressing violence is a systemwide effort at UPMC. UPMC has a forensic nursing council that includes forensic nursing leaders from different hospitals, including Rachal. She collaborates with the council to help improve care for victims.
UPMC Children’s Hospital of Pittsburgh provides consultation on pediatric cases.
Having a forensic nursing team is important for the community, Dr. Gerst says. It provides dedicated support to patients and reduces strain on the emergency department.
Rachal estimates her team sees between 80 and 100 sexual assault cases and 120 child abuse cases per year. Through early September, they had covered over 30 domestic violence cases.
“These cases exist. We know that,” Dr. Gerst says. “And rather than ignore it or act as though they don’t exist, we’ve approached it head-on. We have put in place a service that’s needed for the community and that we can provide for the community.”
Rachal’s work is making an impact in north central Pennsylvania. She’s secured funding from the Lycoming County Commissioners to provide for training and education for her nurses.
She says she’s proud of her team’s dedication to helping people. She hopes to increase awareness of her team within the community. That way, victims of violence know they have somewhere to turn.
“I look at it, and I think, ‘We’re making a difference. We’re helping,’” Rachal says. “At least there’s somebody there for them on their worst day. And trying to get that message out is really important because I don’t think everyone knows that programs like this even exist, that there’s a place that they can go even if they don’t want to talk to law enforcement.
“You can still come to us, and we will help you.”