Workplace Harassment and Professional Boundaries

Professional Boundaries in PT Practice

• PT 8351, Professional Issues I
• Boundary issues are a major concern for PTs, encompassing various issues like sexual harassment, gift-giving, and conflicts of interest.

Boundary Issues

• Common examples include:
  • Sexual harassment
  • Gift giving
  • Conflict of interest

Objectives

• Recognize harassment by other healthcare professionals or patients.
• Utilize appropriate professional resources when identifying possible signs of harassment or domestic violence.
• Manage and prevent boundary issues in the workplace.

Harassment in Healthcare

• True or False Questions:
  • Only healthcare providers, not patients, can be victims of sexual harassment. (False)
  • Men cannot be victims of sexual harassment. (False)
  • Patients consent to being touched during a medical appointment. (False)
  • Harassment does not have to be sexual in nature. (True)

Sexual Harassment

• Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature.
• It exists when:
  • Submission to such conduct is made a term or condition of employment.
  • Submission to or rejection of the conduct is used as a basis for employment decisions.
  • It has the purpose or effect of unreasonably interfering with work performance or creating an intimidating, hostile, or offensive work environment.
• Applies to employers with more than 15 employees (Title VII).

APTA House of Delegates

• Sexual harassment is unacceptable in physical therapist environments.
• Members have a responsibility to prevent and report such harassment.

Types of Harassment

• Unwanted sexual physical or verbal attention (e.g., touching, inappropriate proximity, flirting)
• Quid pro quo: Sexual coercion in exchange for something (e.g., money, grades, professional advancement)
• Gender harassment: Verbal and nonverbal behaviors conveying hostility, objectification, exclusion, or second-class status targeting one gender.
• Visual: (e.g., screen savers, inappropriate internet use, posters)

Is it Unlawful?

• Harassment must be unwelcome and based on a protected status.
• The conduct must be:
  • Subjectively abusive to the person affected.
  • Objectively severe and pervasive enough to create a hostile or abusive work environment for a reasonable person.

Personal/Sexual Relationships

• If a personal/sexual relationship exists between a medical trainee and a supervisor with professional responsibility for the trainee, the supervisory role must be eliminated if they wish to pursue the relationship.

Patient Sexual Behaviors

• 86% of respondents reported some experience with sexual behaviors, with 63% indicating at least one experience as harassment.
• 84% of physical therapists experienced inappropriate patient sexual behavior (IPSB) during their career/training.
• 47% had experienced IPSB within the previous year.

IPSB Escalation

• Escalation of IPSB can range from comments, romantic gifts, and sexual gestures to grabbing, touching, indecent exposure, and aggressive behaviors.

Why are PTs at Risk?

• PTs ask patients to disrobe and touch various body parts.
• Close proximity during transfers and lifting.
• Work in private rooms.
• Discuss personal matters.

PTs are Not Alone

• 50% of female physicians experienced gender-based harassment, and 37% reported sexual harassment.
• 60% of female nurses and 34% of male nurses have experienced harassment.

Nursing

• 91% of nurses reported experiencing sexual harassment in the workplace.
• 78.8% encountered teasing remarks.
• 55.2% were asked by patients to initiate romantic relationships.
• 48.5% experienced sexual jokes, 45.8% non-sexual touches, and 20.8% experienced sexual touches during nursing tasks.

Hostile Environment

• Open discussions within earshot of others.
• Promotion based on sexual favors.
• Patients repeatedly asking therapists for dates.
• Pornography in the workplace.
• Supervisors/managers not addressing the behaviors.
• Dirty jokes and sexual slang.

The Norm

• Assess the workplace culture.
• Identify behaviors that are tolerated.
• Understand differing perceptions of sexual comments/gestures.

Severity of Allegations

• The most common allegation is failure to adhere to policies and notify referring practitioners of adjusted treatment plans (11.1% and 18.5% respectively).
• The highest percentage (70.4%) is physical, sexual, emotional abuse/misconduct.

Considerations

• Victims and harassers can be anyone (e.g., supervisor, agent, co-worker, family member).
• The victim doesn't have to be the person harassed.
• Unlawful harassment can occur without a loss of income or job.
• Harasser's conduct must be unwelcome.

Federation of State Boards of PT

• Sexual misconduct includes engaging in or soliciting sexual relationships (consensual or not).
• Engaging in or soliciting sexual relationships with patients, making sexual advances or engaging in other verbal conduct or physical contact.
• Intentionally viewing a patient in the course of treatment without it being related to treatment.

Maryland Code of Ethics

• PTs and assistants must not engage in sexual misconduct (includes various specific behaviors, such as with patients, during evaluations or treatment).

Virginia Code Regarding Sexual Contact

• Defines sexual contact and includes examples of behaviors that may be considered sexual contact.
• Explains when a person is considered a patient.
• Outlines scenarios where sexual contact between a practitioner and a former patient or key third party may still constitute unprofessional conduct.

Legal Resources

• US Equal Employment Opportunity Commission (EEOC) website for guidance on workplace harassment.
• State licensure boards for relevant information.

How to Manage Boundary Issues

• Contact GWU faculty for help.
• Do not tolerate harassment.
• Go to a supervisor if a policy exists and possible.
• Keep a journal of dates, involved parties, and incidents.
• Gather evidence if possible (e.g., emails, photos).
• Clearly set boundaries (verbal, appearance, not accepting gifts).

Institutional Level Policies

• Employers should conduct risk assessments, have policies protecting employees, and offer regular training.

Digital Professionalism

• Analyze the correlation between in-person and digital professional behaviors.
• Digital media guidelines include avoiding sharing patient information, understanding HIPAA implications, and adhering to workplace policies.

Appropriate Digital Media Use

• How to connect and network with other professionals while maintaining an online professional identity.
• How to present yourself and your business appropriately online.
• How to use digital platforms for education, outreach, advocacy, and community engagement.

Inappropriate Digital Media Use

• Avoid sharing patient information, ensuring HIPAA compliance.
• Respect workplace policies regarding communicating online.

Digital Media Landmines

• Identify digital media landmines, such as the potential for HIPAA violations, harassment, crossing professional boundaries, and unrealistic patient expectations.

Tips

• Be careful with all photographs.
• Do not compromise the professional relationship.
• Do not comment on work online.
• Use correct grammar.
• Be judicious with shared links.
• Follow the "mom" test.