Doing favors or giving gifts for patients: Unacceptable?

Nurses Relations

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Is this a generally unwise thing to do? Giving gifts to patients, whether it is small like a piece of candy, or large like sending flowers. Is this something not generally accepted in the health care positions, or any positions in any career? We all know about teachers accepting apples from students and that has never been generally frowned upon so why the difference when healthcare is involved?

Or doing favors for patients such as a patient being admitted to a facility and has no way to contact their family because their phone is off and needs a phone card but is not allowed to leave the facility.

They have the money but just need someone to run and get it.

--Or they need to borrow your phone to make a quick call.

--Or rather would like you to run and get a meal for them from a restaurant with their own money.

It is not like giving a gift but rather doing a favor for a patient that is not necessarily in your line of care but is done out of friendship.

Is this behavior is not acceptable, under which guidelines is it? Maybe only when you are on break or off duty? Or is this still too questionable?

What are proper friendship limits in patient/practitioner relationships?

Does it mater if gender differences play a role in it?

If none of the above is acceptable, how much time should pass after a patient is dc'd before a friendship or personal relationship can be pursued?

It seems in healthcare so many practitioners become hardhearted to individuals situations. Some have issues but don't really need medicine, but care and compassion from a friend. If a practitioner cannot be a friend, it is hard for there to be complete healing, especially if said patient has no support system outside. Sometimes the practitioners are all the patient has. And sometimes these patients are really distressed and cant do a thing about it because it is "outside of everyone's scope of practice".

Where do the limits draw?

A patient I had taken care of every day for almost eight months was being terminal weaned a week before her birthday. Her family and the rest of the staff lied and wrote that it was her birthday on her whiteboard and calendar and threw her a huge birthday party before she died. She was so happy, her whole family came and brought her letters telling her how much they loved her, pictures from her childhood, etc. I still get teary eyed thinking about it. Her appetite had been pretty lousy and she kept telling me how badly she wanted chocolate cake so I brought her a cupcake from this awesome bakery by my house.

I'm not supposed to give or accept gifts at my job, which I 100% understand. Looking back on it, it probably wasn't a professional move but I had been taking care of her for so long it just seemed different. I visit patients at the nursing home I used to work at. I usually stop by every other week and we'll play bingo or go sit out on the porch. I think LTC isn't the place for me because I form these type of friendships haha.

It almost sounds like you're thinking of a specific situation and want to know whether you're acting appropriately or not. Of course every situation is slightly different, what most commenters have said is that "this shouldn't be your norm but for an exceptional circumstance there can be special allowances."

In regards to your example of a person who has not seen someone from their home area in a long time - my best friend's mom was hospitalized when my friend was very young, 5 or 6. This woman is deaf, and ended up forming a close connection with the ASL interpreter who worked her case. After the professional relationship of patient/interpreter was over, they began a friendship and ended up getting married, have been for almost 20 years now. But that came AFTER the professional relationship had ended, and with the understanding that it would not re-start. If you are in a situation where you enter a personal relationship with a former patient, then you should not then return to a professional one IMO. (Exceptions to this obviously being very rural areas where you are going to have a personal relationship with everyone before they become your patient.)

I would do personal favors in certain situations but I would be discreet about it. Say, if you bought someone something don't give it to them in front of the other patients becausse it might make some feel left out. You also need to think about if the recipient is the type to go and brag to everyone else about how they got something. I see this of being more of an issue in a nursing home than a hospital.

Specializes in ED, ICU, PSYCH, PP, CEN.

I know someone that when she has home health she begs them to do her shopping and pick up scripts and pretty much has them be her little go fer until they end up doing way to much. And she brags about doing it to her friends. She is a really nice person, just lonely and likes to be waited on.

It's better to say no from the git go.

I do try to spoil my patients family/visitors. Get them pillows, coffee etc. from the nursing center.

Give gifts, no. Exchange of contact information, no. Errands or favors...we take that on a case by case basis. Who is asking? What is the favor/errand? Why is the patient unable to do this themselves? Patient have any ulterior motives? Are any staff members put in a compromising position due to the request?

Some examples come to mind:

Patient A wants to order in takeout just for themselves and their nurse "who understands me, not like the other ones..." No thanks. (Attempt at staff splitting and manipulation anyone?)

Patient B, on strict bedrest and no visitors expected for some time. Bored beyond belief, anxious about upcoming tests. Patient asks if anyone going downstairs would be willing to take his $2 and get him the daily paper. There is almost always someone willing to do something along those lines. The exchange of cash is witnessed by a second staff member and the change returned with a receipt.

We feel we can be professional and still go the extra mile where and when it's appropriate.

Patient B is the patient I am talking about. The patient that needs a phone card to call loved ones but cant leave said facility. Or the patient who cant stand the facility food and has the money for a takeout meal but needs someone to get it. I honestly dont see any harm in doing any of these actions. Of course patient A's situation can be quite manipulative. Even patient B's situation if those guidelines are not followed.

I think what is most important is that things are judged case by case and unnecessary blanket rules arent established for everyone that causes more harm than good.

I would do personal favors in certain situations but I would be discreet about it. Say, if you bought someone something don't give it to them in front of the other patients becausse it might make some feel left out. You also need to think about if the recipient is the type to go and brag to everyone else about how they got something. I see this of being more of an issue in a nursing home than a hospital.
Exactly. Different settings require different circumstances. In long term care facilities, relationships are already much more personal.

In short term facilities where some patients are only there for a matter of days and small errands/gifts are done or given in a discrete manner, especially if needed, I dont really see the issues.

Referring a patient to a social worker because they really desired a meal outside the facility, or just wanted a book from the store next door they couldnt go get by themselves could be a bit much. The social worker may even think the same as I know many social workers dont really do their job right or care so much either. Then it is really left to you either way.

Specializes in occupational health.

I agree with you Lennonninja, but I was thinking about one elderly patient who did not have denture cream (so he couldn't put his teeth in and couldn't chew food). He had no family, so I went down to the gift shop and bought him a tube and helped him put his teeth in. He ate lunch that day. I never mentioned it to anyone.

Specializes in Pediatrics, Emergency, Trauma.

The social worker may even think the same as I know many social workers dont really do their job right or care so much either. Then it is really left to you either way.

That's a pretty broad brush you have there...

I have collaborated with some pretty good social workers and case managers (MSW and RN)

I have collaborated with them to get phone cards books, whatever the patient needed; including help with financial issues; they have resources and networks that go beyond what we can do in a nurse-patient relationship.

I suggest finding out your resources as jadelpn suggested; one you meet case management and have an idea of what they do and what they are ALLOWED to do, you will have a better way of helping your patients wore effectively. :yes:

That's a pretty broad brush you have there...

How is it a pretty broad brush? I simply said some dont care. This is the truth. That is not a broad generalization but merely the truth. It could happen and it does and if it does, you are still back at square 1. What then?

Specializes in Pediatrics, Emergency, Trauma.
How is it a pretty broad brush? I simply said some dont care. This is the truth. That is not a broad generalization but merely the truth. It could happen and it does and if it does you are still back at square 1. What then?[/quote']

It's broad; saying MANY out a few is broad enough for me

When it does, that's when I give them the information and let them handle it; they are adults. If they are not competent, then I will get the provider and hospital administration involved an they will get someone a legal guardian or advocate. I utilize my resources and the rest of the healthcare team; again, I am for empowering my patients; when educating people to take care of themselves better when they need resources, it means not being complicit in the previous coping mechanisms that didn't help before, especially for financial matters. :no:

There's a healthcare team in place; I fully utilize them.

You also said, or rather, implied that your healthcare team are not as "caring" as they should be towards particular pts that you have taken can of; could it possibly be because their coping and healthy behaviors are not up to par? That they like to manipulate and split staff and healthcare teams? Have they made accusations and reported people, have a habit of lying? The patients may have a history that you have NO idea about; and may need to utilize their boundaries for that patient.

The healthcare team must establish boundaries, and rightfully so; and it is based per individual. :yes:

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Thats where it gets tricky. What is the difference with giving them food from the cafeteria and food from your lunchbox, vending machine, or outside of the facility? If you are on break/off duty and you come back to assist them I see no difference. You bought gifts for the wedding for some patients, why not give gifts to others on a regular basis, if you wish of course.

The same with lending a phone for a phone call especially if the operator tells you that patients are not allowed long distance phone calls. Running errands outside of the facility for them. I dont see where the line is drawn here using this one specific example you used.

If it is allowed to bring in gifts from outside the facility for a couples wedding, what makes one occasion the exception over the second? Contact outside work doesnt have to be made but when it comes to gifts/favors/errands, where are the lines drawn?

The problem with all of this is that it sets up expectations. If you'll lend your phone to Patient A for a very important phone call, why not lend it to him just to chat with his friends? If you'll lend your phone to Patient A, why not lend it to patient B? In fact, why not just leave it at the desk so that anyone who wants or needs to make a phone call can come by and use it? Oh, wait? Your FaceBook account has been hacked? Gee, I wonder how that happened!

As for running errands outside the facility? I don't have enough time to run errands for my own family, I'm for sure not going to start running errands for patients. Because once you set up the expectation, it's a slippery slope. Why is that errand for Patient D more important than a similar errand for Patient M, and how can you say no to M when you did it for D?

It's OK with me if you want to set yourself up -- if all the patients expect to use your personal phone for any of their wants, needs, desires. If all the patients want you to run errands outside of work until you run yourself ragged and have no time or energy left. That's fine with me. The problem is, you're also setting up the expectation that other nurses will do the same thing, and that's not OK. You're effectively sabataging your colleagues. I'm not OK with that.

Specializes in PICU, Sedation/Radiology, PACU.

There seems to be two types of scenarios here:

1. Patient ASKS for a favor to be done.

2. Nurse decides on his/her own to do the favor.

It sounds like most of the posters are saying that when a patient makes a request for a personal favor, and the request is granted, it can lead to blurred relationship boundaries, an expectation of behavior, assumptions of favoritism, etc. But when the nurse decides on his/her own to perform an act of kindness, and does so discretely, this may be more acceptable.

OP, you're not going to get a black and white answer. Where is the line? There is no line. As a nurse, we care for humans. They are human, we are human. Each with our own emotions, experiences, needs and desires. Each with different background, upbringing and life experience that shape our thought process and lead us to our perception of "right".

Have I done favors for patients before? Yes. But my perspective is also different because I work with children. Is going to the vending machine and buying an 8 year old with cancer a pepsi because it's the only thing he doesn't vomit crossing boundaries? Maybe. Am I personally willing to cross boundaries to give him a few moments of happiness in an otherwise awful day? You bet I am.

But I have my own set of boundaries as well. For example, I had just returned from maternity leave and was still breastfeeding my daughter. I encountered a family with a child close to my daughter's age with a terminal illness. The mother really wanted her daughter to be exclusively breastfed, but was not producing enough. My empathetic side really wanted to donate some of my extra supply to this mother? Yes, I considered it, but I also recognized that to do so would be crossing personal and professional lines that I was not comfortable with. So I never even mentioned it as a possibility. But I was able to put her in touch with lactation consultants who were able to help maximize her milk production.

What I'm trying to say is that every situation is different. You're never going to be able to draw a line in the sand and say "This side is ethical and this side is unethical." Our world, our job, is full of grey areas. If you're unsure of your actions or what to do, run it by a supervisor, or an experienced co-worker. Examine your heart, and your gut. What do your instincts tell you about the situation? Does doing this favor make you feel uncomfortable? Are you worried someone might find out? Are their any ulterior motives (the patient OR yours)? Are your actions contradicting what the patient has been told is policy? As you gain experience in nursing, you'll begin to develop a sense of your own boundaries, and when a situation like this comes up, you'll better have an understanding of what is right for that moment.

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