Should Nurses Accept Gifts from Patients?

[Anxious Patient]

There is a discussion in Medscape Nursing about this.

http://medscapenursing.blogs.com/medscape_nursing/2008/05/should-nurses-a.html

Here are some of the nurses' opinions:

When offered a gift for services rendered, I have said that I'm adequately compensated, and don't need more calories.

Why not? How many physicians are out there accepting tokens from pharmaceutical companies?

These small gifts do more than just boost morale in a very demanding and at times thankless job.

When patients give gifts to their care givers, it can symbolize a shift in the relationship from professional/objective/therapeutic to more social and subjective and create a conflict of interest.

When a patient give a small gift to the nurses he is giving part of himself. To refuse would be the ultimate insult.

It is not an acceptable practice to accept gifts on an individual basis. We inform them (patients) that it is a team effort...

I don't feel that it is a bribe and I don't think that the families see it that way either. Often this is only way that they know how to say thank you.

I worked with a nurse who was disciplined for accepting gifts... when reps from companies come in they bring cookies, pens and provide lunch...are we now to say no to this as well?

When family members ask what they can do... we direct them to our charity department.

My previous employer had all employees sign a form stating they would not accept gifts of any kind from a patient or the patient's family.

To me these small gifts are more valuable than gold. I cherish every one of them.

I work with surgeons that accept expense gifts. Why shouldn't nurses?

I cannot think of anything more rude and insulting to refuse a gesture of kindness and appreciation from a patient who just wants to say a simple thankyou.

[pagandeva2000, LPN]

I believe that facilities try to limit gifts to individual nurses because it may compromise the ethics of that nurse. Some questions may be; is the nurse treating all patients the same, giving the same attention to everyone, or is it jaded by the gifts she/he is receiving?

To be honest, I believe that most nurses do the best they can towards everyone and there is nothing wrong with receiving an occasional gratuity if it is based on that alone. But, just like anything else, sometimes, people give gifts for reasons. What if the nurse honestly cannot do the favors, or give attention to the one that gave the gift because two other patients were crashing? Some patients and families really do believe that since they literally paid their dues, that extra attention should automatically shift to them. It is not everyone...that I know. But, I have witnessed it often.

As I said before, I work for a hospital that is always overcrowded, everywhere from the clinics to the ER, specialty clinic appointments sometimes takes MONTHS because these doctors only come once or twice a week. I remember once for the urology clinic, which is two days a week from 1-5, it is not a shock that one attending and 2 physician assistants will have to service 50 patients within these few short hours. A patient tried to give me $10 one time to put him ahead of everyone else. I acted like I didn't even see it and told him that unless it is an emergency, I cannot, because this is not fair to others who waited for months for this appointment as well. Another time, for the breast clinic, a patient's relative told me that she would make sure that she cooked my favorite meal every day just to make sure that her relative is seen early and gets out within an hour. Well, what if I can't do it? And the family reports to administration that I coerced them to cook for me? How does that look for an employed, paid nurse? What if these patients challenge me in front of the entire clinic and say that I took their hard earned $10 or time and money to make me a meal and I still treated them 'like everyone else'? I can't do it, it would not be fair, because I know that these poor people cannot afford it. I have seen too many of these things get ugly, so, to avoid trouble, I do not accept gifts...period. Now, mind you, I don't judge the nurses that have accepted some minor things at all. But, I cannot begin to promise that I will be able to give anyone special attention, let them come early, squeeze them to see a specialist early for no real reason, or such.

I can go into several horror stories, but will limit it to one where an employee did do a disservice to a patient. We have financial counselors who will fee scale self pay patients to pay as low as $20 a visit (this will include labs and diagnostic tests like sleep studies, stress tests, etc...). They are able to do this within about 10 minutes on the computer. But, this jerk decided to make a profit, so, he would tell the patients (especially the elderly), that he can 'speed up the process of fee scaling' for an additional fee of $50. These poor people paid it, until one savvy one decided to report it to administration. The powers that be set up the employee by giving that patient a marked $50 bill and he took it. When the patient demanded a receipt, he didn't produce one (because there is no policy regarding the speeding up of fee scale service) and then, security came in and discovered the marked bill.

Now, this patient started spreading around to the rest of the clients that we all are this way. Again, I know that not everyone, either the patients or staff mean to be anything but nice, appreciative or respectful. But, to me, it is not worth my integrity or my job, so, to be safe, I just say no.

[Tait, MSN, RN]

I have accepted the various piece of chocolate, an amazing hero sandwich from a baker visiting a good patient of mine, a paper bookmark handmade for the staff and the occasional bag of left over Halloween candy for the staff.

I once had a patient offer me a discount on a condo in Destin, FL that they owned for my honeymoon. I ran it past my manager, and she said since the patient had been discharged it was ok for me to accept. I declined however because the patient died shortly thereafter and I didn't feel like it was my place, at all. She was an ICU nurse.

I have accepted a "connection" that was set up by a patients family for me, connecting me to a minister to facilitate my wedding. I gave her my email, and let the woman contact me. Also approved by my manager.

Generally however I refuse most candies, fruit etc because in the end, those gifts were meant for my patient. I have definitely felt bad for refusing, especially when you can see the patient is hurt by it.

[santhony44, MSN, RN, NP]

Years ago, I took care of an elderly lady who had been beaten and left for dead by someone who broke into her home. We had her for quite a while. Not long before she passed away, her niece , her only relative, brought every nurse and nursing assistant on the floor a small embroidered pillowcase. These were OK to be accepted, since she brought one for everyone.

I also was given a pincushion by a nursing home resident, who spent most of her day doing crafts. She made things like that constantly and delighted in giving them away.

Otherwise, gifts have generally been food and have been meant for the group, not an individual. I've never worked anywhere that it was not OK to accept these. Where I am, in Texas, it's not unusual to have patients bring in a bag of vegetables from the garden to be shared out by staff.

[chenoaspirit, ASN, RN]

I took care of a patient once who I got so attached to her and her mom. I had taken care of her, on and off, for about 2 years. On one of her stays, she gave me a "what not" of a little girl holding a beachball. It would have broken her heart had I not accepted it. I thanked her and I still have that what-not sitting on a shelf in my house. Everytime I see it, I think of her. That rarely happens to any of the nurses at work, but I cant imagine not accepting a small thank-you, just because it would embarrass them and hurt their feelings. Granted, it made me uncomfortable and I wondered if it was ok to accept. Now, I would NEVER accept anything expensive...no way. I have also received thank you cards, although 99.9% of cards are left for the entire staff. But I have received an occassional card to me. I have even bought patients gifts. I had a patient who was dying and wanted a bracelet so badly (she didnt have much). I went to Walmart and bought her an anklet (she was obese and needed a large size) and I also bought a little girl a teddy bear. I prefer not to exchange gifts at all, but occassionally a patient will tug my heart strings and I just cant help but to get them something to cheer them up, especially the terminal or pediatric patients.

[locolorenzo22, BSN, RN]

personally, I feel that something very pricey, or one that comes with implied favoritism should not be accepted....you know, somebody brings in candy with the statement, "ok, the doc will see me first, right?" etc....

However, we've had many patients come back to see us and bring in flowers, candy, store bought goodie bags, etc..for both shifts....AND bring in something special for their main nurse....this is viewed as ok, since the patient is recognizing the entire staff, and their main nurse at the same time....

I've recieved countless "thank yous" and "they're not paying you enough" comments at work, and my response is always "Ok, when you get that survey, my name is lorenzo....that's l, o, r, e, etc....." usually gets a laugh.

My most touching one is a thank you card sent to me by a family that said thank you to everyone...but mentioned me, the night RN, and the day RN by name....really makes me remember that we have such an impact on people.

[handyrn]

I admit that I will accept the occassional piece of candy from a resident in our nursing home as a thank you. However, our staff is always sharing our candy or food with our residents as well. In a nursing home, you end up becoming family, espicially in our rural area where everyone knows everyone. We also have a resident who crochets things and likes to give them away. All her yarn is donated, some of it by us employees, so we do accept small things such as pot holders, etc. However, the one thing that I have not seen posted yet...

In the state that I work, accepting gifts can be considered a form of adult abuse. Unfortuneately there are those who coerce their patients into giving them expensive things, money in their wills, priceless keepsakes, etc. The people who do this are very clever and sometimes the patient doesn't even know that they have been taken advantage of. Due to this, I can see why some places make rules that no gifts are to be accepted.

The problem is that there is no monetary value placed on this. Coercing a patient out of a piece of candy can be abuse just as coercing them out of a priceless keepsake. One would like to think that we, as nurses, as professionals, have enough moral values to not take advantage of patients in this manner, but sadly enough, it happens.

[BlueRidgeHomeRN]

i don't see anything wrong with "little" tokens, if you know the patient well enough to be sure they aren't a froot-loop or trying to bribe (again, i mean a homemade cookie, an "angel" keyring, and a coffee mug)

btw, the rn who was my mom's primary in icu while she lingered after an ultimately fatal cva got a big basket of flowers, a letter to the vp of nursing, and a handwritten thank you card. she was the nurse when this nurse wanted to research "rehab centers" for someone with a glasgow scale of 3. "let's talk about your mom's status....(in the quiet room, with kleenex!) can't remember her name 14 years later, but i will always remember her skill and caring...

[LandDRN]

We are allowed to accept things as cookies, pizza orders for us ect ( and it is such a very kind and appreciated thing to do!) but our company has a strictly enforced rule of not accepting individual gifts, no matter how small or inexpensive.

[lisab82]

working on paeds ward in the uk we are always getting brought chocolates or biscuit which we share among the staff and is accepted , but gifts we are not meant to receive.

It horrible sometimes refusing gifts as you feel its insulting and can see the hurt when you refuse . what we try is if they really insist then we point them in direction of ward fund or equipment for our playroom.

I have it been known for patients to by nurses little gifts and what been done is to accept and then put them in to a box for Christmas & birthday gifts for patients.