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 so that future risks do not result in 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 complaints and reports. However, occurrences of sexual abuse during this timeframe are likely higher because many patients do not report it. This aligns with Canadian research on sexual violence, which finds that few victims disclose or formally report their experiences; many do not report because of stigma, embarrassment, self-blame or fear of not being believed.^[1]

From these matters, we collected information to identify common trends on patient sexual abuse. 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. For example, not being aware of their surroundings because of a health condition or a medication they were taking. 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 reported sexual abuse occurred were:

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

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

Our research also showed that nurses commonly used grooming techniques to draw victims in. Grooming refers to a preparatory stage, in which the offender will “prepare their potential victims to accept the sexual contact.”^[2] The offender does this by building a trusted relationship and desensitizing the patient to minor boundary violations, which then grow over time. Research on patient sexual abuse shows that the abuse rarely occurs spontaneously. Offenders engage in behaviours “designed to develop a relationship with their victim prior to the initiation of sexual contact”^[3]. The goal of this approach is to foster the victim’s cooperation and silence when the sexual abuse begins to occur.

In CNO’s research, the most common grooming techniques are shown in the table below (some nurses used more than one technique).

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 relationship 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.

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

^[1] The Learning Network. 2012. Overcoming Barriers and Enhancing Supportive Responses: The Research on Sexual Violence Against Women, A Resource Document: 5, 12.

^[2] Ibid, 84.

^[3] Elliott, I. 2017. A Self-Regulation Model Of Sexual Grooming. Trauma, Violence, & Abuse, Vol. 18(1) 83-97: 83.