Careers Advice and Frequently Asked Questions

 

Police Custody Nurse / Custody Paramedic

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Q: How do you become a custody nurse/custody paramedic?

A: Custody healthcare providers vary across the UK, as such each provider has different recruitment criteria.  Most contracts employ a mixture of nurses (Adult and Mental Health) and paramedics.

  • Registered with appropriate professional body (NMC for nurses and HCPC for paramedics)
  • At least 3-4 years post registration experience
  • Successful applicants will undergo enhanced background and security checks
  • Applications should be made directly to the healthcare providers or recruitment agencies.  Look for adverts in the relevant professional journals or online adverts

Q: Who provides custody healthcare services?

A: There are several companies providing custody healthcare services with some forces currently employing their staff directly.  The main healthcare providers are;

  • G4S
  • CRG Medical Services
  • Care & Custody Health
  • Primecare
  • Serco
  • mitie
  • NHS Trusts;
    • Leeds Community Healthcare NHS Trust
    • Northamptonshire NHS Foundation Trust
    • County Durham & Darlington NHS Trust

Q: What experience do you need to become a custody nurse/custody paramedic?

A: The exact skill mix of the healthcare team will vary depending on the local health needs assessment.  Custody healthcare is varied and includes a mixture of minor injuries, illness, acute medicine, mental health and substance misuse.  As such, relevant experience includes;

  • Accident & Emergency / Emergency Department nurse
  • Urgent Care / Walk-in-Centre nurse/paramedic
  • Minor injuries/illness
  • Acute mental health experience
  • Prison nursing
  • Substance misuse
  • Acute medicine
  • Ambulance paramedic

Most important is a solid clinical background, ideally with experience of more than one of the above.  Download the joint UKAFN and FFLM Quality Standards for Nurses and Paramedics in General Forensic Medicine.  UKAFN recommends that anyone interested in becoming a custody nurse or paramedic joins UKAFN (see membership page) to be able to access the UKAFN Knowledge base.  To give you additional information, that may give you the advantage in an interview.   The role of custody nurse/custody paramedic is unsuitable for the newly qualified.


Q: What does the custody nurse/ custody paramedic role involve?

A:  Initially, when first introduced, the scope of practice for custody nurses and custody paramedics was limited. However, it has expanded over the past ten years, and there are now only a small number of roles that are not contained within a custody nurse or custody paramedics scope of practice.  For example, a doctor or forensic medical examiner is required to assess individuals who have been subject to a  Taser device discharge or to conduct a formal mental health assessment under the Mental Health Act 1983. Also, the initial evaluation of individuals detained under the Terrorism Act 2000 also requires a doctor or forensic medical examiner.

Custody nurses and custody paramedics work independently and autonomously at an advanced level, that is they work beyond the level of their initial qualification. The work is varied and complex and can be challenging. Custody nurses and custody paramedics are required to diagnose and treat individuals presenting with a broad range of undiagnosed and undifferentiated conditions.  As well as dealing with long-term conditions.  The below is list of commonly undertaken tasks, it is by no means exhaustive;

  • Assessing fitness to be detained in police custody and recommending a level of observation
  • Assessing fitness to be interviewed by police and recommending, where appropriate, safeguards such as appropriate adults
  • Undertaking detailed examination of an individual, forensically documenting any injuries
  • Conducting forensic samples such as;
    • Blood samples;
      • For drug and/or alcohol toxicology
      • For Road Traffic Act offences
    • Hand and nail swabs
    • Cutting and combing head hair or pubic hair
    • Taking swabs of the penis in some rape cases
  • Assessing the need and verifying a detainee’s medication, ensuring that it available in a timely and appropriate fashion
  • Prescribing medication or administering medication using Patient Group Directions (PGD)
  • Assessment of drug and alcohol intoxication and withdrawal
  • Assessment and management of minor injuries
  • Responding to medical emergencies when on site
  • Assessing mental state, mental health, suicide and self-harm risk.
  • Referring to appropriate services;
    • Doctor or Forensic Medical Examiner (FME)
    • Crisis assessment teams
    • Liaison and diversion
    • Hospital
    • Approved Mental Health Practitioners (AMHP)
    • Child and Adolescent Mental Health Services (CAMHS)
    • General Practitioner
    • Social Services (including safeguarding referrals)

Q: Is it dangerous work?

A: Police custody suites are staffed with a variety of staff.  Including Police Constables, Sergeants and civilian detention officers.  Because of the close proximity of police staff, custody nurses and custody paramedics are probably safer in custody than nurses working in Accident and Emergency departments or front-line paramedics.  However, because of the environment, there is a need for a heightened awareness of the risk of violence from detainees.  As such, custody nurses and custody paramedics should be trained in de-escalation and breakaway techniques.


Q: What courses can you attend? Is there on the job training?

A: All healthcare providers are required to provide role-specific induction training and period of supervision for new custody nurses and custody paramedics.  The specifics will vary between providers.  The role lends itself to further studies in;

  • Minor illness/injuries
  • Non-Medical Independent Prescribing
  • Mental health, Mental disorder and Mental capacity
  • Substance misuse, such as the RCGP Part I and II
  • Clinical examination and physical assessment skills
  • UKAFN’s ASET (Advanced Standards in Education & Training)
  • Licentiate of the Faculty of Forensic & Legal Medicine (LFFLM) – General Forensic Medicine (GFM) – Part I & II

Currently, only Staffordshire University provides a UKAFN badged postgraduate training programme.  The Postgraduate certificate, diploma or MSc in Advanced Forensic Practice has two stream, custody and sexual offences.  Successful students will be awarded UKAFN’s ASET certificate.  The PgC involves achieving advanced clinical competencies, a forensic science module, including a practical crime scene examination and a legal skills module, which includes giving evidence in a mock Court.


Q: Under the NHS Agenda for Change, what is the banding for custody nurses or custody paramedics?

A: The majority are band 6.  UKAFN firmly believes that the role of the custody nurse/custody paramedic should be a minimum band 6 and is lobbying NHS England to include this within their specification.


Q: Will I be called to Court to give evidence?

A:  Custody nurses and custody paramedics working in police custody are likely to have to attend Court at some point.  Custody nurses and custody paramedics are required to prepare high-quality statements for the Court based on their assessments, observations or forensic examination.  Where a statement is insufficient alone, evidence may be given in person in Court.  Custody nurses and custody paramedics provide professional witness evidence and not expert opinion or evidence.


Q: Who can I contact for additional information at UKAFN?

A: Click on the contact link. Complete the sections and you will be contacted by a UKAFN steering group member that specialises in that area.


Q: Where can I read more about custody nurses and custody paramedics?

A: The literature on custody nursing and custody paramedics is thin, but it is starting to grow.  Here is a list of available resources.

Articles

  • Payne-James, J. (2017) Healthcare and forensic medical services in police custody – to degrade or to improve? Clinical Medicine.  17(1).  6-7. Click here
  • Holman, A. (2014) Cops, robbers … and nurses.  Nursing Times.  110 (36).  25.
  • Metro (2010) Taken in by custody.  Click here.
  • McKean, S. (2013) The forensic paramedic: an outline of the role and essential criteria for the job.  The Journal of Paramedic Practice.  5 (10).  588-590.
  • Peel, M. (2015) Assessing fitness to detain in police custody.  Nursing Standard.  30 (11).  43-49.

Books;

  • Norman, A. & Walsh, E. (2014)  Nursing in Criminal Justice Services.  Cumbria: MK Publishing.

Professional publications;


 

Sexual Assault Nurse Examiner (SANE)

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Q: How do you become a Sexual Assault Nurse Examiner (SANE) / Forensic Nurse Examiner (FNE)?

A: You should be a nurse with more than three years post registration experience.  Ideally, have a sexual health background or experience in gynaecology (A background where you are competent and experienced in the use of a Speculum).  Companies that employ Forensic Nurse Examiners / Sexual Assault Nurse Examiners:

  • G4S
  • Mountain Health Care
  • Prime care
  • Some NHS Trusts

Forensic Nurses can have full flexibility in the way they work.  There are opportunities for full or part-time contracted hours that usually cover office hours.  There is also the opportunity for zero hours work that covers bank holidays, evenings and weekends.


 

Q: What do Sexual Assault Nurse Examiner (SANE)/ Forensic Nurse Examiners  (FNE) do?

A: Forensic Nurse Examiners vary in their competencies.   It is usual practice to become competent at examining post-pubertal adult women before progressing to become competent at examining men and in some areas examiners have the opportunity to expand their competency to examine post-pubertal adolescents (age 13 and up).  It is usual practice in some areas that Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE)  assist the paediatricians in examining pre pubertal children.

The role of the Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE) is to collect evidence from clients that have been raped/sexually assaulted within a forensic time frame and to provide immediate after care (i.e. Emergency Contraception; Post Exposure HIV treatment and referral on to appropriate follow-up services including Independent Sexual Violence Advisors and Genito-Urinary Clinics).  The work requires focus and attention to detail if you don’t have a good support network amongst your colleagues and at home or access to counselling when you require it, it can be stressful.  You may wish to re consider this type of work if you have other stress factors in your personal life.

While collecting forensic exhibits you need to have a level of detachment from the distress of the client which you can only gain through experience in the role. As nurses, our instinct is to be “nursey”, where as a Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE) role is to balance the nurse role with forensic integrity ensuring not only the collection of exhibits but also documentation and to evidence throughout that you are non-judgmental and unbiased.  Hence the client is referred to as the “complainant” and not the “victim”.

No Forensic examiner should practice without training and Stafford University offer the Advanced Forensic Practice Course and is the first University in the country to provide forensic training for nurses

  • Examination of female / male genitalia (case dependent / based on alleged assault/incident) Recording of DVD genital examinations with Consent (all children aged 16 and under and any case where genital injuries are seen on examination)
  • Referral to other health care professionals, agencies as required
  • Maintain Contemporaneous notes
  • Body mapping
  • Photograph injuries
  • Gather evidence (forensic) case dependent
  • Submit evidence to the Police Peer
  • Review cases examined with Clinical Supervisor (allocated Dr)
  • Attend team meetings, participation in these and peer reviews
  • Training and input for Sexual offence training Police officers courses at the Constabulary Head Quarters
  • Answer phone calls/queries from police for advice re cases or victims they have seen
  • Answer calls and offer advice to health care professionals concerning sexual assault/rape.
  • Examination of Self-referrals to include storage of samples, specimens, etc
  • Provided statements as requested top Police
  • If required and called attend Court
  • Maintain own clinical credibility keep up to date with own training and clinical needs in line with NMC maintain registration, training and development
  • Attend own clinical supervision

: Under the NHS Agenda for Change what is the banding for Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE) are there?

A: This variable as it is a service that is often run by private companies although there are areas where the nurses are employed directly by the NHS.  Often pay, and grading is comparable with a Band 6/7 on the AfC scale.


Q: What courses can you attend? Is there on the job training?

A: All healthcare providers are required to provide role-specific induction training and period of supervision for new Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE).  The specifics will vary between providers.  The role lends itself to further studies in;

  • Minor injuries
  • Non-Medical Independent Prescribing
  • Mental health and suicide risk assessment
  • Clinical examination and physical assessment skills
  • Sexual health studies
  • Safeguarding studies
  • Licentiate of the Faculty of Forensic & Legal Medicine (LFFLM) – Sexual Offences Medicine (SOM) – Part I & II.  Previously referred to as the DFCASA.

Currently, only Staffordshire University provides a UKAFN badged postgraduate training programme.  The Postgraduate Certificate, diploma or MSc in Advanced Forensic Practice has two streams, custody and sexual offences.  Successful students will be awarded UKAFN’s ASET certificate.  The PgC involves achieving advanced clinical competencies, a forensic science module, including a practical crime scene examination and a legal skills module, which includes giving evidence in a mock Court.


Q: How many Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE) are there?

A: There is no accurate figure for the number of Nurses and Paramedics trained in the Sexual Assault Examination.  But what is clear is that many of today’s Sexual Assault Examination healthcare providers are taking on more and more nurses and paramedics.


Q: Who can I contact for information?

A: Your first port of call would be UKAFN.  Click on the contact link. Complete the sections, and you will be contacted by a UKAFN steering group member that specialises in that area.  As it is such a unique speciality, forensic nurses feel supported by this organisation.

Your other option would be to contact your nearest Sexual Assault Referral Center (SARC) and speak to the SARC Manager for advice and information on what vacancies are available.  <<>>


Q: Will I be called to Court to give evidence?

A: Yes you will be cited for court on numerous occasions. You would attend as a Professional witness to provide a witness/statement of factual evidence, based on the clinical notes you made at the time of your assessment of the complainant.  You will not be appearing as an expert witness.


Q: Where can I read more about Forensic Nurse Examiner (FNE) / Sexual Assault Nurse Examiner (SANE)?

A: The literature on custody nursing and custody paramedics is thin, but it is starting to grow.  Here is a list of available resources.

Articles;

  • Cowley, R., Walsh, E. & Horrocks, J. (2014) The role of the Sexual Assault Nurse Examiner in England: nurse experience and perspectives.  Journal of Forensic Nursing.  10(2).  77-83.
  • Day in the Life; Forensic Nurse Examiner.  Click Here

Books;

  • Hammer, R. (2004) Forensic Nursing: A Handbook for Practice.  Canada: Jones and Bartlett Publishers.
  • Lynch, V. & Duval, J. (2010) Forensic Nursing Science.  2nd Edition.  Missouri: Elsevier.
  • Norman, A. & Walsh, E. (2014)  Nursing in Criminal Justice Services.  Cumbria: MK Publishing.

Professional publications;