Building psychological safety requires ending gender-based violence in healthcare

Healthcare workplaces are not immune from “the society-wide social norms and cultural beliefs that justify, excuse, or facilitate violence [and discrimination] against women” (UN Women: Virtual Knowledge Center to End Violence Against Women & Girls).

I’m helping to design an intervention for women and LGBTQ+ people experiencing interpersonal violence (IPV) in Honduras. I started the project thinking primarily about people’s risk of experiencing impulsive violence in the context of poor emotional control. Before I got too deep into the project, I decided that I should do some research to understand IPV better if I’m going to make a meaningful contribution that doesn’t perpetuate violence or stereotypes about the people on the receiving end.

I picked up Anita Hill’s book, Believing, yep, that Anita Hill, in which she explores the systemic and cultural roots of gender-based violence in the US. Her words quickly shifted my thinking from personal conflicts to the systemic and cultural causes of violence in our society. And if you’re wondering how this applies to healthcare, medicine, or leadership, hear me out.

We cannot create environments genuinely safe for innovation and creativity in healthcare unless we address “the society-wide social norms and cultural beliefs that justify, excuse, or facilitate violence [and discrimination] against women” (UN Women: Virtual Knowledge Center to End Violence Against Women & Girls), LGBTQ+ people, and other historically marginalized and underrepresented people working in and being treated by our healthcare systems.

Healthcare workplaces and ecosystems of care are no different from the larger culture in which they are embedded. Healthcare systems are certainly not better at addressing gender-based violence and discrimination. I say this based on personal experience and the stats demonstrating that healthcare workers, particularly nurses, are among those professionals at the highest risk for workplace violence and gender-based violence or sexual harassment.

When I picked up Believing, I wasn’t thinking about how gender-based violence applied to me. Throughout my career, I have had great bosses and colleagues who have been supportive and respectful and have, at times, helped me navigate complex challenges related to sexual harassment and violence at work.

Thankfully I have never experienced sexual discrimination from an authority figure. But I have experienced countless inappropriate sexualized comments from patients and other staff members in various clinical settings. And much of this inappropriate behavior has occurred in public within full view of other patients and staff. And I cannot think of a single time when anyone has ever stepped in to address inappropriate behavior on my behalf.

Early in my career, I experienced egregious sexual harassment from a patient. This individual made explicit, crude, and demeaning sexual comments about me. And he made these comments over and over and over for weeks. At the time, I was working on an inpatient unit, and when I brought up my distress and discomfort, my concerns were dismissed mainly because the patient “was not responsible for his behavior.”

While that may have been true, no efforts were made to limit the behavior or intervene to redirect the patient. Ultimately, I was informed that because I had more training than other staff members, I was responsible for addressing the problem myself. There was no backup.

At first, I felt intensely ashamed, then I decided to dig into the research to figure out how to address the problem. It turned out that the nursing literature was chock full of similar stories and provided excellent strategies about how to address sexual and gender-based violence in inpatient and outpatient settings. I was so grateful.

This experience led to my involvement in training health professions trainees and early career professionals about managing sexual harassment, racism, and other inappropriate patient and staff behaviors in the healthcare workplace. I’ve always considered this work to be tertiary to my primary interests. Yet I must acknowledge that gender-based violence has impacted me and most of the female and LGBTQ+ trainees I have worked with.

And when I consider gender-based violence in the context of the current healthcare staffing crisis, it becomes clear that gender-based discrimination and violence have profoundly contributed to the overall lack of physical and psychological safety, absence of belonging and inclusivity, and disrespect for basic human needs of healthcare workers.

Gender-based violence and discrimination must be acknowledged and rooted out before healthcare leaders successfully address the challenges and threats to psychological safety in healthcare.

To create inclusive, safe, and diverse healthcare communities, we must equip trainees from diverse backgrounds with the leadership skills to address gender-based violence and race-based discrimination. While Dr. Nicole Torrence and I did not have a chance to delve into gender-based violence, we explored other challenges diverse trainees face. We also consider how leaders ability to appreciate trainees' or employees' inherent peculiarities, strengths, and diverse perspectives builds a foundation for the next generation of courageous servant leaders.

Bio: Dr. Nicole Torrence is a training director for a psychology pre-doctoral internship training program in a public sector healthcare system.