KANSAS CITY, Mo. - Nurse Sarah Andres is so used to male patients calling her "sweetie" or "cutie"-or even asking her for a kiss-that it rarely upsets her anymore.
"I usually chalk it up to they don't feel good, a lot of them are confused," said Andres, who has been a nurse in St. Louis for five years and works in the critical care unit at St. Mary's Health Center. "I never really thought of it as sexual harassment."
But nursing organizations say such treatment is common, and it is definitely sexual harassment.
The American Nurses Association cites a 1982 study that reported that 60 percent of the nurses surveyed said they had experienced sexual harassment at work, though that included all cases, not just from patients. Still, nursing officials said it is clear that inappropriate behavior among patients is a widespread problem.
"I suspect that if you ask nurses if they've been harassed by patients, a majority would say yes," said Belinda Heimericks, executive director of the Missouri Nurses Association. "Nearly every nurse will run into it at some time in their career."
The harassment can run the gamut from offensive jokes or sexual comments to inappropriate touching. Sexual assaults are rare but do occur, nursing officials say. Some male nurses have reported being harassed, but the overwhelming majority of cases are between male patients and female nurses.
Such harassment creates tension for nurses, who must walk a fine line between meeting their professional responsibilities to the patient and protecting themselves.
Debbie Dougherty, an assistant professor of communications at the University of Missouri-Columbia, interviewed 29 nurses in four states to determine how they react to the harassment and how it affects their relationships with patients.
She found that nurses usually crack jokes or sternly reject the patient's conduct. Most nurses said they continue to provide medical care, but the emotional support patients need from them sometimes declines, Dougherty said.
"It probably makes the relationship a little more tense because there is a feeling of uncomfortableness between the nurse and patient," Heimericks said.
Dougherty's study, which will be published in the spring issue of Management Communication Quarterly, found nurses are generally more distressed by harassment from co-workers or doctors. Heimericks agreed, saying patients come and go, while nurses have to see the co-workers every day.
Federal and state laws protect nurses from sexual harassment by patients, and the institutions' written guidelines must reflect those laws.
In most cases, the harassment stops far before a lawyer has to be called in or charges are filed.
Nursing organizations say that if harassment from a patient continues, nurses can ask to have a second nurse stand by in the patient's room, refuse to care for the patient, ask that the patient be transferred to another floor, or report the behavior to a superior. Doctors and administrators are sometimes called in to talk to the patient.
In extreme cases, institutions can "fire" patients and send them to another hospital, said Scotty Shively, an employment and health lawyer in Little Rock, Ark.
But medical institutions are constrained by certain legal obligations to care for patients, Shively said. For example, patients needing emergency care must be admitted. And dealing with harassment becomes more complex if the patient is mentally ill.
Andres said she has sometimes asked not to take care of a particularly troublesome patient. But usually, she said, "I just tell them that we are supposed to be professional here. I tell them we need to have mutual respect. Sometimes you have to talk to them almost like children."
Dougherty's study found that nurses receive little training in handling sexual harassment from patients. Andres agreed.
"It's something you learn as you work," she said. "I just try to keep the relationship professional. I call the patient `Mr.' or `Mrs.' whatever, and I expect the same thing from them. I don't expect to be called pet names at work."