July 2019

Stopping sexual abuse before it happens

Sexual abuse of patients is one of the most harmful events that can occur in nursing practice. As a regulator, CNO’s only mandate is to protect the public. That is why we are committed to researching ways to prevent sexual abuse before it happens.

We believe that one way to do this is to make sure nurses understand what sexual abuse is, what the warning signs are, and why and how to maintain appropriate boundaries with patients. The more nurses know about sexual abuse, the better they will be able to advocate for patients and stop abuse before it happens.

For nurses, sexual abuse has a specific meaning

Did you know that there is a specific legal definition of sexual abuse for regulated health professionals? The Regulated Health Professions Act, 1991, states sexual abuse of a patient occurs when a regulated health professional:

  • 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)

  • has a sexual or intimate relationship with a patient.

An individual is considered to be a “patient” for one year after the therapeutic nurse-client relationship ends. This means that any sexual contact between a nurse and patient (or former patient) within the one-year time frame is sexual abuse. It does not matter if the patient consents to the sexual acts.

For nurses, this definition addresses the inherent power imbalance in the nurse-patient relationship. Although nurses may not immediately perceive it, they have more power than patients by virtue of their role as health care providers. Nurses have more authority and influence than their patients in the health care system. They have professional knowledge and skills patients rely on, and access to patients personal health information. Understanding professional boundaries and the power imbalance are essential to being able to provide safe care to patients, especially those who are vulnerable. See the Therapeutic Nurse-Client Relationship practice standard and the Code of Conduct for more information.

Engaging in a sexual relationship with a patient is one of the most harmful abuses of the power imbalance and infringes on the primary goal of providing safe patient care. Because of this, any sexual relationship with a patient is abuse and professional misconduct. It does not matter if the patient agreed to the sexual acts.

Your role: maintain boundaries

It is the nurse’s responsibility to maintain appropriate boundaries, not the patient’s. If a patient makes a sexual advance or crosses a boundary, it is your accountability to manage the situation and maintain a professional nurse-patient relationship. This may include explaining why your relationship needs to be professional. The Therapeutic Nurse-Client Relationship practice standard can help with this.

Patients are often in vulnerable positions when accessing care through the health care system. If you suspect another health care professional may be crossing a boundary, speak up. Patients need nurses to be their advocates. Inform your supervisor, manager and report the violation to CNO.

Over the coming months we will be publishing tools and resources about preventing sexual abuse that nurses, employers and others involved in patient care can use. Look for this new information in The Standard, on our Trending Topics page and on our Facebook, Twitter, LinkedIn and Instagram feeds.

Let’s work together to prevent sexual abuse.

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