The Board That Certifies the Nation's Rape-Kit Nurses Is Dissolving. The Shortage It Was Built to Fix Isn't.

A sexual assault forensic exam has to happen fast — evidence degrades within hours — and it has to be performed by someone trained to do it: a Sexual Assault Nurse Examiner, or SANE.▸ For three decades, one organization built and guarded the national credential that certified those nurses. On April 3, 2026, the American Nurses Credentialing Center announced it had reached an agreement to take over the SANE-A (adult/adolescent) and SANE-P (pediatric) credentials from the International Association of Forensic Nurses (IAFN) "in advance of the dissolution" of IAFN itself. Credential holders who were due to recertify in 2026 got an automatic extension to the end of 2027, while a new board reviews the exams it just inherited. Nobody has said why IAFN is dissolving. What it leaves behind is a workforce nobody has fully recounted since — and by its own numbers, was never large enough to begin with.

The only comprehensive national count of SANE programs was a one-time study, not a standing government tally.▸ Between 2018 and 2021, the Urban Institute and IAFN surveyed the field directly: using IAFN's own program directory as of August 2019, they identified 598 verified SANE programs nationwide and got 379 of them (63%) to complete a survey on staffing, funding, and caseload. As of June 2021, IAFN recognized just 1,511 nurses as board-certified SANE-A examiners — measured against the 6,100 hospitals the American Hospital Association counted in its 2024 survey. The two numbers aren't a precise ratio — not every hospital runs an emergency department, and one SANE can cover more than one facility — but they are the only two numbers anyone has, and they were already five years old before the organization that produced the smaller one said it was closing.

Funding is no more centralized than the workforce.▸ Of the 340 surveyed programs that named a funding source, the plurality — 35% — draws on Victims of Crime Act (VOCA) crime-victim assistance grants, the same pass-through fund whose annual distribution to states is set by federal criminal fines and forfeitures, not an appropriation. Everything else is a patchwork of state budgets, Violence Against Women Act formula and discretionary grants, hospitals' own funds, and private foundations — no single line item funds the field. The one federal grant earmarked specifically for the national SANE field's own infrastructure is smaller still: the Justice Department's FY2025 solicitation to revise the SANE Program Development and Operation Guide — the reference document programs use to stand themselves up — carried a total award pool of $350,000, split among however many organizations applied for it, for a three-year contract. That money pays someone to rewrite a manual. It does not pay a single nurse.

No state has re-measured its own SANE workforce as recently, or in as much county-level detail, as Kentucky did in December 2025.▸ Directed by a legislative resolution to study the problem, the Kentucky Legislative Research Commission found that the number of Kentuckians holding a state SANE credential grew from 296 in 2019 to 556 in 2025 — a real gain, and evidence that the pipeline is barely net-positive: the state issued 43 to 94 new credentials a year over that stretch, while 23 to 42 lapsed without renewal in the same years. As of July 2025, 512 nurses held an active credential. They are not evenly spread. Six of Kentucky's 120 counties have 10 or more resident SANEs; 81 counties have three or fewer, and of those, 30 have none at all.

Credentialed nurses are one thing; a hospital that guarantees one is actually on call is another.▸ Kentucky calls the latter a "SANE-ready hospital" — one that has certified to the state it has a SANE available 24 hours a day — and as of October 2025 there were 25 of them, up from seven in January 2017. That is real growth, nearly four-fold in under nine years. It still leaves 100 of Kentucky's 120 counties without one, and 44 of those 100 don't even border a county that has one. Every SANE-ready hospital in the state sits east of Owensboro; west of it, there is not a single one. When a hospital without a SANE has to transfer a patient instead — the LRC's own hospital survey found 30 hospitals that had done exactly that — the forensic exam happens later, farther from home, and after the survivor has already been moved once.

This piece anchors its national figures to the last full census of SANE programs (2019–2021) and its ground-level detail to Kentucky, the most recently and thoroughly re-measured state (December 2025); coverage gaps and funding structures vary by state, and no comparably detailed national county-level count currently exists.