Let’s Get Real About Gender Stereotypes In Nursing

Recently, I posted a meme on Instagram about being hit on by patients.
The tagline read, “When a creepy patient hits on you”, and the picture showed a giraffe pushing another animal away with its hoof, some kind of wild cattle or wilder beast, with the word “No” in bold letters, indicating the giraffe was not having any of what the wilder beast was offering.

When I was making the meme, I laughed, because that is quite often how it feels in nursing, deflecting unwanted comments and advances pretty much all the time. The more I think about it though, the more it occurs to me that there really is something wrong with being able to be so casual about it, so offhand, about something that shouldn’t even be happening in the first place. Why is it that it really seemed like no big deal to post that?

A few reasons, one being that I consider it my sworn duty to say the things that no one else will say about nursing, to let others know that they are not alone, it’s ok to be frustrated and angered by some of the uglier parts of the profession, we don’t have to pretend it’s perfect, and that doesn’t mean we are bad nurses or that we don’t love what we do. I have a pretty thick skin. But another reason, a far more disturbing one, is that it is so commonplace, so much a part of the every day, that we almost ignore it, we almost EXPECT it, and that is really, really not ok.

In a profession dominated by women historically, (historically being the last century or so, before which most PAID nursing positions were held by men), sexual harassment might seem inevitable: women have, for eons, been viewed as the weaker, inferior sex in the vast majority of cultures and societies, and while feminist efforts have brought us light years out of the dirt, we still struggle under some of the vestiges of those atrocities. Because nursing is so intimate by the content of the work we do, bathing, skin examination, head to toe assessments, clinical review of social, sexual, and recreational habits, medication administration, dressing changes, essentially the provision of most direct care, the perception of our role and intention is subject to misinterpretation by those receiving the care, particularly if they are uninhibited or disrespectful by nature, or have an altered mental status.

While you wouldn’t think you’d have to explain to a male patient in whom you were inserting a catheter that this would not be a good time to ask “you like what you see?” with a giant leering grin, unfortunately, it is often the case that you do. Or when you ask a patient, “Is there anything I can do to help you be more comfortable?”, and they reply, “Yeah, hop on in here and keep me warm”, you’d kind of like to think they understood that was not an option. I mean really. When, in the history of nursing, has such a comment ever yielded the desired result?

In a study published in the Journal of Nursing Administration, a reported 70% of female nurses admitted to being harassed by male patients or co-workers, and while they would frequently confront patients at the time of the incident, they were far less likely to take action when their counterparts or superiors were involved. Verbal harassment made up the majority of the offenses, but touching, grabbing, and slapping were also reported. The EEOC (the Equal Employment Opportunity Commission, the recognized authority on what you can and can’t do as an employer or employee) defines sexual harassment as “unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature”, when it affects terms and conditions of employment, advances in employment, or interferes with the work or work environment of the individual (you can read the specifics of this on the EEOC website at www.eeoc.gov ).

So to get really technical, Sexual Harassment falls under Title VII of the Civil Rights Act, which put the kibosh on discrimination against an individual because of their sex, also prohibiting sexual harassment as a form of sex discrimination (www.eeoc.gov/laws/statutes/titlevii.cfm ). This means that it is against the law, let me say it in all shouty caps, AGAINST THE LAW, to verbally or physically harass someone based on, because of, or suggestive of, sex.

The two primary categories this falls into, in terms of legal standing, are “quid pro quo” and “hostile environment”. “Quid pro quo”, which most of us are probably familiar with, refers to “submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment (or) (2) submission or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual” (reference above EEOC website). So for example, when a person of authority offers a promotion, or an easy assignment, or a prescription pad, or first dibs on the cool promo pens from pharmaceutical reps, in exchange for submission to, or participation in, unwanted sexual behavior. Or when it is implied that you might be penalized, even terminated, for non-participation. And look at the language of the law. “Explicitly” or “Implicitly”. That’s right. Explicit, when you come right out and say something directly, or implicit, when you suggest something indirectly. That means that whether you lay it right out on the table, or just sleaze it in to the conversation, it’s not within your rights. They covered all the angles on that one. Nice work, writers of the law.

“Hostile environment” is outlined by the EEOC guidelines as “Unwelcome sexual advances, requests for favors, and other verbal or physical conduct of a sexual nature (that) has the purpose or effect of interfering with an individual’s work performance or creating an intimidating, hostile, or offensive work environment”. That one is pretty self-explanatory. If you make it clear that you are not interested and the behavior continues, it’s a problem. Or if someone is blatantly inappropriate in a way that has the immediate effect of damaging your sense of safety and security at work, also a problem. (I want to add a quick foot note here, and just mention that this doesn’t mean you aren’t allowed to show a respectful and appropriate interest in someone, so long as you behave like an adult. For instance, if you really jive with someone in the work place, and want to take it to the next level, understand that that next level should be suggesting coffee or a meal outside of work, not answering the door to your office wearing only a necktie and galoshes. If you plainly and politely ask someone to dinner, and they say no, that’s not sexual harassment, per say. If you keep asking, that’s when you enter the danger zone. Just be polite, duh. So if anyone wants me to be their Valentine, now is the time to ask).

When you see the particulars written out like that, then, it’s kind of alarming to realize that this biz is commonplace, even expected, working as a nurse. Why is that? How is this still going on? Are we inadvertently contributing to the ongoing prevalence by not taking action when it happens to us in more direct and effective ways? Most instances go unreported for a number of reasons, including the shame and stigma associated with reporting, fear of not being believed, or the potential for it to somehow reflect poorly on the reporter themselves (“what did you do to invite this behavior?”).

One nurse described an incident to me in which a male coworker and a male patient were discussing, right in front of her, during handoff, how “sexy” she looked considering she had just had a baby several months earlier. They went on to say how “they shouldn’t be discussing it” because “you know how it is nowadays, everyone gets offended”, and then said to the nurse “But you’re not offended, right?” Actually, she was, she admitted, and with good reason. Not only was it objectifying and intrusive, it set an intimidating tone, not just because there were two men involved, but also because she was cajoled into minimizing her reaction. When I asked her if she reported it, or said anything, she shrugged it off. “No,” she told me, “It wasn’t going to affect my raise, or my employment, and I didn’t really think anyone would listen. Besides, what are they going to do, punish the patient?” So she was, by her own account, taken aback, offended even, by the behavior. But she dismissed it because there was no clear avenue to action.Personally, in the course of one shift, I’ve been proposed to, invited to “run away to Alaska”, because “A pretty girl like you would do well there”, had my breast grabbed, and performed an involved dressing change with a family member seated nearby not even trying to be discreet about their gawking. This isn’t to suggest that every day is a meat market, but it happens a lot more than it should, and while I don’t blame myself or other nurses at all, I wonder if I could be doing more to discourage the culture that allows this behavior by speaking up. We get so busy, so distracted, during the course of our work, with patient concerns and priorities, that it sometimes seems easier to just brush it under the rug instead of speak up. Our work can be exhausting, both physically and emotionally, and we can become numb very quickly if we’re not alert to it.

Personally, in the course of one shift, I’ve been proposed to, invited to “run away to Alaska”, because “A pretty girl like you would do well there”, had my breast grabbed, and performed an involved dressing change with a family member seated nearby not even trying to be discreet about their gawking. This isn’t to suggest that every day is a meat market, but it happens a lot more than it should, and while I don’t blame myself or other nurses at all, I wonder if I could be doing more to discourage the culture that allows this behavior by speaking up. We get so busy, so distracted, during the course of our work, with patient concerns and priorities, that it sometimes seems easier to just brush it under the rug instead of speak up. Our work can be exhausting, both physically and emotionally, and we can become numb very quickly if we’re not alert to it.

And now, there’s a new twist. Since 1970 the number of men practicing nursing has more than tripled, and currently, according to the AACN, 12% of nursing students are male. So roughly 9% of the nation’s 3.1 million nurses are men, making about a 10:1 female to male ratio in the field. And if we think they are immune to sexual harassment, we are definitely out of our trees.

In a study published by the Journal of Health Organization and Management, about 34% of male nurses reported having been sexually harassed, with patients being the primary culprits, followed by family members, and then peers and superiors. And, by all accounts, male nurses are far less likely than their female counterparts to report harassment, for a number of reasons, including the notion that it isn’t very masculine to complain about being harassed period, never mind sexually. Historically and culturally, just as women have been touted as the delicate, submissive sex, men have been conditioned to flaunt virility and strength, thereby theoretically calling into question their masculinity when they refute such advances, wanted or unwanted.

Whether we admit it or not, we marginalize male nurses much more often than we realize. We utilize them for lifting heavy patients, for restraining rowdy patients, for dealing with the rougher, less congenial patients because they are men. And how many times have we knowingly assigned a male nurse to a grouchy old lady who is otherwise uncooperative because “She loves men, she’ll love you!” Would we send a young, 20 something new grad female nurse into a grouchy old man’s room because “He loves young blond girls, he’ll love you”? Unlikely.

It’s difficult to acknowledge, but we still sort of treat male nurses like a commodity, more often than we should, a novelty of sorts. “Oh isn’t that cute, he wants to be a nurse.” Many of the male nurses I’ve worked with say that they feel they are objectified on almost a daily basis by their patients, and at times their coworkers (I once overheard a female nurse exclaim, “How come none of the hot travel murse’s come to work here?” ….truly… out loud). One male nurse told me about a time a female stroke patient reached out and tried to swat his backside, but couldn’t reach because of her new deficit. Another described a time he went in to assess a female patient, whose middle-aged daughter was at the bedside and commented when he entered the room, “Oooh, look mom, they send in the sexy ones for you!”. He admits he thought the woman might be trying to flatter him, but also that he felt like he wasn’t really being taken seriously for his expertise as a medical professional. And he’s right. He wasn’t. Which is really unfair.Within our own practice, we can change this culture by evaluating our language and behavior with regard to males in the profession. We can acknowledge that men are contributing real, valuable insight to the field, and are just as fluent when it comes to providing care as their female peers. And by treating harassment as something unacceptable, rather than rolling our eyes and considering it part of the day, we can empower ourselves and our male counterparts to report and address these issues.

Within our own practice, we can change this culture by evaluating our language and behavior with regard to males in the profession. We can acknowledge that men are contributing real, valuable insight to the field, and are just as fluent when it comes to providing care as their female peers. And by treating harassment as something unacceptable, rather than rolling our eyes and considering it part of the day, we can empower ourselves and our male counterparts to report and address these issues.

So when you know what’s not ok, what’s not allowed by LAW, never mind human decency, you’re better able to make accurate and efficient decisions when shit like this happens. Remember that saying, “Nurse, know thyself”? It’s one of the most important considerations for any of us. Evaluate your interactions with others, your beliefs, and behaviors, ruthlessly and truthfully. Make sure the behavior you display and support in your day to day is reflective of the moral and ethical gravity inherent to our profession. We don’t all have to be prudes, but we do need to treat each other with respect. Raise the bar when it comes to addressing and reporting incidental transgressions, to send the message that it’s not going to be tolerated. It is possible, I think, to set a new standard in our culture, and it can happen one rebuked butt slap at a time.

My name is Kitterhi Durgin and I work as an RN in med-surg at a busy teaching hospital. I love my work, and I love to spread laughs where I can and to advocate for ongoing change and improvement in our practice. You can find me on Instagram at @rn_mfkrs_ , on Twitter under the same name, out in a field somewhere chasing butterflies, or in the kitchen, trying to remember why I walked in there.