This story is by the Kentucky Lantern, which is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. More of Kentucky Lantern’s work can be found at kentuckylantern.com. Follow them on Facebook and Twitter.
This story discusses sexual assault. If you’ve been sexually assaulted, you can call the Rape, Abuse & Incest National Network helpline at 800-656-4673 or chat with someone from RAINN online at https://hotline.rainn.org/online for support.
Melissa Gilpin remembers the first time she collected evidence for a rape kit — but not the woman who had been assaulted.
That was the “worst thing” about her introduction in 2001 to a specialized field of forensic and compassionate care that she’s since dedicated her life to.
“I don’t remember anything about the woman I was taking care of,” recalled Gilpin, now a sexual assault nurse examiner of more than 20 years who works at Med Center Health in Bowling Green. “I remember paying attention to the instructions on the kit, making sure the police officer got it.”
She knew after that experience that she needed more education and resources so the next time a sexual assault survivor came to her emergency room, she was better prepared. She had to learn how to balance the human connection and the forensic exam. In 2004, she was finally able to take the class she needed to become a sexual assault nurse examiner (SANE).
Two decades later, Kentucky still needs to improve access to — and incentives for nurses to pursue — SANE education, a report released in December by the Legislative Research Commission shows.
The report is the culmination of research sought by Rep. Rebecca Raymer, R-Morgantown, who in 2025 sponsored a resolution directing the LRC to study access to sexual assault nurse examiners across the state. Raymer wasn’t surprised by the report, which she said provides the General Assembly with a good foundation for addressing gaps outlined in it.
“One of the reasons why we wanted to do the report is we knew there were gaps in coverage. I suspected that … urban versus rural was going to be a big part of it,” she said. “To do good legislation, you really need good data. So, I felt like before we just started passing bills, we really needed to see what that data looked like.”
The report shows an increase in recent years of nurses getting credentialed in sexual assault examination, but an urban-rural divide persists and 100 of Kentucky’s 120 counties do not have a SANE-ready hospital. Hospitals must have a sexual assault nurse examiner on call 24/7 to qualify for SANE-ready certification.
Of those 100 counties without SANE-ready hospitals, 44 don’t border a county with a SANE-ready hospital, according to the report. This was among the most “concerning” findings to Raymer, she said. During the 2026 legislative session, she plans to introduce a bill that would create a statewide SANE coordinator, a recommendation that came out of the report.
This person would be housed in the Cabinet for Health and Family Services and would help more hospitals get SANE-ready, Raymer said. She also plans to add an appropriation request to make sure the position has adequate state funding.
“We’re still having those conversations of what that price tag would be,” she said, but: “I do plan on putting that in the bill.”
The number of SANE credentials increased from 296 in 2019 to 556 in 2025, according to the report, though Gilpin said that may not accurately represent access to this specialized care.
“I know of at least a dozen who have those same credentials, and they’ve never taken care of a patient for various reasons,” she said. “So having those credentials doesn’t necessarily mean they’re working as a SANE anywhere.”
Raymer’s proposed statewide coordinator would also keep a more accurate database of who both has a SANE credential and who is using that credential, she said.
(Photo provided). LouCity FC
Kentucky Board of Nursing Executive Director Kelly Jenkins said the report wasn’t surprising to her and the recommendations were “very thoughtful and very much in line with the work that’s already been underway.”
For example, the report recommends hospitals should train all staff to work with sexual assault survivors. A law passed in 2025 already directed facilities to conduct such training.
Sexual assault nurse examiners are “a very unique, dedicated, compassionate group of people,” said Jenkins.
“I just have the utmost respect for SANE nurses,” she said. “They’re seeing somebody in their worst moment. It takes a lot to deal with that trauma, especially those that (handle) multiple facilities, so they’re being called out a lot. It’s a lot going through that trauma. They definitely have a lot of respect, for sure, from me. It’s … the gold standard of care for survivors.”
Kentucky emergency departments are required by law to be able to examine, collect and report evidence of sexual assault and treat victims. Without a sexual assault nurse examiner with advanced forensic training on hand, though, the nurse using a rape kit may experience what Gilpin did in 2001 before she was certified as a SANE: A heavier focus on reading rape kit instructions than on caring for the patient in the room.
Findings and recommendations
According to the report:
- Access to training and the costs and time commitments associated with training are major obstacles to becoming a sexual assault nurse examiner. Burnout and lack of incentives for becoming a SANE are additional barriers to nurses qualifying for and maintaining their credentials.
- Kentucky has 45 hospitals that employ at least one SANE full time, and 25 hospitals contract with at least one SANE for on-call services.
- As of July 2025, there were 512 nurses with a SANE credential in Kentucky. Of those, 491 had a sexual assault nurse examiner adult or adolescent credential and 66 had a sexual assault nurse examiner pediatric or adolescent credential. There were 45 nurses with both credentials. These nurses were mostly concentrated in urban counties.
- The number of SANE credentials increased from 296 in 2019 to 556 in 2025.
- Six counties have 10 or more SANEs living in them.
- There are 81 counties with three or fewer SANEs living in them. Of those 81 counties, 30 counties have no SANEs living in them.
- As of October 2025, there were 25 SANE-ready hospitals in Kentucky. That number has increased steadily since 2017.
- As of October 2025, most SANE-ready hospitals were located in Louisville, Central Kentucky and Northern Kentucky. There are no SANE-ready hospitals west of Owensboro.
- There are 100 counties without a SANE-ready hospital, and of those, 44 counties don’t border counties with a SANE-ready hospital.
- From 2019 to 2024, there were 4,468 sexual assault forensic examinations that were logged in the Kentucky State Police kit tracking portal.
The report’s recommendations include:
- Hospitals should consider developing monetary incentives and specialized job codes to incentivize more nurses to become SANEs.
- The Kentucky Board of Nursing should consider working with SANE training programs to make them more accessible to potential candidates.
- The General Assembly may wish to consider requiring that hospitals have a sexual assault nurse examiner on call 24 hours each day.
- All applicable medical providers should receive training that includes information on the treatment of survivors of sexual assault.
- Kentucky hospitals should consider developing potential monetary incentives and job codes for SANEs.
- The Cabinet for Health and Family Services and the Sexual Assault Response Team Advisory Committee should consider developing a statewide SANE coordinator position, which would coordinate the efforts of different state agencies and hospitals in order to increase access to sexual assault nurse examiners, promote standards in training and practice, provide technical assistance to build and maintain SANE programs, and to collaborate with community partners and appropriate state agencies.
Overall, the Board of Nursing, the Kentucky Hospital Association and Gilpin support the recommendations outlined in the report.
The suggestion that hospitals provide a 24/7 SANE nurse, however, could be a challenge for some.
“Although we think that is a great goal, and we’ve been trying to help work toward it for a long time, just (with) the reality of the financial situation of many of our very small hospitals, particularly our rural hospitals — I just would hate to have that probably-unfunded mandate in place,” said Deborah Campbell, the vice president for clinical strategy and transformation at the Kentucky Hospital Association.
That recommendation, said Campbell, is “really the only one that gives me any heartburn.”
Vice President, Clinical Strategy and Transformation with Kentucky’s Hospital Association.
Creating job codes specific for SANEs could help ensure certified SANEs can work in that role.
“Many of the SANEs now are working in labor and delivery, or the ED. They have their regular job, and the only difference in pay is if they sign up as ‘on call’ (for SANE work) outside of their hours, and then if they get called in,” Campbell explained. “Is that enough incentive for someone to do the training and keep up the continuing education that needs to happen?”
Additionally, access to SANE education — and help paying for it — varies by location.
“I think it is fair to say that if you are working in rural Eastern Kentucky and you want to go to a training, it’s not going to come to you,” Campbell said. “And it’s several days of training for just the didactic part of it. Either their hospital has to pay for them to go and have a hotel and food and travel expenses, or they have to have that burden themselves.”
“If they have children, they have to have sitters or arrange for their family,” Campbell said.
“It’s a bit burdensome, depending where you live,” she added. “That’s something that we really want to work on.”
Having a statewide coordinator to connect survivors to resources, and SANEs with various facilities, as recommended in the report, would be a huge help, Gilpin and others said.
“I would not be opposed to having such a position at the (Board of Nursing),” said Jenkins. Funding would have to align to make it happen, she said, but “it would just help align resources and try to cover some of those regional gaps that we’ve got.”
“We know we need more training in the far east and far west,” she said.
Hybrid training opportunities have and will continue to help bridge that gap as well, she said.
“SANES are a vital role in providing care to citizens in the state,” Raymer said. “We would hope that nobody ever needs that type of care, but if we find our citizens needing that, I think that it’s an expectation that we make sure that that care is available to our citizens.”
Being a SANE in Kentucky: Part of the healing
Gilpin, who is the clinical educator for the emergency department at Med Center Health, started her career as a sexual assault nurse with a clear goal: “I wanted bad guys to go to jail. I wanted to get good evidence so it could go to trial and put a bad guy in jail so they couldn’t hurt another person.”
She’s learned over the last 20 years that real life justice is slow, if it happens at all.
Now, she’s more focused on how her presence makes her survivor patients feel.
A sexual assault exam is a success when “the person that I’m taking care of — that’s right there in front of me — is glad that they came, feels that coming to the hospital, having the exam was a positive, and they’re leaving knowing that they were cared for, knowing that they have a connection to what they need going forward to begin that healing process,” Gilpin said.
Still, the stress of seeing so many people — including young children who can’t yet talk about being assaulted — can wear with time. Gilpin has her own mental health “touchstones” that she uses to support her mental health.
“I like to just be outside, walking in quiet, or spending time with family,” she said. “But I always encourage nurses who are getting into this field to have a recharge, to know when they need a break, to know when they need to talk to somebody else. And I think everybody deals with trauma and stress a little bit differently.”
It also helps to stay connected to other nurses in similar roles, she said, who will understand the unique stressors of the job.
“But I certainly encourage every nurse that takes this class: This is very difficult, and it compounds over the years, right?” Gilpin said. “All of the things that we hear and see; the worst part of what humans do to other humans. So I think that having other nurses who are in similar roles that you can talk these things through is very helpful, and then having a plan for your own mental health is super helpful, whether it is in exercise or in activities that just recharge you. I think that that is critical to not allowing this to sort of overtake everything that you do.”
The hard truth, Gilpin said, is that rape and sexual assault are much more common than some may realize.
According to the Kentucky Association of Sexual Assault Programs, around 39% of women in Kentucky will experience sexual violence at some point in their lives. Around 23% will experience a rape. And, about 18% of men will experience sexual violence in their lifetime, according to KASAP’s data, which only represents what is reported.
“What I’ve learned over the years of doing this is this is so much more prevalent than we realize,” Gilpin said. “I learned early on in my career that a lot of the survivors that I served would disclose to me that this was not the first time that they had been assaulted. It may be the first time they sought help, or even felt comfortable telling anyone, but this wasn’t the first time they’d experienced rape.”
Over time, Gilpin said, sexual assault nurses learn the skills needed to correctly gather evidence, which frees them up to show personalized compassion and humanity to their patients.
“Collecting evidence is one aspect, and we need to do that and we need to do that well, but more importantly, we need to take care of that human being and ensure that we are helping that human on their path to healing, rather than re-traumatizing,” she said. “And that’s always the goal, that we’re not part of the problem, that we’re part of the solution and part of that healing process.”
This article appears in Jan 1-31, 2026.