We’re proud to celebrate the people who serve and connect our incredible community. Each month, we interview a different member of Resilience’s community to hear more about the work they’re doing to empower survivors and end sexual violence. This month, we’re shining a spotlight on Anna Candoleza Muglia, BSN, RN, SANE-A, Pediatric SANE, and SANE Program Coordinator in the Department of Emergency Medicine at Rush University Medical Center. Read our interview below to hear from Anna about working with survivors in hospitals, the importance of building trust with patients, and her hopes for the future.
Read our interview with Anna below.
You are a Pediatric SANE, SANE-A, and SANE Program Coordinator at the Department of Emergency Medicine at Rush University Medical Center. Can you tell me about your career and work?
I’ve been an ER nurse for most of my nursing career. I’ve never actually left the emergency department. About 20 years ago, there was an opportunity to study forensic nursing and to train to become a SANE (Sexual Assault Nurse Examiner) in my old job, and I took that opportunity. I took the 40-hour didactic at that time. I wasn’t able to complete the training due to scheduling limitations. At that time, I did not consider myself an expert; however, I ended up performing medical forensic exams for sexual assault survivors presenting in our Emergency Department. Despite the limitation of my expertise in forensic nursing, it became apparent that becoming a SANE would be an important aspect of my career, and I realized that it will take more than my experience as an ER nurse to provide comprehensive medical forensic exams to survivors of sexual assault. As an ER nurse, trauma is something that we see on a daily basis, like the obvious physical trauma sustained from a gunshot, stabbing, or other altercations. Sexual violence is a different kind of trauma. As clinicians, we may see minimal, subtle, or sometimes non-visible bodily injury. But it does not negate the fact that the violent acts these survivors have sustained are debilitating and life-altering. Psychological trauma from sexual assault is impactful and can lead to a lifetime of negative sequelae. The training and expertise of a SANE is crucial for this patient population. When I started working at Rush, my passion in this field was renewed, and with the support from our leadership team I was able to pursue and become successful as a SANE. When SASETA (The Sexual Assault Survivors Emergency Treatment) was expanded and the bill was passed, I went back to my leadership team at Rush and proposed the need for a 24/7 SANE Program. This program was built from the strong support of our leadership, passionate SANEs, collaborative relationship with law enforcement, and our partners from Resilience. I’m proud to say that these supporters are instrumental in building the program from the ground up. I take pride in helping my team grow and successfully practice as SANEs, as well as creating policies and clinical pathways for this vulnerable population.
What inspired you to pursue this career and work with survivors?
I am a proponent of recruiting more SANEs and forensic nurses. We need trauma-informed care clinicians who are equipped with expertise and ability to support these survivors from the moment they meet them, during the process of medical forensic exams, and while providing them with discharge instructions. Implementing trauma-informed and empowering care are crucial steps to the survivor’s visit to the ER. Medical forensic exams can be very difficult for these patients, and they need all the support from us to help them make it through this process. When I assumed the role of the SANE Coordinator, building an army of SANEs was an important goal for me. All the sexual assault patients that I have taken care of in the past really inspire me to do this work. In my personal experience, part of my initial conversation with a sexual assault patient is to explain my specialty, followed by what we can offer, explaining all options that are available to them and allowing them to make their own choice and giving them control back. These conversations and interactions oftentimes lead to a trusting relationship that would pave the way to a patient-focused medical forensic exam. This approach helps lessen the patient’s anxiety: trust is built, and they know that they are in good hands. That—coupled with our partnership with our Resilience Medical Advocates—offers an extra layer of support to the survivor. The subtle thank you, the look in their eyes, and knowing that I was able to provide the care that they needed inspired me to not only continue with this career but also help mentor and support other SANEs.
Can you tell me a little bit about what your day-to-day looks like at Rush?
As the Program Coordinator, 24/7 coverage is an important part of my role. Scheduling is crucial to this program. It’s scheduling and making sure that the team is in place on a 24-hour basis. Peer review is integral to the role as well. When we have a case, reviewing that case is an expectation, and part of that review process is to offer feedback and education. It’s also important to support them and to debrief if necessary. The understanding that most SANEs are susceptible to vicarious trauma is important, and reaching out to them is key. Our team is amazing when it comes to supporting each other. We have an understanding of what each one can potentially go through while performing medical forensic exams. Part of the peer review is not just to check on their work, but also to check on them. The other part of my role is to ensure that we have what we need to do our job the right way, so that means supply management. We are currently working on a more streamlined process within the institution to connect a patient to a SANE once a disclosure is made. Through education, we can spread the word about the program that we provide survivors of sexual assault. I want everyone to know within our institution, the city, and the entire state that Illinois SANEs may be a small network, but we are strong and mighty.
Rush is one of Resilience’s 15 partner hospitals where we offer Medical Advocacy. Can you talk a bit about why Medical Advocates and SANEs are so important for survivors in hospitals?
When I onboard a new SANE in our program, I always stress the importance of the Medical Advocate’s role. This collaborative relationship best serves our patients. Our advocates from Resilience are always there for the survivors, first and foremost. They make sure that the survivors’ questions are answered. That partnership helps strengthen the trust we build with the survivors. Typically, this is how we introduce the role of the Medical Advocate to the patient: “We partner with Resilience, and they help us provide medical advocacy as part of your care. I would like for you to meet them. There are a variety of services that they can offer you.” What I’ve noticed is that sometimes they say, well, I don’t really want anyone right now, I just have my friend or someone with them, but my sell is that I am going to need them at some point during their examination. One of my memorable experiences with a Medical Advocate was when I was taking care of a male survivor. He was very uncomfortable and very scared and I could sense he was feeling hesitant. I didn’t request a male Advocate, so the Advocate that came was a female. They hit it off immediately. She was able to break that ice when it came down to the vulnerable exam that we have to do. They were playing music and they actually shared the same music taste and liked the same genre and that helped the survivor. I will always remember that. I know that if it wasn’t for the connection that Advocate had with the patient, I may not have been able to complete the whole exam. That always resonates with me, and I’ve seen several other instances where the work of the Advocate is an extension of what we are doing with our forensic exam.
What are your hopes for the future of Rush and Resilience and the work that we both do?
I want to continue this collaborative relationship, this relationship that we have with our organizations working really closely together. We can do more as institutions. One of the biggest gaps that I have identified in my program right now is follow-up care. My team and I are really extending what we can do further with making sure that our survivors have the adequate follow-up that they need. Through a lot of the trends that we had audited, we feel like the discharge portion of their care is not always optimal. Sometimes, once the patient leaves the hospital, they just want to forget about what happened to them, they don’t want to review it, and I don’t blame them. So we are looking for ways to bridge that gap just in case they may need just a little more support in order for them to get follow-up care. And you don’t want to be pushy, you don’t want to say hey, did you do this yet, did you do that? Did you have this follow-up? Did you see this doctor? Did you finish your pap? I feel like if you just keep pushing them in that direction, it moves towards feeling just so clinical. One of the approaches that we took was helping build and create what we call the My Chart Messaging, which is secure messaging. It’s there so we’re able to tell our patients, hey, FYI, thank you for letting us take care of you. Do you have any other questions? It’s not intrusive, it doesn’t say a lot about what they came to Rush for. But hopefully, that will help them know that there is a way to connect with us without so much intrusion.
Another thing that we’re hoping to start that is still in the works is the opportunity to provide survivors with the option to do a televisit with one of our doctors at Rush. Again, that allows them to stay in the comfort of their home while being able to still talk to a doctor and hopefully get advice and be able to tell if they really need a physical follow-up with the doctor for further evaluation.
What is one fun fact about you?
I’ve been at Rush for a long time, so I am the work mama, as they call me. I like that, and I like that designation. I like mentoring. Mentoring is really important to me.