Doing favors or giving gifts for patients: Unacceptable?

Posted

You are reading page 4 of Doing favors or giving gifts for patients: Unacceptable?. If you want to start from the beginning Go to First Page.

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 11 years experience. 1 Article; 3,377 Posts

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.

Do-over, ASN, RN

Specializes in CICU. 1,085 Posts

I don't even carry my cell phone at work (the one time I "broke the rule" about it the phone ended up soaked in blood in my pocket). Anytime a patient needs to call long distance I give them my ascom phone to use. Or, I could call the number and transfer it to the room phone, but the ascom is easier.

KittyLovinRN

KittyLovinRN

Specializes in Pulmonary, Lung Transplant, Med/Surg. Has 5 years experience. 125 Posts

I'm work in home health, I've stopped at the pharmacy on more than one occasion to pick up prescriptions for a patient who was home bound or during bad weather, I work in a busy urban area so getting to the pharmacy is quite literally on my way to their homes. I don't go around the office bragging about it but I don't see it being that big of a deal, especially if it means my patient is getting their insulin/dig/metformin/etc. They always pay me back so it's not exactly like I'm BUYING them anything.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience. 142 Articles; 9,977 Posts

I think patients respect nurses more who stay within professional boundaries. I'm not talking about running down to the Coke machine as a favor, or letting a dialysis patient have a slice of pizza once in a while because it's the only thing he'll eat. I'm talking about crossing the line between professional/patient and friendship.

An example: I happen to have a doctor whom I absolutely adore, and who makes no secret of the fact that he likes me as a person too. In fact, sometimes I wish he weren't my doctor because we would make the best of friends---we think a lot alike, laugh at the same things, and connect with each other as clinicians. However---he is still DOCTOR Awesomesauce, not Scott, and I respect him for keeping things professional. I already have friends; what I need him to be is my port in the storm when I run into trouble, and he fulfills that need in a friendly but ethical manner.

I treat my own patients in much the same fashion; I'm not the least bit afraid to bend a few rules here and there, but again, I HAVE friends. If I bump into someone at Wal-Mart that I've cared for, we'll say Hi and exchange pleasantries, but it would unprofessional to contact them at home or otherwise meet them on a personal level, even at their invitation.

Just my two cents' worth, from both sides of the coin. :)

minniebrown

minniebrown

64 Posts

Small trinket gifts seem like they are ok. Going to the vending machine, buying a paper, and getting special food. But I think it starts to get inappropriate when you are connecting with a patient outside of work. They aren't there to be your friends. What they tell us in school is, you aren't there to get your needs met. If you need companionship, join a club outside of work or get a hobby.

AZ_LPN_8_26_13

AZ_LPN_8_26_13

461 Posts

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.

This is exactly what I was referring to in my earlier post when I commented that these things "will take you to a place you don't want to go". Small teeny favors and no-value gifts may seem harmless, but they get the ball rolling toward bigger things, in a direction you shouldn't be going. So my advice is don't even get started. As for the sharing your phone thing, I don't do that even away from the hospital. To me it's sort of like sharing your toothbrush with someone. Share your cell phone with all of your personal messages and contacts on it? Really??? Well go ahead if you want but it's something I've always found a bit odd. I've had complete strangers on the bus come up to me and ask if they could borrow my cell phone and I always politely with a smile tell them "No". Teenagers with almost no money buy Virgin Wireless pay as you go cell phones for $20 for cripes sake - if you don't even have that you can get an "Obama phone" for nothing with the govt paying for it.

AZ_LPN_8_26_13

AZ_LPN_8_26_13

461 Posts

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.

Well, that's not what I was saying. The net effect of either one is that you are doing them a favor, and it still opens up a whole same can of worms. Doesn't matter if they asked (which is usually in my experience the more common scenario) or if you take it upon yourself to do it without being asked (less common IMO). The net effect and results are the same and it all pushes you down that slippery slope toward being on the other side of inappropriate.

I guess a lot of this depends on how you look at life and what your philosophy of life is. I am not really an "all things are relative" sort of person. I believe that there are absolutes and there are definite black and white "lines" that should not be crossed. Even when it seems like "hey what would the harm be......". I resist the temptation to give into that. I'm a health care professional and I have a nursing license to protect. We have chaplains, social workers, case managers, etc. to take care of a lot of this other stuff. Don't open yourself to charges of favoritism, profiting off of patients, getting to chummy with patients, etc.

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience. 2,406 Posts

Patients are patients and friends are friends and never the twain shall meet.

It works for me.

SaoirseRN

SaoirseRN

Has 8+ years experience. 650 Posts

I have on occasion done favours for patients, but it is more of an exception than a rule.

We have a coffee kiosk just outside the front doors. I have occasionally agreed to bring a patient back a coffee when I go out to get mine, but only if they a) can't get there on their own, b) have money for it, and c) aren't likely to have someone bring it to them, and possibly d) when I know that cup of coffee is going to make their day.

I had an end-stage liver failure patient who just wanted a TV to watch while in hospital. He didn't have a credit card so his wife bought a prepaid card, but the TV company wouldn't accept prepaid cards unless they were attached to an online account. This patient could not do this (he didn't even own a computer) so I set everything up online and got him his TV.

We had a homeless patient one winter who badly burned his hands trying to warm up with a fuel-burning heater. Social work was helping him with things like clothing and housing but refused to buy him cigarettes. He was not in a place to quit, and so did the only thing he could to get cigarettes, which was dig through ash trays for butts with his burnt fingers. Yes in an ideal world we should promote smoking cessation, but I am a realist and so was my coworker that day. We bought him cigarettes and left them anonymously in his room with a note asking him to please not dig through ash trays.

Another patient, quite young, alone, frequent visits for multiple real health challenges. He had one pair of shoes that were full of holes. My husband had a pair of almost new shoes he got on super clearance and rarely wore, so we gave them to this patient.

There have been things occasionally, but always for what I consider a valid reason.

Conqueror+

Conqueror+, BSN, RN

Has 28 years experience. 1,457 Posts

Not sure how long the OP has been a nurse but as a 20 year vet the post just made me cringe. It is SO easy to get in trouble in these situations and it will ALWAYS be the nurse who takes the hit. I have very few rules but no outside contact with patients and NEVER TOUCH A PATIENTS MONEY ! are two. It isn't always the pt you have to worry about. What if their kids get spooked that you are getting to close to their meal ticket...I mean mom and accuse you of financial abuse ? And as for you "witness" peoples memories get very fuzzy standing in the nurse managers office in front of a firing squad. Do what you want but I get the impression you aren't going through this for some nice person you met through work. It feels more like an attempt to justify starting a romantic relationship with the "timeless connection" you found on duty. This can go bad in more ways than I care to think about. Hope he's/she's worth it

SaoirseRN

SaoirseRN

Has 8+ years experience. 650 Posts

Not sure how long the OP has been a nurse but as a 20 year vet the post just made me cringe. It is SO easy to get in trouble in these situations and it will ALWAYS be the nurse who takes the hit. I have very few rules but no outside contact with patients and NEVER TOUCH A PATIENTS MONEY ! are two. It isn't always the pt you have to worry about. What if their kids get spooked that you are getting to close to their meal ticket...I mean mom and accuse you of financial abuse ? And as for you "witness" peoples memories get very fuzzy standing in the nurse managers office in front of a firing squad. Do what you want but I get the impression you aren't going through this for some nice person you met through work. It feels more like an attempt to justify starting a romantic relationship with the "timeless connection" you found on duty. This can go bad in more ways than I care to think about. Hope he's/she's worth it

If an completely competent, A&O adult who say, has just had his knee replaced or for some reason just physically cannot get to the coffee place (which is on-site) hands me two dollars and asks if I could get him a coffee while I am already headed out to get one for myself, I don't see a problem with that. It's his money and he is responsible for it. I don't do it for everyone, and maybe that's a difference between Canada and the US. I am not afraid of being sued over $2.

LadyFree28, BSN, RN

Specializes in Pediatrics, Rehab, Trauma. Has 10 years experience. 8,427 Posts

If an completely competent' date=' A&O adult who say, has just had his knee replaced or for some reason just physically cannot get to the coffee place (which is on-site) hands me two dollars and asks if I could get him a coffee while I am already headed out to get one for myself, I don't see a problem with that. It's his money and he is responsible for it. I don't do it for everyone, and maybe that's a difference between Canada and the US. I am not afraid of being sued over $2.[/quote']

I don't think a lot of people have an issue with doing that; and I don't think that's a US or Canadian thing either; we just tend to analysis the situation more closely, because we have a VERY litigious society, and most of us are VERY protective of our licenses against foolishness. :)

It's the issue of what the OP is discussing and HOW they are discussing it that makes a lot us wonder if this person is establishing and intends on furthering a relationship, an intimate one, after the nurse relationship is over...I agree with the PP...it's too risky.

I have had patients ask me out on dates, inquire about my marital status; difficult patients that my peers were up in arms about, and some who took me giving them the daily newspaper (after I read it) as a "gift"...some people get it too twisted in their minds about a relationship-nurse or patient or both, and it steps out of the professional realm sometimes; again, it's a case by case basis.