Inappropriate behaviour

A growing body of evidence suggests a range of sexually inappropriate behaviour is a huge problem for the nursing workforce.

A Unison survey of 2,000 nurses in 2021 found that 60% had experienced sexual harassment at work. Some said they were expected to put up with abusive behaviour because it was seen as ‘just part of the job’, while others said it happened so frequently that it had become normal.

In May, it was revealed that NHS organisations in England recorded more than 35,000 cases of rape, sexual assault, harassment, stalking and abusive remarks between 2017 and 2022.

Most incidents (58%) involved patients abusing staff. Police recorded nearly 12,000 alleged sexual crimes on NHS premises in the same time period.

Concern about the issue prompted a meeting between health and social care secretary Steve Barclay and NHS leaders earlier this year. Mr Barclay said he was determined to ‘root out this vile behaviour’, a Department of Health and Social Care spokesperson said.

Surveillance is divisive

NHS England is piloting nurses’ use of bodycams in an attempt to crack down on the problem. They are already widely deployed by paramedics and the police, but surveillance is a divisive issue for the profession.

Advocates argue bodycams are necessary in the face of high levels of violence and abuse. Opponents say they compromise the therapeutic relationship and infringe individuals’ rights.

The RCN acknowledges use of cameras has been rising steadily in the UK. At the end of May, the college published a lengthy statement in support of their use by nursing staff. It argues the evidence suggests participants in trials felt more safe and supported when wearing cameras.

But it notes it is a difficult and complex area for nurses, and urges employers first to look at other factors that can allow violence against staff to take place, including short-staffing.

Bodycams were introduced in the emergency department (ED) of John Radcliffe Hospital in Oxford about 18 months ago after an increase in violence. There are 12 devices that staff wear routinely, or can put on if they are concerned about someone’s behaviour, says ED matron Katy Mimpress.

‘We always try to de-escalate a situation through communication first. We switch the camera on if we are not able to do that. We tell the patient or relative their communication is unacceptable and we are switching it on,’ she says.

The equipment used in Oxford has a screen that plays back to the viewer what is happening in real time. Just seeing their own behaviour projected back can often be sufficient for the person to calm their behaviour, Ms Mimpress says.

‘It has become part of our working life,’ she says. ‘It is difficult to say if there is a reduction in incidents. But it shows staff that we value their safety.’

Staff have become more supportive since the cameras were piloted early last year. In a survey of 30 members of staff after the trial, 96% agreed or strongly agreed the cameras were needed, compared with 63% beforehand. Likewise, 86% said they would have a positive impact on the organisation, compared with 53% before the trial.

Critics of surveillance

Ms Mimpress can think of at least one case where a nurse was subjected to highly sexualised comments by a patient and hopes the cameras can curb such behaviour. ‘We never want to normalise it,’ she says.

Use of such surveillance has its critics in the profession, though. Gender-based violence nurse specialist Leanne Patrick works with traumatised women for a service in NHS Scotland. She says bodycams would be a ‘huge violation’ particularly for those undergoing an intimate procedure.

‘It is just a sticking plaster on a situation that requires a much more complex solution. Sexual violence is rife in the NHS and that is a shocking thing, but we don’t have the basics right in terms of reporting. Some health boards are reporting zero incidents and some, astronomical numbers.’

Disrupting relationships

Ms Patrick says the devices could be disruptive in caring for those with trauma or psychosis because they may have concerns about being watched. ‘Nurses are one of the most trusted professions and we must protect that relationship with patients,’ she says.

A study published in April of patients’ and staff’s views of bodycams in inpatient mental health settings found no evidence either group believe such surveillance could reduce aggression or violence, but that it could ‘intensify power dynamics and undermine the therapeutic relationship’.

The Surviving in Scrubs website was set up by two doctors to record incidents of sexism, harassment and sexual assault.

‘It was accepted as the norm to sexually harass young nurses. One doctor would continuously make sexual advances such as trying to put his hand up my dress, and would put his fist up to my face and call me a prick teaser,’ one nurse recalls on the site.

Websites such as Surviving in Scrubs and Project S provide a forum for previously voiceless healthcare staff, says Kate Jarman, director of corporate affairs at Milton Keynes University Hospital NHS Foundation Trust and founder of Project S.

‘The power of these platforms, in the sharing of experiences to drive change, is they can break the silence and stigma,’ Ms Jarman says.

She adds that while speaking out against sexually inappropriate behaviour is finally gaining more attention, it seems to be more geared towards doctors at the moment.

‘The nursing voice is still unheard,’ she says. ‘How do we get the profession talking about this and feeling confident to share their experiences?’

She adds nurses are likely to be under-reporting for a number of reasons: they fear repercussions, do not want to report incidents involving patients because the behaviour could stem from the person’s condition, or they do not believe action will be taken.

Address underlying cause

Changes that address the underlying causes of inappropriate sexual behaviour are needed rather than cameras, campaigners argue.

Giving victims confidence will not be easy. ‘It will take a lot of collective will. It is important to have these conversations and important for nurses to be vocal about what they have to face and what they need to make the work environment better and more comfortable,’ she says.

Find out more

BMJ Investigation (2023) Medical colleges and unions call for inquiry over ‘shocking’ levels of sexual assault in the NHS. BMJ. 381, 1105. doi.org/10.1136/bmj.p1105

Cook R, Jones S, Williams G et al (2019) An observational study on the rate of reporting of adverse event on healthcare staff in a mental health setting: An application of Poisson expectation maximisation analysis on nurse staffing data. Health Informatics Journal. 26, 2, 333-1346. doi: 10.1177/1460458219874637

Milton Keynes University Hospital NHS Foundation Trust (2023) Project S. mkuh.nhs.uk/projects

Rape Crisis England & Wales (2023) What Is Sexual Assault?

Rape Crisis England & Wales (2023) What Is Sexual Harassment?

RCN (2023) RCN Position on the Use of Body Worn Cameras.

Surviving in Scrubs (2022) We are Surviving in Scrubs. survivinginscrubsorg.wordpress.com

Wilson K, Foye U, Thomas E et al (2023) Exploring the use of body-worn cameras in acute mental health wards: a qualitative interview study with mental health patients and staff. International Journal of Nursing Studies. 140, 104456. 10.1016/jijnurstu.2023.104456

To read the full version of this article, go to rcni.com/bodycamsin-hospitals