Do you accept tips?

wayunderpaid · Aug 23, 2008

A grateful family left me a card with two 2.50 coupons for the coffee cart. I thank them. I told them that I was going to use it to buy coffee for the nursing/ancilliary staff that morning. It cost me $ 12, so I paid $ 7 out of pocket. I would do that again. Collective gifts are definitely less awkward than personal gifts. Personal gifts which include money are the most delicate of all. It is reassuring to know that under most circumstances nurses won't take money. I agree with the case in which the father thought that it would bring luck to the newborn. Every situation is different. I would skip on the money about 99.9 % of the times, leaving room for the .01 that might be the exception.

waynderpaid

TLCinCICU · Aug 23, 2008

It's wrong to accept any kind of monetary gift/tip for our care from patients or families. Just think of how it could be if tips were allowed. Those who could afford to tip generously would receive the most devoted attention and "service" while the poor would get the minimal attention required by law. An economic bias (worse than what already exists in places) would then become built-in to healthcare.

I had one patient send a card to me, care of my unit. Enclosed with the card was a personal check for $500. I just couldn't even think of accepting it. She then figured a way around my own personal ethics and donated to a nursing fund through the hospital. It will reimburse me for attending a future conference. The fact that she WANTED to make such a gift actually meant more to me than the amount of the gift...

moongirl · Aug 23, 2008

no.

But I reallllllly liked the very nice bottle of Pure& Natural cherry almond body wash I got last week :)

rph3664 · Aug 23, 2008

A few years ago, I took care of a mom and baby who had a rough start. They didn't speak much English, and the mother would ring out literally every few minutes, usually to have her bedside table pushed a little closer, or to hand her something that was already within reach. They were not the most popular couplet on the unit, to say the least.
The day I was assigned to them was no different. This time the father/husband was there, sitting quietly as I continually returned to the room to hand the patient a cup, or the phone, or something else either one of them could have done by themselves and I did my best to smile all the while.
A few hours later the father walked out into the hall after me, with five one-dollar bills in his hand. "For taking such good care of them," he said. Face red, I thanked him but said it wasn't allowed, that I was just doing part of my job. He insisted, saying it would bring good luck and good health to the baby, who was the most severely jaundiced infant we'd had in a long time. I finally accepted it and told him I would see that it was put to good use.
A nurse on the eve shift was leaving shortly on a mission to build a school and infirmary in Africa. I taped a note to her locker explaining the circumstances of the little windfall, hoping that it would bring good luck and good health to a child who needed a little of both.
I couldn't think of a more appropriate way to 'pay it forward'.

What you described, from the mother asking the nurses to do things she could do for herself to the father offering you money, was probably something people did in their home country. And that gift proves that they weren't just lazy or whatever - the really appreciated what you did for them.

:nurse:

djc1981 · Aug 23, 2008

ONLY if it was alot of money and the patient was really cute. ONLY.

Bortaz, MSN, RN · Aug 23, 2008

Heh. I'm just amazed that people make such a big deal out of taking a few bucks, but revel in lotion, cookies, brownies, etc.

"Sorry, we can't accept tips. It's IMMORAL! (dumdum DUMMMMMMMM clash). What's that? Oh, you're not offering money, but steak dinners for life? I'M THAR, BABE...MAKE SURE YOU SPALE MUH NAME WRITE!"

By the way, I don't think hospital employees should take money from patients, either. I just can't stand what I see as hypocrisy.

LisaA917 · Aug 23, 2008

No I do not, so I agree with everyone else

MaryAnn_RN · Aug 23, 2008

Well I just completed our yearly training for my hospital and I can tell you for a fact at our facility we are not allowed to accept cash gifts of any amount. We can however accept small gifts valued less the 50.00

We tend to get cards, chocolates, biscuits etc addressed to 'the nurses in ICU' and we share.

I once cared for a patient whose family organised a benefit evening, raising quite a lot of money and they invited me to attend. People had made craft items which were raffled. The proceeds for the evening were donated to the critical care directorate and the money used to benefit the patients.

Dolce, RN · Aug 23, 2008

Heh. I'm just amazed that people make such a big deal out of taking a few bucks, but revel in lotion, cookies, brownies, etc.
"Sorry, we can't accept tips. It's IMMORAL! (dumdum DUMMMMMMMM clash). What's that? Oh, you're not offering money, but steak dinners for life? I'M THAR, BABE...MAKE SURE YOU SPALE MUH NAME WRITE!"
By the way, I don't think hospital employees should take money from patients, either. I just can't stand what I see as hypocrisy.

But the thing is, no matter how you look at, there is a difference between money and gifts like cookies, candy, flowers, etc. Think of how a guy brings a bouquet of flowers to a woman when he takes her out on a date. It is sweet and thoughtful to show up at the door with flowers, it would be weird and awkward to show up with $19.99. Yes, the cost equivalent is the same but the intent and meaning of the gift just isn't. Money conveys many things. It is the currency of a wage. For a patient to pay a caregiver it implies that they are paying that caregiver for services outside of the sector of insurance, billing, etc.

I have accepted little token gifts from patients before--homemade coasters, brownies, candy, flowers, etc. But, cash gifts make me very uncomfortable and I prefer to leave money out of it! I haven't taken a tip since I quit waitressing and I don't intend to start again now!

Bortaz, MSN, RN · Aug 23, 2008

That's all just semantics, IMO. Or rationalizing.

Hacker · Aug 23, 2008

Hi Kuklara511,

Here in BC, Canada, nurses cannot accepts gifts from clients, except in certain situations.

Here are some references from the CRNBC (College of Registered Nurses of British Columbia):

From the Practice Standard, Nurse-Client Relationships:

"SITUATIONS THAT MAY CREATE PROBLEMS WITH BOUNDARIES

Giving and Receiving Gifts

Generally, it is not acceptable for nurses and clients to exchange gifts. A group of nurses may give or receive a token gift in situations where it has therapeutic intent. Any significant gift must be returned or redirected.A gift is defined as anything that is voluntarily transferred from one person or group to another without compensation. Gifts may be small, such as chocolates, or large, such as a bequest in a will. Gifts have many different connotations. There may be situations when refusing a gift may be difficult and seem impolite. Gift giving may be an expectation under certain circumstances or within some cultures. It may be an expression of gratitude or the recognition of an event. Gifts may indicate favouritism or create a sense of obligation. A gift,intended as a simple expression of appreciation from a client to a nurse, may be perceived by colleagues as special treatment of that nurse which can create resentment. The nurse may perceive the gift as pressure from the client to provide extra care. Other clients may feel under obligation to provide similar gifts. In any case, a gift has the potential to change the nature of a relationship, depending on how it is intended and how it is perceived. Nurses need to consider carefully the implications of giving or receiving any gift, including its value, intent and appropriateness. For the most part, nurses politely decline gifts and they work with their agencies to develop clear and relevant policies for all staff regarding gifts.There are some limited circumstances when giving or receiving a gift is acceptable. Generally, it is more acceptable for a gift to be given to or from a group. Any gift must be openly declared to ensure transparency.

Nurses may accept a token gift on behalf of others who provided care. For example, a nurse may accept a box of chocolates from a client to share with other staff.
Occasionally a gift may be part of a therapeutic plan for the client. For example, the nursing team may give a small gift to hospitalized children on their birthday.
Gifts from clients may be accepted through a charitable organization and used directly or indirectly to benefit client care. For example, a client who wishes to give money, even a small amount, to a nurse in appreciation of care received must be directed to the hospital's foundation.

Monetary Gain or Personal Benefit

Nurses have access to personal and confidential information about their clients. It is possible for nurses, who are unaware of their professional responsibilities, to take advantage of situations that could result in personal, monetary or other benefits for themselves or others. Nurses have the potential to borrow or misappropriate money. A nurse could also influence or coerce a client to make decisions resulting in benefit to the nurse or personal loss to the client. It is unacceptable for nurses to take such actions. Clients who have formed a close relationship with a particular nurse over time may wish to include the nurse in

their wills in gratitude for care and services provided. This situation is particularly difficult for several reasons. There may be family considerations. The family may or may not be supportive of the bequest. The family and the nurse may not even know about the bequest until the will is read. Family members or colleagues may perceive that the nurse has exerted undue influence on vulnerable clients. For these reasons nurses must not accept a bequest of any nature. As with a gift, the best option is to refuse a bequest with a polite explanation or to reassign it to an

appropriate charitable organization. For the same reasons, nurses do not act for clients through representation agreements nor do they accept power of attorney responsibilities to make legal and financial decisions on behalf of their clients. There may occasionally be an exception to this principle when the client is also a relative or close friend and no alternative arrangement can be made. The nurse needs to discuss the situation with both her supervisor and other family members." (http://www.crnbc.ca/downloads/406.pdf)

From the Practice Standard, Conflict of Interest:

"Whenever a gift or any soft is offered, identify the possible motives of the giver and the potential for a conflict of interest. Examples of gifts include pens, food, door prizes and [...]." (http://www.crnbc.ca/downloads/439.pdf)

Personally, I would accept any small gifts. Otherwise I will reconsider how the gift be accepted without creating a conflict of interest (sharing with the team, proposing to give to a non-profit organisation, etc.) To conclude, a nurse should also take into consideration the how much the gift offered is valued by the client, and the cultural aspect of the offer.

I hope this helps.

nerdtonurse?, BSN, RN · Aug 23, 2008

Cash vs. Stuff? Think about it. When do you give "tips" -- you give tips to waiter/waitresses, cab drivers, bellhops, -- ever gave a tip to your doctor? Your accountant? Your lawyer? The firefighter who just put your house out? The cop who just arrested the burglar in your kitchen? Of course not. How about another nurse on your shift that really helped you out? Think how you'd feel if another nurse said, "Gee, you really helped me out tonight, here's 5 bucks?" Honestly, I'd feel offended, because in our culture, you tip people situaltionally subordinate to you. A waitress may go out and tip another waitress who's serving her, but she'd never tip another waitress working with her for bringing her a soda on break.

I would never accept cash; if someone did send in a card with a gift certificate or something I couldn't return, I'd turn it into the hospital auxilary for use in a raffle (we're a non-profit, and every bit helps).

Food and flowers are different. I'm Southern, and we bring food at the drop of a hat, anyway. My grandma used to say, "Food and flowers are love." And she was right. When there's a death among family or friends, we bring food to the home, we send flowers, we donate to the person's favorite charity, we don't drop off 20 bucks at the house. When we had a firefighter lose his life, people in the community brought food and flowers to his station. It's a way of acknowledging someone as a person, not a job title.

And if someone thinks they are going to be corrupted or insulted by accepting a piece of candy from a bag Hershey's kisses that a 80 year old sends to the unit -- you don't have to eat any, the rest of us will take care of it. :wink2: