patients harassing nurses? oh, yes!
How nurses, administrators and society can respond.
By Mildred L. Culp

How has our attitude toward sexual harassment changed? How does the nurse-patient relationship inform that change?

Look back at the late 20 th century and you can't miss the unalterable fact that although the workplace became increasingly aware of the problem of sexual harassment, it's failed to eradicate it.

Little-known research by the Equal Opportunity Commission (EEOC) paints a disturbing picture of frequency, by industry. Here are six industries with numbers of charges filed in FY2004:

These numbers don't tell us:

• whether sexual harassment is increasing or decreasing over previous years;
• the relationship between the alleged harasser and the claimant (boss, customer, other); or
• the extent of unreported cases in an industry.

These numbers do tell us, however, that sexual harassment is alive and well. Debbie Dougherty, assistant communication professor at the University of Missouri-Columbia, details the patient-nurse variation of it in "Paradoxing the Dialectic," published in the Spring 2005 issue of Management Communication Quarterly. She cites statistics of 60 percent to 87 percent of nurses in various studies attesting to sexual harassment by patients.

PATIENT HARASSMENT

Dr. Janet Younger, associate dean at Virginia Commonwealth University 's School of Nursing (VCU), served on the Virginia Board of Nursing for almost a decade. "I saw many cases in which a patient sorely provoked the staff member who lost it and either said the wrong thing or was more forceful in movement than otherwise would have been," she recalls, "and it was reported to the board. In some instances, the patient physically attacked the nurse and the nurse simply reacted, turned quickly or pushed away," causing the patient to fall backward.

Younger also remembers "fairly regular" calls for police assistance, leading more than once to a cease-and-desist order signed by the patient. As an academic administrator, she's frequently observed sexual orientation as "the patient's favorite topic of conversation" when dealing with a male student.

The complicated nature of the relationship between harasser and victim may be no clearer than that of nurses in relation to patients. Dougherty states that "nurses must negotiate between closeness and distance to fulfill their roles as caregivers. The sexual harassment of nurses by their patients, however, serves to destroy this ability to move between these poles and instead calls for a single response-distance."

Are male nurses absolved? Younger states that they don't have the same environmental safeguards for sexual harassment as their female counterparts. "They have to learn to deal with it," she explains. "When a female student is sexually harassed, the reaction is more 'Oh, good grief.' When male students are sexually harassed, it's much harder to deal with." They begin to question their career choice and the prospect of continuing assaults on their manhood. Younger believes that women don't view the issue as personally.

Donna McCarthy, a member of the workplace advocacy staff at Virginia Nurses Association, receives several hundred telephone calls from nurses, registered or not, throughout the state. They come from a group of approximately 80,000. After a year and a half on the job, she hasn't received a single call specifically about the problem of patient/nurse harassment. Why does she think this is the case?

"I believe that there's a range of behavior from awkward moments between patients and nurses," she states. "It's an intimate process that frequently makes people uncomfortable. To cope, they may make inappropriate remarks. Most nurses with a little experience learn how to cope with it and aren't unduly disturbed by it."

McCarthy points out that nurses have a number of internal resources to deal with such problems, beginning with their supervisor or the HR department, depending upon their organization's procedure. She believes that such avenues are, "very often, enough for them." She mentions that the brevity of relationships between nurses and patients, especially in acute care, favors a lack of continuity in harassment, should it occur. "In long-term care," she states, "the issue is more serious. If a person is impaired, lacking judgment about appropriate behavior or a behavioral health care setting," the nurse can access the team involved in assisting in overcoming the problem. She doesn't think that increased home health care nursing assignments will lead to an increase in the problem of patient harassment, because, "generally, it's the same population."

Younger disagrees, commenting that "any time there's less structure, there's more primitive behavior. Yes, I think it's more problematic, just as it is in the middle of the night rather than at 7:00 a.m." Indeed, claims to the EEOC in home health care services increased to 28 in 2005 from 24 in 2004 and 21 in 2003.

Nancy Hughes, director of the Center for Occupational and Environmental Health at the American Nursing Association, points to the importance of administration creating policies for a safe work environment and support should allegations arise. VCU prepares students for the likelihood of patient harassment, then suggests a patient change and reports to the agency.

"Patients get quite a bit of latitude," Younger mentions. "It's common for them to make a sexually suggestive remark, maybe because they feel inadequate."

Dougherty also writes that most nurses thrive on their ability to develop "connections" or "relationships" with patients, that they require "closeness," both relational and proximate, to do their work. For them, like many others throughout industry, the EEOC statistics reflect that sexual harassment comes with the territory.

DISTANCE

What can nurses do when confronted with harassment? Some laugh it off. Consultant Patricia Trite of Healthcare Compliance Resources in Augusta, Mich., points out that reporting can lead to "the added humiliation of being ostracized (or) mocked," and, thus, working in an extremely uncomfortable environment. Others may hesitate to sue because of a "smart" harasser.

Richmond 's Carolyn Lavecchia, a former nurse with extensive experience as a medical malpractice attorney at Williamson & Lavecchia L.L.C., points out several options:

• reassignment;
• administrative intervention stating that the behavior is unacceptable;
• the nurse "confronting the patient, saying, 'If you don't stop, I'm going to have to report this.'"

VCU's Younger adds that the School of Nursing tells students "not to take it personally, how to respond and how to discourage it by being kind but firm."

What is society's role? "Nurses are an endangered species," Younger declares. "Everybody has a stake in protecting them from abusive treatment. They are smart and it's not like they have to have this job. If they can do this, they can do anything else. When a society or agency decides that abuse won't be tolerated, (a situation) changes remarkably fast."

Meanwhile, nurses who are harassed must ask themselves how much trouble they're willing to go to for the distance they seek to create.