An Unexpected Twist

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I work in an adult ICU where I had the privilege of caring for a wonderful patient for 3 days in a row. She was the kindest, sweetest woman, who unfortunately had something terrible happen to her. Despite the unfortunate circumstances, her positive attitude and spirit were inspiring. Her family was just as wonderful. I grew close to her and her family over the 3 days I worked.

On the last day, I transferred her to a step-down unit. After my shift was over, I stopped by her new room to visit her and her family. I wanted to check on them, make sure they were doing ok, and let them know I was thinking about them (I was going to be off work for a few days and didn't know if I'd ever see them again). After saying my goodbyes, hugging the patient and her family, and stepping out into the hallway, the husband pulled me aside. He thanked me for the exceptional care I had given his wife, told me I was a great nurse, and wanted me to know how much I was appreciated. He started to tear up and so did I. It was an emotional, touching experience. He went to shake my hand, and that's when I felt it....the folded up piece of money in his hand. My heart sank.

Immediately, I told him I could not accept his money. But he insisted. He wanted me to know how truly grateful he was. Again I told him I would not accept it. He wouldn't listen. Defeated, and not wanting to make a scene, or be disrespectful, I put the bill in my pocket and walked away. When I got to the elevator I was so confused. I wanted to cry. I felt guilty and ashamed. I wondered if I had done the right thing by stopping by to visit her after my shift. I convinced myself that if I hadn't stopped by, none of this would have happened. And worst of all, I felt alone. I didn't want to tell any of my co-workers in fear of being judged, getting in trouble, or worst of all being fired.

I took the bill out of my pocket when I got to my car. $50. The whole drive home, all I felt was sadness. I replayed the previous scenario over and over again in my head. What I could have said. What I should have done. When I got home, I put the $50 bill on my kitchen table. I decided that I wasn't going to spend it. I couldn't even think about spending it. I looked at it over and over. The guilt never subsided. A few days passed, and that's when I decided what to do.

I found a non-profit organization that dealt with the same condition that she unfortunately had to experience. Then I made a donation in her honor using the money her husband had given me. Instead of keeping the money, and feeling guilty, ashamed, and sad, I decided to turn this experience into something positive. I knew that the patient and her family wouldn't want me to feel upset, and I wasn't going to let myself be upset either.

Put in the same situation, I would have told the husband that if he wanted to thank me, he could write about his experience on our hospital survey. I would have told him to recognize our unit and our nurses as the best. Because we are.

Sometimes being a nurse can be a thankless job. We provide our patients with exceptional care despite hospital-wide budget cuts and staffing shortages. We come to work early and leave late. We don't always get breaks. Sometimes we don't even have time to use the restroom. We apologize for things that sometimes aren't our fault. We get can get spit on, bit, kicked, and be manipulated by patients. We work in high-demand, high-stress environments that would break the weak. We are exposed to all types of bodily secretions. We are advocates for patients who don't have family. We speak up for those patients who society has given up on; the homeless, the drug and alcohol abusers, prisoners, and gang members. But when it's all said and done, we have the honor and privilege of caring for patients and their families at their most vulnerable time.

I don't know about you, but I think our job is pretty awesome. And while I'm still uneasy about receiving money from my patient's husband, I know that he did it because he wanted me to know how much I was appreciated. How much nurses are appreciated. Because we are the heartbeat of the hospital. And we make a difference each and every day.

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Specializes in Nurse Leader specializing in Labor & Delivery.

Thank you for that story, and I think you made the right decision. It's hard to be in that situation. I've never been given cash, but I've been given gifts a few times that have exceeded the $10 limit set by our facility.

My husband is a hospice nurse, and he's been given lots of gifts from grateful patients and families. I remember one particular patient who lived alone, had no family, and had been a jewelry maker. He gave my husband a few pairs of really pretty earrings (with semi-precious stones like garnets and peridots) to give to me. I treasure them, even though part of me feels guilt as well.

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Your emotional attachment to the patient / family is unprofessional.. bordering on pathological. That is what invited the whole 50 buck tip.

Your facility has a policy on the value of "tips" you can accept. You should know this.. and follow procedure. If you do not.. you can be terminated for accepting it, kitchen table or not.

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Specializes in Nurse Leader specializing in Labor & Delivery.
Your emotional attachment to the patient / family is unprofessional..

I do agree with this statement quoted, though. I recently read on here a thread about how to create appropriate boundaries, and someone said something that resonated with me.

Is going to see the patient/family at the other unit for THEIR benefit, or for YOUR benefit? If it is for YOUR benefit, then it's not appropriate boundaries.

I've been there, I do get it. But it's something that we, as nurses, should check regularly.

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Your emotional attachment to the patient / family is unprofessional.. bordering on pathological. That is what invited the whole 50 buck tip.

Your facility has a policy on the value of "tips" you can accept. You should know this.. and follow procedure. If you do not.. you can be terminated for accepting it, kitchen table or not.

I wouldn't go as far as "pathological," but, yeah, the whole problem started when you visited the client on another unit to satisfy your curiosity and emotional needs. And it was all downhill from there. Yes, donating the $50 is better than keeping it, but taking it in the first place is an error that donating the money doesn't really fix. And you know that, and that's why you felt "guilty and ashamed" and felt you couldn't say anything to you coworkers.

One of the classic "tests" for whether something is a professional boundary violation is to consider whether it is something you would do in the presence of your boss and coworkers. If you are not willing to do (whatever it is) with them watching, you shouldn't do it at all. This scenario flunks that test, as you acknowledge. I hope you'll know better next time.

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It seems like you're trying very hard to romanticize a bad situation. I agree that the family should not have been visited after they left your care and that accepting the cash was just plain wrong.

I do think you meant well, but...

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Specializes in Psychiatric nursing; Medical-Surgrical.

:no:

I don't agree.

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Specializes in Psychiatric nursing; Medical-Surgrical.

Did I hear someone say UNPROFESSIONAL?!!!.....How could you! Patients are human beings and I would love to have a nurse that would care for me the way she cared for the Pt and her family. There have been so many times I have had patients lean on me and cry and I had to hold them and let them release all that pain...sometime I get teary eyed myself. I have had patients and their families who wanted me to be with them as their loved one passed...again they would hold me and I had to comfort them and in some cases I would tear up but my presence there and genuine compassion and care was all they needed. You see nursing is not supposed to be cold and stoic and ROBOTIC...This was a situation she could have handled better (talking about the gift) but I realize that at the moment she did not expect it and also she was pressure to take it and she did. I need to remind you that in some cultures giving gifts is a way of showing gratitude and if you refuse, it is more like a rejection and an insult...you need to exercise your cultural competence. I am not saying people should accept gifts...I would have politely asked him to donate that money instead of taking it and left quickly. Please do not be too harsh and discourage good nurses...we are not robots you know. She was able to think about it later and know what to do next time. Quoting her words "I would have told the husband that if he wanted to thank me, he could write about his experience on our hospital survey. I would have told him to recognize our unit and our nurses as the best".

If you don't agree...I hope you understand what I am saying and not come for my head:no::)

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Did I hear someone say UNPROFESSIONAL?!!!.....How could you! Patients are human beings and I would love to have a nurse that would care for me the way she cared for the Pt and her family. There have been so many times I have had patients lean on me and cry and I had to hold them and let them release all that pain...sometime I get teary eyed myself. I have had patients and their families who wanted me to be with them as their loved one passed...again they would hold me and I had to comfort them and in some cases I would tear up but my presence there and genuine compassion and care was all they needed. You see nursing is not supposed to be cold and stoic and ROBOTIC...This was a situation she could have handled better (talking about the gift) but I realize that at the moment she did not expect it and also she was pressure to take it and she did. I need to remind you that in some cultures giving gifts is a way of showing gratitude and if you refuse, it is more like a rejection and an insult...you need to exercise your cultural competence. I am not saying people should accept gifts...I would have politely asked him to donate that money instead of taking it and left quickly. Please do not be too harsh and discourage good nurses...we are not robots you know. She was able to think about it later and know what to do next time. Quoting her words "I would have told the husband that if he wanted to thank me, he could write about his experience on our hospital survey. I would have told him to recognize our unit and our nurses as the best".

If you don't agree...I hope you understand what I am saying and not come for my head:no::)

Yes.. I said it was unprofessional.

Standards of Practice state:Nurses use professional judgment to determine the appropriate boundaries of a therapeutic relations

nurses do not exchange gifts with clients

The relationship differs from a social relationship in that it is designed to meet the needs only of the client.

Even suggesting the husband give kudos by a survey violates that standard.

Professionals do their job, go home and forget about it.

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Specializes in RN, BSN, CHDN.

It happened to me once many years ago, I so totally understand the feeling-The patients wife gave me a folded bill I tried reasoning but they were so instant when I looked it was $100 and I never felt so awful and horrible in all my life

I left the money in a drawer in my house for a long time and then I too donated it

I will never ever allow anybody to give me money again

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I have found myself in situations in the past in which clients and/or their families have wanted to give me money as a thank-you gift. I have not taken the money. I have cheerfully declined as many times as it took, and told them that a) if they really want to recognize my care (which isn't necessary, because I was just doing my job and doing the same for them as I would for any client), the best thing they can do for me is to tell my bosses they were happy with the care, and b) if they really want to give money, the hospital has a foundation that will gratefully accept any donation they want to make, but I cannot accept any money or any other kind of personal gift.

You don't have to take money just because people really want to give it to you, and you can decline without offending them.

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Specializes in Vascular Access.

Your compassion and caring heart is something to celebrate. I would not listen to the PC crowd who are discouraging you from your excellent care of this patient. How many of us could only dream to have an attentive nurse like you Pinky. Keep your head up high and know that nursing is more than knowing what drugs to give, and which to hold.. It is more than knowing tasks.. It is the heart and soul that reaches out to another in times of crisis. Your touch meant so much to this family. They will never forget your kindness, as well as your great care, BE PROUD. You did nothing wrong.

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