Addressing workplace harassment: a multifaceted approach for nursing students in a tertiary hospital in Singapore

Workplace harassment among healthcare workers, particularly nursing students, has reached concerning levels, often resulting in serious consequences. At an acute tertiary teaching hospital in Singapore, reported cases of harassment among nursing students doubled from four in 2019 to eight in 2021. Delayed reporting, often due to a lack of awareness of a structured reporting system, exacerbates the issue. The Clinical Abuse Preventive Education for Students (CAPES) team was formed in January 2022 to empower nursing students to identify, manage and report abusive situations, with its impact evaluated using Kirkpatrick's four-level training evaluation framework.

Interventions included the development and dissemination of infographic booklets, the establishment of CAPES Buddy for incident reporting and faculty training in psychological support skills. A total of 811 nursing students commenced training under the CAPES initiative between January 2023 and April 2024. Of these, 542 completed both baseline and follow-up surveys, which measured understanding of workplace harassment and confidence in responding. Additionally, 54 faculty members underwent psychological support training to strengthen their ability to support students in crisis.

Following the interventions, nursing students demonstrated a 13.7% increase in their ability to identify harassment and an 18.7% increase in confidence to respond appropriately. Overall, 98% of students demonstrated comprehension of harassment-related issues. These improvements were accompanied by increased reporting and more appropriate triage of harassment cases, with students using CAPES Buddy for complex incidents while clinical instructors managed less severe cases as first-line support. Faculty members also reported enhanced competence in supporting students, contributing to a safer learning environment.

CAPES strengthened students' awareness of workplace harassment and improved their confidence in responding and reporting incidents. While most students found the training relevant and beneficial, delayed reporting remains a challenge. Future work should explore factors contributing to reporting delay such as fear of retaliation or lack of trust in reporting systems and evaluate targeted strategies to address them.