Gifts vs. bribes...is there a line?

RNsRWe, ASN, RN · Sep 23, 2012

Yucky situations! I've been fortunate in that the only gifts that come our way come without strings. My facility frequently has repeat patients, very common actually, and every now and then someone will bring a pie, cookies, bagels, that sort of thing. We always appreciate it and have never once had someone then demand a favor.

In the case of the tomatoes, I think I would have taken the bag and the papers and told the patient I'd get them to the doc when I had a chance, but not sure when that might be....or if she knew you could easily get them to the doc, might still have said "I'll be glad to give these to her but I can't say when she'll fit in your friend. We'll see what we can do...later". Maybe as a way of making it clear that the gift is nice, but there can be NO expectation of reciprocation as a favor, you know?

And the person who gifts you a clock and then wants special consideration, well....if it's no big deal, you can make it SEEM like a big deal and throw them a bone.....or, if it IS a big deal, just say "sorry, wish we could". Keeping the two events--the clock giving and the demand for favors--entirely separate.

ajr31 · Sep 23, 2012

I agree. There must be a line between just being nice and bribery. People talk a lot and if you give special consideration to one patient with a gift and not to the other patient word gets around and rumors spread quickly. I think it would be best to let patients know that everyone is given the same consideration, no matter what.

Hope this helps,

Ajr

classicdame, MSN, EdD · Sep 24, 2012

a gift comes after, a bribe before. Anything with strings attached is not a gift. Just my view.

amoLucia · Sep 24, 2012

I've always been uncomfortable accepting any kind of individual gift for something that I do - I feel what I do just goes with the job. Soem employers haave strict rules prohibiting accepting gifts, and yet others have nothing to dissuade it.

I try my absolute most to turn down any gifts, but every once in a while, it is all but impossible to decline without offending someone's feelings (this usually occurs with foreigners or very elderly family members). So I'll accept graciously and eventually I'll regift or donate it back to the Recreation/Activity Dept, most esp if it's money that can be used for the community benefit. Of course, edibles are usually welcomed by all staff!

Asystole RN · Sep 24, 2012

There are two types of gifts (or bribes) that can be of concern in healthcare. The first of which is a gift from a patient or their family. Regardless of the monetary value or nature of the gift, the willful receipt of such is unprofessional, regardless if the gift is given to a specific individual or unit. Although I am sure that we all appreciate it when a patient or family thanks us, we should not encourage them to tip us, which is essentially what it is. We provide our services to the patient without the anticipation of, nor desire, to obtain a reward for our service beyond our contracted reimbursement from our employer. To do anything else violates the nurse-patient relationship.

Gifts from a vendor typically represent a conflict of interest and are generally illegal according to the federal anti-kickback laws which have been around since 1972, in various forms. Typically, it has been interpreted by most facilities that a gift of a “nominal value” is acceptable. It should be noted that the various federal laws do not differentiate between nominal or substantial reimbursement. Receiving a gift from a vendor, no matter how small, is likely to sway the staff to recommend that product or service if only that the gift reminds the staff of the product or service.

Asystole RN · Sep 24, 2012

a gift comes after, a bribe before. Anything with strings attached is not a gift. Just my view.

A gift is a nice way to say tip. Accepting "gifts" creates a culture of tipping and thus insinuates that better service or care will be provided in the expectation of a gift.

amoLucia · Sep 25, 2012

A gift is a nice way to say tip. Accepting "gifts" creates a culture of tipping and thus insinuates that better service or care will be provided in the expectation of a gift.

I'd like to politely disagree on this... I don't consider a box of Russell Stover chocolates a "tip" when someone gives a box to the unit upon discharge. When any of my family has been in-pt, we've always 'thanked' the staff on all 3 shifts, trying to catch the weekend crew as poss. I have never considered it to be a 'tip'. It's been a 'thank you' when 3 of us sat quietly at bedside. It's 'thank you' when we've gone a little past visiting hours. It's 'thank you' when we've stashed a few extra towels, wipes, gowns, etc and nobody removes them.

Maybe the difference is that a gift is given post or at time of discharge. There is NO expectation that rule bending (wink, wink) will be happening. It's time past and that's all it's meant to be - a 'thank you' for past services, not anything present or future.

Asystole RN · Sep 25, 2012

I'd like to politely disagree on this... I don't consider a box of Russell Stover chocolates a "tip" when someone gives a box to the unit upon discharge. When any of my family has been in-pt, we've always 'thanked' the staff on all 3 shifts, trying to catch the weekend crew as poss. I have never considered it to be a 'tip'. It's been a 'thank you' when 3 of us sat quietly at bedside. It's 'thank you' when we've gone a little past visiting hours. It's 'thank you' when we've stashed a few extra towels, wipes, gowns, etc and nobody removes them.
Maybe the difference is that a gift is given post or at time of discharge. There is NO expectation that rule bending (wink, wink) will be happening. It's time past and that's all it's meant to be - a 'thank you' for past services, not anything present or future.

Exactly, it is a tip.

When you tip your waiter you give the "gift" after he has provided the service correct? When the attendant brings your bags to the room you give him a gift after the service provided correct?

It is a tip and it is unethical to accept. You should stay after, if you so desire, out of a professional kindness with no expectation of a gift.

xoemmylouox, ASN, RN · Sep 25, 2012

During the holidays we get lots of goodies as thanks. I don't expect it, but it is very nice. I see nothing wrong with it. It is a simple thank you for all that we do for them. I also do the same for my healthcare provider and staff. Eh we are all so worried we are being "bought". I wouldn't accept money, but cookies.. bring them on :yes:

SHGR, MSN, RN, CNS · Sep 25, 2012

We've had specific rules about this. A gift must be able to be shared- for example, the box of chocolates, or coffee pouches for the unit.

There is a money limit for an individual gift that you would be able to accept and this is set forth in our policy and procedures. When I worked on hospice every once in awhile a family would give us each a token (a little bracelet, etc) but it was always after the patient passed. I still treasure those.

So in the case of the tomatoes you could say something like, per our clinic policy we can only accept group gifts that are meant for the staff to share.

nurseprnRN, BSN, RN · Sep 25, 2012

I have accepted small gifts with no monetary value, but great sentimental value, from a very, very few patient families-- a small painting done by the wife of a man who died among them. When I look at them I remember the special times we shared as we both did what we could to ease their husbands' passing from this world when it became clear that we couldn't keep them in this one. The painting in particular is about 5" square in a little frame -- there's a large tree in the foreground, and a large bird and two smaller ones in the sky behind it. Flying away or towards the tree? I always looked at it as the wife and her two little boys leaving the husband who sheltered and loved them.

As to the occasional offers of money, if I couldn't get them to take it back I told them I'd donate it to the staff entertainment fund.