≥ 92% of participants will know how to report sexual harassment both inside and outside the organization.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
CEUFast, Inc. is an AOTA Provider of professional development, Course approval ID#9399. This distant learning-independent format is offered at 0.1 CEUs Intermediate, Categories: OT Professional Issues AOTA does not endorse specific course content, products, or clinical procedures. AOTA provider number 9757.
≥ 92% of participants will know how to report sexual harassment both inside and outside the organization.
After completing this continuing education course, the participant will be able to meet the following objectives:
Sexual harassment is a universal, prevalent, destructive, and sometimes tolerated occurrence in all occupations. Instances occur daily in business, education, industry, the military, medicine, and religious and charitable organizations (Ross et al., 2019).
The American Nurses Association (ANA), the National Academies of Sciences, Engineering, and Medicine, and the National Institutes of Health endorse a harassment-free workplace and recommend education on prevention. The ANA represents the interests of over four million nurses and seeks to protect its nurses from all types of harassment through its position statement and policies (American Nurses Association, 1993). The California Nurses Association also advocates for its nurses and others who are harassed. For example, in 2018, the California Nurses Association called for the resignation of Senator Joel Anderson when he harassed their lobbyist (Anapol, 2018).
The results of a systematic literature review demonstrated that sexual harassment against female nurses was 43.15%. Further, 46.59% were harassed by patients, 41.10% by physicians, 27.74% by patients' families, 20% by fellow nurses, and 17.8% by coworkers. Because of harassment, 44.6% developed mental health issues, 30.19% acquired physical health problems, 61.26% reported emotional troubles, and 51.79% had psychological disturbance (Kahsay et al., 2020). Given these percentages, sexual harassment is likely to be underreported.
This definition includes many forms of offensive behavior and gender-based harassment. The following is a partial list of prohibited behaviors:
The harassment must be severe or pervasive to be unlawful. That means that it alters the conditions of one’s employment and creates an abusive or hostile work environment. A single act of harassment may be sufficiently severe to be unlawful (California Civil Rights Department, 2023a). An example of an illegal single act could be rape or sexual assault.
The definition of abusive conduct is when an employer or employee in the workplace acts with malice that a reasonable person would find:
Abusive conduct may include:
A single act shall not constitute abusive conduct unless especially severe and egregious.
Two categories of sexual harassment exist: Quid Pro Quo and Hostile Workplace/ Indirect Sexual Harassment. Each will be examined more thoroughly.
A legal case, Faragher v. the 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).
Ken manages a medical-surgical unit in a large metropolitan hospital in California. 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. She 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 sexy 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 and lover.
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. She thinks he should provide her performance appraisal in the work setting during work hours. Jenny needs her job and fears reprisals if she does not meet with Ken as requested. What should Jenny do?
Jenny can take her documentation to the hospital’s human resource director or the company’s compliance officer. Jenny’s notes will help validate what happened and will be critical to the investigation. The employer, in this case, the metropolitan hospital, is “strictly liable” under California law. This means the employer is responsible, and the law requires them to take corrective action.
Employees such as Jenny have several options for reporting incidents, both internally and externally. An external venue is California’s Civil Rights Agency. In the scenario below, Stanley reported this complaint inside and outside his organization.
Dan is a case manager for an insurance company in California and works remotely.
He has not met his supervisor, Stanley, or other team members.
Dan researched Stanley on social media and knows that his boss is gay. Dan would like to meet his boss socially and sends the following email through the company email system:
Hi Stanley, Please pardon me for intruding in your personal life. I love talking to you on the phone and working for you. Your voice is very sexy. I would love to get to know you better. I think we could have a good time under the covers, if you get what I mean. Can we meet for a drink sometime to see if there is chemistry? My treat.Hugs and Kisses, Dan |
Stanley says “No” to Dan and tells him that his email is inappropriate. Stanley asked Dan to stop all behavior related to a personal relationship. Next, Stanley reports the matter to his supervisor. His reporting complies with the employer’s sexual harassment policy and California’s Fair Employment and Housing Act.
Under California law, sexual harassment need not be motivated by sexual desire but may be based upon an employee’s actual or perceived sex or gender identity or their actual or perceived sexual orientation. Dan knew that Stanley was gay, and his email was based on that knowledge.
After being told “No” by Stanley and counseled by the Human Resources department, Dan sent additional emails of a provocative nature. This time, Dan uncovered Stanley’s personal email address, which became the venue for further unwanted contact.
Stanley decided to report the matter to California’s Civil Rights Agency. He called the Communication Center at 800-884-1684, filled out an intake form, and, when requested, sent copies of the inappropriate emails. California’s Civil Rights Agency started an investigation. Stanley decided not to use the Right-to-Sue option. The Right to Sue option gives Stanley and others the right to sue their employers for a hostile workplace.
While both Jenny and Stanley experienced direct sexual harassment, others may experience indirect sexual harassment.
An employee who is not precisely the target of any sexual harassment may have a valid claim to sexual harassment, especially if comments are persistent and/or disturbing.
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 significant 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 class, overhears Ms. Powell's comments to Chuck and finds them offensive and distracting. She is afraid of making clinical mistakes because of the distraction. Victoria has not been sleeping well and is anxious about the situation. She is considering asking the Director to assign her to another instructor. She is afraid that if she says anything to Ms. Powell about her comments to Chuck directly, her grades 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 of another person uncomfortable or intolerable. Victoria is a victim of sexual harassment, although the instructor's comments are not directed toward her.
Victoria reports Ms. Powell's behavior to the Director. The Director,
Mrs. Nuttall also interviews Chuck, who collaborates the statements of the other student nurses and confirms that he is not offended. Mrs. Nuttall completed an occurrence report and made 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 California sexual harassment education course before returning to work. Mrs. Nuttall ensures that Ms. Powell has a copy of the school’s sexual harassment and non-retaliation policy.
To recap, 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.
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 the Dean do not take proper steps to stop the offensive behavior, Mrs. Powell's actions could continue and offend other nursing students. Other students 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 lawsuits brought under Title IX of the Education Amendments of 1972 (U. S. Department of Education, 1979).
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:
Bobby is a middle-aged, single medical student physically attracted to Audra, a classmate. Audra, age 21, has lived a sheltered life in a rural, religious setting. Bobby continually flirts with Audra and tries to kiss her during class breaks and school activities. At times, he pinched her on her rear end and tried to squeeze her breasts.
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 to meet him at bars. Audra wants to withdraw from school because she is so uncomfortable.
How should the Dean handle this situation?
The Dean interviewed Audra and asked why she wanted to withdraw from the program. The Dean learns about Bobby's inappropriate behavior. The Dean continues the investigation by asking Audra for evidence. Audra shows the Dean the offensive text messages and emails. The emails and text messages are examples of the burden of proof supplied by the complainer.
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 further incidents are reported.
While most 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 gender or non-cisgendered persons.
Students who are uncomfortable reporting matters to school officials may contact the U.S. Department of Education's Office of Civil Rights (OCR) at (800) 421-3481 or ocr@ed.gov(U.S. Department of Education, 2020). If students want to fill out a complaint form online, they may do so here (U.S. Department of Education, Office of Civil Rights, 2021)
The Department of Education requests that complaints be filed within 180 days of the alleged sexual harassment (U. S. Department of Education, 2020).
California’s Fair Employment and Housing Act (FEHA) prohibits the following wrongful behaviors in the workplace:
FEHA requires employers to take reasonable steps to prevent and correct wrongful behaviors in the workplace. The California Civil Rights Department is the state's enforcement agency related to the obligations about sexual harassment. The Department of Fair Employment and Housing's name changed to the Civil Rights Department in July 2022 to reflect the department's broadening duties.
California SB-1343 outlines employers’ duty to prevent sexual harassment. These duties include having written harassment and retaliation prevention policies that include several important elements, particularly regarding training.
The following are SB-1343 training requirements for sexual harassment training:
The law establishes minimum training requirements. Employers may want to provide more frequent, longer, or more elaborate training. More frequent training over time directly buttresses valuable awareness and communicates the significance of harassment prevention in a company’s culture. Further, interactive training, with practical examples, is more favorable than training that repeats the same facts year after year. Interactive training can be online or in person. In both venues, employees must be able to ask questions and receive responses within a few days.
Bystander intervention occurs when a witness to sexual harassment sees a problematic incident and takes action to interrupt the situation and prevent further harm. Employers should consider Bystander Intervention Training, which is encouraged but not required by California law (California Legislative Information, 2019).
The 5 D’s help to make bystander intervention training memorable.
Direct: Directly intervene by saying to the harasser; I overheard what you said; stop- that is unacceptable.
Distract: Oh, look, there is a parade outside the window. Another strategy is to pretend to be lost and ask for directions.
Delegate: Step aside if you are uncomfortable and call someone, like a security guard, in to help.
Delay: After the incident, check in with the harmed person and encourage them to report it.
Document: Document the interaction by recording it on your phone, photographing the harasser, or writing notes (Mujal et al., 2021).
Supervisors/Managers have resources and regulations for sexual harassment training. One educational resource was developed by the California Civil Rights Department (CRD). The CRD provides training online via a computer or mobile device. Training is available in various languages, including English, Spanish, Korean, Chinese, Vietnamese, and Tagalog (California Civil Rights Department, 2023).
Employers must implement a tangible action policy and procedure to prevent and/or stop sexual harassment before it rises to a level of unlawful conduct. The plan must include education, investigation procedures, and disciplinary measures for those found to be harassers (Amlong, 2006).
Sexual harassment procedures and disciplinary actions must be communicated to all employees and strictly enforced. In addition to the fact sheet, posters and flyers are suggested. Supervisors must be ready to receive and sometimes research complaints of harassment. They must be on guard to identify and take immediate steps to stop any untoward action. Discipline or remedial action for misconduct aims to stop the behavior and prevent its reoccurrence. Actions typically include education, possibly demotion, suspension, transfer, and sometimes termination.
Regulations provide the framework for an Anti-Harassment Program. This section summarizes some of the requirements of California regulations necessary for a successful program.
Employers must give employees a clear, easily understood, and written anti-harassment policy. The policy must be discussed at meetings regularly. Ongoing education reinforces the importance of the anti-harassment policy.
Managers support and are role models of appropriate workplace behavior. The anti-harassment policy or program should designate who will receive the complaints. Sometimes, this is a leader in the Human Resources office. Alternatively, it could be the compliance officer. The person receiving complaints must be approachable, a good listener, and designated for each shift where a nurse is present. The person also needs to be a good notetaker. Important to this role is the gathering of evidence.
When a report of sexual harassment is received, it should be a top priority. The fact that the complaint is anonymous is not a reason to ignore the complaint.
The confidentiality of the complaint is limited.
Supervisors/managers should keep the investigation as private as possible. However, there have been court rulings that say it is inappropriate for an employer to require that employees keep the information secret since employees have the right to talk.
Investigations should be started and completed as soon as possible.
Filing a complaint or participating in a sexual harassment investigation is protected from retaliation.
Complaints filed with CRD or EEOC are automatically cross-filed with the other agency. Those reporting only need to submit one complaint.
Supervisors should be alert for any signs of retaliation. An example is a clinic employee who enjoys working day shifts and is assigned to nights after she reports that a supervisor sent her suggestive emails.
Retaliation can take many forms, including:
The FEHC regulations require an employer to take appropriate remedial steps when there is proof of misconduct. Wrongful behavior does not need to rise to the level of a policy violation or the law to require a remedy.
An employer's legal obligation is to take reasonable steps to prevent and correct unlawful behavior. Meeting this obligation includes:
Remedial measures can include:
Resources for victims of sexual harassment include:
The Civil Rights Department assists with voluntary dispute resolution. The Civil Rights Department may file a civil complaint in state or federal court if the evidence is sufficient and the resolution is unsuccessful.
Civil Rights Department
Toll-Free: (800) 884-1684
TTY: (800) 700-2320
California’s Relay Service at 711
Email contact.center@calcivilrights.ca.gov
Correspondence and mail to:
CRD Headquarters
2218 Kausen Drive, Suite 100
Elk Grove, CA 95758
Some individuals may be afraid to report harassing behaviors for fear of reprisals. They may not know that employees and students who report sexual harassment are protected from retaliation by whistleblower laws. You have the right to file a whistleblower complaint with OSHA if you believe your employer retaliated against you for exercising your rights as an employee under the whistleblower protection laws enforced by OSHA (U. S. Department of Labor, n.d). In States with OSHA-approved State Plans, employees may file complaints under section 11(c) of the Occupational Safety and Health Act with Federal OSHA and the State Plan under its equivalent statutory provision (U. S. Department of Labor, n.d).
For California, the OSHA designated center is:
Division of Occupational Safety and Health (DOSH)
1515 Clay Street, 19th Floor, Oakland, California 94612
Tel: (510) 622-8965
Fax: (510) 286-7037
Sexual harassment against female nurses is as high as 43%. Sexual harassment can be in the form of quid pro quo or a hostile work environment. Offering a promotion in exchange for sexual favors is an example of Quid pro quo. A hostile work environment occurs when one’s workplace behavior creates a difficult or uncomfortable milieu for another person to work in. Indirect sexual harassment occurs when one person overhears sexually suggestive comments and is offended.
Sexual harassment can include vulgar pictures, unwanted sexual advances, offensive gestures, and requests for sexual favors. A harasser can be a direct supervisor or a supervisor in another area within the company, a co-worker, a subordinate, or an outside vendor.
Healthcare professionals and students are entitled to an environment free of sexual harassment. 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. If one does experience sexual harassment in any form, employees should document instances of uncomfortable behavior, including the time, date, place, witnesses, and facts about the occurrence. Complaints of sexual harassment can be filed internally or externally. Supervisors and managers must be ready to receive and research complaints promptly. Investigations should include interviews and the collection of factual data. Investigations must reach a conclusion based on the burden of proof. Educational employers may face legal consequences when they know it exists and ignore it.
California SB-1343 outlines the minimum training requirements an employer must comply with regarding sexual harassment prevention training in California. The employer must prevent sexual harassment. These duties include having written harassment and retaliation prevention policies that include several important elements, particularly regarding training. California’s Civil Rights Department prohibits harassment and retaliation. California SB-1343 requires one hour of training every two years for employers with five or more employees. California SB-1343 requires employers to provide sexual harassment training within 30 calendar days after the hire date or within 100 hours worked, whichever occurs first. California SB-1343 requires employers to keep documentation of sexual harassment training on the worksite for at least two years, including sign-in sheets and hand-outs. Employers must give each employee a copy of the anti-harassment policy and discuss it in meetings regularly.
In July 2022, the Department of Fair Employment and Housing's name changed to the Civil Rights Department (CRD) to reflect the department's broadening duties. Employees may file complaints under section 11(c) of the Occupational Safety and Health Act in states with OSHA-approved State Plans. Complaints filed with CRD or EEOC are automatically cross-filed with the other agency.
Students who do not feel comfortable reporting sexual harassment to school officials may contact the U.S. Department of Education’s Office of Civil Rights.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.