One in six U.K. nurses know of a coworker who has had sex with a patient, and one in ten think it is acceptable for nurses to have relationships with patients, according to a Nursing Times survey. A British nurse received a one-year suspension for having a three-month affair with a cystic fibrosis patient after he was discharged from her hospital and despite his returning for a heart and lung transplant. Hardly discreet about it, she joked to coworkers that she had to increase his oxygen and give him a nebulizer inhaler before they had sex.
In the United States, between 1999 and 2009, state nursing boards disciplined 636 nurses for sexual misconduct. “The actual prevalence, however, is not known. Indeed, 38 to 52 percent of healthcare professionals report knowing of colleagues who have been sexually involved with patients,” the National Council of State Boards of Nursing (NCSBN) reported. The NCSBN defines sexual misconduct as “engaging in conduct with a patient that is sexual or may reasonably be interpreted by the patient as sexual; any verbal behavior that is seductive or sexually demeaning to a patient; or engaging in sexual exploitation of a patient or former patient,” according to the council’s Practical Guidelines for Boards of Nursing on Sexual Misconduct Cases. “Any and all sexual, sexually demeaning, or seductive behaviors, both physical and verbal, between a service provider (i.e., a nurse) and an individual who seeks or receives the service of that provider (i.e., client), is unethical and constitutes sexual misconduct.”
It’s arguable that healthcare employers can hold tighter reins on staff because their stakes are so high. The Oklahoma Nursing Board barred a hospice nurse from practicing for twenty years because she had a sexual relationship with a married patient who was terminally ill. While the nurse argued the relationship was consensual, the board’s lawyer told the judge, “It is the responsibility of the professional to say no to the vulnerable patient.” The 43-year-old Lou Gehrig’s Disease patient attempted suicide after the nurse broke up with him.
When officials try to micromanage nurses’ sex lives, the slope slides rather precipitously. In Australia, a 61-year-old nurse faced disciplinary action because of a sexual relationship with a patient who was an old childhood friend she had not seen in decades and whom she ultimately married after they reunited. The Nurse Board nevertheless argued that the nurse had behaved unprofessionally because: “Consent is not an excuse with issues of professional boundaries. The care of a patient needs to be in a safe and trusting ethical relationship.”
Headlines in the U.K. exploded in 2010 when the Nurse and Midwifery Council investigated a British nurse whose hospital fired her because of accusations of “inappropriate relationships” with patients’ widowers. The resulting headlines—“Cancer Nurse Bedded Three Victims’ Husbands”—implied that the nurse had affairs with the men while caring for their wives. In reality, the divorced mother of two said that she began a ten-year relationship with one widower more than a year after his wife died, and later fell in love with the second widower, with whom she was in a year-long relationship that began months after his wife passed away.
It’s hard to see how engaging in a serious relationship with a former patient’s widower compromises nursing care of other patients (not to mention the dead one). But some states, including Maine, Arizona, and Washington, officially ban nurses from dating patient family members. When you work near your home, you inevitably will encounter people in different contexts. If nurses who spend most of their days working long hours at the hospital can’t have a relationship with coworkers, patients, or patients’ relatives, then Lord help the small-town nurse who wants to date.
The NCBSN prohibits nurses from sexual activities with former patients, clients, or “key parties” (defined as immediate family, including the spouse, domestic partner, sibling, parent, child, guardian, and others “who would be reasonably expected to play a significant role in healthcare decisions”) for two years after the individual is no longer a patient. After two years, nurses still cannot engage in sexual activities with a former patient or a former patient’s “key party” if chances are high that the patient will need future treatment or if there is an “imbalance of power, influence, opportunity, and/or special knowledge of the professional relationship.”
If healthcare employers can dictate whom nurses date, can they also control whom they befriend? Three weeks after a psychiatric patient was discharged from a Canadian hospital, she saw her nurse at a greenhouse, where the women chatted and exchanged phone numbers. The women eventually decided to rent a place together. The hospital fired the nurse for becoming platonic friends with a former patient. When the nurse took the case to court, the judge sided with the hospital. According to the Hamilton Spectator, the judge argued that the nurse should have known better because of the high “return rate” of psychiatric patients to their hospitals as well as their vulnerability and emotional dependency within the nurse-patient relationship.
Certainly, hospital paramours are duty-bound to uphold their responsibilities and maintain professionalism even after the relationship ends. Healthcare workers cannot afford to have “bad blood” between them. But nurses in particular are stuck; they are glorified as sex objects, then punished when they have sex.
In Ontario, after nurse Lori Dupont tried to end a long, rocky relationship with married anesthesiologist Marc Daniel, the doctor, who had a history of inappropriate and unwanted contact with nurses, harassed her at work, according to the Windsor Star. When several nurses complained, their manager reprimanded them. The nurses took it upon themselves to protect Dupont, inserting themselves between Dupont and Daniel when they were in close proximity, or sneaking Dupont out of the room.
Administrators were aware of Daniel’s physical, verbal, and sexual harassment of nurses. Internal reports list that Daniel suggested he give a nurse a naked, oiled backrub; kissed a nurse who bent over to speak to him; and broke a nurse’s finger when grabbing a pillow from her. On a quiet weekend day, Daniel and Dupont were inexplicably both scheduled in the OR. Daniel stabbed her to death, then killed himself.
While the hospital board chairman called the murder-suicide “an unforeseen event,” Dupont’s family and coworkers said that Hôtel-Dieu Grace Hospital prioritized Daniel’s career over Dupont’s safety. “When a nurse behaves badly, I’m before a disciplinary hearing and the hospital reports it to the College of Nurses of Ontario. When a doctor behaves badly, nothing happens,” nursing union officer Colin Johnston told the Star.
Before their relationship began, when Daniel was pursuing Dupont, a single mother, he would grab her and try to push her into rooms. When a friend told her that she should report the sexual harassment, she replied, “He’s a doctor. I’m a nurse. You just can’t do that. There’d be all kinds of problems.”
Chapter 3
Who Protects the Nurses?
Taking Care of People Who Punch You in the Face
“The nurse takes appropriate action to safeguard individuals when their care is endangered by a coworker or any other person.”
—The International Council of Nurses’ Code for Nurses
“Almost every single ER nurse I know has been assaulted by a patient at some point. If someone walked into a bank and told the teller, ‘Fuck you, you little bitch, now get me my money,’ they’d probably be arrested or, at the very least, kicked out of the bank. I’m expected to take no action and, worse, to continue to treat the patient.”
—an ER nurse in Colorado
“If I had a dollar for every horny old man who’s tried to grab my ass or tits, I would be a crazillionaire.”
—a medical/surgical nurse in Illinois
MOLLY October
The Fertility Clinic
A few weeks after her initial blood draw at the fertility clinic, Molly was in the patient’s seat once again for her first intrauterine insemination (IUI). As she lay on the table in what resembled a standard ob-gyn exam room, she was both excited and, to her surprise, slightly nervous. Thus far in
her cycle, she had not been fazed by the medications, the hormonal changes, or the diagnostic procedures. She was optimistic that she and Trey would have a baby.
Trey had been a rock throughout the process. He was what Molly called “a man’s man,” easygoing and even-tempered. He got along with everyone. As loud and brassy as Molly was, Trey was quiet and stoic. So his reluctance to come to this appointment had been unsettling. “This is going to be really awkward,” he said as they waited for the doctor to come in to deposit a vial of Trey’s sperm directly into Molly’s uterus.
“What? You standing next to me while another man tries to get me pregnant?” Molly cracked.
“You’re not helping.”
When the doctor and a tech entered the room, they hardly said anything to Molly or Trey. The tech put Molly’s feet in stirrups and the doctor got to work.
Molly had heard that IUIs were painless, but the physician had difficulty threading the catheter through her cervix. As much as she had tried to make light of what she called her turkey basting, she reached for Trey’s hand in discomfort. His palm was clammy. If Trey was uneasy, then so was she.
Abruptly, the doctor got up and left without a word; no “Have a good day,” no “Good luck.” A tech placed a kitchen timer next to Molly. “Lie still for the next five minutes,” the tech said, and she left, too. Molly remained still for ten minutes, her legs in the air.
Normally, Molly would crack more jokes or make conversation to fill the airspace. Disconcerted by the strangeness of this form of conception and overcome with emotion about the possibility of success, Molly and Trey continued to hold hands in silence.
When Molly and Trey left the clinic, the women at the front desk didn’t even look up from their chatter.
Molly had not booked agency shifts in advance for the week of the IUI because the clinic didn’t schedule the procedure until a few days before. For Molly, the most stressful part of the fertility process so far was that she had to keep changing her work schedule, and she didn’t like to bother her hospital bosses.
Citycenter Hospital
When she got home, Molly called Citycenter’s scheduler, who had two full days available. “Every time I turn around, someone else is resigning. I don’t know what’s going on,” the scheduler said.
I do! Molly thought. Your ER sucks!
Of the three hospitals to which the agency had assigned Molly, Citycenter was her least favorite. Since she had started working there once or twice a week, the hospital’s quality had declined even further.
When Molly arrived at Citycenter, the charge nurse assigned her to minor care, the ER zone for nonserious injuries. At other hospitals, this assignment was considered relatively low-key; the minor care nurse would assess each patient and talk to the doctor or PA, who wrote orders or treated the patient. The nurse would see the patients two or three times before discharging them. Usually there were no more than ten nonemergency patients at a time.
At Citycenter, however, Molly saw twenty patients on her board. She raced from chart to chart, checking orders and reading the triage nurse’s notes to prioritize her rounds. Citycenter minor care nurses were not supposed to assess patients themselves because the hospital wanted to turn the patients over as quickly as possible: more patients, more profit. The minor care nurse was supposed to trust that the triage nurse had accurately separated the urgent care patients from the minor care cases. Based on that quick analysis, patients waited to see the doctor or PA while the nurse attended to one patient at a time.
Molly took a patient with a broken ankle to get an X-ray, discharged another patient, then returned to the first patient to put on a splint. She retrieved crutches from the supply closet, taught the patient how to walk with them, and pulled pain medications from the Pyxis (an automated medication dispensing machine).
As Molly sped down the hall to get his discharge instructions, she ran into Sam, whom Molly had known when she was a tech at Pines Memorial. Molly liked Sam; she was a hard worker always willing to pitch in, and she had no idea that she was beautiful. Molly remembered when Sam had dated one of the murses at Pines. The murse had dished to several coworkers that while Sam was quiet and reserved in the ER, she was, he insisted, a “freak in the sheets.”
“What do you think of this place?” Molly asked her. “The patient ratio is pretty scary.”
Sam looked beaten down. “A new grad should not have seven or eight patients on her own.”
“I have twenty patients in minor care and I’ve seen two of them,” Molly said.
“That’s normal here.”
Sam told Molly that Citycenter patients were often mistriaged, which meant that sick patients who needed more serious, urgent treatment sat in the minor care area for hours. If a patient had an emergency such as an allergic reaction, the minor care nurse might not know in time to save him. The nurses had the clear impression that, rather than blame understaffing or hospital policies, administrators would let the nurse take the fall for any errors.
After her shift, Molly met with several nurses in the break room. Some of them were crying in frustration because they couldn’t properly care for their many patients. Molly had seen this happen during about half of her Citycenter shifts so far. These nurses were petrified because of the combination of patient volume, concern about losing their licenses because they didn’t have enough time to keep patients safe, the unhelpful ER director, and patients who treated them horribly and threatened them physically. When tensions ran high and nurses were spread thin, patients could snap and turn violent in an instant. Victoria, the ER director, remained unsympathetic to nurses, which was particularly distressing because she had been a nurse herself.
“No other hospital in the area operates like Citycenter,” Molly told the nurses in the break room. “The nurse-patient ratio is insane, the hallways are full of patients, most patients aren’t seen by the attending until they’re ready to leave, and the policies are really unsafe.”
“That’s just how Citycenter does things,” a nurse replied, resigned.
“Maintaining eight to nine patients at a time isn’t safe,” said Renée, a veteran Citycenter charge nurse. Molly and the other ER nurses had a tremendous amount of respect for Renée, who had worked in the department for twenty-five years. She was stern but fair, and willing to teach less experienced nurses whenever they asked for help.
“Yeah, for patients or for our nursing license,” another nurse muttered.
“I talked to Victoria about the patient ratio,” Renée said. “She told me she didn’t understand what all the grumbling is about.”
“I don’t understand how the hospital can completely ignore repeated safety concerns from staff!” Molly said.
“We’ve all been submitting complaints to The Joint Commission. You should do one, too,” Renée suggested. TJC accreditation was required for hospitals to receive federal funds and Medicare/Medicaid reimbursement. To get the accreditation, hospitals had to recertify every three years. Supposedly, TJC inspectors could show up at any time to investigate whether a hospital maintained TJC standards.
At home, Molly reviewed The Joint Commission website: “Joint Commission standards focus on safety and quality of care.” Everything I complain about involves safety and quality of care! she thought. She clicked to a page where she could register a complaint. The website made it easy: She had only to select a few categories from drop-down menus and fill out a short comment box. “Citycenter’s ER is unsafe based on workload,” she wrote. “I’m expected to care for nine patients at a time when the standard is four to five. When my partner goes to lunch, I’m required to take care of double that number, even if it’s eighteen patients. And minor care consistently has one nurse to twenty patients.” She wondered whether the authorities would step in.
Academy Hospital
Molly was working triage at Academy when a fellow ER nurse, upset and disheveled, came
in for treatment. She told Molly she was trying to get a patient settled in bed when the patient jumped up and walked out of the room. The nurse called for security, but the officer only watched. “Wait!” the nurse had shouted as the patient continued toward the elevator. The nurse hurried after her. “If you want to leave, I’ll take out your IV and get you ready to go!”
The elevator door opened. “Come back!” the nurse said, leaning in the doorway. The patient lunged, grabbing her neck and scratching her multiple times before the security officer finally stepped in.
“You should file charges,” Molly told the nurse.
“It’s too much trouble. Administration wouldn’t like it.”
Molly exhaled loudly. This incident had hit too close to home. “If you worked at Macy’s and someone grabbed you by the neck and scratched you up, would you do nothing?”
“It’s different in healthcare.”
“No!” Molly yelled. “Too many people have that attitude! It is not okay to assault healthcare workers. If a nurse thinks that, how can we possibly get anyone else to change their mind? You need to get mad!”
The previous week, a Citycenter patient had thrown her urine sample into a nurse’s face. Management had pleaded with the nurse not to report the incident; when she did, the police said the report probably wouldn’t go anywhere because “the patient is mentally ill.”
Molly was livid. “I can’t believe even the cops gave her a hard time,” she told a friend. “There’s no other career where you can be hit, scratched, spat on, verbally assaulted, have people threaten your life, and you just go about your business like it never happened.”
It had happened to Molly two years before. Daryl was a frequent visitor to the ER. In his forties, he lived in a shelter, and when he wanted free meals and time to himself, he came to Pines, claiming to be suicidal. He would refuse all treatment, medication, and therapy, but the hospital kept him for three to five days. He had done this countless times. One day Molly entered his room in the ER’s psychiatric area and prepared to take his blood pressure. Within a matter of seconds, Daryl punched her in the eye, yanked her long hair, and scratched her arms and neck. He grabbed Molly’s shirt and began to pull her onto the bed. As Molly struggled with him, Daryl bit her arm, breaking the skin. Molly tore herself away and rushed out of the room. Daryl fell to the floor, unharmed.
The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital Page 11
