Advanced Practice Nurses Combatting Human Trafficking

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Nurses may be the first – and sometimes only – professionals able to interact with trafficking victims.


In the words of American Nurse Today, human trafficking, also known as modern slavery, “is no different from slavery of ancient times: It’s a brutal, highly profitable business with no regard for its victims.”

Trafficking falls into three basic categories: forced sexual exploitation, forced labor, and domestic servitude, though the latter two are sometimes considered together for statistical purposes. Women and girls account for 71% of modern slavery or trafficking victims, notes the International Labor Organization (ILO). The ILO includes cases of forced marriage in its figures and estimates that, worldwide, some 40.3 million people were victims of trafficking in 2016, the latest year for which its figures were available.

The U.S. Department of State’s 2019 Trafficking in Persons report called trafficking “one of the most heinous crimes on Earth,” one that, by its estimates, was “robbing a staggering 24.9 million people of their freedom and basic human dignity.”

“Each instance of human trafficking takes a common toll; each crime is an affront to the basic ideals of human dignity, inflicting grievous harm on individuals, as well as on their families and communities,” the report continues.

Human trafficking and nursing are undeniably connected. Trafficking victims may live in plain sight and frequently seek or need medical care. Many of our nation’s primary caregivers, including advanced practice registered nurses (APRNs), are qualified to identify and assist victims of human trafficking. Online MSN programs such as the one offered by Ohio University can help RNs develop the skills necessary to provide care for patients in this vulnerable situation.

Human Trafficking Statistics

According to Human Rights First, human trafficking is a $150 billion industry worldwide. Its victims are forced to work in agriculture (11%), domestic work (24%), construction, manufacturing and mining (47%), and sex work (19%).

In the United States, specific human trafficking statistics are harder to come by. The Global Slavery Index reports that the reason “is largely due to federal privacy laws.” However, the Global Slavery Index (GSI) estimates that “on any given day in 2016 there were 403,000 people living in conditions of modern slavery in the United States.”

The majority of these of these individuals were engaged in domestic work, living and working inside households for little or no money. The GSI says that, “Of the 110 cases of modern slavery identified by National Domestic Worker Alliance affiliated organizations in a 2017 report, 85% of victims reported having pay withheld or being paid well below minimum wage, and 80% were tricked with false or otherwise deceptive contracts. Additionally, 66% of victims reported having experienced physical or sexual abuse, either by their employer or a family member of their employer, and 78% were threatened by deportation by their employers if they complained.”

These statistics underscore the important role that nurses and other healthcare workers play in helping to identify and provide aid to suspected victims of human trafficking.

A Nurse’s Role in Fighting Human Trafficking

Nurses are often the first — and sometimes only — professionals able to interact with trafficking victims.

According to an article on by Claire Zangerle, DNP, MBA, RN, NEA-BC, “An estimated 88% of sex trafficking survivors sought medical care during their exploitation, mostly through an emergency department or an outpatient clinic.”

Nurses need to be aware of their own unconscious biases, the article continues.

“As nurses, we must acknowledge our own feelings in these areas,” Zangerle writes. “For example, a prostitute who presents in the clinic or emergency department may not be engaging in the profession by choice. A teenage girl who repeatedly presents with a sexually transmitted disease may not be amoral but forced into prostitution. A malnourished man with a tattoo and paranoid behavior may not be mentally ill, but in a labor trafficking situation.”

Because they are a patient’s first touch point, nurses are ideally positioned to identify and communicate with victims of human trafficking, particularly those trafficked for sex. Knowing nurse practitioner terms and understanding the complexities of trafficking can help APRNs and other nurses provide the best care.

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) recommends that nurses be alert to signs such as:

  • The presence of cotton or debris in vagina or rectum
  • Problems with jaw or neck
  • An inability to keep appointments
  • A lack of identification
  • The presence of tattoos or branding scars
  • The presence of a person who does not allow the individual to speak or who does not want to leave them alone during the interview and/or care
  • Inconsistent stories (conflicting stories or misinformation)
  • The use of a language other than English
  • A lack of documentation of age-appropriate immunizations and health care encounters

Once they identify suspected victims of human trafficking, nurses should follow situation-specific interview techniques to avoid causing additional harm for the victim and inviting harm for themselves.

Interviewing Suspected Victims of Human Trafficking

The U.S. Department of Health and Human Services provides a screening tool called the Adult Human Trafficking Screening Test (AHTST) for healthcare providers who suspect they are treating victims of human trafficking. Their recommendations include:

  • Establishing a one-on-one relationship by removing all others from the room prior to screening, ensuring that no one else can hear the conversation, and allowing the individual to choose where to sit
  • Meeting the individual’s physical needs, including offering them a snack or a drink, showing them where the restrooms are located, and by periodically asking them if they need anything
  • Using open, non-threatening body language
  • Engaging the individual by remaining calm, maintaining eye contact, keeping a warm, natural facial expression, and using active listening skills
  • Adapting the screening process to the individuals’ needs by using mirroring to accommodate to their language and pace and by providing individuals with their choice of screener (male or female)
  • Using empathetic, non-judgmental language

In addition, the AHTST recommends that providers be prepared for trauma reactions and ready to employ stress management exercises including breathing techniques and the 5-4-3-2-1 technique, which “can calm a person and help them stay anchored to their present surroundings (as opposed to becoming lost in traumatic memories or dissociating) by simply asking them to name five things they can see in the room, four things they can feel, three things they can hear, two things they can smell, and one good thing about themselves.”

Finally, healthcare providers should be prepared to make appropriate referrals for services, including agencies that can help victims meet their basic needs, such as food and shelter.

About the Ohio University Online Master of Science in Nursing Program

Ohio University’s online MSN program prepares registered nurses (RNs) and other Bachelor of Science in Nursing (BSN) graduates for advanced nursing careers, including as family nurse practitioners (FNPs) or psychiatric mental health nurse practitioners (PMHNPs).

For more information about Ohio University’s online MSN program, visit the program webpage today.


Recommended Reading:

Shaping the Future of Healthcare: The Role of the Nurse Leader

How Clinical Pathways are Leading Us Towards Patient-Centered Care

8 Ted Talks for Nurse Practitioners


Human trafficking: Preparing for a unique patient population: American Nurse Today

Global Estimates of Modern Slavery: International Labor Organization

Human Trafficking by the Numbers: Human Rights First

2018 | Findings | Country Studies | United States: Global Slavery Index

Human Trafficking: Nursing for Women’s Health

Nurse Leaders Play Key Role in Battling Human Trafficking:

Adult Human Trafficking Screening Tool and Guide: Administration for Children and Families, Office of Tracking in Persons