A 2019 report by the American Association of Universities documented increasing sexual and gender-based misconduct as a significant problem on college campuses. Female students overall, undergraduate students, and gender-diverse students report the highest rates of nonconsensual sexual contact by physical force or inability to consent compared with men and graduate/professional students.1 Additionally, undergraduate gender-diverse and female students reported the highest rates of experiencing sexually harassing behaviors.1

In response to public and anecdotal reports of sexual and gender-based misconduct and in accordance with our commitment to create and maintain a safe and nondiscriminatory community for learning, we conducted a survey to understand what students at the University of Michigan School of Nursing (UMSN) experienced and understood reporting of sexual and gender-based misconduct as a UMSN student in the clinical setting. We created an electronic survey with several brief questions. Sexual and gender-based misconduct was described: "Sexual and gender-based misconduct can take a variety of forms, including sexual assault, sexual exploitation, sexual or gender-based harassment, sex and/or gender-based stalking, intimate partner violence, and sex and gender-based discrimination."2 The survey was deemed nonregulated by the authors' university. The results were used to update and revise our internal policies and procedures for student clinical placement. We share these findings and our response with other nurse educators who may find it helpful, as they face similar misconduct challenges.

The survey was sent to all graduate and undergraduate UMSN students with a 2-week window for completion. Three demographic questions were followed by 5 sexual or gender-based misconduct questions. The demographic questions asked whether the student was (1) an undergraduate or graduate student; (2) currently practicing as a registered nurse [yes, no, or not applicable]; (3) and how many years total they practiced as a registered nurse [fill in text box, if not a registered nurse enter "not applicable"].

The first 3 misconduct questions asked (1) if the student had ever experienced sexual or gender-based misconduct as a student in the clinical setting (eg, hospital, clinic, and community) [yes or no]; (2) if they had, did they know who to report this to [yes, no, or unsure]; and (3) if they did not, did they know who to report this to should they experience this while a UMSN student [yes, no, or unsure]. The next question asked if they experienced sexual or gender-based misconduct, what did they do? Options included (a) report to university; (b) report to police; (c) report to someone within the UMSN (faculty); (d) report to someone within the clinical site (preceptor, staff nurse); (e) report to someone external to the university (counselor, family member, friend, and physician); (f) did not report to anyone/kept it to myself; and (g) other. Additional comments regarding the process of reporting could be entered in a text box. The last question asked if they had experienced sexual or gender-based misconduct and did not report its occurrence, what barriers prevented reporting? Options included (a) did not think I would be believed; (b) felt ashamed/embarrassed; (c) afraid of what might happen if I reported it/fear of repercussions; (d) did not know if it should be/needed to be reported; (e) did not know who I should report this to/what I should do; and (f) other. At the completion of the survey, a link was included to sexual and gender-based misconduct reporting and student resources at the University of Michigan (https://sexualmisconduct.umich.edu/student-resources/)

Eighty students responded but did not answer all questions. Of the 77 who indicated their status, 57 (74%) were undergraduate students. Most (81%) were not practicing as a registered nurse. Almost one-fifth (18.75%, 15/80) indicated that they had experienced sexual or gender-based misconduct as a UMSN student. Of the 13 who had experienced sexual or gender-based misconduct, only 2 indicated they know to whom to report this-the others did not know or were not sure. The most common actions taken (24%) were to report it to someone outside the university (counselor, family member, friend, and physician) or to some other person (15%). Barriers to reporting were not knowing if it should/needed to be reported (26%); feeling ashamed/embarrassed and other (18% each); being afraid of what might happen if reported/fear or repercussions (15%); did not think would be believed and not knowing who to report this to/what to do (12% each).

By student status, 15% (3/20) of graduate students and 17% (10/57) of undergraduates reported experiencing sexual or gender-based misconduct as a UMSN student in the clinical setting. Among students who had experienced sexual or gender-based misconduct, 22% of undergraduate indicated knowing to whom to report this; 0% of graduate students indicated knowing. Among students who indicated they had not experienced sexual or gender-based misconduct, 31% of graduate and 22% of undergraduate students indicated knowing whom to report this should they experience it. Undergraduate students who experienced sexual or gender-based misconduct were equally likely to report it to someone external to the university or within the clinical site (21% each) while graduate students were most likely to report it to someone within the clinical site (21%).

Findings from the survey identified that some students experienced sexual or gender-based misconduct in the clinical setting. This finding is aligned with previous reports, acknowledging the need for further education of students on how to identify and report adverse experiences due to sexual or gender-based misconduct.3 This can include raising awareness among students as to the definition of misconduct and self-advocacy strategies including training on understanding the behaviors that constitute misconduct, factors that increase risk, the effects of misconduct on individuals and organizations, and ways to intervene quickly and efficiently in a number of potential clinical scenarios to stop such misconduct from continuing forward, whether one is the subject of misconduct or a bystander. Additionally, it is clear from this small survey that students were not clear as to the reporting structure for such misconduct in a clinical setting even though they are required to complete a university-level training for students on sexual misconduct prevention and reporting.

Several interventions have already been implemented within the school to improve awareness. For example, specific guidelines for reporting have been further highlighted for students that provide clear definitions, reporting structures at the university level, and confidential resources (see Supplemental Digital Content available at: http://links.lww.com/NE/B216). These guidelines have been communicated to all UMSN students through several modalities (eg, email correspondence, learning management system, student handbooks, and school website). In the graduate program, students are introduced to the policy during their new student orientation and then reminded of the policy and reporting resources when they begin their first clinical placement by both faculty and the Director of Clinical Placements. To support ease of reporting an "address mistreatment" button has been added to the home screen of the UMSN webpage, which links to a series of steps for reporting and resources available to students for all types of mistreatment (eg, bias and microaggression, sexual and gender-based misconduct, or student academic and professional misconduct).

As a school and university, we are committed to providing a nondiscriminatory safe learning environment for our students. As such, we will continue to monitor and assess for sexual and gender-based misconduct and take steps to improve awareness, convey reporting structures, and address and thwart misconduct should it occur in the clinical setting.

References