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?

[Rose_Queen, BSN, MSN, RN]

4 minutes ago, Pixie.RN said:

Good grief, I read this as "bartending." Which might be a lot more effective than bartering!

Effective for the patient or the nurse? I mean, I could go for a nice glass of wine right now...

I'm not quite sure what you're asking here. Clustering care? Absolutely. But bartering is usually more of a give and take, not that.

[DesiDani]

1 hour ago, MunoRN said:

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?

It could be allowing a pt to go outside to smoke or go to 7-11 (seen it) if they do lab.

 

[DesiDani]

A patient can't give you anything in return, but the positive behavior you want.

[MunoRN, RN]

2 hours ago, Pixie.RN said:

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. 

I also read it as "bartending", didn't think that was a particularly odd topic to be honest, it's kind of what we do.

[MunoRN, RN]

35 minutes ago, DesiDani said:

It could be allowing a pt to go outside to smoke or go to 7-11 (seen it) if they do lab.

 

I don't know that I've ever come across that, I guess the nurses I've worked with have generally been more hard-assed.

I do see how that would easily become problematic once they see every aspect of their care as something they can exchange for something of value.

Ultimately though, if they don't want a lab done then I don't really care either way, if they don't want it they don't want it, so long as they are aware of the consequences might be then it's on them not me.

[Lunah, MSN, RN]

59 minutes ago, DesiDani said:

It could be allowing a pt to go outside to smoke or go to 7-11 (seen it) if they do lab.

 

I am glad I never worked in an inpatient area, in the ER if you leave, we turn your room over and give the bed away! ?

[amoLucia]

20 hours ago, MunoRN said:

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?

My bolding.

I've outright BRIBED pts!!

In LTC, I had numerous dialysis pts. One thing, they HAVE TO GO to dialysis - not really any options. Even miserably sick feeling, they need to go. One resident, a too-young-for-hypertensive-CVA  AA woman sometimes resisted. I'm not sure if she 100% understood the consequences of resisting.

One day she refused after the ambul arrived. The transport driver promised her a pepsi and Ms E went. I made her the promise that I would provide her favorite Milky Way candies all the time as long as she continued to go to dialysis without problem. For the time I remained there, she WENT to dialysis and I always made sure she had a small baggie supply of mini-Milky Ways.

It was an out & out bribe, no argument. But that CVA had left her with hemi-paresis,  dysphasia (she could only say 2 words, only 2, like a broken cassette). And the high BP that killed her kidneys still continued. She needed dialysis. She did the Milky Way deal.

I have no regrets about those Milky Ways. She enjoyed those candies and  she went to dialysis. It worked.

So where's any problem??

[whalestales, ASN, RN]

We have a patient we bribe with ginger ale to shower and take their meds

 

[DesiDani]

I floated once to ER this autistic pt 16 going on 8 (literally). They needed blood draw, but she wasn't having it. I had a Hershey saved for lunch. Promised I'd give it to her if she let us do the draw. She was happy, ER doc and nurses happy win win.

 

In some circumstances you have to do it.

[DesiDani]

5 hours ago, amoLucia said:

. For the time I remained there, she WENT to dialysis and I always made sure she had a small baggie supply of mini-Milky Ways.

Were the other nurses aware of the arrangement?

[DesiDani]

On 8/3/2021 at 3:25 AM, NightNerd said:

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.

I like that. Nice, respectful, and straight forward. No patient can argue with that. Wait... I forgot a patient can complain about Jesus AND Buddha!

[hppygr8ful, ASN, RN, EMT-I]

I think that as long as the entire treatment team is involved,  the patient's family agrees and is and on board with the arrangement as well as the goals, I am all for it.