Nursing “brought out this side of me that I didn’t know I truly had.” Annie Lewis O’Connor PhD, NP-BC, MPH, FAAN never planned on being a nurse. She didn’t even know if she could handle blood. But, after becoming a single mom at a very young age, one social worker gave her the opportunity to experience a new side of herself. O’Connor was able to shadow nurses, and she saw the “human, caring side of what people did when others were sick. I felt it brought out this side of me that I didn’t know I truly had. I think being a new mom brought out this caring side of me as well.”

Today, O’Connor has expanded that side of herself into an influential career. She holds faculty positions at Harvard Medical School and Boston College and received her master’s degree in nursing from Simmons College in Boston, her master’s degree in public health from Boston University, and her PhD from Boston College. She currently serves as the founder and director of the C.A.R.E Clinic (Coordinated Approach to Recovery and Empowerment) at Brigham and Women’s Hospital in Boston. Specializing in forensic nursing, maternal-child care, pediatrics, and women’s health, O’Connor cares for victims of domestic and sexual violence, human trafficking, and gender-based violence. She also serves on the editorial board of the Journal of Forensic Nursing, which makes her the perfect Nurse On the Move for Forensic Nurses Week.

Q: How has nursing changed since you began your career?
A: Careers are very much about a journey. I believe back in the day when I ended up in nursing school, it was sort of a calling. Today, it’s a great job, profession, and it’s a business. It didn’t feel like a business when I first started out, and that’s not good or bad. What I hope I bring to it is that people never lose sight of the honor and privilege it is to take care of people at the most vulnerable time in their life, and that’s when they are lying in a hospital bed. I get to do this every day with young nurses in the clinic where I work. I love that I am at the stage in my career where I really am feeling that “pay it forward.” I don’t want anyone to feel that nursing is just a good job. It’s much deeper than that, and I try to model that for the next generation of nurses.

Q: You founded C.A.R.E. (Coordinated Approach Recovery & Empowerment), which assists victims of sexual assault, domestic violence, human trafficking, and gender-related violence. Why is this approach important to you?
A: Brigham and Women’s Hospital gave me the opportunity to grow and develop this clinic; I couldn’t have done it without the support of that administration. This was done through dialogue and gathering statistics on my concerns around victims of intentional violence. These patients are unique in so many ways. My research, which is published in Journal of Forensic Nursing, shows a lot of these patients who come into the emergency department (ED) just experienced a traumatic event, and they get handed a packet of information they are expected to navigate through. It’s a mess; they don’t know who to call first.

I wanted to create a follow up with these patients through C.A.R.E. that will become a national model. Within 48 hours, a victim, with their consent, will receive a text message from us. We provide phones if they don’t have one. About 98% of the victims we see agree to the follow up, and our numbers around being able to contact patients have gone from 27% up to 91%.

We also do consultations with in-patients. For example, they are admitted for a non-related issue and during their stay disclose violence and trauma. This week alone, I’ve done six in-patient consults. I have two victims of human trafficking who came in for asthma and diabetes, and we are educating the nurses on how to provide trauma informed-care for these other issues they are experiencing.

I would also like to mention that I invited 14 survivors to become my patient advisors and to name our clinic. When suggestions come from the actual survivors, the policies and procedures we develop have much more relevant and significant meaning.

Q: When a patient comes in with suspect injuries, what should nurses keep an eye out for?
A: People want a domestic violence screening tool, which we’ve had for three decades now. But, this has not transformed well into actual health care. I think we need to have an actual conversation with these patients about their relationships and pay attention. As I’m taking the history, I am looking for the red flags, such as a partner who won’t separate or the young girl who comes in with an older man. You need to educate yourself around what those flags are and then talk to the patient. You don’t want to go in and say off the bat, “Have you been hit, kicked, or punched? Has your partner forced you to have sex when you didn’t want to?” The correct way to ask is after you’ve established a rapport with the patient to say, “What do you like about your partner or your work? What don’t you like about it? Tell me three things you would change if you could.” The next thing you know, they are telling you their whole story. Really recognize that this affects one in four women. People are always surprised by this, but the statistics are pretty solid.

Q: What is the biggest challenge related to caring for these victims and how do you combat it?
A: The biggest challenge is really when there are mental health issues or substance abuse involved. If you look at homeless women, women with mental health problems or substance abuse, you think of it as an onion. You start peeling that onion back to get to the core, where you find that there’s a lifelong history of exposure to trauma and violence. You may be treating them for this one incident they came into the ED for, but you are really treating their whole history.

Q: Has there been a particular patient whose story has stayed with you?
A: The real hard one recently was we had a woman whose boyfriend strangled and beat her pretty bad. The neighbors called and the police came and brought her in. He choked her so bad we could see the strangle marks. As we are working her up and getting her ready for discharge, she was calling the boyfriend to come pick her up. She just looked at me and said, “I know you must think I’m crazy. I don’t even know if I love him, but I just don’t want to be alone.” That was a “Wow” moment for me. I told her, “How about we try to work on the loneliness? So, you aren’t alone.” She left and two weeks later he beat the living day lights out of her again. She wound up in a different hospital, but called and asked for us. I was able to get her transferred and care for her and that was it. She finally left him, and now she’s soaring. If we didn’t have this follow up program, she would have walked out of there and never come back.

Q: Why is every nurse a forensic nurse?
A: When you look at ED nurses, they see themselves as ED nurses. But, when they see an injury, like someone looks like there were whipped with a belt, they don’t see that as forensic science, they see that as the emergency care. I think that forensic nursing is not a term they are familiar with, and the more we define and share what it means, the more nurses will recognize that’s what they are doing. Nurses in all aspects of delivering health care will see that.

Q: Why is Forensic Nurses Week important to you?
A: We get to recognize our colleagues in forensic nursing and that there’s a body of knowledge and expertise we’ve built. During this week, I also think it’s important for every nurse to reflect on their own practice and see what is in their own job that is forensic nursing. Working with the elderly or children, for example, there’s a lot of forensic nursing that goes on there.

Q: How has serving on the editorial board of the Journal of Forensic Nursing affected your career as a nurse?
A: It’s been really wonderful. It takes me to a different level, where I can grow and develop. Reading manuscripts, providing feedback, and encouraging others to write has been great. It makes me very proud of our profession, and I’m honored to be on the editiorial board. I know that whatever winds up in print is very good quality. I’m very proud of the high standard we set in this journal. I see this journal as the flagship for forensic nursing.

Q: You are traveling to Haiti in November. What work will you be doing there?
A: I travel to Haiti frequently, where I have two roles. One is that I work with local Haitian nurse leaders to develop nursing leadership in Haiti along with my organization, EqualHealth.org. We host a conference there and our work is very interdisciplinary. There teams need to work in harmony, so we focus on that. Second, I’ve done research on gender-related violence in Haiti.

Q: What do you envision for the future of nursing?
A: Nurses will be allowed to practice in the full extent of their license. I would love to see all nurses continue their education in some way, shape, or form. I also think that nurses need to be at those tables where policies are being made. Nurses can play a vital role in education, practice, research, and policy, and I want nurses to recognize that.

*Do you know an inspiring nurse to be featured for the next Nurse On the Move? Email your submissions to [email protected].