This week’s Blog is written by Leanne Patrick (@LeanneHPatrick) a specialist nurse in domestic abuse and sexual violence.

Following “serious allegations of sexual harassment”, The Royal College of Nursing has taken the decision to move its annual congress event online. Although the announcement has come as quite a shock to many members and potentially divided opinion, sexual harassment of nurses is not uncommon. Despite its prevalence and associated harms, it is not taken particularly seriously which has implications for staff wellbeing, workforce planning and patient safety.

Prevalence

Earlier this year, Unison and the Nursing Times surveyed a convenience sample of over 2,000 UK nurses and nursing students about sexual harassment in the workplace. The results showed that 60% had experienced sexual harassment, with some describing it as being so frequent that it had become “normal”. A 2020 systematic review found the prevalence of sexual harassment against female nurses to be particularly high, averaging at around 43.15% affected, with sources of harassment ranging from patients to physicians, nurses and other colleagues. The review found quite a broad range of results, however, with some studies finding 10% of female nurses affected and others as many as 87%. One reason for this, which isn’t explored in the review’s limitations, might lie in the influence of language upon methodology.

Donde et al. (2018) explored this concept; some women who have been raped do not acknowledge their experience as rape if it didn’t involve force. In her PhD thesis, Dr Jessica Taylor links this phenomenon to victim blaming of women and social constructions of “the perfect victim”. She argues that when women experience sexual violence, they do not always recognise the experience when it is described using common terminology. Dr Taylor went on to expand upon this theory in a survey of over 22,000 UK women, utilising a broader range of language. The results found a staggering 97% of responders had experienced some form of sexual violence.

Normalisation

The implications of this are significant; research into sexual harassment of nurses should consider how the offence is described in order to accurately capture the scale of the issue. Since it is so normalised, with as many as 97% of UK women affected, it may be that nurses do not always recognise what has happened to them as sexual harassment. As such, the figures we currently have may not be a true reflection of how prevalent this issue is for nurses. Beyond this, the insidious normalisation of sexual harassment is contributing to a culture that tacitly permits such behaviour and has demonstrable consequences.

Last year I wrote briefly about this issue when a female student nurse sought advice on social media. Upon asking how she might respond to a patient making sexual comments, following a recent uncomfortable experience, the student was met with a variety of replies suggesting that she should “take it as a compliment”, “laugh it off” or that it is “just a normal part of the job” and to get on with it. These comments came from both men and women in nursing who ranged from students to chief nurses, suggesting that these attitudes are pervasive and culturally ingrained within the profession.

Implications

The effects of sexual harassment in the workplace are nebulous. Victims report a significant impact on their mental and physical health, resulting in missed days at work and resignations. For women it can also stall career progression. Compounding the issue is a lack of robust policy and practice in place to adequately support victims of harassment in many NHS trusts and health boards. This is particularly troubling as it suggests a lack of attention or regard for the matter, which is a key factor in victims feeling able to come forward. The result is a culture of hidden victims and normalisation of sexual violence, with a high degree of prevalence.

It should therefore not come as a shock that the RCN might have a problem with sexual harassment since this is a common occurrence within the profession. Rather the irregularity is that an organisation has chosen to take the matter seriously. As a profession, nursing requires better research, education, policy and practice to protect students and registrants from sexual violence. Currently, both are being let down and with significant implications for staff wellbeing, workforce planning and patient safety.