D030 Task 1 Service Line Proposal and SWOT Example

Nursing Service Line Proposal, Part One: A Regional Sexual Assault Nurse Examiner Service for Three Rural Hospitals, With Market and SWOT Analyses

Student Name

Leavitt School of Health, Western Governors University

D030: Leadership and Management in Complex Healthcare Systems, Task 1

Course Instructor

Month Day, Year

Nursing Service Line Proposal, Part One: A Regional Sexual Assault Nurse Examiner Service for Three Rural Hospitals, With Market and SWOT Analyses

Proposed Nursing Service Line and Its Purpose

The proposed service line is a regional sexual assault nurse examiner (SANE) service operated by a composite health system that owns one 220-bed referral hospital and three rural critical access hospitals within 70 miles of it. The service would provide around-the-clock medical forensic examinations, trauma-informed care, emergency contraception, prophylaxis against sexually transmitted infections and referral to advocacy for adolescents and adults who have experienced sexual assault. Care would be delivered in person at the referral hospital and, at the three rural hospitals, through a hub-and-spoke model in which a SANE at the hub guides the local emergency nurse through the examination by secure video when an on-site examiner is not available.

The purpose is to make sure that every survivor who comes to any of the four emergency departments receives a timely, expert examination close to home. Today only the referral hospital has trained examiners, and only on some shifts. Survivors who arrive at a rural hospital are often transferred or asked to drive more than an hour for an examination, and some decline care rather than travel. Specially trained forensic nurses who provide first-response medical care and crisis intervention have been associated with better psychological recovery, more complete medical care, more thorough forensic documentation and stronger community response, although the studies behind those findings have methodological limits (Campbell et al., 2005).

Leadership Skills and a Diverse Staffing Model

The service needs a nurse leader with three skills in particular. The first is building partnerships across organizations, because the service depends on law enforcement, prosecutors, a rape crisis center and the state crime lab working with the health system. The second is trauma-informed leadership: the leader must protect examiners from vicarious trauma through debriefing, reasonable on-call loads and access to support, since burnout is the main reason forensic nursing programs lose staff. The third is managing change in four emergency departments with different cultures and resources, which requires clear protocols and patience with rural teams who have never had this service.

The staffing model is deliberately diverse. A SANE program coordinator, a registered nurse with national forensic certification, leads the service. Eight part-time SANEs drawn from emergency, women's health and pediatric nursing cover a 24-hour on-call rotation, and the team intentionally includes bilingual English and Spanish speakers and examiners of different genders, because survivors may prefer an examiner who shares their language or gender. Emergency physicians provide medical backup, a victim advocate from the partner crisis center joins every case, and a pharmacist maintains the medication kits. At each rural hospital, two emergency nurses complete foundational training so they can perform the hands-on parts of an examination with remote SANE guidance.

Importance of the Service to the Population

The service matters most to people in the three rural counties, where access to forensic nursing is weakest. A study of 13 Appalachian states found that availability of certified SANEs ranged from 0.34 to 0.86 per 100,000 residents by state and was significantly lower in rural than urban counties (Brannock et al., 2024). For a survivor, distance is not an inconvenience: every hour of travel is another hour before emergency contraception and prophylaxis, another chance that evidence is lost, and another reason to decide not to seek care at all. A regional service built on video consultation has shown promise elsewhere; in a program serving rural and urban hospitals, 89.5% of eligible patients accepted a telehealth SANE consultation (Miyamoto et al., 2025).

Market Analysis

The target population is adolescents aged 13 and older and adults in the four-county service area of about 310,000 residents who seek care after sexual assault. In the composite system's records, the four emergency departments saw 118 patients reporting sexual assault last year, 41 of them at the rural hospitals; 23 of those 41 were transferred for examination and 9 left without an examination. Because many survivors never seek care, demand is likely to rise once a local, reliable service is known to exist.

Referral bases include the four emergency departments, county sheriffs and city police departments, the regional rape crisis center, college health services at a community college and a state university campus in the area, school nurses, and primary care and urgent care clinics in the system. Competitors are few but real: a SANE program at a larger hospital in a neighboring county 55 miles away, an independent child advocacy center that examines children under 13 and would remain the preferred site for that age group, and informal arrangements in which rural hospitals transfer patients to whatever program has an examiner on duty. The proposed service would not compete with the child advocacy center; it would refer children to it and accept adolescents it does not serve.

SWOT Analysis

Strengths (internal): The health system already employs three certified SANEs at the referral hospital who can train and mentor new examiners. The four hospitals share one electronic health record, so documentation templates and forensic photographs can be managed consistently. Emergency physicians and pharmacists support the service and have agreed to standard order sets. The system owns secure video equipment already used for tele-stroke consultations at the rural hospitals.

Weaknesses (internal): Rural emergency departments often have a single nurse on nights, making it hard to release that nurse for a two- to four-hour examination. Staff turnover in emergency nursing could erode the trained workforce. The system has no forensic photography or evidence storage protocols at the rural sites. Nurses at the rural hospitals report discomfort with sexual assault care and fear of testifying in court.

Opportunities (external): State and federal victim services funding supports forensic examinations and examiner training. The regional rape crisis center has offered to place advocates in all four emergency departments. Law enforcement agencies in the area have asked for more consistent evidence collection. Telehealth SANE models are gaining acceptance and published support, which strengthens the case with the system's board.

Threats (external): Reimbursement for examinations is fixed by the state and may not cover full costs. Recruitment of certified examiners is difficult nationwide. Court subpoenas can take examiners away from clinical work with little notice. Public attention to a poorly handled case could damage trust in the service and the hospitals.

References

Brannock, M. K., Sullivan, O. A., & Beatty, K. E. (2024). Availability of certified sexual assault nurse examiners in Appalachian states. Journal of Emergency Nursing, 50(4), 544-550. https://doi.org/10.1016/j.jen.2024.04.003

Campbell, R., Patterson, D., & Lichty, L. F. (2005). The effectiveness of sexual assault nurse examiner (SANE) programs: A review of psychological, medical, legal, and community outcomes. Trauma, Violence, & Abuse, 6(4), 313-329. https://doi.org/10.1177/1524838005280328

Miyamoto, S., Delwiche, J., Mareboina, M., Hur, Y. S., & Greninger, E. (2025). Acceptability of forensic sexual assault telehealth consultation. Telemedicine and e-Health, 31(4), 424-430. https://doi.org/10.1089/tmj.2024.0461