SANE Nurse. Cornell Mom. FNP/PMHNP.

Sexual Assault Has No Profile, and Nurses Need to Be Prepared to Support Whoever Walks Through the Door

By Rachel Y. Hill, DNP, FNP-BC, PMHNP-BC, AHN-BC, HWNC-BC

Content note: This post discusses sexual violence and may be triggering. Please read it when you have the space, and see the support resources at the end.

A Word Before I Begin

Before I say anything else, I want to be clear about what this is not.

This is not about taking anything away from the woman at the center of the Cornell case, known publicly as Jane Doe.

Her story is hers. What I share here is mine.

And it comes from the many seats I have sat in over the years.

I mention the case because it reopened something in me, and in a lot of people, and because it reminds us how many survivors never get a public hearing at all.

I can't say I know what happened at Cornell.

I wasn't in the room.

What has circulated on social media has felt nothing short of horrifying, to say the least.

But social media is not a courtroom, and not everything that circulates is established fact, so I believe evidence should be weighed fairly and objectively.

False accusations can destroy a life, and so can abuse, which is exactly why the truth has to be pursued and not managed.

I have many stories from my years in this work.

I am not going to tell them all here, and I am not going to share the endless accounts of children I have supported through therapy.

Those belong to the people who lived them.

What I can share is what all of those stories taught me about how to be prepared, because someone is always walking into a clinic or an emergency department having just survived the worst thing that has ever happened to them.

I was a S.A.N.E. nurse first, a Cornell mom second, and a psychiatric-mental health nurse practitioner (FNP/PMHNP) third.

And before any of those, I was a victim.

First, I Was a Child Who Wasn't Protected

I grew up seeing the people who hurt me every single day in our home.

Then every Sunday I watched them praise God as if nothing had ever happened.

That taught me early what silence can look like when it wears its best clothes.

I learned that being close to something holy is not the same as being safe, and that the people who protect their image will sometimes protect it at your expense.

I also saw how far accountability would go.

I watched how it bent when a person could give a generous offering.

I watched it show up when there was something to gain, or when it could be used to advance a cause.

I wished I could have seen true accountability for my sisters and me, and it never came.

Instead, the explanation was that Satan was always the culprit, and that what had happened was spiritual warfare against the man who harmed us and his family.

That is how we were gaslit into being the problem.

I know.

I stopped talking about it.

I dealt with it on my own, quietly, the way a lot of survivors do.

I decided my shoulders were broad enough to carry it.

They were.

But carrying something alone for that long changes the shape of a person.

It is also why I became the nurse I became.

I wanted to support others in the best ways I could, in the ways I had needed someone to support me.

Then, I Was a SANE Nurse

I worked on the forensic side of things, alongside law enforcement.

I did my best to make a difference, and I hoped that it was good enough.

I have held the hands of many people through a rape exam.

People imagine a kit and a checklist.

They don't picture the reality of it.

We don't just take hair samples. We pull them from the roots.

We swab every place there was contact.

We photograph.

We collect.

And all of it happens while a traumatized person is asked to tell their story out loud in a cold emergency room, with their mind running through the questions:

How did I get here?

How did this happen?

What did I do?

Who would put themselves through that for no reason?

The Weight of What Nurses Witness

I remember the tears and the shaking.

I remember the loneliness in the room and the isolation that so often followed.

I remember the police interviews, which could feel like one more interrogation on top of the first.

I remember my own questions, the ones I carried home with me.

And I remember the on-call and the burnout that came with it, from learning that there was always someone being raped, sometimes more than once a night, in the ED.

It was mind-boggling then, and it still is.

I was never called to trial.

I only hoped the kits hadn't sat so long, so backed up, that the evidence had gone bad.

That is a strange thing to carry.

The hope that the work you did in a few exhausting hours would still mean something years later, waiting on a shelf.

Sexual Assault Has No Profile

When people picture a victim, they usually picture someone specific.

A young woman.

A stranger in a dark parking lot.

A certain kind of person in a certain kind of situation.

That picture is wrong, and it costs people dearly.

It is wrong because the idea that a victim must have behaved a certain way, or dressed a certain way, or failed to avoid a certain place, takes the responsibility off the perpetrator and puts it on the person who was harmed.

I have seen that playbook in many settings.

It was never just the woman dressed seductively.

It can be a child walking home from school.

It can be a man in prison, serving time for a crime.

Nothing a person wears, or has done, or is serving time for, makes them responsible for what someone else chose to do to them.

When a Survivor Is Met With Laughter Instead of Care

I think about this often.

When I was a sophomore in college, a young man was abused by a group of women.

When he went to the campus police, they laughed at him.

They told him he should be so lucky.

I have never forgotten that.

Think about what he learned in that moment.

The people whose job it was to take him seriously decided his story was a joke.

He learned that what happened to him didn't count, and that it wasn't worth saying out loud.

How many people have walked away from a desk or a clinic or a hospital room because of one dismissive remark?

Years later, I performed rape exams on men in the prison system.

Different walls.

Different uniforms.

The same silence, and often the same disbelief.

Men who are incarcerated are still people.

They still tremble.

They still wonder what they did to deserve it.

And somewhere in someone's mind is the thought, if you go to prison, you can expect this to happen.

It makes the violence sound unavoidable.

The "dropping the soap" jokes are met with belly laughs, and the people who are violated in those settings are met with disregard.

No sentence includes sexual assault.

They still deserve a nurse who sits down, lowers their voice, and takes them seriously.

Sexual assault does not check who you are before it happens.

It reaches women and men, young and old, the rich and the poor, the faithful and the doubting, the incarcerated and the free.

And the first response a survivor meets, whether it comes from a friend, an officer, a parent, a pastor, or a nurse, often decides whether they ever speak again.

Then, I Became a Cornell Mom

I have two sons and two daughters.

One of my sons went to Cornell for graduate school, where he met and married his wife, also a Cornell graduate.

I have the sweatshirt, the sweatpants, and the campus bag to prove how proud I was.

My son was active in his church ministry the whole time, and I was proud of that too.

Like a lot of mothers, I would love to assume I would never have to worry about my children being anywhere near what is circulating right now.

But a prestigious name is not a guarantee, and neither is a faithful reputation.

I know from my own life that abuse has happened inside the four walls of churches, and I know that no school and no institution is exempt.

Love, Loyalty, and the Limits of Certainty

I have seen some mothers speak out in defense of their sons, saying they know how their boys would behave.

I understand that.

Confidence in your own child is a beautiful thing, and I'd want it too.

But it leaves me curious how much certainty any parent can have about what happened in a room they weren't in.

Love can tell you who your child is. Only evidence can tell you what happened on a particular night.

What worries me is how institutions with a great deal to lose behave:

A reputation.

Donors.

Tithes.

Enrollment.

The pull to protect the institution can be stronger than the pull to do right by the evidence in front of them.

That is how cover-ups are born.

And Cornell is not the only place.

I talk with patients all the time about campus experiences at many universities, and the patterns look the same.

More stories will come out.

Think, too, about how many people stay silent because they don't have evidence to back up what they experienced.

A lack of evidence is not proof that nothing happened.

Now, I Am an FNP/PMHNP

Today I help people work through the trauma of sexual and emotional abuse through psychotherapy and medication management.

This is where I see how long trauma lives.

Cases can take years to reach trial, and evidence can sit in storage or in a backlog while survivors wait.

The time it takes to heal is real, and some people wonder if they ever will.

Many of my patients tell me nothing happened.

They never said anything, because it was easier that way, and very often because they were not believed.

I understand, because after a while I stopped talking about it, too.

I also hear, again and again, "no charges were pressed."

Please hear what that sentence does and doesn't mean.

It tells us how a case was handled.

It does not tell us whether something happened, and survivors know the difference better than anyone.

One Voice Can Make Room for the Next

Recently, a patient came to me because a case involving her had been reopened after a few other young women had experiences of their own and came forward.

Seeing them speak gave her the confidence to come forward again, two years later.

I think about that often.

It shows how much courage it takes to speak your truth, and how often people stay quiet because they don't know how their words will land.

One voice can make room for the next.

From all of these seats, I still can't offer a verdict.

What I can offer is this:

Be prepared to support.

Start the healing process.

Be a safe environment.

A "no" today is not a "no" forever, and the way we respond may be the first safe thing a person has experienced in years.

Why So Many Stories Go Untold

The longer I live, and the longer I work in health care, the more clearly I see how many people carry a story of sexual abuse, sexual assault, or sexual harassment.

It may be the person at the next desk.

The colleague in the break room.

The patient in the waiting room.

Or the neighbor who always seems fine.

Most of those stories are never told.

Telling can cost a person a great deal:

Their family structure.

Their reputation.

Their job.

Their standing in a church or a community.

Institutions have things to lose too, and they are not always quiet about it.

I know, because I have lived on both sides of that decision.

I understand the pros and cons of telling.

Coming forward opens a person up to scrutiny.

They may be doubted, questioned, blamed, or made the center of a conversation they never wanted.

Some people weigh that and choose silence, and I don't judge them for it.

Staying quiet can be a way of surviving.

That is why I think the best thing we can do is not to push anyone toward speaking or toward silence, but to make the telling less costly.

A person who knows that at least one place will receive their story with care is carrying a very different weight than a person who is sure no such place exists.

How to Be Prepared

Sexual assault has no profile, so preparation can't depend on guessing who might need it.

Here is what I have seen help.

For Every Nurse

Ask privately and gently.

Trauma-informed screening in a private room tells people the topic is allowed.

Use language that doesn't assume who the survivor is or who the perpetrator was, because men and women, partners, relatives, and authority figures can all be on either side of a story.

Accept a "no" without pushing, and leave the door open.

Check your own reflexes.

The campus officer who laughed at a young man had a picture in his head of what a victim looks like.

We all carry one.

Notice yours.

Never joke, never smirk, never say "you should be so lucky."

If someone discloses something that doesn't fit your expectations, take it as seriously as you would take any other disclosure.

Give control back.

Trauma is, at its core, a loss of control.

Ask permission before each step, explain what is coming, and remind patients they can pause or stop at any time.

This matters just as much in a prison exam room as in an emergency department.

Watch the "why" questions.

"Why did you go there?" and "Why didn't you say something?" can land as blame.

Ask what the person needs, not what they should have done.

Slow down and stay.

Sit at eye level.

Lower your voice.

Let silence be okay.

The exam, the paperwork, and the clock all push us to hurry, and the person in front of us can feel that.

Document in their words, not ours.

Connect them to an advocate and to follow-up care, and never pressure anyone about reporting.

That decision belongs to the survivor, subject to applicable reporting requirements.

Never treat evidence as a verdict on their story.

The kit exists for them to use or not, within applicable consent and legal requirements.

No kit does not mean no assault.

For Advanced Practice Nurses

Treat the trauma, not only the symptoms.

Poor sleep, nightmares, panic, numbness, and chronic pain often trace back to something no one ever heard.

Trauma-focused therapy and careful medication management can work together.

Set the pace.

Disclosure can take years.

Make the room safe enough that patients can go deeper when they're ready, and don't mistake silence for nothing happening.

Support them through the wait.

Interviews, court dates, and delays can reopen wounds.

Plan for those stretches and check in more often.

Know your reporting duties and local resources.

Explain them up front so nothing comes as a surprise.

Normalize delayed disclosure.

Many survivors wait years.

Telling them so lifts shame.

For the Nurse Who Is Carrying Their Own Story

Many of us came to this work because of what happened to us.

That can be a strength.

It can also be a weight.

Hearing these stories night after night, and year after year, is heavy.

And a nurse who is running on empty cannot hold space for anyone.

Find your own safe place.

Tell your own story to someone you trust.

You deserve to be heard too.

I'll say this plainly:

I am not above a therapy tune-up myself, and after reading this you might think I could use one.

This work can be triggering, and writing it was no exception.

I remember telling my very first therapist about everything that had happened.

She said she just couldn't believe my church would have allowed those things to take place.

Even a well-meant reaction like that lands heavily when you are finally the one telling.

Thank God for good therapists, for trauma work, and for an immediate family where my siblings and I supported one another and created safe spaces to share our pain together.

Healing is rarely something we do alone, and no one in this profession, including me, is too experienced to need help.

Words That Help, and Words That Harm

Most of us were never taught what to say in the first thirty seconds.

And those thirty seconds matter more than almost anything else we do.

A survivor may be deciding, in that moment, whether this is a person they can trust with any of it, or whether it is safer to say "nothing happened" and walk out.

Words that help are simple:

• "Thank you for telling me."
• "This is not your fault."
• "You decide what happens next."
• "We can go as slowly as you need."
• "I'm here, and I'm not going anywhere."

None of those require us to know what happened.

They don't ask us to judge anything, solve anything, or promise an outcome.

They simply tell a person they have been heard.

Words that harm are just as simple, and usually well-meant:

• "Are you sure?" or "Are you certain that's what happened?"
• "Why didn't you tell someone sooner?"
• "At least you're alive."
• "You should be so lucky." (Yes, someone really said that.)
• "Let's not dwell on it," or "You need to forgive and move on."

That last one is worth pausing on.

Pushing someone toward forgiveness before they have been heard is not kindness.

It asks the person who was harmed to do the work of making everyone else comfortable again.

I believe in grace and I believe in forgiveness, and I believe both have to come after safety, truth, and being heard.

Never in place of them.

Professional With the Evidence, Human With the Person

I would also say this to every nurse who works with law enforcement, as I did:

The survivor in front of you is not a case file.

We can be professional about evidence and still be human about the person.

Introduce yourself.

Explain who else will be in the room and why.

Ask whether they want someone with them.

Small gestures like these say:

You are a person here, and not only a crime scene.

One Message From Three Seats

I began this by saying it isn't meant to take anything away from Jane Doe.

It isn't.

Her case is a reminder, and I hope everyone who reads it becomes more prepared than before.

The many stories I carry, the child who wasn't protected, the nurse who held trembling hands, the mother who is proud of her son, the clinician who sits across from people still working through it, all teach me the same thing.

Survivors don't need a verdict from us. They need a safe place to start.

I am 56 years old now, and I'll tell you what has changed.

How my words land matters less to me than it used to.

Who feels uncomfortable matters less.

What matters is that the generations after me keep being educated, and that they know they do not deserve injustice because of how they look, who they are, or what anyone assumes about them.

If my telling it plainly makes the next young person's path a little safer, then it was worth the discomfort.

To anyone carrying something quietly: tell somebody. You are not the problem.

If You Need Support

• RAINN (National Sexual Assault Hotline): 1-800-656-HOPE (4673) | rainn.org
• Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453) | childhelp.org
• Missouri Coalition Against Domestic and Sexual Violence (MOCADSV): mocadsv.org
• 1in6 (support for men who have experienced unwanted or abusive sexual experiences): 1in6.org
• Just Detention International (support for survivors of sexual abuse in jails and prisons): justdetention.org

--Dr. Rachel