Are you okay with bartering?

[DesiDani]

Is okay to promise a patient or their family members something in order to get to the goal you want? If the ends justify the means during that shift, is all good and well? Is it possible for bartering to lead to manipulation and a lack of control? If it does who is at at fault if chaos arises, the person who does not continue on with the bartering arrangement or the one who agrees with it in the first place? Lastly who does bartering benefit or harm overall the patient, patient's family, or the staff?

[NightNerd, MSN, RN]

No way! I literally have nothing I can exchange; you're going to get the same care I give everyone, no extras. I have no incentives to offer to get you to care about your health. The closest I get to these kinds of negotiations is scheduling non-critical tasks and care in a way that doesn't overwhelm the patient, which doesn't feel like bartering so much as common decency. I think there are populations I would feel differently about bartering with (e.g., peds), but my A/O adult med-surg patients need to understand that I'm already there for them and on their team, and there's nothing I can do to sweeten the deal; either you'll let me do what I need to do to help you, or you won't.

[MelEpiRN]

If the bartering involves breaking the rules then it's screwing your colleagues over. I absolutely hate it when I hear "but so-and-so let me do this" and now you're either the bad guy for saying no or you're on the hook for breaking the rules too. 

[subee, MSN, CRNA]

It's a health care setting - not a casino.  Why would anyone want to barter anything?

[Davey Do]

If options equal bartering, I'm all for it.

Giving others a sense of power can allow a win/win situation.

We all want to feel special, and if special consideration is perceived, bartering can be used as a form of positive manipulation.

I've used positive manipulation in psych many times with positive outcomes.

[JBMmom, MSN, NP]

I'm with Davey Do, I try to approach all of my patients with some options related to their care. Involving the patient, rather than top down managing all aspects of care keeps them engaged, more oriented, and hopefully give them some sense of responsibility. 

I say all of that with the caveat that I'm not breaking any rules to meet patient "demands". But if it's things like giving them a snack before we get cleaned up for the night, or trying to let someone get out of bed safely even though they haven't gotten up in a couple days, I try to be flexible. Nothing makes a night longer than drawing a line in the sand and spending the next 8 to 12 hours watching a patient toe across it. 

[SmilingBluEyes]

Yes IF IF IF this does not break policy or put coworkers in a bad place (staff splitting). Boundaries are needed more than ever for any kind of bartering however!

[DesiDani]

My problem with it is that there is never limitations set, or the pt is never told this is for this shift only. I don't mind allowing/giving something with clear cut limits, but when you allow it for the entire shift and leave the next shift to impose a limit problems arise.

[Davey Do]

Those who are not appropriately self-governing require boundaries and communicate between shifts- continuity of care- is required in any therapeutic endeavor.

[DesiDani]

If there are established limits there is no need to barter.  

Plus if another sees they will ask for it too round and round we go. Not good if that person is another patient's family member.

[MunoRN, RN]

I'm having trouble imagining what examples of 'bartering' in patient care would be, does this refer to taking something away that they otherwise would have gotten, what would that be?  Or is it offering to give them something that they otherwise wouldn't have gotten, and what would that be?

[Lunah, MSN, RN]

Good grief, I read this as "bartending." Which might be a lot more effective than bartering! ? I agree, OP — the problem is when the boundaries continue to blur, it's that whole "if you give them an inch, they'll take a mile" thing.