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Sexual harassment against nurses: what to do if you or your colleagues are affected

New RCN guidance aims to empower nurses to recognise and report it

Sexual harassment at work is not part of the job. New RCN guidance aims to empower nurses to recognise and report it

  • Research suggests nurses are at high risk of sexual harassment from patients, service users and relatives known as third-party harassment
  • Nurses need to be supported by employers to have the confidence to report harassment and know it will be taken seriously
  • Steps to take if you experience inappropriate behaviour from patients, relatives and those with cognitive impairment

Unwanted sexual advances, inappropriate touching and comments about physical appearance are often directed at nurses as they carry out their jobs.

New RCN guidance aims

...

Sexual harassment at work is not ‘part of the job’. New RCN guidance aims to empower nurses to recognise and report it

  • Research suggests nurses are at high risk of sexual harassment from patients, service users and relatives – known as third-party harassment
  • Nurses need to be supported by employers to have the confidence to report harassment and know it will be taken seriously
  • Steps to take if you experience inappropriate behaviour from patients, relatives and those with cognitive impairment

Picture: iStock

Unwanted sexual advances, inappropriate touching and comments about physical appearance are often directed at nurses as they carry out their jobs.

New RCN guidance aims to empower nurses to recognise and report sexual harassment in the workplace from patients, service users and relatives – known as third-party sexual harassment.

Depictions of nurses in the media fuel stereotypes, leading to nurses being treated as ‘fair game’, the college says in its publication.

This article outlines the steps nurses should take if they or their colleagues experience sexual harassment at work.

What is sexual harassment?

Sexual harassment is behaviour which violates a person’s dignity and/or creates an intimidating, hostile, degrading, humiliating or offensive environment. It includes:

  • Inappropriate touching.
  • Unwanted sexual advances.
  • Sharing or sending lewd images via social media.

What is ‘third-party’ sexual harassment?

In nursing, this is when a member of the nursing workforce, including a student on placement, is sexually harassed by a client, patient, patient’s associate or a member of the public while at work.

Nurses who work alone may be particularly vulnerable, especially those visiting patients in their homes, the RCN guidance states.

Many media reports have been about men harassing female staff, but anyone can experience sexual harassment and the perpetrator can be the same gender as the person they are harassing.

How many nurses are affected?

Data from research and surveys vary, but unions and campaigners agree nurses are at high risk of experiencing third-party sexual harassment.

International research suggests that 25% of nurses have experienced sexual harassment.

In 2019, nearly one in ten healthcare staff responding to a Unison survey reported being sexually harassed.

Verbal abuse – for example, unwanted remarks, offensive ‘banter’ and jokes – was the most common complaint among to the 8,487 NHS workers who responded, cited by 64%.

Of these incidents, 42% involved patients, the rest related to colleagues.

Nearly a third (31%) of respondents who said they had been sexually harassed said it happened regularly; more than one in ten (12%) said it happened every week or every day.

What kind of experiences are nurses having?

Nurses and other healthcare staff told Unison about incidents that had shaken their confidence, left them scared and affected their mental health.

‘While I was on placement a patient attempted to take my tunic off, but none of the staff on the ward did anything,’ one student said.

Another spoke about the ongoing effect of having to see the patient who had sexually harassed her.

‘It was an incident that spooked me. I now purposely wear a larger uniform and feel myself tense up if we're called to the area where the patient lives.’

Many nurses feel they are expected to put up with a certain amount of inappropriate comments.

A clinical nurse specialist with almost 20 years’ experience said: ‘While I’ve never had what you would call a serious experience, I think back to my days when I had just qualified and some of the comments do make me shudder.

‘I’ve always looked quite young for my age and I’d often be called “my darling” or “gorgeous” by patients or their relatives and would get asked if I had a boyfriend.’

What impact can this have on nurses?

Such harassment can be very distressing, particularly when a nurse has to return to see the patient who harassed them every time they go to work, the RCN says.

This distress can lead to emotional and psychological distress, including feelings of anger and fear, and it can cause physical symptoms including palpitations, insomnia and headaches.

It may result in absenteeism from work due to the stress and anxiety associated with facing the perpetrator.

‘Don’t dismiss the impact of sexual harassment’

NHS Forth Valley community drugs and alcohol nurse Leanne Patrick says nurses need to be more alert to sexual harassment.

Leanne Patrick: ‘Women are socialised to
accept objectifying comments’

She says that nurses often consider unacceptable comments ‘part of the job’.

Ms Patrick recognises that sometimes it can be difficult to work out exactly when these comments have crossed the line.

Reading a Twitter discussion on how nurses felt about sexual or inappropriate comments highlighted for her the complexities of improving responses to it, she says.

‘Some people were comfortable with it, some thought it was a bit of a joke, some people felt very uncomfortable,' she says.

‘Alarmingly, several felt it should be taken as a compliment, saying they would have thanked the patient. This advice, from senior nursing staff and fellow students, is dismissive at best.’

‘We’re often told it’s a joke or not a big deal’

Ms Patrick adds that women, in particular, tend to be socialised to accept sexual and objectifying comments as normal.

‘We're often told it's a joke or not a big deal and so we ignore discomfort rather than registering it.’

The international #MeToo campaign highlighting sexual abuse and harassment against women should give nurses confidence to stand together against sexual harassment, she says.

‘Learning from some of the wider social movements, we need to start listening when a student or staff nurse tells us they are uncomfortable, that they have been harassed or groped by a patient or colleague.’

How well is the issue generally dealt with by employers?

This has long been a problem, according to campaigners.

Former RCN UK stewards committee member and retired forensic psychiatric nurse Zeba Arif says she saw sexual harassment at work poorly handled repeatedly throughout her career.

She raised the issue in a successful resolution at the 2019 RCN congress, drawing attention to how little action is taken by employers when sexual harassment is reported.

Ms Arif says most of the harassment comes in the form of innuendo or touching – mostly on the hand or arm – which people often laugh off as ‘a compliment’, but which is unacceptable.

Zeba Arif: ‘Innuendoes from patients
are often not dealt with’

She recalls a particularly unpleasant experience one newly qualified nurse had when a patient’s brother started to ask her out, saying he fancied her.

The nurse reported it to her manager who didn’t do anything and there was no policy that covered patients’ visitors.

She reported it to the patient’s consultant and asked if the brother’s visits could be curtailed but was told she had ‘just pushed his manhood buttons’.

‘The man ended up following the nurse to the car park, grabbing her and pushing her onto the bonnet of a car.

‘She managed to escape and wanted to call the police, but her manager asked her not to do so as he thought it would bring the trust into disrepute.

‘The nurse left and went to work at another hospital.’

Subsequently, Ms Arif said she tested the water with management to see if anything had changed when nurses approached for her help but discovered 'again and again' nobody would take action when the harassment involved patients.

‘Colleague-on-colleague sexual harassment was taken care of, the trust had a very good policy on that, but not when it was a patient.’

What managers can do about third-party sexual harassment

Under health and safety legislation, employers must take steps to protect the health and safety of their staff at work, including from the risk of harm by abuse from patients, relatives or others encountered while undertaking a nursing role.

When made aware of cases of third-party sexual harassment, employers should carry out a risk assessment and put steps in place to prevent reoccurrence.

This may include:

  • Moving care from home to a clinic or hospital building
  • Providing lone worker alarm devices or doubling up on home visits
  • Speaking to the perpetrator about their behaviour – perhaps with a yellow/red card warning system
  • A review of treatment and care in cases where the patient has limited or no capacity

Employers should support nurses in reporting any incidences of sexual assault or threats of sexual violence to the police.

RCN members with concerns about the way their complaint of third-party harassment is handled should contact RCN Direct.

Can sexual harassment lead on to other problems?

The RCN guidance says that harassment can lead to sexual assault – a sexual act of physical, psychological and emotional violation, inflicted on someone without their consent.

Sexual assault can involve forcing or manipulating someone to witness or participate in sexual acts and can cause severe distress, emotional harm and injuries that can’t be seen.

Sexual harassment can also lead to nurses being stalked.

Nurses should feel confident to report sexual harassment to their managers Picture: iStock

What should nurses do if they have been sexually assaulted?

Sexual assaults, or sexual assault threats and stalking behaviours, should be reported to the police.

The RCN urges all nurses who have experienced any kind of sexual harassment not to be put off reporting it to their colleagues or managers.

The guidance says: ‘Anything that makes you feel uncomfortable, violated or abused, no matter how small, should be reported. It could be the start of something bigger or, unbeknown to you, other staff could have complained previously.’

It advises nurses:

  • To look at their employer’s policy on violence, abuse and workplace harassment and follow steps on how to report.
  • If there is no policy, to report verbally to their manager and record it on the organisation’s incident reporting system.
  • To keep a record of all instances of harassment.

Sadly, nurses often do not report assaults, either thinking that it is part of the job to put up with such behaviour, or because they do not expect much action to be taken.

In the Unison survey, over a quarter (28%) of those who had experienced sexual harassment said they kept quiet about it and only one in five (20%) reported it to their human resources department or their managers.

‘Learning from some of the wider social movements, we need to start listening when a student or staff nurse tells us they are uncomfortable, that they have been harassed or groped by a patient or colleague’

Leanne Patrick, NHS Forth Valley community drugs and alcohol nurse

RCN national officer for health and safety Kim Sunley says: ‘Third-party harassment is too often under-reported because nursing staff are concerned their employers won’t take their concerns seriously.

‘Sometimes people feel embarrassed or think their career will be affected if they tell someone, but that should never be the case.'

Sexual harassment where a health condition may be a contributing factor

Many conditions, including dementia, brain injury, learning disabilities and some mental health problems, may contribute to service users displaying inappropriate sexual behaviour.

Sexual harassment in these cases should be treated differently, but still acted on and never ignored, nursing experts say.

Imperial College Healthcare NHS Trust consultant nurse in dementia Jo James says nurses should establish boundaries and be clear the behaviour has made them uncomfortable.

Stopping inappropriate behaviour while being aware of the nuances

However, she counsels to avoid ‘grand tellings-off’ that could exacerbate a situation if the patient becomes distressed.

‘All responses to a person with cognitive impairment should be considered in light of the person’s condition, degree of impairment and communication skills.

‘Any form of behaviour that makes a nurse uncomfortable should be stopped or redirected immediately.

‘However, it is important to look at some of the nuances when dealing with people who have cognitive impairments because the behaviour might not be coming from the same place or motivation.

‘It might be that the person is unaware of who the nurse is, misinterprets an action or care task or is unable to stop the disinhibition.’

What should nurses do if their employers do not act or if they need extra support?

Nurses can seek help from their union representative.

Some organisations also have Freedom to Speak Up Guardians, independent sexual violence advisers or dignity champions – to whom nurses can escalate concerns.

Students on placement should talk to their mentor and document the incident using the organisation’s incident reporting form, then flag the incident with their tutor and RCN student ambassador.

If no action is taken to address the incident or the behaviour continues, they should contact RCN Direct for advice on what to do next.

What should you do if you witness third-party sexual harassment against a colleague?

Nurses should let their colleague know what they have witnessed and encourage them to report the incident, and act as a witness on any forms.

It might be helpful to signpost colleagues to sources of support, such as their union representative, dignity champions or occupational health service.


Erin Dean is a health journalist


Further information

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