Last year, I read about a case of a nurse who alleged being sexually harassed by a doctor during her job interview, and a couple of months later I was struck by a report from the Netherlands about the high rate of sexual harassment experienced by female nursing and healthcare workers. Although cases like these make it seem like doctors and managers are the primary perpetrators of sexual harassment, reports show that it is patients who sexually harass nurses most often.

With a recent study suggesting that nurses simply distance themselves from patients who are sexually inappropriate, how do nurses maintain quality health care of these patients? A new book, Catheters, Slurs, and Pick-up Lines: Professional Intimacy in Hospital Nursing (Temple University Press) sheds light on female nurses’ experiences of being sexually harassed by patients.  For this month’s column, I had the chance to ask the author, sociologist Lisa Ruchti, Ph.D. of West Chester University, about nurses experiences of “intimate conflicts” with patients.

Adina Nack: Why did you decide to study the dynamics of patient-nurse interactions?

Lisa Ruchti: I initially thought that nurses’ experiences of sexual harassment by patients would be similar to waitresses’ experiences of sexual harassment by customers because they are each one type of women’s work. Instead, I found that nurses did not refer to their encounters as ‘sexual harassment’ because work culture affects definitions of sexual harassment (other sociologists have found this too; for example, Christine Williams and Kirstin Dellinger).  In nursing, it was the fact that nurses provided both professional and intimate care that contributed to differences in how and when nurses said they were sexually harassed. I became intrigued with the function of intimacy in professional care work and wanted to learn more.

AN: I’m intrigued by the concept of “professional intimacy” – how is this experienced by nurses?

LR: In my work, I found that nurses negotiated a cycle of what I call “professional intimacy” with patients. I also found that negotiating intimate conflict with patients is inextricably a part of how nurses gain their trust. Nurses start with gaining the intimate trust of their patients. This trust sometimes escalates to patients having feelings of familiarity for their nurses, which leads to conflict for the nurse. These conflicts include patients feeling entitled to service beyond the scope of care in nursing, angry verbal interactions, and/or sexualized entitlement. This conflict can also be unavoidable such as the ways that nurses negotiated the sexual encounters between patients and their visitors. Nurses negotiate care through this conflict to renew trust to ensure that quality health care is administered.

AN: How do nurses experience conflict when providing care to patients?

LR: The majority of the 45 nurses I interviewed avoided describing patient care as involving conflict. They used words like nurture, kindness, and compassion to make it seem like nurses “being caring” was a natural personality characteristic characterized by goodness. Feminist philosopher Eva Kittay discusses this in her work: patients are not usually described as anything other than “needy,” and we don’t tend to think of needy people as causing conflicts for those who provide their care. My focus on identifying conflict is as much about seeing patients clearly as it is about seeing the work of nurses clearly.

AN: You make a key point about not only a nurse’s sex but also her race/ethnicity shaping her experiences of patients’ harassment – can you give a couple of examples of how nurses described these interactions?

LR: It is one thing for nurses to manage sexually explicit language or touches; it is quite another when those are combined with racial slurs and epithets.  Imagine that a nurse not only walks in to check on a patient and sees himmasturbating, but she is also called a “dirty foreigner.” Or, a nurses isgiving a patient a bath, and the patient says you remind him of his mammy. It was incredibly important for me to look at the function of multiple identities since I was looking at intimate care as something that is constructed in interaction between patients and nurses and informed by social ideologies. Intersectionality is an incredibly useful tool when explaining complex social experiences.

AN: As a medical sociologist, I was instantly hooked by your book’s title, but I can also see why many of us — not just nurses — should read your book. 

LR: Thanks, I wrote it not just to give voice to nurses but also because almost all of us have all been patients or visited loved ones in hospitals. Many of us have or will have long medical journeys at some point in our lives, and this book can help us understand a vital part of that journey. If we can better understand the lives of those who are taking care of us, then we can help ensure that quality care occurs when we need it.  Other studies have documented how much nurses care about patients, and it’s time for us to listen to their stories – we need to understand their experiences of caring for us.