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AP: "Inappropriate patient behavior tough on nurses"

December 15, 2005 -- Today MSNBC posted a short, unsigned Associated Press item about the widespread problem of sexual harassment of nurses by their patients. The Missouri-based piece provides a fairly good look at the breadth of the problem and some of its effects, though the piece understates the danger harassment can pose to patient care and nurses themselves, and it does not convey that some harassed nurses feel they do not get enough support from their institutions.

The piece uses the experience of St. Louis critical care nurse Sarah Andres as a frame. It reports that Andres, a nurse for five years, has actually become so used to being called "sweetie" or "cutie," or even being asked for a kiss, that "it rarely upsets her anymore." She says she never really considering it sexual harassment, noting that many patients are confused and in pain. Andres has asked to have someone else care for a "particularly troublesome" patient. But generally she tries to manage the situation based on experience, since she--like other nurses--has received little training in the area. Her tactics: "I just tell them that we are supposed to be professional here. I tell them we need to have mutual respect. Sometimes you have to talk to them almost like children...I just try to keep the relationship professional. I call the patient 'Mr.' or 'Mrs.' whatever, and I expect the same thing from them. I don't expect to be called pet names at work."

The report notes that nursing groups argue that such conduct is sexual harassment, and that it is common. A 1982 American Nurses Association study found that 60% of nurses reported experiencing harassment, including harassment from colleagues. Missouri Nurses Association executive director Belinda Heimericks is quoted as saying that nearly every nurse will run into it at some point. The report explains that the problem conduct ranges from "offensive jokes" and "sexual comments" to "inappropriate touching." Sexual assaults are "rare" but do occur, the piece notes. Indeed, there have been worrisome reports of such assaults in recent years, and some nurses have reported not receiving adequate support from hospital employers afterwards. (See the Massachusetts Nurses Association supportive guidelines about workplace violence.) According to the AP piece, most cases involve male patients and female nurses. The piece does not discuss why the harassment occurs in the first place, or whether public perceptions of nurses might play a role.

The piece goes on to discuss how such harassment affects the care of the nurses, who "must walk a fine line between meeting their professional responsibilities to the patient and protecting themselves." It cites a forthcoming study by Debbie Dougherty, a communications professor at the University of Missouri-Columbia, based on interviews with nurses in four states. The study addresses how nurses react to harassment and how it affects their relationships with patients. Dougherty found that the nurses generally "crack jokes or sternly reject" the conduct, and continue to provide care, but that there is "tension," and the nurses' "emotional support" for the patient may decline. Surely that is correct. But the piece might have explored the extent to which harassed nurses, possibly with their focus affected, may also be inhibited from doing other things that can mean the difference between life and death, like assessing patient conditions and needs, or asking questions that are vital to their critical care decisions. And these concerns apply not just to the patients who are committing the abuse, but all patients, since a nurse does not necessarily stop being upset about sexual harassment when s/he moves to the next patient. The piece might have also addressed the potential role of such harassment in nursing burnout and the nursing shortage. The piece does note that Dougherty's study also showed the nurses were more distressed by harassment from "co-workers or doctors" (perhaps the AP writer does not realize physicians are co-workers, rather than superiors, though it may also be that the writer is accounting for the fact that many physicians are not on staff).

The piece explains that federal and state laws do protect nurses from this kind of patient harassment. It notes that the harassment generally stops "far before a lawyer has to be called in or charges are filed," though again, many nurses report that such legal mechanisms are not put in motion even when nurses ask for that. The piece does note that health institutions are "constrained" by obligations to care for even problem patients, according to Arkansas employment lawyer Scotty Shively. The piece says that hospitals must admit patients who need emergency care, and that harassment is "more complex" if the patient is mentally ill. The piece does not explain how those rules would inhibit a hospital from acting in most cases. It cites no instance where a nurse or nursing organization felt that a hospital or other authority had failed to step in to protect a nurse who was suffering sexual harassment. And it does not note that many nurses try to weather unacceptable abuse because they feel inhibited from speaking up for themselves.

The piece does offer some practical advice for nurses confronting persistent sexual harassment. Nursing organizations suggest that nurses ask a second nurse to be present, refuse to care for the patient, ask that the patient be transferred to another floor, or report the conduct to a supervisor. It reports that "doctors and administrators" are sometimes called in to speak with patients. Shively notes that patients may be sent to other hospitals in "extreme" cases. Some of these options may be more practical than others. Most basically, the options that involve actually confronting the harassment--with the harassed nurse, or if necessary more senior nurses or hospital management, telling the patient the behavior will not be tolerated--would seem better than the ones that amount to sweeping it under the rug. The piece does not discuss whether broader public health messages might also be appropriate, such as including warnings about harassment in the notices about patients' hospital rights and duties. Of course, press pieces like this may help educate some patients.

We thank the AP for reporting on these important issues.

See the AP article "Inappropriate patient behavior tough on nurses: Sexual harassment a widespread problem, health official say" from December 15, 2005.

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