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My name is Laura and I am currently the coordinator for a sexual assault nurse examiner program. Although the program has been around for numerous years in the community, the number of victims we have attending the hospital for evaluation is very minimal comparatively to the number of sexually violent crimes that occurring in the community.
I am currently struggling to have nurses interested in the program due to the on call portion, and I also struggle to maintain the nurses I have trained because they are not seeing cases often enough to feel confident in this area of practice. Sadly, this has led to victims not receiving the care they deserve because of the lack of on call coverage.
I also feel there is a disconnect between the hospital SANE program and receiving support in the community. I feel that I need to give all resources and counselling in that first initial appointment, because the likelihood of being able to follow up with the victim is minimal. I worry that there is community based services that could be offered, but the patient would have to make the effort to reach out themselves, and they may not be in the place to do so after a traumatic event. And most likely, they will not remember much of the education because these individuals are still in shock from the event that occurred to them.
Lastly, sometimes there is a duplication of services. So for example, if an individual was assaulted and seen by a sane nurse, but also disclosed that they have no where to live that is safe- the sane nurse may try to tackle this instead of social work in the hospital, which is part of their service.
As a fairly new nurse and new to a coordinator role- I want to build a program that is most effective for the community, while not breaching on others job roles, and hoping address some of the services that are missing completely in the community.
Where do I start? How do I become a better leader?

          Thanks for writing to us with your important and challenging question. Of course, we don’t know the details of your community situation, but from our outside perspective we can offer some general comments for your consideration.
           You ask “Where do I start?”, but we would suggest that you have already started, simply by identifying the problem and asking questions about it.  That much in itself is good; so please take credit for that.
          As we see it, much of the problem you identify seems to be a community systems problem, involving not only you but also other service agencies in your community. (E.g., the small percentage of victims you evaluate, the disconnect between your program and receiving support in the community, the duplication of services.)  This suggests that solutions are not likely to come simply from yourself, nor should they. They are more likely to come from these agencies working better together.
            How can that happen?   We don’t know to what extent service agencies in your community have attempted to work together, or what the outcomes have been,  or to what extent they are working together now.  But if  the answers resemble “not very much,” or “not very well,” or “not as much as they could, ” one scenario could go something like this:
       You discuss the situation with your own supervisor, to get his/her perspective on the situation, and the backing to make some inter-agency contacts. Then you talk to a few confidantes in other agencies about the challenges you face – much as you are talking to us – and ask if it would be a good idea if the different parties concerned met to talk about these issues together.
            If they are supportive, even mildly supportive, you then expand the circle to include a larger network of players, with small, informal, one-on-one dialogues on the same topic. By doing so, you aim to get  buy-in for a larger meeting and to lay the groundwork for it.      
        After following this procedure for a while, you decide at some point you are ready to call an inter-agency meeting. You propose an agenda in advance, saying in effect to the group: ”These are the challenges I see; do you see things the same way?; how do you feel about them?: and what can we do about them?  This might be a two-part meeting, the first part focusing on spelling out the problems, and the second on changes you as a group could make to deal more effectively with them.
             That’s the basic framework, which you can adapt to your own setting depending on your community history, your current status, and the idiosyncrasies of your particular situation.   Do you think this might be worth a try?
            All that said, a number of improvements could also come about in-house. Some examples: expanded in-service training for your team members;  printed handouts for clients on community resources; establishment of in-house protocols for follow-up.
            There may also be ways to strengthen your own program’s recruiting and retention.  Part of that involves the reward structure, which can be changed though additional salary or bonuses, or payments for on-call contacts – all of course easier said than done. Part of it, though, could involve reframing:  Would it be possible to frame being on-call as more of an honor rather than as an added burden, where only the best get to be chosen as a member of an elite team?  At first blush, this may seem fanciful; but at second thought we wonder… Part of being a coordinator Is to be creative!  
            Finally for now, you ask how you can become a better leader -- as if we could add something useful beyond the millions of words that have  already been spilled on this topic. But since you ask, we will try.
            In your situation, to be a better leader may not so much mean  doing anything really differently, but rather more a matter of permitting the full expression of your natural self.  
            That is, in your coordinator role you can allow yourself to be a full person, to let your own uncertainties and vulnerabilities and limitations show.  You communicate, both explicitly and implicitly, that you care deeply about your team, both individually and collectively, and that you are doing the best you can.  You have an inherently difficult job, even though you chose it, and if everything you do is not done with brilliant competence or accompanied by perfect sensitivity, that’s okay.   
            Going a step further, your job not only allows you to put your full self on display, but also your best self, the kind of self you would like to be in any case – a kind, trustworthy, and compassionate person of great integrity, one who models the spirit they’d like to convey, one with high devotion to your team as a whole and to your broader cause.  
            Not all jobs make that possible; in that sense, your job is a privilege. So why not take advantage of it? 
           We hope some of these thoughts may be helpful to you. Thanks again for writing to us, and all best wishes for success as your work continues.

Question Date: س., 06/27/2023