Workplace violence and harassment from patients is an unfortunate and common occurrence in nursing. From verbal and physical altercations to inappropriate sexual advances, the potential for harassment is very real for nurses, who must learn to protect themselves.
Plus, patient harassment and workplace violence toward healthcare workers became much more prevalent and apparent during the COVID-19 pandemic. Addressing this unfortunate phenomenon will take work on the part of healthcare workers, educators, leaders and policymakers. But day-to-day management of harassment and appropriate responses to harassment often still comes down to nurses and nurse managers on the floor.
Nurses can gain the nuanced knowledge and skills needed for managing patient harassment through studying topics like nursing leadership and management, culturally competent nursing, current issues in the field, health education and policymaking. The online Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) program from Southern Utah University (SUU) covers these and other subjects in depth, preparing nurses to play important roles in creating and managing safe workplace environments for both colleagues and patients.
What Does Patient Harassment Look Like?
Harassment takes many forms. The U.S. Equal Employment Opportunity Commission (EEOC) defines harassment as “unwelcome conduct that is based on race, color, religion, sex (including sexual orientation, gender identity, or pregnancy), national origin, older age (beginning at age 40), disability, or genetic information (including family medical history).”
The EEOC further states that harassment is unlawful when either “1) enduring the offensive conduct becomes a condition of continued employment, or 2) the conduct is severe or pervasive enough to create a work environment that a reasonable person would consider intimidating, hostile, or abusive.” Although the EEOC’s definition of harassment generally applies to how employers treat their employees, it provides a deeper view of how harassment by patients may unfold.
Unfortunately, nurses experience harassment and workplace violence in a variety of ways, such as the following:
- Physical threats, intimidation or assaults like hitting, biting or kicking
- Verbal abuse such as the use of racial slurs or nicknames like “baby” and “sweetie” as well as offensive jokes, teasing or questions
- Sexual misconduct and assault, including patients intentionally exposing themselves, making gestures or propositions, or touching nurses in a suggestive manner
As to the regularity of harassment, a 2023 survey from Premier found that 40% of healthcare workers “experienced an incident of workplace violence in the last two years.” Sixty percent of survey respondents who experienced workplace violence identified as bedside nurses. Out of this population of nurses, 34% experienced emotional or verbal abuse while 66% experienced physical or sexual assaults. More than half of respondents believed workplace violence incidents increased during their tenure. Further, the most common context for workplace violence was when healthcare workers were explaining or enforcing organizational policy, reflecting exacerbated challenges during the pandemic.
How Can Patient Harassment Be Prevented or Addressed?
Due to the intimate nature of nursing care and the close physical contact that is often required, full prevention can be extremely difficult in daily practice. For example, when nurses care for patients who are under the influence of drugs and alcohol or who have neurological conditions like traumatic brain injuries or dementia, the emergence of violent, aggressive or inappropriate behavior may be outside the patient’s cognitive control. Yet 67% of the Premier survey respondents reported that “their perpetrator was not noticeably or confirmed to be under the influence of drugs or alcohol.”
Whatever the situation may be, patient harassment solutions are typically multifaceted, requiring action plans and policies to be put into place by administrators, employers, nurses and their colleagues. Here are some tactics:
- Know your employer’s policies. Nurses must feel comfortable reporting incidents up the chain of command and know all reports will be thoroughly investigated. Administrators should ensure a streamlined and confidential reporting process and encourage nurses to voice concerns right away, commonly to the charge nurse or nurse manager.
- Staff education. It is critical that nurses understand the breadth of potential behaviors classified as harassment. It is not always blatant and can be very subtle, making it equally critical for the physicians and other healthcare providers working alongside nurses to be able to identify troublesome situations and intervene as necessary. All staff should receive continuing education that defines patient harassment as well as acceptable preventive and de-escalation strategies.
- Be clear on your boundaries. Know your boundaries and be prepared to communicate those to patients. If a patient is behaving in a way that makes you uncomfortable, addressing the issue directly and stating that it will not be tolerated is often enough to ward off future transgressions.
- Bring in backup. If the behavior continues, do not hesitate to bring in backup in the form of one or more people — another nurse, physician or security guard — who can provide support when interacting with the patient. If those measures do not serve as an effective deterrent, consider removing yourself from the situation completely and requesting another nurse to take over. Some hospitals and physician practices will consider terminating relationships with repeat offenders.
Patient harassment is a prevalent issue for nurses. However, that does not mean it should be tolerated. Administrators, employers and nurses should have safeguards in place to afford protection and dissuade ongoing harassment. Many healthcare organizations have stepped up anti-harassment efforts as well as transparency and accountability measures in response to increases in workplace violence during the COVID-19 pandemic. For instance, signs reflecting zero-tolerance policies surrounding harassment and workplace violence are now commonplace in healthcare settings.
These are important steps, but deeper institutional- and policy-level change is needed, along with outreach and education efforts. Much of this change will come from nurses in leadership roles. Nurses can pursue such roles through advancing their education and equipping themselves with the tools needed to be effective movers and shakers in the healthcare industry.
Learn more about SUU’s online RN to BSN program.
