Perils Of Sexual Healing

Sun Herald

Sunday May 25, 2008

Erin O'Dwyer

It may be unethical, but many nurses believe it is acceptable to sleep with patients in their care, writes Erin O'Dwyer.

Irishman Tom Walsh was close to death when he met his Australian wife-to-be Carol.

"I was looking real bad and she still fell for me," laughs Tom in his still-thick brogue. "There was just something between us."

It was 1965 and the 22-year-old Tom had succumbed to viral pneumonia. He was admitted to a cottage hospital in Surrey, England where he was living. Carol, a 26-year-old nurse from Sydney, had started working there a month earlier.

"I was extremely ill and she came on to do night shift when I was first taken in," Tom recalls. "I thought that she was attractive and very caring."

After a few days Tom began to improve. He asked Carol about her days off. Then, after he was discharged, he asked her out. "We fell in love," Carol says. "You don't have a lot of say in these things, it just happens."

Their story conjures up all the romance of the silver screen - the beautiful nurse and her dapper young patient. Except that in the movies, it's always an impossible love. Think of the heartbroken Chris O'Donnell in In Love And War or the tear-stained face of Juliette Binoche in The English Patient.

Then, as now, romance between nurses and patients is taboo. And in an era of strict ethical accountability, there is increasing concern about where caring stops and loving begins.

A recent survey in Britain found that thousands of nurses believed it was acceptable to have an affair with a patient in their care. That is despite sanctions - in extreme cases, being struck off - for sleeping with patients.

In Australia, stories of nurses sleeping with patients in their care are on the rise, says the chief executive of the Australian Nursing and Midwifery Council (ANMC), Karen Cook. "I wouldn't even like to hazard a guess as to why," says Cook. "We just thought it was high time we had professional boundaries for nurses across the country."

There are no Australian statistics on how many nurses step over the so-called "zone of helpfulness". But the British survey reveals these illicit relationships are not uncommon.

The survey, published in March in the Nursing Times newspaper, found one in 10 nurses believed it was acceptable to start a relationship with a patient. One in six said they knew of a colleague who had had a sexual relationship with a patient they were looking after.

The results caused untold controversy in England and gave credence to much-scorned comments from Conservative peer Lord Mancroft, who last year described nurses as "drunken", "lazy", "promiscuous" and "unprofessional".

Mancroft, who had a short stay in a Bath hospital in August, claimed nurses discussed their sexual and drinking exploits across the bed in front of him. He singled out one nurse who said: "I really shouldn't be here because I had so much to drink last night and I feel like I'm going to be sick." A second nurse asked: "Did you shag so-and-so?" and the first nurse said: "No, but I think I'm going to."

The survey came just weeks after Britain's Council for Healthcare Regulatory Excellence issued strict rules warning nurses they would face disciplinary action if they had a sexual relationship with a current patient. The rules stop short of banning nurse-patient relationships, but state "relationships with former patients will often be deemed unacceptable". The regulations are contentious among nurses who say that many such relationships lead to marriage.

For Carol Walsh, there was no question of having an affair with a patient in her care. But even back then, dating a former patient was not quite the done thing, despite the fact that ethics were never discussed.

"For me particularly, there was a bit of a stigma. But that faded fairly quickly. We fell in love and began planning our future together," she says. Says Tom: "Guys think nurses are sex maniacs. That's the perception but it's totally incorrect. The guys used to joke but [the jokes] died away when they realised it was serious between us."

In Australia, the ANMC already has a tough code of professional conduct which reminds nurses about the privileged relationship that exists between them and their patient and that a "sexual relationship between a nurse and an individual for whom they provide care is unacceptable".

The code also states: "Consent is not an acceptable defence in the case of sexual or intimate behaviour within a relationship between a nurse and an individual for whom they provide care."

There is no denying that a healthy consensual relationship may eventuate after the caregiving has finished, especially where the pair are similar ages and particularly in small communities.

"You meet people in all kinds of places; women don't all meet their future husband in bars or at a party," says Rosemary Bryant, executive director of the Royal College of Nursing. "As long as nothing happens in a dependent relationship. That's just not on."

But the key question for Australia's 313,000 nurses is, where does the therapeutic relationship begin and end?

"We hear about some pretty horrendous stuff," Cook says, citing one case in which a nurse fell in love with a mental health patient. That patient, she says, later got into trouble with drugs and when he wound up in court, he was bailed to the nurse's home. Was the nurse a lover or carer or both?

"It becomes very murky and most unprofessional on the nurse's behalf," Cook says. "Nurses have the potential to cause harm and not just physical. There are issues around power in terms of the nurse and vulnerability of the patient. And it's inappropriate for nurses to exploit that relationship."

Leading nurse educator Professor Jane Stein-Parbury from the faculty of nursing at the University of Technology, Sydney, recalls a classmate marrying a patient some 30 years ago.

"We were student nurses in the VA [Veterans' Affairs] ward and these guys had just come back from Vietnam. One of them had been shot in the leg ... he married one of the student nurses. We only learned about it after he was discharged. I suppose she gave him her number but he didn't say anything to us."

For Stein-Parbury, an expert in mental health nursing, there is no doubt that involvement with mentally ill patients is never acceptable. But for nurses in other situations, the key consideration is, what is in the best interests of the patient?

"The nurse is there for one reason only and that is to care for the patient," she says. "There is more and more concern about boundary crossing. As to whether or not it's appropriate once the therapeutic relationship has ended, that's unclear."

Michael Cleary, executive director of the NSW Nurses and Midwives Board, acknowledges there are many endearing stories of nurses marrying their patients and that in the '40s, '50s and '60s, it was much more acceptable. But he says the next generation of nurses should not hope to find their life partner among their patients. He says: "I did my training 30 years ago and I don't remember us ever being told it wasn't OK. But it is a bit like teaching kids the facts of life - someone has got to sit down and tell them."

© 2008 Sun Herald

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