Accepting gifts from patients...

[ProBeeRN, BSN, RN]

First off, I work in homecare but I'm posting this here because I think we all encounter this in one form or another and I want some opinions. Where do you draw your boundary lines on accepting gifts from patients? For example, I will generally accept a thank you card or a small "homemade" gift (however if the home wasn't clean you better believe those cookies are going straight in the trash when I get home).

The problem is when the patient/ family goes beyond. When I worked in LTC as a CNA one of my patients and her husband gave me a Christmas card. I accepted it, and opened it later to find money in it- a relatively small amount, $5 or $10 or something. I refused to take it and returned it to them-- they were really offended. The other aides I worked with were like "Heck, yeah, should have taken it". No floor policy on things like this.

Yesterday I discharged an adorable little old man from the agency. His sisters gave me a little make-up bag type thing. I was not sure about accepting it but they insisted and I saw a $5 price tag so I did go ahead and leave with it. Then I look in the bag later-- those brats (using "brats" affectionately) stuck $10 in there! So what do I do? I'm leaning toward bringing in donuts or something for everyone with it next time I'm at the office on the weekend.

I just read on article on dealing with maintaining personal/professional boundaries and it was really interesting. I get the feeling that I need to work on this in the future. I'm not sure how to say "I can't accept this" without hurting the giver. I seem to have the hardest time with old Polish ladies- they are the ones that get VERY offended if you don't accept a gift. It's even tougher in homecare because of the 1-on-1 relationship I have with my patients.

Any ideas? Stories from similar encounters?

[TwilightRNurse]

Never accept a gift of cash from a Home Health patient no matter what. Give it back and tell them you cannot accept it. They mean well but that's a big no no that can and will get you fired.

[BluegrassRN]

I recently received a card from a pt that contained a $20. I took it to my director, and was rather surprised to have her tell me that it is considered a small enough amount that I should just keep it. I work nights, so I rarely get anything from pts. Her reasoning was that it's fairly often that a pt's family will send a large bouquet of flowers or have sandwiches brought in for the day shift, it costs more that $20, and we don't refuse those items. I told her I was uncomfortable keeping it, but that I was also uncomfortable returning it as I did not want to offend the pt.

We decided that I would send them a thank you note, and nicely inform them that I had taken the liberty of donating the money to our floor fundraiser for heart disease (the pt has CHF) in his honor.

[blonde73]

I also work in LTC and often family members want to give me "gifts" .It is our policy that if we accept a gift of any kind we will get fired.I just inform them that as much as I would like to accept the gift I am not allowed to, but the thought of them wanting to give me something is more than enough.or that their smile is the only gift I need. at the holidays giving food to the staff is fine any other time it's a big no ~no. whether you are in home care or a ltc setting it is never a good idea to accept gifts of any kind. (even chocolates or candy) just my take but ggod luck.

[ghillbert, MSN, NP]

Yes just put it off onto policy and tell them you would be fired if you accepted, but you appreciate the thought. Suggesting they make a donation to a cause if they would like is nice.

[cardiacmadeline, RN]

I don't know if we have a policy on this, but I was told we are allowed to take gifts of small value, but no one is sure what the maximum amount is. I guess we are just supposed to use our discretion. (FYI-I work in a hospital.) I once had a patient give me a Christmas candle. I would feel strange accepting cash, but if you are allowed to accept it, I like the idea of donating it to a charity or using it to buy something for you and your coworkers. Most families bring us food or flowers or just write a lovely thank you note.

[RNKPCE]

Usually it is candy. But once I got a set of heart shape paper weights, still have them. Recently I got a book a patient wrote. One patient folded a dollar bill in the shape of a shirt and gave it to me and said it was for "good luck" it has been greater than 10years and it is still in my wallet.

Larger gifts I would talk to my manager about. One time a family insisted on giving each staff member either $20 or $50 dollars(can't remember), the family had a lot of clout at the hospital and management allowed it.

[ProBeeRN, BSN, RN]

yep, agreeing with pretty much all advice here. I'm off today but will talk to my manager tomorrow. Maybe at least I can find out what policy is (and if there isn't any maybe I can help get one going). I will let you all know if I get an answer!

Even if they tell us that we can accept up to a certain amount...I have the feeling I'll just be using the "I'll get fired" line across the board in the future. I just don't want to play the "How much is this worth and is it acceptable" game. :) I mean hey, techincally I'm already white-lying to them about the "oh, no thanks, I just finished a cup" otherwise I'd be having a cup of coffee 6-8x a day.

[RunningRNBSN]

I always tell our families who want to buy me something to instead purchase some fruit or candy for the unit.

When I worked in case management (in non-nursing) I once had a client randomly come in one day with an expensive bottle of wine and some gifts she purchased for me from San Francisco. I tried to give them back to her but she left them on the front desk and left. I gave them to my manager who then used them as give-a-ways for our annual banquet.

[mamamerlee, LPN]

I have been offered and/or received gifts over the years. Sometimes it is better to accept some gifts after decining twice. The first ever gift I received was in nursing school during my post-partum rotation. The pt was a 40 yr old primip, who delivered a Downs baby. This was in 1973. She was my only pt, and I stayed in her room most of the shift (3 1/2 days!). The staff nurses ignored her, not wanting to deal with this issue. Her doc told her to institutionalize the baby. She asked me what I thought. I gave her the names of some organizations she might want to contact. Later she told me I gave her hope, and the doctor gave her nothing. My last day on the floor her husband gave me a small gift - a bangle bracelet - which I wore for many years. And yes, I initially declined it, not even knowing what it was, but he insisted that I take it.

I have often wondered what their decision was.

In home health, I received a scarf/hat/glove set from a family who will STILL hug me and kiss me if I see them somewhere.

[kalieRN]

In my workplace there is a policy regarding accepting the gifts. It happened to me one time. One of the relatives gave me a box of chocolates, i returned it to them. But still they insisted. I placed it in the office then i told to the manager that someone gave it to me and i am in doubt to take it. The manager told me to take it and so i did, because if the managers says i wont, obviously i dont have to. And sometimes in our place every gift we receive we use it as a raffle price for staff events.

[nicole109]

I work in home health also--and we actually have a written policy on accepting gifts, I would check to see if your agency does as well. Our policy very strictly states that we are not allowed to accept any gifts of any shape or form, including cards. So, that's what I tell my patients if they try to give me something--thank you very much, I appreciate the thought, but I could lose my job if I take this...we laugh about it for a minute, because it's very silly to think that someone could get fired over a greeting card, and then it's over.