Newhouse News Service

A fortunate nurse contends only with the patient who mutters a sexual one-liner, inquires about a husband, or winks while patting his mattress.

But others have endured patients of another sort. Sandy Summers remembers two: one a homeless man, the other a diplomat. Both were drunk. Both grabbed her breasts.

“I really don’t know what men are thinking,” said Summers, executive director of the Center for Nursing Advocacy, a group that promotes public understanding of nursing. “I don’t know where they get the idea that nurses are there to provide them sexual pleasure.”

From the days of Florence Nightingale, who insisted that hospital hallways be lighted to discourage the groping doctor or patient, nurses have dealt with sexual harassment.

Today the topic gets little attention compared with such problems as staff shortages, labor disputes and violence in emergency rooms, nurses say. But the problem of inappropriate sexual behavior – predominantly on the part of male patients and directed at female nurses – remains, they say. At best, incidents are benign and quickly forgotten. At worst, they add to stress and end nurses’ careers.

Evelyn Bain, an occupational health and safety expert with the Massachusetts Nurses Association, said one hospital nurse was psychologically wounded last year when an older patient made sexual advances while she was helping him to the bathroom. Even after it was learned the man had once been charged with a sex crime, the nurse received little support from supervisors, Bain said.

“She finally left,” Bain said. “And that’s what happens a lot. Nurses just leave. A lot of it comes down to no one said they were sorry.”

Nurses frequently find themselves in intimate situations with patients, whether helping with bathing, inserting a catheter, assisting with toileting or conducting an exam that requires a degree of patient nudity. Unintentional sexual aspects of these situations, though awkward, typically are ignored or mildly excused.

Laurie Grubbs, now a nursing professor at Florida State University, recalls a male patient who became aroused during a sponge bath. Both he and Grubbs were embarrassed, but they relied on a laugh to carry them through.

Another of Grubbs’ patients was not so innocent. His bones broken in a crop duster crash, the man was bedridden but nonetheless capable of harassment. Again she defused the situation with humor.

“I got a really long stick and put his medicine in a cup at the end of the stick, and passed him his medicine with the stick,” Grubbs said. “He was inappropriate, and he knew he was inappropriate. But it’s hard for someone in traction to be much of a threat, so I made a joke out of it.”

A generation ago, it was doctors or hospital supervisors who were most likely to corner a nurse in a scrub room or threaten retaliation after sexual rejection, experts say. Such incidents decreased after passage of anti-discrimination laws.

Sexual harassment by patients occurs in a different context. The oath to care for patients, even difficult ones, is a value deeply held by health care workers. A nurse – fixed on that mission, inured to errant patient behavior and otherwise hustling to keep up with job demands – might tend to overlook it.

“Sometimes, you’re running around so much, you wonder whether you’d notice if someone exposed themselves,” said Patricia Eakin, a nurse for 29 years and president of the Pennsylvania Association of Staff Nurses and Allied Professionals.

Often it is instinct that tells a nurse when behavior has gone from innocuous to intolerable.

“Some people are very sensitive to sexual harassment, and some are a little more used to it,” said Jan Johnson, executive director of the Virginia Nurses Association. “But when you feel that prickling feeling across the back of your neck, you know that some boundary has been crossed.”

When a patient breaks the implicit pact of respect with a nurse, the result can exceed embarrassment or hurt feelings.

“A good nurse provides technical care and social support” to patients, said Debbie Dougherty, assistant professor of communications at the University of Missouri-Columbia and author of a new study on the subject. When a patient harasses a nurse, the nurse “will continue to provide the technical care, but withdraw the social support. … Once you withdraw the social support, it withdraws part of their care.”

In her study, Dougherty noted past research estimating that 60 percent of female nurses are harassed by male patients, most often during patients’ baths. One study showed harassed nurses got headaches, became irritable, and felt angry and alienated.

Of 28 nurses interviewed for Dougherty’s study, 21 had experienced sexual harassment, several on multiple occasions. One patient bragged about his genitals and asked to be called by a sexual nickname. Others exposed themselves.

Nurses who were targeted commonly belittled the offending patients, either to their faces or to colleagues, Dougherty said. Some, shocked by patient behavior, “froze” and could not respond, she said.

Dougherty said training should help nurses prepare for the emotional stresses of harassment. Others said nurse supervisors should provide more support for nurses who encounter lecherous patients.

Nurses typically don’t report abuse by patients, experts say. Some assume their employers won’t care. Others are embarrassed or unfairly blame themselves for a patient’s misdeed.

“Like the myths we heard around domestic violence 20 years ago: “It must have been something I did to provoke the person,”‘ said the Massachusetts Nurses Association’s Bain.

Summers said she was a nurse in a Washington, D.C., emergency room when she was pawed by the drunken diplomat several years ago. Her first response was to scream at the man and leave the room. Then she called the police.

“They didn’t see it as a crime, and it certainly is low on the list of the crimes that are out there,” Summers said. “But it’s demoralizing. I had to pass (the patient’s) care on to another nurse.

“It makes it difficult to go back to work the next day, and to feel like you can be open with patients, and be by their side.”

Bruce Taylor Seeman can be contacted at [email protected]