Sexual harassment in the nursing community creates an intimidating, hostile, degrading, and humiliating work environment. It is possible that civilian nursing leaders can learn from the best practices demonstrated in established policies for sexual harassment in the military environment. This article offers an overview of U.S. military, and specifically Department of Defense goals, policies, procedures, and protocols related to sexual harassment, and also considers such harassment in the civilian sector. In addition, the authors compare policy differences between military and Equal Employment Opportunity Commission. Finally, discussion addresses the #MeToo and #EndNurseAbuse campaigns, followed by suggestions for what nurses need to know and do, recommended best practices from the military, and important areas for future research.
Key Words: Sexual Harassment, Nursing, Military Guidelines, Equal Employment Opportunity Commission (EEOC)
Sexual harassment creates an intimidating, hostile, degrading, and humiliating work environment, whether the harassment takes the form of unwanted sexual attention, quid pro quo demands, gender harassment, sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature (Berdahl, 2007; Gardner & Johnson, 2001; Webster, 2018; U.S. Equal Employment Opportunity Commission [EEOC], 1990, 2018d). Sexual harassment, whether verbal or nonverbal, is illegal and in violation of Title VII of the Civil Rights Act of 1964 (EEOC,1990) if the behavior affects the individual's employment; interferes with their performance at work; or creates a work environment that is intimidating, hostile, or offensive. The United States (U.S.) Supreme Court has further clarified that sexual harassment creates an abusive work environment if the behavior is severe or pervasive (EEOC, 1990, 2018d). Under Title VII of the Civil Rights Act of 1964, a perpetrator can be prosecuted for sexual harassment and for creating a hostile environment.
In addition to being illegal, sexual harassment can create psychological and physical effects that damage health outcomes for both victim and accused In addition to being illegal, sexual harassment can create psychological and physical effects that damage health outcomes for both victim and accused (Department of Defense [DoD], 2018b; EEOC, 2016; Zhang et al., 2018). In spite of these devastating effects, sexual harassment is common in the nursing community, making this an important area of concern for nurses. The purpose of this article is to provide an overview of U.S. military, and specifically Department of Defense (DoD) goals, policies, procedures, and protocols related to sexual harassment.
Sexual Harassment in the Nursing Community
As a result of sexual harassment, nurses may experience emotional distress, be less productive, provide reduced quality care, and fear for their personal safety Sexual harassment occurs at unacceptably high rates in the nursing community, with one in four nurses experiencing sexual harassment worldwide (Spector, Zhou, & Che, 2014). As a result of sexual harassment, nurses may experience emotional distress, be less productive, provide reduced quality care, and fear for their personal safety (Subedi, Hamal, & Kaphle, 2013; Zhang et al., 2018).
...harassment can also come from patients as well as from coworkers Traditionally, nursing has been a female-dominated profession, but data show the number of male registered nurses has continued to rise. In 2016, the male nurse population reached over 350,000 full-time equivalent (FTEs) positions in the United States. The male workforce in nursing has remained firm at 11% for the past five years (Auerbach, Buerhaus, Skinner, & Staiger, 2017; U.S. Census Bureau, 2013). The increasing number of males has brought an increased level of interpersonal complexity to the nursing work environment. While either males or females can be victims or perpetrators of sexual harassment, females are more commonly the victims of sexual harassment (Hibino, Hitomi, Kambayashi, & Nakamura, 2009). Further, harassment can also come from patients as well as from coworkers (Suhaila & Rampal, 2012).
Risk factors for sexual harassment include: being female, job title, level of experience, length of employment, physical-care duties, and traditional stereotypes of female nurses (Hibino et al., 2009). The EEOC has identified 12 risk factors associated with sexual harassment. Workplace factors recognized by the EEOC that promulgate sexual harassment include a workforce that is young in age; has highly esteemed and valued employees, with considerable power disparities; and one that depends on customer service and satisfaction (EEOC, 2018b). In general, sexual harassment is most commonly perpetrated by a person in authority towards a junior person (EEOC, 2018c, 2018d; Webster, 2018). Therefore, less experienced nurses are more vulnerable to sexual harassment (Suhaila & Rampal, 2012).
Risk Factors for Sexual Harassment (EEOC, 2018)
- Homogenous workforce
- Workplaces where some employees do not conform to workplace norms
- Cultural and language differences in the workplace
- Coarsened social discourse outside the workplace
- Workplaces with "high value" employees
- Young workforces
- Workplaces with significant power disparities
- Workplaces that rely on customer service or client satisfaction
- Workplaces where work is monotonous or tasks are low-intensity
- Isolated workplaces
- Workplaces that tolerate or encourage alcohol consumption
- Decentralized workplaces
While EEOC rules and procedures regarding sexual harassment apply to the nurse’s employer or contracted company (EEOC, 2018d; EEOC & Department of Health and Human Services [DHHS], 2018), nurses are expected to follow local policies, which may vary from employer to employer. Given (at least in part) these variances, sexual harassment remains unacceptably high in the civilian nursing sector, coupled with the lower rates of sexual harassment in the military sector (detailed below), it is possible that those in civilian nursing can learn from practices in the military.
Sexual Harassment in the Military Environment
There are seven uniformed services in the United States (see Table 1). All are considered military; four are under the DoD; the remaining three Services are under other separate federal agencies (Department of Commerce, 2018; Commissioned Corps of the U.S. Public Health Service, 2018; U.S. Coast Guard, 2018). Each service abides by the policies and regulations of their respective services and/or departments. Each of the non-DoD Services can be transferred to the U.S Navy during times of war (Department of Commerce, 2018; Commissioned Corps of the U.S. Public Health Service, 2018; U.S. Coast Guard, 2018).
Table 1. Seven Uniformed Services of the Federal Government.
|U.S. Army||U.S. Coast Guard/Department of Homeland Security|
|U.S. Air Force||U.S. Public Health Service/Department of Health and Human Services|
|U.S. Navy||National Oceanic and Atmospheric Association Corps/Department of Commerce|
(Department of Commerce, 2018; Commissioned Corps of the U.S. Public Health Service, 2018; DoD, 2018b; U.S. Coast Guard, 2018)
This section provides an overview of the policy; definition; data collection; processing and responding to complaints; as well as response training and prevention education. Also discussed will be responsibilities of senior command, all in accordance with DoD Instruction 1020.03 (DoD, 2018b).
...the military/DoD has strict sexual harassment policies and procedures. To foster an environment free from sexual harassment, the military/DoD has strict sexual harassment policies and procedures. The DoD encompasses the uniformed services: Army, Navy, Air Force, Marines, and the respective Reserve and National Guard Components. The military has implemented formal sexual harassment policies since 1994, with the most recent update of DoD Instruction (DODI) 1020.03 Harassment Prevention and Response in the Armed Forces, becoming effective on February 8, 2018 (DoD, 2018b). This instruction updated procedures for submitting complaints and requirements for responding to, processing, resolving, and tracking sexual harassment complaints. It also includes requirements and standards for training and education.
DoD policy sets standards to prosecute those who attempt to violate the process of reporting The DoD Retaliation and Prevention Strategy (RPRS) is a policy to safeguard against retaliation. This policy was created to standardize retaliation definitions, develop a shared understanding about retaliation, standardize support processes for sexual harassment victims, and create a culture to prevent retaliation (DoD, 2017, 2018b). For service members who inform their command about sexual harassment and who have experienced retaliation, DoD policy sets standards to prosecute those who attempt to violate the process of reporting (DoD, 2017; 2018b).
The DoD received 6,769 reports of sexual harassment involving service members in fiscal year 2017 (Sept 2016 – Oct 2017), which represents less than 1% of DoD employees (DoD, 2018a). Although, this is a 10% increase in cases from the previous year, these numbers still represent 1% of the DoD population. Regardless of whether the complaint was restricted (confidential) or unrestricted (automatic investigation, command notification, and notice of intent for healthcare, victim advocacy, and legal services), the DoD had sufficient evidence to take disciplinary action in 62% of the 2017 cases of accused service members. This represents a high rate of resolving sexual harassment complaints (DoD, 2018a). In sum, compared to the civilian nursing community, the military has a low rate of sexual harassment and a high rate of convictions.
Sexual Harassment: Military Definition
The military definition of sexual harassment is outlined in Section 3.3 of DoD Instruction 1020.03. Briefly, the military defines sexual harassment as unwelcomed “offensive comments and gestures of a sexual nature” that are “severe or pervasive,” and if overlooked or submitted-to, can impact career decisions or career situation (e.g., job status, pay; DoD, 2018b, p. 9). The military does not require a demonstration of “concrete psychological harm,” but merely that “a reasonable person would perceive, and the victim [complainant] does perceive, the environment as hostile or offensive,” whether this behavior occurs in person, through electronic communications, or through social media (DoD, 2018b, p.9). Further, supervisors are explicitly responsible to address, (and not overlook) sexual harassment in any form.
...supervisors are explicitly responsible to address, (and not overlook) sexual harassment in any form. Military Sexual Harassment Policy
DoD leaders are responsible to ensure a harassment-free workplace for their subordinates because “harassment jeopardizes combat readiness and mission accomplishment, weakens trust within the ranks, and erodes unit cohesion” (DoD, 2018b, p.3) and because “Harassment is fundamentally at odds with the obligations of Service members to treat others with dignity and respect” (p. 3). DoD leaders are therefore responsible to ensure that subordinates are aware of the sexual harassment policies; that prevention regulations are enforced; that response policies are consistently enforced; that retaliation against accusers will not be tolerated; and that sexual harassment policy violations “may constitute violations of… ‘Uniform Code of Military Justice (UCMJ)’ and may result in administrative or disciplinary action” (DoD, 2018b, p. 3; Morral, 2018).
Data Collection and Reporting in the Military
Data collection begins with recording the type of complaint (i.e., formal, informal, anonymous); type of harassment; demographics of complainant and alleged offender (e.g., sex, rank, ethnicity); relationship between complainant and alleged offender (e.g., superior, coworker, subordinate); and duty status (e.g., training, on duty, off duty, on leave/ vacation) at the time of the alleged incident. Prior substantiated harassments complaints regarding the accused are added to the record as well (DoD, 2018b).
A report timeline is also created, from the initial complaint to final disposition. Initial data collection also includes acquiring narrative descriptions of the alleged incident from the complainant, incorporating the location and an incident timeline. A report timeline is also created, from the initial complaint to final disposition. The report timeline also includes the names and ranks of investigators and adjudicators. Any associated retaliation complaints are also recorded in the case file. It is important to note that all reports are reviewed for legal sufficiency (DoD, 2018b).
Processing Sexual Harassment Complaints in the Military
Sexual harassment complaints from service members are reported and processed as anonymous, informal, and more formal complaints. These types of complaints are briefly discussed below.
If an anonymous complaint contains sufficient information, the commanding officer opens an investigation...Anonymous complaints. For anonymous complaints, if the complaint does not contain sufficient information to initiate an investigation, the complaint is logged in a Memorandum for Record and maintained on file with the contact responsible for processing sexual harassment complaints. This record includes the time, date, location the information is received, along with a description of the facts and circumstances and any other pertinent information. If an anonymous complaint contains sufficient information, the commanding officer opens an investigation in compliance with service-specific guidelines (DoD, 2018b).
Informal complaints. Informal complaints are processed at the lowest possible level. Data collection requirements for informal complaints are identical to data collection requirements for formal complaints (DoD, 2018b). For example, a female logistics officer who works with several men at a warehouse is asked out every week for the past month, by a male coworker. These requests are without any other sexual connotations. The female officer has always declined. This situation could be regarded as sexual harassment. The female officer has never told the male worker to stop asking her out and has not told him that the conduct is unwelcome. Informal complaints do not require memorandum in writing and are not reported to higher authorities if the female officer resolves the situation by telling him that she is not interested and to no longer ask her out. This conversation could be an open dialogue, pointing out misunderstandings and/or clarifying the situation.
Formal complaints. For formal sexual harassment complaints that do not include sexual assault allegations, the facts and circumstances of the complaint are forwarded to the next superior officer with authority to convene a general court-martial within five days. The investigation begins within five days of receipt of the complaint. The complainant is then immediately notified of the commencement of an investigation, details of the investigation process, the support resources that are available, and appeal rights. Investigations are closely monitored, with the goal to complete the investigation within 30 days from commencement, if practical. A final report is submitted to the next superior officer within 36 days of the commencement of the investigation and must include results of the investigation and actions taken (DoD, 2018b).
Formal sexual harassment complaints that include sexual assault allegations are referred to the appropriate criminal investigation organization... For formal sexual harassment complaints that include sexual assault allegations, the processing steps are similar, but the timelines are accelerated. The facts and circumstances of the complaint are forwarded to the next superior officer with authority to convene a general court-martial within 72 hours. The investigation begins within 72 hours of receipt of the complaint, with the goal of completing the investigation within 14 days and submitting the final report to the superior officer within 20 days of investigation commencement. Formal sexual harassment complaints that include sexual assault allegations are referred to the appropriate criminal investigation organization, in accordance with DoDI 5505.18 (DoD, 2018c)
The complainant and the accused are entitled to receive a copy of the final report. They are provided an opportunity to redact information as necessary pursuant to Title 5, U.S.C. Section 552a (U.S. Department of Justice, 2015).
Response Training and Prevention Education in the Military
Training and instruction. Section 6.2 of DoD Instruction 1020.03 details the requirements and programs for sexual harassment prevention, response training, and education. Prevention and response training and education programs are mandatory across all levels of the military, from the lowest grades to senior grades. A qualified instructor is tasked to inform service members of their roles and responsibilities regarding fostering a harassment-free environment, including how to identify sexual harassment per DoD guidelines. The instructor discusses options and procedures to submit anonymous, informal, and formal complaints, as well as how to identify and report sexual assault, retaliation, and reprisal. This education must also include pertinent information regarding bystander intervention skills and disciplinary actions that may arise from sexual harassment and sexual assault (DoD, 2018b).
Responsibilities. Section 2 of DoD Instruction 1020.03 details the responsibilities of DoD members regarding sexual harassment. The chain of command is respected, from the Under Secretary of Defense for Personnel and Readiness to the Secretaries of the Military Departments. The Under Secretary is responsible for DoD-wide sexual harassment prevention and response, as well as establishing standardized reporting requirements and automated data collection. The Secretaries of the Military Departments are tasked with making sexual harassment data available to superiors and providing a 24-hour toll-free hotline available to all service members to submit complaints or acquire pertinent sexual harassment and sexual assault information (DoD, 2018b).
Why Military Sexual Harassment Policies and Procedures are Effective
...the system incorporates layers of oversight and frequent evaluation by responsible parties... Military policies and procedures are effective because of a robust set of policies, procedures, and training sessions, including well-defined steps to submit complaints; procedures with strict timelines to process complaints; and clear requirements that protect both the complainant and the accused (Morral, 2018). Responsibilities are delegated to appropriate ranks. Training sessions are conducted by qualified instructors. Administrative or disciplinary action is taken, if necessary, to protect the complainant while cases are processed. Further, the system incorporates layers of oversight and frequent evaluation by responsible parties to ensure effectiveness and currency, with the goal of meeting the mandate to provide an environment free from sexual harassment.
Sexual Harassment in the U.S. Public Health Service
The U.S. Public Health (USPHS) Commissioned Corps is one of the seven Uniformed Services, and falls under the Department of Health and Human Services (DHHS), with operational command and control provided by the U.S. Surgeon General (Commissioned Corps of the U.S. Public Health Service, 2018). Corps Officers are highly skilled medical, nursing, research, and public health professionals (Brown-Stephenson, 2017; Commissioned Corps of the U.S. Public Health Service, 2018). Although the USPHS is not a DoD Service, there are policies regarding sexual harassment that apply to Commissioned Corps Officers of the USPHS.
USPHS Commissioned Corps officers work for the various federal agencies under the DHHS (e.g., Centers for Disease Control and Prevention; Food and Drug Administration; National Institutes of Health), and external DHHS federal agencies (e.g., DoD; Department of Homeland Security; Department of Justice; Commissioned Corps of the U.S. Public Health Service, 2018). USPHS officers report instances of sexual harassment by following the guidelines of the respective assigned agencies. In the recently published Disciplinary Action Commissioned Corps Directive 111.02, dated June 2018, sexual harassment is considered misconduct, and USPHS officers who commit this offense are subject to disciplinary action (e.g., counseling, letter or reprimand, suspension from duty, or termination of commission; Commissioned Corps of the U.S. Public Health Service, 2018).
Sexual Harassment in the Civilian Sector: EEOC
Before a victim of sexual harassment decides to make a complaint, the victim should first inform the harasser that the conduct is unwelcome The U.S. EEOC is a government agency responsible to enforce federal laws and investigate allegations of discrimination and sexual harassment. By definition, sexual harassment is unwanted sexual encroachment, asking for sexual favors, and other forms of verbal or physical harassment that are sexual in nature. Before a victim of sexual harassment decides to make a complaint, the victim should first inform the harasser that the conduct is unwelcome. Additionally, the victim should use their employer’s procedures to report the complaint, then report the sexual harassment to the EEOC within 180 days of the incident (EEOC, 2018d).
The EEOC reviews the complete record, nature of the sexual advances, and context of the alleged incident. A determination is made from the facts; findings are either substantiated or unsubstantiated (EEOC, 2018d). The sexual harassment victim has 90 days to file a civil lawsuit against the harasser (EEOC, 2018a; 2018c). The EEOC is required to issue the notice if 180 days have passed from the filing date of the charge. Adjudication outcomes include case dismissal, employment disposition, or financial compensation.
Prevention Education in the Civilian Sector
In the fall of 2017, the EEOC launched the new training program named “Respectful Workplaces Training Program.” This program includes two opportunities for training: Leading for Respect (for supervisors) and Respect in the Workplace (for all employees). Rather than compliance training that focuses on legal definitions and standards for liability, the new program provides an exciting training alternative for harassment prevention (EEOC, 2018d). The EEOC Training Institute also provides training for private employers and state or local government agencies (EEOC, 2018d).
Sexual Harassment Policy Differences Between Military and EEOC
Military and civilian employers alike are mandated to provide an environment that is free from sexual harassment (EEOC, 1990, 2018d; EOOC & DHHS, 2018). However, DoD sexual harassment policies are structured and consistent across the entire military, while civilian sector sexual harassment policies and procedures vary between organizations (EOOC & DHHS, 2018). In the military, processes are clearly defined, and commanding officers are charged with fostering a climate free from harassment and without retaliation against those filing harassment complaints (DoD, 2018c). The complainant is notified of the investigation, and provided details about the investigation, resources, and appeal rights (DoD, 2018a). In the civilian sector, sexual harassers can be fired and sued. The company may be also sued for violating the victim’s civil rights (EEOC, 2016; EOOC & DHHS, 2018).
Military and civilian employers alike are mandated to provide an environment that is free from sexual harassment In the military, sexual harassment accusations are investigated with the additional consequence of service members violating the DODI enduring UCMJ action (e.g., loss of rank/pay, military discharge). While a civilian who loses employment may easily find another job without the harassment becoming known, the military formally tracks sexual harassment as part of the service member’s record. The risks of a permanent recording of substantiate sexual harassment or discharge for sexual harassment can gravely affect a service member’s career and future job prospects. Lastly, the military, and many civilian employers provide a 24-hour hotline to obtain relevant information and anonymously file sexual harassment complaints.
Moving Forward: Overcoming Barriers and Policy Implications
The civilian nursing community can learn from the established and consistent military sexual harassment policies and procedure to handle complaints. However, it is first important to note the problem of under-reporting, how to overcome these barriers, and what individual nurses should know and do to foster a harassment-free work environment.
The Problem of Under-Reporting
Sexual harassment is under-reported in general (EEOC, 2016). It is not surprising that sexual harassment is often underreported in the nursing profession (Nelson, 2018). Overall, formal reporting within organizations is low, with only 25% of victims filing an official account to their company, often as the last option when all other possibilities have been exhausted (EEOC, 2016; Nelson, 2018).
Common barriers to reporting include fear of blame, disbelief, inaction, retaliation, humiliation, ostracism, and damage to one's career and reputation (Bergman, Langhout, Palmieri, Cortina, & Fitzgerald, 2002; Cortina & Berdahl, 2008). Fear of reporting includes assumptions that the process of reporting would not render many benefits and is costly to the victim (Cortina & Berdahl, 2008; Cortina & Magley, 2003; Nelson, 2018). Sexual harassment victims may overlook the event or placate the harasser in an effort to maintain the relationship (Magley, 2002). While victims may seek support from peers, friends, or family, only one third report the harassment to management (Cortina & Berdahl, 2008; Cortina & Magley, 2003; Magley, 2002). Rather, many victims instead choose to evade their harasser, separate themselves mentally from the situation, continue to undergo harassment without attempting to settle the situation, or attempt to appease their harasser by formulating excuse justifications to explain the behavior (Magley, 2002).
Fear of retaliation is perhaps the most insidious reason for non-reporting. Retaliation may take the form of work-related actions that have negative effects on the employee. Retaliation may take a social form, with verbal and nonverbal acts such as name calling, ostracism, blame, threats, or the ‘silent treatment’ (Cortina & Magley, 2003). Consequently, some victims of sexual harassment simply consider leaving their profession (National Academies of Sciences, Engineering, and Medicine, 2018; Nelson, 2018) .
Overcoming Barriers to Reporting
To overcome reporting barriers, the first step is prevention from sexual harassment To overcome reporting barriers, the first step is prevention from sexual harassment (EEOC, 2016; DoD, 2018b). The EEOC urges employers to take necessary measures, such as constructive discussion of sexual harassment, stating clear-cut condemnation of harassment, creating appropriate penalties, and advising employees of their right to speak out against such acts as protected under Title VII provisions (EEOC, 2016). EEOC guiding principles emphasize that anti-harassment policies created should be disseminated and enacted along with effective grievance processes. Annual review of sexual harassment policies is also recommended, along with ensuring that organizational senior leadership endorses the policy. Ideally, the policy should be well-defined, include a statement of zero tolerance of sexual harassment, and confirmation that the employee will be safeguarded against any form of retaliation (EEOC, 2016; EEOC, 2018d).
To avoid fear of retaliation, nurses should be aware of protections that are within the federal law that prohibit retaliatory acts. The EEOC has identified recommended actions for organizational managers and supervisors to avoid retaliation (EEOC, 2016). These include:
- Avoid publicly discussing the allegation
- Do not share information about the EEOC activity with any other managers or subordinates
- Be mindful not to isolate the employee
- Avoid reactive behavior, such as denying the employee information, equipment, or benefits provided to others performing similar duties
- Do not interfere with the EEOC process
- Provide clear and accurate information to the EEOC staff, EEOC investigator, or judge
- Do not threaten the employee, witnesses, or anyone else involved in the processing of a complaint
#MeToo and #EndNurseAbuse Campaigns
Awareness of sexual harassment and increased confidence can reduce non-reporting. Recently, the hashtag #MeToo has been used to acknowledge victims of sexual harassment and sexual assault, particularly in the entertainment industry. The #MeToo movement has led to a number of powerful people being held accountable for alleged sexual assault or harassment. The #MeToo movement has led to a more than 50% increase in lawsuits for sexual harassment in 2017 (EEOC, 2018a, 2018c). Additionally, in 2017 charges filed with the EEOC of alleged sexual harassment increased by more than 12% (EEOC, 2018a). It appears that the #MeToo movement has increased the confidence of victims to step forward and report sexual harassment in Hollywood and beyond (Nelson, 2018).
Awareness of sexual harassment and increased confidence can reduce non-reporting. The American Nurses Association (ANA) has developed a new campaign, #EndNurseAbuse, which promotes zero tolerance policies for workplace abuse of nurses (Nelson, 2018). Eradicating sexual harassment is also included in the recent position statement released by the ANA in June 2018, which advocates that nurses report sexual harassment. As with the #MeToo movement, it is hoped that the #EndNurseAbuse movement will decrease sexual harassment and increase sexual harassment reporting throughout the nursing community (Crary, 2018; Nelson, 2018).
What Nurses Need to Know and Do
Individual nurses should educate themselves about how sexual harassment is defined and what to do if they experience sexual harassment. Awareness, prevention, and reporting are keys to counter sexual harassment. Individual nurses should educate themselves about how sexual harassment is defined and what to do if they experience sexual harassment. Nurses should know their rights and how to file a complaint both within their organization and with the EEOC. Per EEOC guidelines, nurses should clearly indicate to the harasser their desire for the behavior to stop and, if the harassment does not stop, adhere to organizational anti-harassment policies. If organizational sexual harassment policies do not exist, then employees should report to their supervisor or the supervisor of the perpetrator (EEOC, 1990, 2018b, 2018d). Nurse managers carry the responsibility for sexual misconduct even more so as they are considered the employer. Managers need to know how to identify sexual harassment and how to intervene. Nurses should be bold in demanding that their organizations take effective steps to prevent sexual harassment and to enact clear procedures that protect both the accuser and the accused.
Recommended Best Practices from the Military
From a policy perspective, civilian nursing leaders struggling to implement fair and appropriate procedures might benefit from adopting best practices from the military by establishing standardized and clear organizational sexual harassment processes. Recommended organizational strategies to address sexual harassment may include the following steps:
- Establish a clearly written statement declaring zero tolerance of sexual harassment by employees and staff, including language similar to the military definitions.
- Include insurances in the sexual harassment statement that the employer will take immediate and appropriate correction if the harassment is substantiated, up to and including termination (EEOC, 2016; Gardner & Johnson, 2001).
- Highlight in the statement that sexual harassment may be perpetrated by males or by females; that the victims may be male or female; and that supervisors in particular must be made aware of steps to avoid committing sexual harassment with subordinate nurses.
- Institute mandatory training sessions at the hiring process to clearly inform nurses of their rights and responsibilities regarding sexual harassment, as well as periodic training to reemphasize unacceptable behaviors will not be tolerated in the nursing workplace.
- Create local policies that emphasize confidentiality. Nurses should be assured that complaints will be adjudicated under a cloak of confidentially, with the complaint only divulged on a need-to-know basis.
- Emphasize protection from retaliation for harassment complainants, witnesses, and the accused. The military often separates the accuser from the alleged perpetrator, which can reduce the threats of coercion and retaliation.
- Establish local procedures that include speedy investigation and adjudication by unbiased parties. The processes should have clearly defined timelines, akin to the military procedures described above. To avoid bias and to foster correct adjudication, a robust appeals process that protects the rights of the accused should also be established, as in the military.
- Create a user-friendly neutral process for nurses to report alleged sexual harassment with more than one reporting path. The military has a 24-hour toll-free hotline available to all Service members for submitting complaints or for acquiring pertinent sexual harassment and sexual assault information.
Areas for Future Research
What works well in a military setting may or may not be useful for civilian organizations. What works well in a military setting may or may not be useful for civilian organizations. It is important to conduct objective research to determine which optimal sexual harassment policies derived from the military work best for civilian nurses. It is possible that there might be differences between private and public hospitals; large and small facilities; and organizational specificities. It is also conceivable that barriers to reporting and how to overcome those barriers might differ between facilities within organizations. It is essential to base decisions on empirical evidence, including the effects of sexual harassment policies on nurse job performance, nurse job satisfaction, and nurse retention.
Sexual harassment is unacceptable and too common in the civilian nursing workplace. This article provided an overview of military sexual harassment policies and procedures. Individual nurses and leaders in civilian nursing organizations can consider this information to incorporate the best aspect of the military structured framework to prevent and reduce sexual harassment, and to effectively adjudicate sexual harassment cases while protecting the rights of all involved. It is hoped that the information provided here will foster a harassment-free work environment for all nurses.
Natasha Colmore, MBA, BSN, RN, CCHP, LCDR, USPHS
LCDR Natasha Colmore is a Registered Nurse in the United States Public Health Service (USPHS). She has served 12 years in the nursing field. LCDR Colmore is detailed to the Health Service Corps as a Program manager with the Department of Homeland Security, serving USPHS offers in personnel management. LCDR Colmore holds a baccalaureate degree in nursing from Virginia Commonwealth University and an MBA with a concentration in healthcare from George Washington University.
LCDR Rhonita Culver, MSN, RN, NP-C, CCHP
LCDR Rhonita Culver is a nurse practitioner who has served 10 years in nursing within numerous subspecialties. She earned baccalaureate degrees in biology and nursing science. LCDR Culver has a master’s degree in nursing and is a certified Family Nurse Practitioner. She is currently serving in the Washington metro area.
Wendy Lee, DNP, RN, FNP-BC
Dr. Wendy Lee is an Associate Professor/Clinical at the University of Texas Health San Antonio School of Nursing. She teaches in the undergraduate and graduate nursing programs. She is a retired Air Force Lieutenant Colonel who has served 28 years on active duty. She has been a Family Nurse Practitioner (FNP) for the past 20 years. As an expert clinician/educator, she earned the role as an Air Force Surgeon General FNP consultant. Dr. Lee created inter-professional hybrid simulation education on proper assessment and treatment for the sexual assault (SA) victim. She reviewed and revised the policies on SA prevention and response, to include the standardization of sexual assault training, qualifications and experience of the providers. This review and revisions lead to authoring the AF instruction to standardize and improve medical care for the victims of sexual assault. Dr. Lee completed a Doctor of Nursing Practice from George Washington University with a concentration on interprofessional graduate training using simulation.
CAPT April D. Kidd, PhD, MBA, RN, NEA-BC
CAPT April D. Kidd is the Chief of the Medical and Development Unit within the Health Service Corps at the Department of Homeland Security, where she leads the continuing education and professional education efforts for over 1,400 personnel. CAPT Kidd has served in a vast array of U.S. Army and U. S. Public Health Service assignments throughout her nursing career with the Department of Defense, the U.S. Food and Drug Administration, and the Office of the U.S. Surgeon General. Additionally, CAPT Kidd served as Adjunct Faculty teaching Community Health Nursing at the Hood College School of Nursing in Frederick, MD. CAPT Kidd holds a Ph.D. in Nursing from Duquesne University, an MBA from Webster University, and a BSN from the University of Alabama at Birmingham.
Auerbach, D., Buerhaus, P., Skinner, L., & Staiger, D. (2017, April 7, 2017). 2017 data brief update: Current trends of men in nursing. Retrieved from http://healthworkforcestudies.com/publications-data/data_brief_update_current_trends_of_men_in_nursing.html
Berdahl, J. L. (2007). Harassment based on sex: Protecting social status in the context of gender hierarchy. Academy of Management Review, 32(2).
Bergman, M. E., Langhout, R. D., Palmieri, P. A., Cortina, L. M., & Fitzgerald, L. F. (2002). The (un)reasonableness of reporting: Antecedents and consequences of reporting sexual harassment. Journal of Applied Psychology, 87(2), 230-242.
Brown-Stephenson, M. (2017). United States Public Health Service Nurses: Deployment in Global Crisis. OJIN: Online Journal of Issues in Nursing, 22(1), 6. doi:10.3912/OJIN.Vol22No01Man06
Commissioned Corps of the U.S. Public Health Service. (2018, October 11). Commissioned Corps management information system. Retrieved from https://dcp.psc.gov/ccmis/ccis/documents/CCD111_02.pdf
Cortina, L. M., & Berdahl, J. L. (2008). Chapter 25: Sexual harassment in organizations: A decade of research in review. In J. C. Barling, C.L. (Eds.), The SAGE Handbook of Organizational Behavior: Volume I - Micro Approaches: SAGE.
Cortina, L. M., & Magley, V. J. (2003). Raising voice, risking retaliation: Events following interpersonal mistreatment in the workplace. Journal of Occupational Health Psychology, 8(4), 247-265. doi:10.1037/1076-89188.8.131.52
Crary, D. (2018, September 28). After Kavanaugh-Ford hearing, does MeToo face a backlash? Associated Press. Retrieved from https://www.apnews.com/8a9550a60c8e464a966b0aa2ce1bfe64
Department of Commerce. (2018). Office of Marine and Aviation Operation (OMAO). Retrieved from https://www.omao.noaa.gov/learn/noaa-corps
Department of Defense. (2017). DoD Retaliation Prevention and Response Strategy Implementation Plan. Retrieved from http://sapr.mil/public/docs/reports/Retaliation/DoD_RPRS_Implementation_Plan.pdf
Department of Defense. (2018a). Department of Defense annual report on sexual assault in the military fiscal year 2017. Retrieved from Washington DC: http://sapr.mil/index.php/reports
Department of Defense. (2018b). DoD Instruction 1020.03- Harassment prevention and response in the Armed Forces. (1020.03). Retrieved from https://www.documentcloud.org/documents/4375091-DOD-INSTRUCTION-1020-03-HARASSMENT-PREVENTION.html.
Department of Defense. (2018c). DoDI 5505.18 - Investigation of adult sexual assault in the Department of Defense. DoD Retrieved from https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/550518p.pdf.
Gardner, S., & Johnson, P. R. (2001). Sexual harassment in healthcare: Strategies for employers. Hospital Topics, 79(4), 5-11. doi:10.1080/00185860109597912
Hibino, Y., Hitomi, Y., Kambayashi, Y., & Nakamura, H. (2009). Exploring factors associated with the incidence of sexual harassment of hospital nurses by patients. Journal of Nursing Scholarship, 41(2), 124-131. doi:10.1111/j.1547-5069.2009.01244.x
Magley, V. J. (2002). Coping with sexual harassment: reconceptualizing women's resistance. Journal of Personality and Social Psychology, 83(4), 930-946.
Morral, A. R., Schell, T.L., Cefalu, M., Hwang, J., & Gelman, A. (2018). Sexual assault and sexual harassment in the U.S. military - Volume 5. Estimates for installation - and Command-level risk of sexual assault and sexual harassment from the 2014 RAND military workplace study. Retrieved from https://www.rand.org/content/dam/rand/pubs/research_reports/RR800/RR870z7/RAND_RR870z7.pdf
National Academies of Sciences, Engineering, and Medicine. (2018). Job and health outcomes of sexual harassment and how women respond to sexual harassment. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519461/
Nelson, R. (2018). Sexual harassment in nursing: A long-standing, but rarely studied problem. The American Journal of Nursing, 118(5), 19-20. doi:10.1097/01.NAJ.0000532826.47647.42
Sexual Harassment. (2018). In Merriam-Webster.com. Retrieved from https://www.merriam-webster.com/dictionary/sexual%20harassment
Spector, P. E., Zhou, Z. E., & Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. International Journal of Nursing Studies, 51(1), 72-84. doi:10.1016/j.ijnurstu.2013.01.010
Subedi, S., Hamal, M., & Kaphle, H. P. (2013). Sexual harassment in the hospital: Are nurses safe? International Journal of Health Sciences and Research, 3(6), 41-47.
Suhaila, O., & Rampal, K. G. (2012). Prevalence of sexual harassment and its associated factors among registered nurses working in government hospitals in Melaka State, Malaysia. Medical Journal of Malaysia, 67(5), 506-517.
U.S. Census Bureau. (2013). Male nurses becoming more commonplace (CB13-32). Retrieved from https://www.census.gov/newsroom/press-releases/2013/cb13-32.html
U.S. Coast Guard. (2018). U.S. Coast Guard/ U.S. Department of Homeland Security. Retrieved from https://www.uscg.mil
U.S. Department of Justice. (2015). Privacy Act of 1974. Retrieved from https://www.justice.gov/opcl/privacy-act-1974
U.S. Equal Employment Opportunity Commission (2016). Select task force on the study of harassment in the workplace. Retrieved from https://www.eeoc.gov/eeoc/task_force/harassment/upload/report.pdf
U.S. Equal Employment Opportunity Commission. (1990). Policy guidance on current issues of sexual harassment ( N-915-050). Retrieved from https://www.eeoc.gov/eeoc/publications/upload/currentissues.pdf
U.S. Equal Employment Opportunity Commission. (2018a). Charges alleging sex-based harassment (charges filed with EEOC) FY2010 - FY2017. Retrieved from https://www.eeoc.gov/eeoc/statistics/enforcement/sexual_harassment_new.cfm
U.S. Equal Employment Opportunity Commission. (2018b). Chart of risk factors for harassment and responsive strategies. Retrieved from https://www.eeoc.gov/eeoc/task_force/harassment/risk-factors.cfm
U.S. Equal Employment Opportunity Commission. (2018c). EEOC releases preliminary FY2018 sexual harassment data [Press release]. Retrieved from http://www1.eeoc.gov/eeoc/newsroom/release/10-4-18.cfm
U.S. Equal Employment Opportunity Commission. (2018d). Sexual harassment. Retrieved from https://www.eeoc.gov/laws/types/sexual_harassment.cfm
U.S. Equal Employment Opportunity Commission & Department of Health and Human Services Office for Civil Rights. (2018). Memoranda of Understanding. Retrieved from https://www.eeoc.gov/laws/mous/doh_health_programs.cfm
Zhang, S. E., Liu, W., Wang, J., Shi, Y., Xie, F., Cang, S., . . . Fan, L. (2018). Impact of workplace violence and compassionate behaviour in hospitals on stress, sleep quality and subjective health status among Chinese nurses: a cross-sectional survey. BMJ Open, 8(10), e019373. doi:10.1136/bmjopen-2017-019373