Volume 7 • 2020 • Issue 2

disturbing were the reports of blatant sexual remarks aimed at trainees, such as “I am fantasizing about you.” To our dismay, often dental students who had been harassed didn’t tell anyone. Sometimes when they did tell someone, they were told that harassment is just a job hazard, “it is what it is,” or to toughen up. Q Are there things that a dentist can do to help prevent sexual harassment from happening in his or her practice? HVh: Dentists should create anti-harassment policies and develop the practices that support those policies. Have an open dialogue about the risk to oral health care workers of sexual harassment or sexual violence. Post signs that state that all forms of harassments and violence are prohibited in your practice. At my dentist, the door is never closed. Have an open door policy. When you set up an operatory, try to decrease the risk of entrapment, makes sure people can get out easily. Video cameras can be a deterrent, and you should post a sign indicating there is video surveillance. Train workers how to have those difficult conversations so they know how to say when something isn’t acceptable. SR: In this scenario, the hygienist laughed and felt like she had to appear friendly when she felt uncomfortable. Change the culture. You can say, “We don’t encourage employees to go along with things that make them uncomfortable.” Talk about what it means to be friendly, but also have strong professional boundaries based on mutual respect. The scenario’s hygienist went along because she didn’t want to be offensive, she hoped it would go away on its own. We don’t like conflict. But we need to train ourselves and our colleagues on healthy ways to have boundaries. A difficult conversation early can often prevent a worse conversation in the future. HVh: In training, add a practical component: practising what you are going to say makes it easier when a situation comes up. IK: I agree with what you’ve said. Policies and training are a mandatory part of being an employer but enforcing them is where many employers fail. Showing employees that there is zero tolerance for harassment would help to prevent internal harassment (amongst employees) and will ensure that when a staff member is harassed by a third party (for example, a patient), the staff member will not hesitate to report it to the employer. Q What’s one thing a dentist should read on the subject? HVh: I would recommend that dentists read their provincial or territorial legislation. Most explicitly mention sexual harassment, though a few only mention harassment. Other good resources can be found via the Ministry of Labour and provincial health and safety associations. The federal government has a public consultation report that they could read as well. a • Healthy Workplace Series • * Ten provinces and territories have legislation for both workplace violence and harassment. They include: Ontario, Manitoba, Alberta, Saskatchewan, British Columbia, Newfoundland and Labrador, Prince Edward Island (PEI), New Brunswick, Nunavut, and Northwest Territories. Nova Scotia has legislation on workplace violence, but not on harassment, whereas Québec has legislation for workplace harassment, but not workplace violence. The Yukon Territory does not have legislation for either workplace violence or harassment but provides guidance through policy and procedures documentation. The federal government has legislation for workplace violence and harassment for all federally regulated workplaces. Q As an employer and colleague to someone who has been sexually harassed, how do you provide appropriate support? HVh: An experience of being sexually harassed is very personal and it can be traumatizing. Always refer someone who has been sexually harassed to a trained professional, such as a counsellor. An individual may decide that they don’t need it, but offering it is critical. SR: I totally agree. Long term, sexual harassment takes a significant toll. It increases the risk of burn out. Facilitating professional support is very important. We need to create real culture change, instead of just going fire to fire, so that sexual harassment doesn’t continue in our workplace environments. Q Once the dentist investigates, if he or she concludes that the hygienist was sexually harassed, what should the dentist do? IK: As the employer, the dentist has an obligation to maintain a safe work environment for the hygienist. This means that the dentist must ensure that the hygienist is protected from harassment by the patient. At a minimum, the dentist should ensure that the hygienist does not have to interact with this patient again, by moving the patient to another hygienist. Another option is for the dentist to refuse to provide services to this patient, but the dentist should consult with the regulatory body before doing so. This second option will send a message not only to the patient that the dentist will not tolerate sexual harassment of the clinic’s employees, but just as importantly, it will send the same message to the other employees. Q Does how you respond to a report of sexual harassment affect the health and safety of a workplace afterward? HVh: How you respond has huge implications for whether the victim will recover quickly. Will they feel safe coming back to work? Do they feel understood and believed? The victim’s experience will impact the rest of the staff. If there isn’t a response, the rest of the staff may feel more at risk and they certainly won’t report sexual harassment if they feel like it will just be brushed off. SR: I was recently in Houston doing training for health care providers about resilience skills. We talked about compassion fatigue. Health care is a helping profession. Health care workers are patient-centered and are always thinking about patient needs. And that can be really hard when a patient mistreats you. With sexual harassment, you also run the risk of secondary trauma. The next time the hygienist in this scenario sees a patient, will she be triggered? Will her trauma affect her ability to care for patients? Will she burn out? Burn out is when you can’t replenish and renew yourself to the point that you feel like you can do the work effectively, or at all. Another important idea is moral distress. This is when a person knows the right thing to do, but due to work place factors, is restrained or prevented for doing the right thing. If the practice doesn’t seem to care about sexual harassment, your colleagues will likely experience compassion fatigue, secondary trauma, and moral distress. HVh: These kinds of incidents can lead to occupational stress, which in many provinces is a compensable injury. Just because it isn’t physical trauma, doesn’t mean there isn’t a psychological injury. SR: Mental health affects physical health. Dental professionals are already at risk for physical injury due to the demands of the work. Add anxiety. People are more vulnerable to physical pain if they are dealing with emotional pain. HVh: Great point. As well, in a dental health setting, you can’t keep your distance from people if you are anxious about sexual harassment. The requirements of the work are that you are in very close physical proximity to your patients. Q How common is sexual harassment in the context of health care? HVh: There was a 2017 survey of hospitals that showed that among hospital workers, including practical nurses, 42% had experienced sexual harassment or assault. In 2018, a survey in the nursing home sector of support staff and practical nurses showed that 65% of female respondents had been harassed and 44% assaulted. These are professions that are female dominated, where you work closely with people. You can’t keep a physical distance away, you are always within reach. SR: Recently, I worked on a survey with some leaders in dental education. The survey included about 400 dental students from 20 dental schools that revealed that 20% of female dental students had been harassed by patients. The survey included questions about sexist remarks, crude sexual remarks, and unwanted sexual advances. Female dental students reported feeling that they were taken less seriously by patients because of their gender. Patients said things like, “When will the real dentist arrive?” or “You’re too pretty, or too young, to do this well.” Even more • Healthy Workplace Series • Resources Government of Canada report: Harassment and sexual violence in the workplace canada.ca/en/employment-social-development/ services/health-safety/reports/workplace- harassment-sexual-violence.html RAINN resources about sexual harassment rainn.org/articles/sexual-harassment PSHSA resources regarding sexual harassment in the workplace pshsa.ca/blog/workplace-harassment- investigations-will-you-panic-or-be-prepared The views expressed are those of the authors and do not necessarily reflect the opinions or official policies of the Canadian Dental Association. I ssues and P eople I ssues and P eople 34 | 2020 | Issue 2 35 Issue 2 | 2020 |