Sexual Harassment Prevention

Sexual harassment is a universal, prevalent, destructive, and sometimes tolerated occurrence in all occupations. The Equal Employment Opportunity Commission (EEOC) defines sexual harassment as frequent or severe behavior, usually of a sexual or gender nature, that is unwanted or unwelcome and affects job performance (EEC, n.d.). Instances occur daily in business, education, industry, the military, medicine, and religious organizations (Ross et al., 2019). The harasser can be a direct supervisor, a supervisor in another area, a co-worker, a physician, or someone outside the organization, such as a vendor, visitor, or patient.Harassers can be of the opposite or same gender or any sexual orientation.

The scope of this continuing education program does not include outside harassment, visitor, or patient harassment. The emphasis will be on sexual harassment prevention in health care, including clinical, administrative, and academic settings. With more online education, the possibility of cybersexual harassment is explored briefly. Sexual harassment is a legal, safety, ethical, and social issue. Zero tolerance is expected, and incidents are subject to swift disciplinary action without retaliation. The American Nurses Association, National Academies of Sciences, Engineering, and Medicine, and the National Institutes of Health endorse a harassment-free workplace and recommend education on prevention (ANA, 2015).  The National Institute for Occupational Safety and Health (NIOSA) provides prevention strategies.

Ken is the nurse manager for a medical-surgical unit in a large metropolitan hospital in Illinois. He has been in this position for a year and is newly divorced. Jenny is a recent graduate and a new nurse on the unit who has just completed her three-month orientation and probationary period.

Ken has commented on how well Jenny fills out her scrub suit and frequently tells her how pretty she is. Ken requests that Jenny come to his apartment for a candlelight dinner to discuss her three-month performance appraisal. He claims to be an excellent cook.

Jenny is irritated with Ken's comments about her body and avoids him as much as possible. She has not asked him to stop his offensive remarks because she does not want to confront her boss. She does not want to go to his place for dinner but is conflicted because she needs her job and fears reprisals if she does not meet with him as requested. What should Jenny do?

Quid pro quo is a type of sexual harassment where a person in authority, such as a manager, hints at sexual favors in return for employment benefits, in this case, a favorable performance appraisal.

Jenny has several options for handling the situation effectively. First, she can firmly tell Ken she is uncomfortable and ask him to stop his comments. She can ask for her performance appraisal to be done during work hours. She can talk to someone in Human Resources, call the compliance hotline where she works, or contact the Vice President of Nursing. Furthermore, Jenny can seek help outside of the organization. One choice is to report the situation to the State of Illinois Sexual Harassment and Discrimination Helpline at 877-236-7703 and be assured confidentiality and anonymity. Additional ways of reporting include emailing, faxing, writing a letter, or delivering her complaint in person to the Illinois Department of Human Rights (n.d.).

To make reporting easier, healthcare professionals should document all instances of uncomfortable behavior, including time, date, and a factual description of the event. If there are witnesses to the unwanted behavior, include their names in the notes. Additionally, notes may consist of any measures taken, such as asking the harasser to stop making comments. Notes facilitate the reporting process. Healthcare professionals may also report incidences to several sources, not just one.

A legal case, Faragher v. City of Boca Raton, provides the background for understanding the legal framework for quid pro quo. Beth Ann Faragher, a lifeguard, complained that her supervisors, Bill Terry and David Silverman, touched her inappropriately and made improper comments. For example, Faragher reported that Silverman had warned her to date him or clean the toilets for a year. Another female lifeguard, Nancy Ewanchew, complained to the City's Personnel Director, but the jeering did not stop after filing a complaint. The lawsuit resulted in the City being held responsible for the supervisors' actions. The court of law decided that the supervisors were granted virtually unchecked authority over their subordinates. Further, the courts agreed that the City did not exercise reasonable care to prevent the supervisors' harassing conduct (Amlong, 2006).

The lesson learned from this case is that employers must implement a tangible action policy and procedure to prevent sexual harassment. The plan must include investigation procedures and corrective actions for those found to be harassers (Amlong, 2006). Sexual harassment procedures and disciplinary actions must be communicated to all employees and strictly enforced. Healthcare managers must be ready to receive and research complaints of harassment. They must be on guard to identify and take immediate steps to stop it. Corrective action typically includes education, demotion, suspension, transfer, and possibly termination.

Ms. Powell, a new clinical instructor in a baccalaureate program, frequently makes sexual comments to Chuck, one of her students. She asks him about his dates and if he took his dates to bed. She remarks about his firm muscles and his sexy physique. Chuck seems to get the best assignments and the most interesting patients, and Ms. Powell spends much time helping him.

Chuck laughs at Ms. Powell when she makes sexual remarks and seems to find her comments entertaining. He is not offended. He relishes the attention and flirts with her when they eat lunch together.

Victoria, another student in the clinical rotation, overhears Ms. Powell's comments to Chuck and finds them offensive and distracting. She is afraid of making mistakes because of the distraction. Victoria has not been sleeping well and is anxious about the situation. She is considering asking the Program Director to assign her to another clinical instructor. She fears her clinical grade will suffer if she directly says anything to Ms. Powell.

Is Chuck a victim of sexual harassment? Is Victoria a victim of sexual harassment, although the instructor's comments are not directed toward her? What actions should be taken?

Because Chuck is not offended or annoyed by Ms. Powell's behavior, he is not a victim of sexual harassment. Sexual harassment occurs when someone objects or finds the behavior uncomfortable or intolerable, such as in Victoria’s situation.

Victoria is a victim of sexual harassment, although the instructor's comments are not directed toward her. If an onlooker is subjected passively to offensive behavior and is uncomfortable, it is indirect sexual harassment because the work environment is perceived as hostile.  This is sometimes termed a hostile work environment.A healthcare worker who is not precisely the target of any sexual harassment may have a valid claim of sexual harassment. Victoria's well-being is affected by indirect sexual harassment. Workplace sexual harassment, both direct and indirect, has been linked to emotional issues, such as downheartedness and anxiety, and may contribute to burnout and depression among victims (Takeuchi et al., 2018).

Victoria reports Ms. Powell's behavior to the Program Director. The Program Director, Mrs. Nuttall, becomes accountable once she hears what Victoria says. Following policy, Mrs. Nuttall investigates by interviewing other students in the clinical group who confirm Ms. Powell's seductive utterances to Chuck. Mrs. Nuttall also interviews Chuck, who collaborates the statements of the other student nurses and affirms that he is not offended. Mrs. Nuttall completes an occurrence report and makes an appointment with the Dean. The Dean disciplines Ms. Powell by giving her a week off without pay. The Dean makes it mandatory that Ms. Powell complete a three-hour remedial sexual harassment education course before returning to work.

What would have happened if Mrs. Nuttall's actions were incomplete? For example, what if Mrs. Nuttall had transferred Victoria to another instructor but did not follow the policy of investigating and reporting the occurrence to the Dean? If Mrs. Nuttall or the Dean had not taken proper steps to stop the unpleasant behavior, Mrs. Powell's behavior could have continued and offended other student nurses. Other student nurses could file lawsuits and be successful since the school had prior knowledge and did not act appropriately. Students who experience sexual harassment may seek monetary compensation in suits brought under Title IX of the Education Amendments of 1972 (DOE, 1972).

Court cases such as Davis v. Monroe County Board of Education confirm that educational institutions can be held liable for student-on-student or teacher-to-student harassment when:

1. The harassment is severe, pervasive, and offensive, depriving another of opportunities or benefits provided by the school.
2. The school has control over the context in which the harassment arose.
3. The school has disciplinary control over the harasser.
4. The school officials knew about the harassment and responded with deliberate indifference to the complaint (O'Conner, 1999).

Bobby is a middle-aged medical student and former medic. Audra is a 21-year-old medical student who has lived a sheltered life in a rural, religious setting. Bobby continually seeks Audra's attention during class breaks and school activities. Audra makes an appointment with the Dean and reports that Bobby had tried to kiss her and touch her breasts. Further, Audra says that Bobby repeatedly asks her for dates and has sent her texts and emails asking for sex. Audra wants to withdraw from school because she is so uncomfortable.

How should the Dean handle this situation?

The Dean asks Audra why she wants to withdraw and learns about Bobby's inappropriate behavior. Audra shows the Dean the offensive text messages and emails. The Dean takes Audra's complaint seriously and instructs her to use the following phrases in a calm but firm voice if Bobby harasses her again.

“What you are saying makes me uncomfortable. Please stop right now.”

Or

"Stop harassing me. I am going to the Dean right now."

As part of the investigation, the Dean interviews Bobby, who confesses to flirting heavily with Audra. Following school policy, the Dean tells Bobby to stop and puts him on probation. The Dean writes a descriptive narrative for Bobby's file. He requests that Bobby sign a written agreement indicating that he understands he will be dismissed from school for any further violations. Bobby complies, and no other incidents are reported.

While the majority of reported cases of sexual harassment involve a male harassing a female, the situation could be reversed. For example, Audra could harass Bobby. Additionally, harassment can occur between members of the same sex. Students who do not want to report matters to school officials may contact the resources, as mentioned earlier, if they live in Illinois. Others may contact the US Department of Education's Office of Civil Rights (OCR). Information is available on their webpage. The Department of Education requests that complaints be filed within 180 days of the alleged harassment.

Juanita, a nurse studying for her Master’s, received an email from an online classmate.  The email contained a picture of a voluptuous nurse in a tight uniform with black net stockings and red high heels.  The email had a short message:  “I would love to see you in this uniform.”  Juanita was offended and immediately took the email to the Dean of the program.

In another example, Jason, who is in Juanita’s class, receives text messages from his professor unrelated to schoolwork and are romantic. Like Juanita, Jason feels uncomfortable and informs the program Dean.

Examples of online sexual harassment include inappropriate and unwanted emails, texts, posts, blogs, and transmission of provocative images.  Online sexual harassment contributes to mental health and behavioral problems (Copp et al., 2021).  The victim may feel threatened, exploited, intimidated, humiliated, upset, and sexualized. Reporting any occurrence that makes one feel uncomfortable is essential to stop the unwanted actions.

Some healthcare professionals may be afraid to report harassing behaviors for fear of reprisal.  It is not common knowledge that employees and students who report sexual harassment are protected from retaliation by whistleblower laws. For example, Illinois offers general whistleblower protection under its Whistleblower Act (DOL, n.d.). If employees in Illinois believe they have been retaliated against for reporting sexual harassment, they can file a complaint with the Illinois Department of Human Rights. The complaint must be in writing and filed within 180 days of the retaliatory action. Another option is to file a lawsuit in the appropriate court. If successful, employees can receive back pay, reinstatement, and compensation for legal costs. Retaliation is considered a criminal offense and a Class A misdemeanor in Illinois.

Healthcare professionals and students are entitled to an environment free of sexual harassment. Sexual harassment, whether verbal or non-verbal, is bothersome, demeaning, irritating, annoying, and unwanted and is illegal.  Action must be taken to prevent it. Employers must implement actionable policies and procedures to prevent sexual harassment, including a written code of conduct, reporting and disciplinary guidelines, and corrective actions for those found to be harassers.  Managers and leaders must be ready to receive and research complaints of all manners of harassment, and any report of harassment must be investigated, even if it is repeated behavior.  Disciplinary action must be taken against those found to be harassers. Sexual harassment harms the victim and can lead to harsh consequences for offenders. Harassers can be of any sexual orientation or gender. For example, males can harass males or females and vice versa. Managers, leaders, and institutions must be ready to follow proper procedures and provide education to reinforce a milieu of zero tolerance and non-retaliation.

Healthcare professionals and students can call the State of Illinois Sexual Harassment and Discrimination Helpline at 877-236-7703 Monday through Friday, 8:30 a.m. to 5:00 p.m. Other options include writing, faxing, filling out a form, and talking to someone in HR or a leadership position. Occurrence reporting should include a description of the uncomfortable behavior, time and date of the occurrence, name of the harasser, witnesses, and a factual summary of the event. In Illinois and every state, whistleblower protections are in place to prevent retaliation from reporting. Retaliation is considered a Class A misdemeanor in Illinois.

• American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. Visit Source.
• Amlong, W.R. (2006). Faragher V. City of Boca Raton: A seven-year retrospective. FL Bar Journal, 80(1), 45. Visit Source.
• Department of Education (DOE). (1972). Department of Education's Title IX regulations, 34 CFR § 106.1 et seq. Visit Source.
• Copp, J., Mumford, E., & Taylor, B. (2021). Online sexual harassment and cyberbullying in a nationally representative sample of teens: Prevalence, predictors, and consequences. Journal of Adolescence. 93(1), 202-211. Visit Source.
• Department of Labor (DOL). (n.d.). Whistleblower Protections. Visit Source.
• Equal Employment Commission (EEC). (n.d.). Sexual Harassment. Visit Source.
• Illinois Department of Human Rights. (n.d.). Illinois Sexual Harassment and Discrimination Helpline. Visit Source.
• O'Conner, S.D., & Supreme Court of the United States. (1999). US Reports Davis V. Monroe County Board of Education. Visit Source.
• Ross, S., Naumann, P., Hinds-Jackson, D., & Stokes, L. (2019). Sexual harassment in nursing: ethical considerations and recommendations. Online Journal of Issues in Nursing, 24(1). Visit Source.
• Takeuchi, M., Nomura, K., Horie, S., Okinaga, H., Perumalswami, C., & Jagsi, R. (2018). Direct and Indirect Harassment Experiences and Burnout among Academic Faculty in Japan. Tohoku Journal of Experimental Medicine, 245(1):37-44. Visit Source.