Kansas City, Mo. ? Nurses trying to provide the compassionate care expected of them sometimes confront patients who ask for more – like sex, or at least a little stimulation.

While nursing advocates acknowledge that most of the sexual harassment nurses encounter comes from co-workers, doctors or other parties, they say such harassment from patients is common.

In its policy statement about sexual harassment, the American Nurses Assn. cites a 1982 study that reported that 60 percent of the nurses surveyed said they had experienced sexual harassment at work, though that included all cases, not just from patients.

Nursing officials could not cite many studies about patient harassment but said that anecdotal evidence is overwhelming that it is a widespread problem.

“I suspect that if you ask nurses if they’ve been harassed by patients, a majority would say ‘yes,”‘ said Belinda Heimericks, executive director of the Missouri Nurses Assn. “Nearly every nurse will run into it at some time in their career.”

The harassment can run the gamut from offensive jokes or sexual comments to inappropriate touching. Sexual assaults are rare, but they do occur, nursing officials say. Some male nurses have reported being harassed, but the overwhelming majority of cases are between male patients and female nurses.

Such harassment creates tension for nurses, who must walk a fine line between their professional responsibilities to the patient and protecting themselves.

Range of reactions

Debbie Dougherty, an assistant professor of communications at the University of Missouri-Columbia, interviewed nurses in a range of medical environments in four states to determine how they react to the harassment and how it affects their relationships with patients.

She found that nurses often crack jokes or sternly reject the patient’s conduct. Most nurses said they would continue to provide technical care, but the emotional support patients often need from them declines, Dougherty said.

Jokes or a firm reaction often stops the behavior, but it can leave lingering bad feelings, Heimericks said.

“It probably makes the relationship a little more tense because there is a feeling of uncomfortableness between the nurse and patient,” she said. “There’s a lot of factors that go into whether it will affect the quality of care the nurse is able to deliver.”

Dougherty’s study, which will be published in the spring edition of Management Communication Quarterly, found nurses are generally more distressed by harassment from co-workers or doctors than by patients.

Heimericks agreed, saying patients are transient, while nurses will have to see the co-workers every day.

“When it’s a patient, the nurse can enlist the support of other hospital staff, who have probably witnessed some of the behavior,” Heimericks said. “From my experience, harassment from co-workers, especially a superior, is more of a challenge for a nurse.”

Clear guides needed

In all cases of sexual harassment, medical institutions must have clear written policies and a culture that says it is not acceptable, nursing professionals say.

“The administration has to have the message out there that this will not be tolerated and they are prepared to take action,” said Nancy Hughes, director of the Center for Occupational and Environmental Health for the American Nurses Assn. “It makes a big difference to nurses if they know they will be supported.”

If harassment from a patient continues, nurses have several options. They can ask to have a second nurse with them in the patient’s room, refuse to care for the patient, ask that the patient be transferred to a different floor, or report the behavior to a superior. Doctors and hospital administrators are sometimes called in to talk to the patient.

In extreme cases medical institutions can “fire” patients and send them to another facility, said Scotty Shively, an employment and health lawyer with Cross, Gunter, Witherspoon & Galchus in Little Rock, Ark.

But medical institutions also walk a fine line between protecting their employees and meeting legal requirements to care for patients, Shively said. For example, patients in emergency situations must be admitted. And the problem becomes more difficult if the patient has mental problems or is in a long-term care facility.