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Sexual Abuse

The College of Nurses of Ontario exists for one reason: to ensure Ontarians receive safe nursing care.

Sexual abuse of a patient by a nurse causes significant harm. The abuse can have lasting effects on a patient’s health and well-being. It can also seriously effect a patient’s caregiver, family and community. CNO considers all complaints and reports of sexual abuse as high risk. We investigate each allegation of sexual abuse with a commitment to provide sensitive and respectful support to victims involved in our processes. Read Sexual Abuse of Patients for more information on what to do if you or a family member has experienced sexual abuse by a nurse.

To enhance public safety, we continue to look for ways to improve how we deal with the issue of patient sexual abuse. In 2019, we completed a research study to better understand what contributes to nurses sexually abusing patients. We chose to do this work because if we can understand what leads to patient sexual abuse, we can potentially prevent it.

We look forward to working with our partners in safety, including nurses, educators, employers and other regulators so that we can do what is needed to eradicate sexual abuse.

For nurses and their patients, the term “sexual abuse” has a specific legal meaning defined under the Regulated Health Professions Act, 1991.

Sexual abuse of a patient occurs when a nurse:

  • has physical sexual relations with a patient
  • touches a patient in a sexual manner (for example, touching a patient’s genitals when it is not required in caring for the patient)
  • behaves in a sexual manner toward a patient (for example, touching a patient’s shoulder or hand unnecessarily and in a manner that implies a sexual interest in the patient)
  • makes remarks of a sexual nature to a patient (for example, commenting on the size of a patient’s breasts or genitals)

Patient sexual abuse is different from the criminal act of sexual assault, which refers to a sexual act without consent.

In the nurse-patient relationship, nurses hold a position of power by virtue of having:

  • professional knowledge and skills patients rely on for their well-being
  • access to patients' bodies
  • access to patient’s personal health information

Because of this power, any sexual or romantic relationship a nurse has with a patient is abuse and professional misconduct. It does not matter if the patient agreed to the sexual acts.

A nurse is also not allowed to engage in a sexual or romantic relationship with a patient for one year after the end of the professional relationship with the patient. This means, if a nurse begins a romantic relationship with an individual to whom they provided care to six months ago, the nurse’s conduct would be sexual abuse.

Nurses are accountable to maintain appropriate boundaries with their patients. Nurses are not to exploit or harm their patients to meet their own needs. There are serious consequences for breaking the law by engaging in sexual acts with a patient.

CNO used a risk-based regulation framework to guide the research. Risk-based regulation is a proactive approach in harm prevention. It focuses on public safety by identifying specific, and relevant, risks of harm, and developing interventions before the risks becomes actual harms.

We began our research by looking at the common trends among complaints and reports received by CNO related to sexual abuse. We also gathered evidence from literature reviews and interviews with sexual abuse experts.

RESEARCH FINDINGS

Between the years of 2000 and 2017, CNO received complaints and reports on 280 sexual abuse matters. However, occurrences of sexual abuse during this timeframe are likely higher because many patients do not report it.

From these matters, we collected information to identify common trends. For example, we looked at the dates of nurses’ initial registration with CNO and their history of conduct matters. We also looked at the age of the patients and any particular vulnerabilities they had. Information about the incidents were also collected, such as the care settings, staffing levels and types of sexual abuse.

Through our research, we learned that the 280 sexual abuse matters involved 264 nurses and 337 patients.

The most common areas of nursing practice where the alleged sexual abuse occurred were:

  • mental health (28%)
  • geriatrics (11%)
  • home care (8%) 

The data in the figure below shows the types of sexual abuse that occurred in the 280 matters (some matters involved more than one type of sexual abuse):

Types of Sexual Abuse (see table below)

The table below shows the same data as the above figure and also shows the percentages.

Type of sexual abuseNumber of occurrencesPercentage
Sexual touching of patient 181 32%
Sexual remarks 126 22%
Kissing 71 13%
Sexual intercourse 59 10%
Hugging 49 9%
Physical relations 39 7%
Ogling 15 3%
Sexual touching of self in presence of a patient 13 2%
Other 8 1%
Pornography 1 <1%

Nurses used grooming techniques to draw victims in. In CNO’s research, the most common grooming techniques are depicted below (some nurses used more than one technique.

Grooming Techniques (see table below)

The table below shows the same data as the above figure and also shows the percentages.

Grooming techniqueNumber of occurrencesPercentage

Provided special attention

89

27%

Discussed nurse’s personal issues

70

21%

Communicated electronically

37

11%

Made romantic gestures or comments

30

9%

Targeted vulnerability

28

9%

Gave gifts

28

9%

Flattered sexually

21

6%

Family integration

12

4%

Provided additional access to drugs

9

3%

Exposed to/made pornography

2

<1%

Other

1

<1%

Patients who reported sexual abuse to CNO said they felt “violated,” “vulnerable,” “ashamed” and “confused.” Patients have the right to be treated in a professional, respectful, knowledgeable, skillful and ethical manner. These rights are not met when a nurse has a sexual relationships with a patient.

While most nurses do not harm their patients, the fact that any sexual abuse by nurses exists tells us that we need more education and prevention measures. We believe that even one case of sexual abuse is one too many.

For more information on our research findings, read item 3.7 (page 155) of CNO’s June 2019 Council briefing note.

The goal of our research project is to prevent sexual abuse of patients. We want to learn from our research and develop interventions to prevent harm before it happens.

In 2019, we are working on four interventions:

  • developing educational content on appropriate professional boundaries
  • developing a tool kit for employers to support them in preventing sexual abuse in the workplace
  • sharing our research and what we learned with others through engagement opportunities with stakeholders, and exploring media stories, publications and conferences
  • implementing continuous improvement initiatives, such as enhancing future tracking and analysis of sexual abuse data

We are hopeful about where these interventions may lead us and aim to work with our partners in safety to prevent nurses from sexually abusing patients.

Page last reviewed August 06, 2019