A recent study by researchers at the Washington, DC, advocacy group Public Citizen found evidence of laxity among state boards of nursing in disciplining nurses cited for sexual misconduct with patients.

The study examined nurse licensure disciplinary actions and malpractice payouts between June 1, 2003, and June 20, 2016, that were filed in the National Practitioner Data Bank, a federal registry of such reports on health care professionals. The researchers found that of the 150,033 nurses who met the study criteria and were either disciplined by state nurse licensing boards or named in malpractice payouts, 882 (0.6%) had one or more sexual misconduct-related reports.

Most of these cases were reported directly to the state licensing boards, and 26.9% resulted in license revocations compared with 10.6% for other types of cases, indicating the severity with which the boards viewed this professional misconduct. But licensing authorities failed to act comparably on cases identified through malpractice actions. "Of the 33 nurses with sexual misconduct-related malpractice-payment reports, 16 (48.5%) had no sexual misconduct-related licensure reports, indicating that these nurses were not disciplined for sexual misconduct by any state board of nursing during the study period," the researchers reported.

Current social trends suggest that nurse sexual misconduct is probably underreported, according to Azza AbuDagga, a nurse and health services researcher at Public Citizen and lead author of the study. In an interview with AJN, AbuDagga said this assumption is based on surveys, news reports, and recent disclosures of previously shielded sexual misconduct in other professions.

But evidence of higher levels of sexual misconduct in AbuDagga's study is thin. For example, it cites mostly older studies, including a survey of psychiatric nurses from 2000 that found that 11% of female nurses and 17% of male nurses reported having had sexual contact with a patient.

Edie Brous, a nurse, attorney, and contributing editor of AJN, noted methodological difficulties in comparing state licensing board data, as the researchers have done, because sexual misconduct may be classified differently from state to state, thereby confusing or obscuring the data. "Overall, [sexual misconduct] is not characteristic of nursing," Brous said. "If we had a rampant level of sexual misconduct, we would not be the most trusted profession in surveys year after year."

AbuDagga called for a "zero-tolerance standard against sexual abuse of patients." And the National Council of State Boards of Nursing (NCSBN) takes that call seriously. For nursing officers and managers who need guidance on how to file a complaint about sexual misconduct, Maryann Alexander, chief officer for nursing regulation at the NCSBN, said resources on professional boundaries can be found at http://www.ncsbn.org/professional-boundaries.htm. The site also includes practical guidelines for boards of nursing regarding sexual misconduct.-Fran Kritz

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