Nursing Assistants from California, only. You must read the material on this page before you can take the test. The California Department of Public Health, Training Program Review Unit has determined that is the only way to prove that you actually spent the time to read the course. Less
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 behavior that affects job performance.1 Instances occur daily in business, education, industry, the military, medicine, and religious organizations.2 The harasser can be a direct supervisor, a supervisor in another area, a co-worker, a physician, or someone outside of the organization, such as a pharmaceutical representative, visitor, or patient.
The scope of this continuing education program does not include outside harassment, visitor, or patient harassment. The audience is healthcare professionals. The emphasis will be on sexual harassment prevention in health care, including clinical, administrative, and academic settings. 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 are three of many medical organizations that endorse a harassment-free workplace and recommend education on prevention.3-7
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 over to his apartment for a candle-light dinner to discuss her three-month performance appraisal. He claims to be a very good 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 that occurs 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 dealing with the situation effectively. First, she can firmly tell Ken that she is uncomfortable and ask him to stop his comments. She can ask for her performance appraisal to be done at work, 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 of 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.8
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 any witnesses to the untoward behavior, include their names in the notes. Additionally, notes may include 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. Additionally, another female lifeguard, Nancy Ewanchew, complained to the City's Personnel Director, but after filing a complaint, the jeering did not stop. The outcome of the lawsuit was that the City was 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 decided that the City did not exercise reasonable care to prevent the supervisors' harassing conduct.9
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 disciplinary measures for those found to be harassers.9 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 it and should take immediate steps to stop it. Discipline typically includes education, demotion, suspension, transfer, and possibly termination.
Ms. Powell, a new clinical instructor in a baccalaureate nursing 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, that is, the most interesting patients, and Ms. Powell spends a large amount of time helping him.
Chuck laughs at Ms. Powell when she makes sexual remarks and seems to find her comments entertaining. He is not offended. In fact, he seems to relish 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 is afraid if she says anything to Ms. Powell directly, her clinical grade will suffer.
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 Victoria.
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. A nurse who is not precisely the target of any sexual harassment may have a valid claim to 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 the development of burnout and depression among victims.10
Victoria reports Ms. Powell’s behavior to the Program Director. The Program Director, Mrs. Nuttall, becomes accountable once she hears what Victoria has to say. 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 confirms 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 happens if Mrs. Nuttall’s actions are incomplete? For example, what happens if Mrs. Nuttall transfers Victoria to another instructor, but does not follow the policy of investigating and reporting the occurrence to the Dean? If Mrs. Nuttall and/or the Dean do not take proper steps to stop the unpleasant behavior, Mrs. Powell’s behavior could continue and offend other student nurses. Other student nurses could file lawsuits and may be successful since the school had prior knowledge and did not act appropriately. Students, who experience or witness sexual harassment, may seek monetary compensation in lawsuits brought under Title IX of the Education Amendments of 1972.11
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 the:
harassment is severe, pervasive, and offensive, depriving another of opportunities or benefits provided by the school,
school has control over the context in which the harassment arose,
school has disciplinary control over the harasser, and
school officials had actual knowledge of the harassment and responded with deliberate indifference to the complaint.12
Bobby is a mid-age nursing student and former medic. Audra is a 21-year-old nursing 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 has tried to kiss her and touch her breasts. Further, Audra reports that Bobby repeatedly asks her for dates and has sent her text messages and emails asking her for sex. Audra wants to withdraw from school because she is so uncomfortable.
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.”
"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 and 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 further 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 sources listed in Scenario 1 if they live in Illinois. Others may contact the U.S. Department of Education’s Office of Civil Rights (OCR). Information is available on their webpage. The Department of Education requests that complaints are filed within 180 days of the alleged harassment.
Some individuals like Jenny and Audra may be afraid to report harassing behaviors for fear of reprisal. They may not know 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.13 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.
U.S. Equal Employment Commission. Sexual Harassment. EEO website. Accessed January 18, 2020. Visit Source.
Ross S, Naumann P, Hinds-Jackson DV, Stokes L. Sexual Harassment in Nursing: Ethical Considerations and Recommendations. OJIN. 2019;24(1); Manuscript 1. doi: 10.3912/OJIN.Vol24No01Man01. Visit Source.
American Nurses Association. Position statement on sexual harassment. ANA website. Approved April 2, 1993. Accessed January 18, 2020. Visit Source.
American Nurses Association. Code of ethics for nurses with interpretive statements. ANA website. Accessed January 18, 2020. Visit Source.
American Nurses Association. Take the pledge to #EndNurseAbuse. ANA website. Published December 22, 2017Accessed January 18, 2020. Visit Source.
The National Academies of Science, Engineering, and Medicine. Home Page. NASEM website. Accessed January 18, 2020. Visit Source.
National Institutes of Health (NIH). Common fund programs: High-risk, high-reward research. NIH website. Updated December 12, 2019. Accessed January 18, 2020. Visit Source.
Illinois Department of Human Rights. Illinois Sexual Harassment and Discrimination Helpline. Illinois DHR website. Accessed January 18, 2020. Visit Source.
Amlong, WR. Faragher V. City of Boca Raton: A seven-year retrospective. FL Bar J. 2006;80(1):45. Published January 2006. Accessed January 18, 2020.
Takeuchi M, Nomura K, Horie S, Okinaga H, Perumalswami, CR, & Jagsi R. Direct and indirect harassment experiences and burnout among academic faculty in Japan. TJEM. 2018;245(1):37-44. doi:10.1620/tjem.245.37.
U.S. Department of Education. Department of Education's Title IX regulations, 34 C.F.R. Â§ 106.1 et seq. 1972. Accessed January 18, 2020. Visit Source.
O’Conner SD & Supreme Court of the United States. U.S. Reports: Davis V. Monroe County Board of Education (97-843) 526 U.S. 629 (1999). LOC website. Accessed January 18, 2020. Visit Source.
U.S. Department of Labor. The Whistle Blower Protection Program. U.S. DOL website. Accessed January 18, 2020. Visit Source.
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