In 2009, a jury awarded nurse Janet Bianco a record-breaking payout of $15 million in a sexual harassment lawsuit, although a judge later reduced the amount to $750,000. Bianco alleged that a physician, Matthew Miller, repeatedly groped and propositioned her over an eight-year period at Flushing Hospital Medical Center in Queens, New York-and that the hospital hadn't done enough to protect her and other nurses from his harassment. Despite multiple complaints to supervisors about Miller's behavior, no action had been taken, even though Miller had previously been sanctioned by the state for engaging in a sexual relationship with a patient under his care. After a particularly aggressive assault in 2001, Bianco filed a formal complaint with the hospital. Miller finally faced consequences: a two-month license suspension, three years' probation, and loss of his admitting privileges.

Trauma clinical nurse specialist Teresa Goodell has experienced many incidents of sexual harassment during her 35 years as a nurse in the Portland, Oregon, area. She blames the hierarchical culture of hospitals and of health care in general. "Once while practicing in intensive care, I questioned a physician about the plan of care," she tells

More recently, Paula Rickey, RN, filed a lawsuit against Kerry Assil, an ophthalmologist and the medical director of 90210 Surgery Medical Center in Los Angeles where they both worked, and Cedars-Sinai Health System, the center's parent company, for battery, sexual harassment, and discrimination. Rickey claimed that instead of disciplining Assil after she reported an instance of assault, Cedars-Sinai reduced her work hours and altered her schedule to accommodate his. Cedars-Sinai has not commented on the case, as it is ongoing.

SEXUAL HARASSMENT: PART OF A LARGER PROBLEM

The #MeToo and #TimesUp movements have put a national spotlight on workplace sexual harassment. As members of a female-dominated profession, nurses have long dealt with on-the-job sexual harassment, and the problem persists in today's workplace.

U.S. Equal Employment Opportunity Commission (EEOC) Guidelines

Sexual harassment is part of a larger picture of overall abuse-both verbal and physical, such as assault, stalking, and bullying-in health care settings. A 2014 literature review in the International Journal of Nursing Studies found that about one-third of nurses worldwide have been physically assaulted (36%), bullied (37%), or injured (33%) in the workplace, while approximately two-thirds have experienced nonphysical violence (67%), such as incivility and verbal abuse. In addition, roughly one-quarter (28%) of nurses reported having been sexually harassed on the job. The types of violence varied by world region, with the highest rates of both physical violence and sexual harassment occurring in "Anglo regions" (defined as English-speaking countries that are culturally and linguistically similar, such as the United States, Canada, England, and Australia).

As to why the rate of sexual harassment of nurses was so high in Anglo regions (39%), the study's lead author Paul Spector, PhD, distinguished professor of psychology at the University of South Florida in Tampa, says that such behavior may be more acceptable in places like the United States than in regions such as Asia or the Middle East.

"One factor that affects some countries, particularly Muslim countries, is that there can be strong inhibitions against men making physical contact with women who are not in their immediate family," he explains. "Thus, men would be highly unlikely to touch a nurse. Such inhibitions are far less in the United States, where sexual behavior is more acceptable outside of marital relationships." Another possible reason, says Spector, is that in some countries, such as those in Asia and the Middle East, "there is considerable shame associated with being targeted, and women are reluctant to report it, even in an anonymous survey."

A LACK OF DATA ADDS TO THE PROBLEM

It is difficult to ascertain the actual rate of sexual harassment among nurses in the United States, since no definitive studies have been conducted, and scant data are available. Bonnie Castillo, RN, director of health and safety at National Nurses United, thinks that sexual harassment in the United States is most likely underreported. "There is an element of shame," she says. "And it is a difficult subject to discuss or report."

In the hospital setting, there is a traditional hierarchy of administrators, managers, and physicians who give orders to the health care team, including nurses. "Within this structure is the inherent assumption of domination or power over another person," Castillo says. "When [harassment] happens, it often gets ignored because of that shame and the assumption that reporting it won't make a difference." She emphasizes that this is particularly true if the perpetrator is a physician or an administrator. "They are revenue generators for the hospital, and they hold power."

In some cases, nurses may fear retaliation or job loss for reporting harassment, even though in theory federal law is supposed to protect workers from this. In Castillo's view, having a union contract may empower nurses who experience harassment. "Being in a union gives nurses a collective protected voice and legal representation in the hospital, so they don't have to rely on the internal reporting mechanisms."

Seun Ross, DNP, MSN, CRNP-F, NP-C, NEA-BC, director of nursing practice and work environment at the American Nurses Association (ANA), says that nurses need to learn how to recognize harassment and how to report it. "Many hospitals and organizations say they have zero tolerance policies, but we don't know how well those are enforced," she says. "What we see is that nurses are not reporting sexual harassment for any number of reasons."

The ANA has a new initiative under way to promote zero tolerance policies for workplace abuse of nurses-#EndNurseAbuse. Eliminating sexual harassment is part of the initiative, which encourages nurses to report abuse rather than view it as part of the job. "Nurses should not be dismissing inappropriate behavior from patients, from coworkers, from doctors-it should be identified, not dismissed. The more we bring it to light, the more it will be addressed, just like in the #MeToo movement," Ross says.

Ross also explains that the topic of sexual harassment needs to be addressed throughout nurses' careers: in nursing school, during internships, and in the workplace. "The onus is on the educators-the professors, the dean, the chief nursing officer-that this kind of behavior will not be tolerated and it is safe to report it."-Roxanne Nelson, BSN