By Suzanne Carroll, RN, MS, AOCN®

The MeToo movement, an online campaign where women from all walks of life shared their stories of personal sexual assault and harassment, went viral in October 2017. The goal of their stories was to demonstrate the prevalence of sexual misconduct, especially in the workplace. Victims of sexual violence and harassment often go unnoticed and unheard, even though the World Health Organization (WHO) estimates that it affects approximately one third of women worldwide. In a 2017 poll of American women, 54% reported “unwanted and inappropriate sexual advances” and 95% said it goes unreported.

A survey of U.S. academic medical faculty members found that 30%–40% of women in health care experienced sexual harassment, and those who complained or reported it received negative consequences to their careers. Moreover, 60% of trainees and medical students also experienced sexual harassment. However, most did not report the incidents.

As nurses, I’m willing to bet that most of us have experienced sexual harassment at some point during our careers. I’m also willing to bet that most of us didn’t report it.

Sexual harassment, as defined by WHO and its partner organizations, is “any unwanted, unreciprocated, and unwelcomed behavior of a sexual nature that is offensive to the person involved, and causes that person to be threatened, humiliated, or embarrassed.” It’s likely that most nurses have experienced unwanted approaches, sexually based comments, or inappropriate jokes—perhaps even unwanted physical contact—at some point in our careers.

An international review of nurse exposure to physical and nonphysical violence, bullying, and sexual harassment in 38 countries found that about 25% of the nurses reported sexual harassment. The highest rates for physical violence and sexual harassment occurred in Anglo countries—Australia, Canada, England, Ireland, New Zealand, and the United States. The highest rates of nonphysical violence and bullying occurred in the Middle East in countries like Bahrain, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Saudi Arabia, and Turkey. Regions varied in the source of violence, with patients accounting for it in Anglo and European regions and patients’ families/friends accounting for most of it in the Middle East. Despite its prevalence, sexual harassment has received less attention than physical and nonphysical violence.

One study also showed that younger nurses, aged 20–30, report sexual harassment more frequently than their middle-aged counterparts, aged 40 and older. Nurses with higher education are more likely to report sexual harassment. The researchers noted that a higher educational level might correspond with recognizing sexual harassment and increased reporting.

Although sexual harassment is rampant, these studies and surveys show that nurses are reluctant to report incidents of abuse, especially when it involves their patients. Nurses are educated to avoid any displays of revulsion at a patient’s health condition, behaviors, or untoward events. We’ve been taught to tolerate certain behaviors from patients, but being a professional nurse doesn’t mean putting up with unwanted or inappropriate behaviors. Unfortunately, nurses currently lack the tools and resources at act when they are confronted with sexual harassment situations.

Research related to handling and prevention of inappropriate sexual behaviors and sexual harassment from patients is sparse. Most studies focus on harassment from colleagues and supervisors, ignoring the harassment by customers, clients, and patients. This lack of evidence is fostered by tolerance and the denial of certain behaviors. In reviewing the literature for this article, I found only eight timely and relevant studies, five of which were from other countries (Australia, Pakistan, Israel, South Korea, and Demark).

The problem of sexual harassment from patients is complex and multifaceted. It can have detrimental effects on well-being, mental health, job satisfaction, and productivity. Specific guidelines need to be researched and developed to prevent sexual harassment from patients in healthcare settings. This is an area where healthcare organizations can act to prevent and mitigate sexual harassment. The American Nursing Association (ANA) position statement on sexual harassment opposes any form of discrimination based on sex, race, and age and believes nurses and students of nursing have a right and responsibility for a workplace free from sexual harassment, including by patients or visitors. By listening to the experiences of nurses impacted by sexual harassment, more can be done among healthcare organizations to create and maintain similar standards.

Nursing staff should feel comfortable reporting harassment and unwanted behaviors to management without fear of retaliation for sharing their concerns. Healthcare organizations need to have a zero-tolerance policy that addresses inappropriate employee and patient behavior. Sexual harassment is a significant hazard for nurses, and it needs to be addressed to make the workplace a safe environment for everyone.

The author gratefully acknowledges the support of Roswell Park Librarian Danielle Glynn for her assistance in researching the literature on this topic.

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