Sexual harassment is a phenomenon that is of serious concern to administrators worldwide and across employment sectors. Within the public health system Valente and Bullough (2004) acknowledge that sexual harassment is a serious problem and they point out that this issue particularly affects nursing and healthcare (p. 234).
Hibino, Ogino and Inagaki (2006) provide that sexual harassment represents unwarranted sexual attention and behavior that potentially prevents an employee from successfully performing job duties (p. 401). Valente and Bullough (2004) support this general definition and contend that such behavior is usually “hostile, offensive and degrading” (p. 237). They further clarify that perpetrators, though they are usually of the opposite sex, may also be of the same sex as the victim.
The Equal Employment Opportunity Commission (EEOC) clearly defines sexual harassment as “sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature” (Kinard & Little, 2002, p. 47). The Commission further clarifies that for legal purposes harassment is categorized as either quid pro quo or hostile environment. Quid pro quo is derived from Latin and it translates to ‘this for that’ (Kinard & Little, 2002, p. 47). With this type of harassment threats or rewards linked with employment are used to coerce employees into compliance. Salary and promotion, among other things, become tied with compliance to the sexual advances of bosses (Valente & Bullough, 2004, p. 236).
Hostile involves acts or behaviors that result in an uncomfortable work environment. In such cases evident consequences related to employment may not be proposed, nor does physical violence have to occur, according to Valente and Bullough (2004). However the victim is usually unable to avoid such approaches and ends up feeling distressed with the environment created in the workplace as a result of those advances. Kinard and Little (2002) list a number of situations that may contribute to a hostile environment including vulgar gestures or language, sending lewd pictures, making uninvited sexual approaches, unpleasant sexual discussions, making sexually suggestive remarks, probing into one’s social or sex life, commenting sexually on physical appearance, sending sexual gifts and getting too physically close to an employee (p. 47).
Sexual harassment in the workplace, particularly against women, is not a new phenomenon. Valente and Bullough (2004) argued that it is the most prevalent sexual crime. Sexual harassment is now considered a very major problem in healthcare and it is more prevalent within the nursing profession. Valente and Bullough (2004) believe that comparatively nursing has the highest rates of sexual harassment. They further note that on average 69% to 85% of nurses report having encountered sexual harassment in one form or another (p. 234). In a questionnaire administered to 464 female nurses in the north-central hospital district of Japan over fifty percent of the respondents reveal that they had experienced sexual harassment and only two of the cases did not cite males as the perpetrators (Hibino, Ogino & Inagaki, 2006, p. 401).
Evidently sexual harassment is not exclusively perpetrated against women. While it is true that most of the cases reported in the United States are by women, men are also being harassed sexually in the workplace. Valente and Bullough (2004) report that males account for 10% of cases filed. Comparing the results of two separate nationwide surveys among hospital human resource managers in 1994 and 2001 Kinard and Little (2002) also found in both cases that men lodged approximately 10% of all complaints (p. 49).
Research conducted in Israel also supports this trend. Bronner, Peretz and Ehrenfeld (2003) report, from a questionnaire administered to nurses and nursing students at medical centers within Israel, that, though 75% of cases were men harassing women, whenever males were harassed, perpetrators were women. This suggests that female nurses are more susceptible to sexual harassment. However Bronner, Peretz and Ehrenfeld (2003) found that males experienced more severe types of sexual harassment (p. 638). Valente and Bullough (2004) observe that same-sex harassment is also common but lament that such instances are not widely reported p. 235).
This variation in the gender of nurses affected by sexual harassment can be attributed to several factors. First, since sexual harassment is often perpetrated by someone who is in a position of leadership, women commit these acts less often because only few of them hold such positions. Furthermore the 10% report rate by males is far from accurate since it is believed that men are embarrassed and fear derision if they should report such cases.
With respect to the category of individuals that perpetrate acts categorized as sexual harassment within the healthcare industry, Valente and Bullough (2004) indicate that coworkers, supervisors, patients and their families are all involved. These writers report that the number one group of perpetrators of assault against nurses is physicians (p. 234). Among the responses produced by 188 critical care nurses 82% indicated that physicians were responsible for the perpetration of acts of sexual harassment (Valente & Bullough, 2004, p. 237). Similarly Kinard and Little (2002) report that physicians accounted for between 10% and 15% of reported cases of sexual harassment in two nationwide studies (p. 49). Bronner, Peretz and Ehrenfeld (2003) show similar results in their Israel study, reflecting 10% to 30% of cases reported to be perpetrated by male physicians (p. 641).
Within the other categories of perpetrators coworkers were found to account for 20% and supervisors for 7% (Valente & Bullough, 2004, p. 237). Male nurses accounted for between 15% and 22% and patients for 18% to 38% (Bronner, Peretz & Ehrenfeld, 2003, p. 641). Female nurses were also guilty in a few cases.
Among the acts that have been perpetrated by patients Hibino, Ogino and Inagaki (2006) note sexual remarks, probing into nurse’s personal life, requesting dates, vulgar stares, touching or requesting that the nurse touch the patient sexually, luring the nurse to the patient’s bed, sexual assault and stalking (Hibino, Ogino & Inagaki, 2006, p. 402). Sexual remarks were found to be the most prevalent but probing into the nurse’s personal life, soliciting dates and making threats also figured prominent.
Supporting the above findings Valente and Bullough (2004) highlight the prominence of various types of harassment being sexual comments – 33%, touching – 26%, soliciting dates – 15%, sexual coercion – 10%, and phone calls, letters, or notes – 10% (p. 237).
Additionally nurses often experience various forms of sexual harassment. One research found that 91% of the respondents experienced at least one form of sexual harassment, 30% experienced more than three and a further 5% experienced more than five types of sexual harassment (Bronner, Peretz & Ehrenfeld, 2003, p. 640). Evidently the rate of sexual harassment against nurses is even higher than the figures suggest since sexual harassment occurs in several forms and are perpetrated by different individuals within the work environment.
The severity of acts of sexual harassment also suggests that the issue is much more serious than reported. Moderate forms of harassment which involve sexual comments are much more prevalent according to Bronner, Peretz and Ehrenfeld (2003), accounting for an approximate 37% of cases. Severe forms of sexual harassment, according to that same report account for 12% of cases. However, even though research found that the frequency of sexual harassment decreased as the severity increased, the acts perpetrated are quite serious and are causes for worry among hospital administrators. Severe acts include forcing nurses to touch sexually and threats to have intercourse with the nurse against their will (Bronner, Peretz & Ehrenfeld, 2003, p. 640). What is bothersome is that 35% of males in this same research reported that they were exposed to the more severe forms of sexual harassment.
The shocking news is that, even given the legislative stringency on sexual harassment, instances of its occurrence do not seem to be decreasing in the healthcare industry. Trends between 1994 and 2001 reveal that reported cases of sexual harassment increased from an average of three to four complaints per hospital (Kinard & Little, 2002, p. 49).
Sexual harassment cases are costly to hospital administrators, the nurses themselves and the general healthcare system in several respects. Valente and Bullough (2004) found that the performance of nurses is negatively affected when a hostile environment is created because of sexual harassment. Psychological, psychosocial and even physical strains are experienced by the nurses. Inefficiency may result as nurses may not be able to concentrate on delivering safe and competent care to patients. Job satisfaction is also affected and this leads nurses to often quit the job, the profession or transfer to another organization.
The decrease in the productivity of nurses reflects in costs to administrators. Nurses may repeatedly absent themselves from the job to avoid compromising situations and the integrity of health care is thus threatened. Staff turnover with the movement of nurses out of the profession results in monetary costs for administrators as the employer has to invest in recruiting and training new members (Valente & Bullough, 2004, p. 235). Further the healthcare industry’s viability is compromised when nurses do not perform their functions effectively because of such harassment. Patient’s lives are endangered when nurses are unwilling to communicate information necessary to a patient’s wellbeing to a colleague who is harassing them.
The repercussions of such actions damage the credibility of the nurses and bring ill repute to healthcare. Furthermore awards from lawsuits cost hospitals in the regions of billions of dollars yearly (Valente & Bullough, 2004, p. 235). To protect itself and its employees almost all hospitals now have formal, written policies on sexual harassment and incorporate these in manuals, training programs and departmental discussions in departmental meetings (Kinard & Little, 2002, p. 52).
Such policies emphasize penalties for perpetrators as an essential element. Warnings, whether verbal or in writing, employment termination, suspension without pay, counseling, transfer, suspension of privileges or demotion are some of the strategies employed (Kinard & Little, 2002, p. 50).
The continuing prevalence of sexual harassment in the workplace could be attributed to several factors. Madison and Minichiello (2004) observe that perpetuating myths on the stereotypical submissive role of women to men contribute to attempts by male physicians to dominate females via sexual advances. They also complain that far too many administrators are still silent on the issue (p. 9). Further employees do not believe they have the necessary support from either their coworkers of supervisors. Hibino, Ogino and Inagaki (2006) found that nurses felt that they had no one to turn to in reporting sexual assault and thus remained silent. Additionally employees are not appropriately educated on the issue either by their employers or during their training as nurses (Madison & Minichiello, 2004, p. 11).
Sexual harassment of nurses in the workplace is a very sensitive issue. While regulation is in place to punish offenders nurses are still not coming forward to report cases individuals in positions of authority are still using submission to sexual advances as conditions of employment. There remains much more for researchers and administrators to do to combat this issue and to come up with feasible short and long term solutions.