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 how to protect themselves.
What Does Patient Harassment Look Like?
Harassment takes many forms. The U.S. Equal Employment Opportunity Commission (EEOC) defines harassment as any "unwelcome conduct that is based on race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability or genetic information" and is "intimidating, hostile or offensive to reasonable people." Although that definition generally applies to how employers treat their employees, it provides a deeper view of how harassment by patients may unfold.
Unfortunately, nurses experience harassment in a variety of ways:
- Physical threats, intimidation or assaults (i.e. hitting, biting, 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
A 2018 Medscape Medical News survey evaluated the prevalence of harassment among nurses. Female nurses were much more likely to face sexual harassment when compared to their male counterparts, at a rate of 73% and 46% respectively. While only 22% of nurses had a patient attempt inappropriate contact with them online or through social media, 96% of male nurses and 84% of female nurses had endured physical threats. The study also found that the rates of harassment remained relatively steady over time, affecting nurses with one year of experience at the same frequency as those more than 20 years into their careers. The only exception was nurses in practice for fewer than 10 years reported higher rates of attempted online communications by patients.
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.
Therefore, 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 that all reports will be thoroughly investigated. Administrators should ensure there is a streamlined and confidential reporting process and encourage nurses to voice their 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.
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