Lodged in resilience
By Jennifer Plant Johnston, MLAS’21
Erin Miller, one of only two pediatric Sexual Assault Nurse Examiners (SANE-P) in the state of Florida, is on a mission to encourage more nurses to dedicate their careers to helping child sexual abuse survivors feel “brave and safe.”
“We need more people who are willing to walk kids through this trauma. Being the person who can represent safety to a child is so impactful, and we need so many more,” says Miller, MSN’19.
Miller first discovered her calling as a pediatric trauma nurse at Monroe Carell Jr. Children’s Hospital at Vanderbilt. After earning a bachelor of science in nursing from Belmont University, she initially applied for the medical surgical nursing team but was offered the pediatric trauma position instead.
“Every step of the journey brought me to where I am today,” she says. “God does that. This was divine intervention. He was trying to tell me, ‘You just wait because you’re going to encounter these patients and you’re going to know exactly why you’re here.’”
The critical role that nurses play in assessing possible child abuse became clear early on when a young patient was admitted to the hospital with significant facial fractures requiring plastic surgery. “He was just a baby—a toddler,” she recalls. “I thought, ‘This just doesn’t make sense given the injuries,’ so I put in a consult for the CARE Team.” CARE is shorthand for Vanderbilt Children’s Center for Child Protection and Well Being. The CARE Team’s assessment that the child’s mother had inflicted the injuries with a frying pan taught Miller to trust her gut.
Being the person who can represent safety to a child is so impactful.” —Erin Miller
The more she experienced, the more she wanted to help the most vulnerable, especially victims of sexual abuse. “I had an affinity with those patients,” she explains. “I wanted to make sure they were going home to a safe place and that our care in the hospital always represented safety.”
One memorable case involved another toddler who had been physically and sexually abused. “She was afraid to talk for a while,” Miller says. “She wanted to hold my hand. I would do that with her if I had a minute. We graduated to talking. By the end of it, she was sprinting around the unit with her baby doll stroller.”
A team of trauma nurses slowly walked the child back through the phases of childhood development to help her overcome fears of normal activities, such as taking a bath. “We got to see her go home with a safe family,” Miller says. “It was such an impactful experience.”
Leap of Faith
Miller continued her trauma nurse career full time while pursuing her master’s degree at Vanderbilt University School of Nursing. As a graduate student, she made the fateful decision to enroll in the school’s pilot Sexual Assault Nurse Examiner program.
“Vanderbilt has been incredible to me in terms of the opportunities and education they’ve provided. I could never have predicted the opportunities I’d receive as a result of taking a leap into their pilot program,” Miller says.
Her SANE certification coursework was followed by a clinical immersion at Our Kids Center, a Nashville nonprofit that provides medical evaluations and crisis counseling in response to child sexual abuse. After the required three-day immersion, Miller continued to reach out to the Our Kids staff for opportunities to learn. “Every week I would text them to see if I could come in and work with them,” she says, “and they just kept telling me, ‘Yes.’”
“Erin was a shining example,” says Hollye Gallion, a nurse practitioner and clinic director who has been with Our Kids for 22 years. “She knew she wanted to do the work and commit to the work. We need more people like Erin in the field, and we need the people full time. You get really good at the work and you understand anatomy and you understand testifying in court. It needs to be something you commit your career to.”
Miller continues to seek advice from the Our Kids staff in her current position as nurse practitioner on the child protection team at the Children’s Advocacy Center of Southwest Florida in Fort Myers—a job that she accepted about 24 hours after passing her NP exam. The fact that the Chicago native’s parents had recently relocated to the area helped seal her decision.
Miller explains that on a typical day, an exam might include taking a history, establishing a rapport with the child, making them feel comfortable, figuring out where they are developmentally, collecting evidence and checking for injury or sign of infection. If warranted, the practitioners conduct a pregnancy exam, treat infections with antibiotics, provide reassurance and family advocacy, and help with financial issues and food security. In Florida, examiners are even equipped for hurricane season with portable kits. “We are everywhere and not in enough places at the same time,” she says.
Helping Kids Still Be Kids
Miller often takes her patients through a series of affirmations. Exacerbating the intensity of the work is the fact that
90 percent of children who experience sexual abuse know and have a relationship with their abusers. The advocacy teams teach children that “your trauma is not your identity. You get to still be a kid, and no one can take that from you,” she says.
To avoid experiencing burnout, Miller has sought support through professional organizations, networking opportunities, continuing education and conferences. “We all get those questions and comments: ‘How do you do that? I could never do that.’ That can feel very isolating sometimes, especially on a day when you have a really exhausting, emotionally heartbreaking case.”
Miller has felt encouraged and supported in her work by School of Nursing faculty, including Ginny Moore, DNP, MSN’90, director of the Women’s Health Nurse Practitioner specialty; Pam Waynick-Rogers, DNP, PMC’96, MSN’92, assistant professor of nursing; Jennifer Wilbeck, DNP, PMC’06, MSN’99, director of the Emergency Nurse Practitioner specialty; and Melanie Lutenbacher, PhD, FAAN, associate professor of nursing, emerita.
In addition to her work as a SANE-P, Miller is a pediatric clinical adjunct professor at Ave Maria University near Fort Myers. She often participates in educational panel discussions and will soon provide a five-day clinical immersion for Vanderbilt nursing students.
Outside of work, her passion for helping children recently led her to become a foster parent to a 5-year-old. Despite the weighty demands of her job, “we just figure it out,” Miller says. She also finds that going to the gym every morning helps ease the transition from home to work.
“I am an avid CrossFit athlete,” she says. “There’s something, especially as a woman, about lifting a heavy barbell above your head. It gives me energy for my day to keep working like crazy and being on call.”
Her tireless calling is lodged in resilience. In fact, she had the word tattooed on her body along with an image of a DNA strand. Resilience is what drives her to teach and learn as much as she can to better serve vulnerable populations. And it is what she wants the children she serves to discover they already possess.
“I want to continue gathering as much knowledge as I can,” she says. “If there is something more to learn so I can show up for these kids, then I want it, whatever it is.”