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May 25, 2008

Should Nurses Accept Gifts from Patients?

Binging72x721 Nurses could be banned from accepting gifts from grateful patients under controversial new plans at many medical institutions. It means nursing staff can not even accept a box of chocolates or a cup of tea for their help and assistance. What, no more chocolates during Christmas? Ohhhh - that hits me hard being a chocoholic!!! (Swiss Lindt is the smoothest of all chocolates. Okay, maybe I’ll also add a bit of Godiva!)

I wonder – maybe we shouldn’t accept anything from any patient’s family? Many bring us baked cookies, bread, drinks (non-alcoholic), tea, thank-you cards, etc. I can understand monetary issues. But, then on the same token, how many physicians are out there accepting tokens from pharmaceutical companies?

I recently attended a neurology meeting out West -- the companies on exhibit gave out pens, penlights, pads, bags, books, even MP3 players (I now own one!), and more. I almost had to buy a second suitcase just to pack the gifts I got free in the exhibit hall.

Should nurses be banned from receiving gifts from those who received exceptional care from them? What’s your take on this?

May 25, 2008 in Beka | Permalink

Comments

I think it is a natural thing to express mgratitude to a carer when gifts are exchanged at Christmas and Birthdays. It has nothing to do with corruption. Carer is a very personal service, and yes it is professional. however don not take the humana element out of it. the rules are sterile enough, but dont remove the element. we have always excanged gifts and always will. It is not a favour or anything sinister about it, and should be allowed

Posted by: Anna Hunt | Aug 7, 2011 9:32:41 AM

I worked as a care assistant at a Primelife Ltd owned care home for adults with learning disabilities in the UK. One of the residents was a good communictator and I developed a friendship. He was aware of my interest in music. To cut a long story short, he gave me a small photograph of him playing a tamborine at a music club he used to visit.I told him what a lovely photo it was. He told me he wanted me to have it, he had written a greeting on the back to me and my partner and signed it with love. I asked him if he was sure he wanted me to have it. He assured me he did. I told him I would frame it and treasure it for ever. I happened to mention it to one of my work collegues.
I have just gone through a disiplinary and my employment has been terminated. My crime was accepting a gift from a service user. This man would have been very upset had I not accepted it. I could understand if it was an item of furnature or an amount of money but a small photograph of someone you care for, I think is a bit trivial. He gave me a hand made Christmas card last year. Apparently that was ok to accept!!
I still have the photo and yes I will treasure it forever. I just feel sorry for these unfortunate people who have limited choices in life. I think prisoners have more liberties.

Posted by: P.G. | Dec 9, 2008 8:25:08 AM

I have come under scrutiny her just recently for a gift that one of my hospice patients gave me back in February. I had been sharing my photography with him as I do with all my patients because it brings them joy. As I was preparing to leave that particular day he mentions to me that I should make some cards for my photography. I said I would eventually get around to it. He then handed me a 20 dollar bill and said "Go over to Office Max and have you some made. I would do it but I am unable to get out"

I tried to politely refuse the money and handed it back to him and told him I was sorry I could not accept it, but he handed it right back to me and said "no this is a gift for all the wonderful things you do."

I handed it back to him again most apologetically yet once more he handed it back insisting that I take it and he would not take it back.

He wanted to make the cards for me but could not. I tried to think of all sorts of ways to return it back to him without causing offense.

Well just this month this persons relative whom he had a falling out with called and complained to my supervisor about him giving and me accepting the money from him. She complained because she was being vindictive of the staff because they would not support her issues regarding him. I wasn't the only one who was brunt of her wrath because of this. A few other staff members were as well whom he had given trinkets and the like to. Nothing of major value.

Anyhow, long story short, it is now under investigation as a breech of policy. Our policy does not say anything about patients giving gifts at all. It talks about vendors and the like and other corporations but does not break it down to that level. And in regards to value, all it says is that one is not allowed to accept a gift of greater than 75.00 value..This was a twenty dollar bill that he wanted me to make cards with. I never did use it and was planning on trying to get him to take it back again.

As of such, I have been put on administrative unpaid leave and may end up being terminated. It is truly sad. Nowhere was it a breech of policy at all. It was not given as a bribe but just as a token of thanks. Nor did I solicit him for it. Which are the no no's in the policy. Nor was it greater than the 75 dollar value. In all my 10 years of nursing has anything like this happened and now I may end up losing my job over something like this...

Posted by: Krista | Sep 23, 2008 5:58:56 PM

During my first year as a new grad I worked the 3-11:30PM shift. For most of my shift one night I was in room 5002 caring for the elderly lady in the bed by the door who was actively GI bleeding. I performed repeated iced gastric lavage & cleaned her up after she had again vomited. Being with her almost my entire shift we talked some, she as best she could & towards the end of my shift we were joined by her also elderly sister. Before I left for the night, the bleeding had lessened immensely, & when a bed was available in ICU she would be transferred. As my patient & I said our respective good-nights, she took my hand in both of hers & thanked me for my competent care. As our hands parted I felt something in mine & upon looking down I saw a few dollars in the palm of my hand. I tried politely to refuse but she insisted, it was her way of showing me how much she appreciated the care I had given her. I reluctantly kept her gift & placed it safely in my uniform pocket. Upon arriving home I called my mom & told her what had happened & how I was upset about taking the money from my patient. My mom then explained to me how sometimes you just have to accept a gift graciously. Yes it was only a few dollars, but for my patient it fulfilled her need to thank her nurse for the care she received. And who knows, it may also have been therapeutic for her. I think what I am trying to say here is that it has to be taken in context. I thought about what my mom had said about accepting a gift graciously & fell asleep contented in knowing that my patient felt she was well taken care of. This occurred over thirty years ago. Nurses made a difference then as they do now. Nurses give 100% & sometimes even more. We don't expect a gift for performing our nursing responsibilities. We do appreciate gestures of gratitude, a little act of kindness does go a long way.

Posted by: Marge F. | Jul 4, 2008 8:10:09 PM

There is a difference between a gift of gratefulness, and a gift to ensure service. I believe it was the latter which raised the question of gifts. I embarrassed myself when a patient enclosed a gift certificate for a meal at a restaurant in a thank you card. I was not a gracious receiver, but rather insisted that I was a professional, and I did not accept tips. This was not a tip, but rather a gift of appreciation. My response still embarrasses me. Many professionals receive gifts from grateful clients, e.g. lawyers, physicians, etc. I think it is an issue of appropriateness, e.g. socially acceptable, cost of the item, etc. Nurses do not have to deny the joy that a patient feels giving a token of appreciation.

Posted by: Ingrid L. Dixon | Jun 28, 2008 10:06:30 PM

Forty years ago, when I was a student nurse, Mrs Rubin was my patient. She had terminal abd cancer. Her family was adamant that she NOT be told she had cancer. We were warned every day at morning report not to reveal her diagnosis to her.
Mrs. Rubin was extremely demanding, nasty, constantly on the light, and medicated frequently for severe pain.She also asked everyone 100 times a day if she had cancer and if she was going to die. The dressings,soaks and packs were long and painful for Mrs. Rubin, and stressful for every nurse, because she had you trapped for an hour demanding you tell her the truth. I don't lie, well, or otherwise. How many ways can you lie without lying? This day I had a split shift and had to change those dsgs. twice! Mrs Rubin was particularly nasty, mean, slapping, contaminating the area, crying and screaming at me, and demanding to know if she was going to die. I jokingly said, "Trust me Mrs Rubin, God doesn't want you, you're too mean to die". Mrs R. smiled and relaxed, reached into her drawer, handed me a box containing a small cameo broach and ear rings. She insisted I take it because now she knew she was NOT going to die. At shift change, in tears, I reported to my HN what transpired,apologized for my behavior and run-a-way-mouth, gave her the box and asked her to return it to her daughter.Mrs R.died within the week. Her daughter asked to meet with me. (There goes my career?) She handed the box to me and said her mother told her she'd given the broach to me, and why! But she found it in the hospital safe. I explained that I knew it was a valuable heirloom that the family should
have and turned it over to my head nurse for safe keeping. She said that it was her wish also that I have
it because I made her mother's last days happy and peaceful. Long story, short,the broach is one of my most treasured possessions, I wear it often. My children and grandchildren love the story that goes with it! Should I have turned it down? Forty years later, I don't know.It was important to the family that I accept it. I like to think it was closure for Mrs R's daughter. Life is not all black and white. This was one of those very gray areas.

Posted by: Mary | Jun 15, 2008 4:53:29 PM

With all this talk of patients being regarded as " Customers and/or Clients ", what then makes us, nurses, so different from physicians who also are regarded as customers and/or clients of the ENTIRE healthcare system that they are allowed to accept gifts, "toys", drug samples, endowments, honorable chairmanships etc. from families and others ???

Uhmm...any thoughts ??? I have yet to see major endowements being given in HONOR of an actively praticing nurse ???

Posted by: beka | Jun 13, 2008 10:55:56 AM

Like Brenda and others, I save the cards and messages from grateful patients in my "Rainbow Can." When feeling depressed or frustrated, I can re-read these to lift my spirits. After 40 years, it is full and brimming over into shoeboxes! While I remind those who give me tokens of their appreciation that it is "usually" against nursing policy, I am in private practice and answer to a higher power that accepts all meaningful behavior given in loving gratitude. To do less is disrespectful and even hurtful or shaming to the giver.

Posted by: Rosemary Nichols | Jun 11, 2008 9:13:42 AM

This is a controversial issue among nurses as professionals. However, in as much as we would want to be approciated for the care given to the patient, and appear to be civilized, as nurses we must be carefull that the issue of gifts or no gifts does not compromise the nusing care we give to our patients. we should remain focused to the the nurses code of ethics and attend to all the patients equally with a gift/ bribe or not. therefore my feeling is that if a patient wants to appriciate the care given let it be to the entire team of nurses nomatter how small or big.

Posted by: ruth kasambla | Jun 9, 2008 7:05:08 AM

Accepting a small gift from a patient you've worked with very closely and have developed a real therapeutic relationship, is something we should do gracefully. Not to accept might be detrimental to the patient's health. However, I agree with many of the preceeding comments. A gift of any value or cost should be shared by the whole group.

Posted by: Jane | Jun 5, 2008 2:50:51 PM

Accepting gifts from patients represents a touchy situation. Taking gifts from patients was not a pattern of professional behavior that I was socialized into. In 1963 I accepted a quarter from a patient. In today's economic climate, the $5.00 gift that one nurse describes is about equal. Yet these small tokens from poorer patients are as valuable as the much larger gifts that wealthier patients might offer. I accepted the quarter because I believed that the woman would have thought that I refused it because it was not enough. I have received many token gifts of appreciation and so have my nursing students from parents who appreciated their support for being there when their newborn made its grand entry. One woman gave an Infant of Prague Statue to a Catholic nurse each time she had a new infant. Most patietns in my experience gave gifts to the group. Accepting larger monetary gifts on an individual basis can get very sticky. It seems to me that if nurses are told to tell appreciative patients to make donations to the agency, the agency should find a way to use some of this donation to reward the nursing staff for doing such a great job! They could bring a cart of easy to serve, healthy food treats, to the unit on each of the shifts! Keep in mind that most of the gifts that physicians have been accepting are from pharmaceutical and medical supply sales people who are promoting their wares and not from appreciative patients. These practices are being looked at very closely. I got a sense from reading your stories that you are all doing a great job. Keep up the good work.

Posted by: terry | Jun 4, 2008 4:37:55 PM

When i was a had nurse. and sone of the relative want to give a present. i say NO!! its againts the low in my cuntry. But a present to the ward , something we need be nice!

Posted by: yael | Jun 4, 2008 6:44:35 AM

I still believe that when a professional nurse is giving and receiving personal gifts from clients it is a factor that creates expectations. Creating those expectations alters the helping relationship in ways that may not end well.

When clients or their caregivers give small tokens of their appreciation such as a fruit basket or box of candy to the entire group it is more appropriate.

A difficult situation exists when someone from a culture that values gifting as a token of their respect and appreciation to you as a professional. I have encountered this on occaision when working with a foreign language interpreter who informs you that great offense will be taken by the person if you do not accept the gift. Each situation like this needs to be considered individually in the framework of the therapeutic relationship.

Posted by: Wendy | Jun 3, 2008 7:00:55 PM

This is crazy. We work so hard and care so much, why is it a bad thing to accept a small gift from a patient or patients family member for going above and beyond. I will never forget a patient I had who was a young guy dying. He told me that I hold my heart in my hands and give so much. His family member handed me an angel with brown hair who was holding a heart in her hands. She gave this to me right before he passed away. How could I say no to this gift. I will never forget this patient and the care I gave him. I look at this angel every day. She reconfirms to me why I am a nurse. I love helping people and would never look for a gift in return, but the very few times you are given a token of appreciation why is this a bad thing. Nursing is such a thankless profession. It is not like we are taking a $100.00 check. Thank you.

Posted by: Dede | Jun 2, 2008 7:34:28 PM

Individual gifts should not be given as reward for someone doing their job, but they need to be declined very carefully. A gift at the end of a hospitalization that the whole team can share is OK. When I've been offered a gift I explain this. Often I explain that they've already thanked me or I tell them a card or note is acceptable. There are times that you need to be creative to avoid hurting feelings. I think a simple verbal thank you is worth a million bucks. Also there are many non verbal expressions of appreciation that are given every day.

Posted by: Ruth | Jun 2, 2008 4:17:27 PM

When I worked in a nursing home, I did receive small tokens from patients' families. However, sometimes a nurse must be creative. One patient(man with dementia) who was accustomed to giving tips, constantly wanted to give me five dollars when I'd give his meds. It became a touchy situation because he was offended if I didn't accept. I would take the money, place in the med cart drawer and return it to the daughter (responsible party) so she could give it back and he could give it again. I think nurses with integrity know what is crossing the line and what is acceptable.

Posted by: Genny | Jun 2, 2008 2:26:51 PM

WOW!!! How very unfortunate that we live in an age where accepting tokens of gratitude is so hot a topic. When I nurse my clients it is in good faith that they will have positive outcomes and not because there are promises of gifts at the end. But how delightful when you have worked well beyond exhaustion at times and put in a major investment of self each and every shift, that someone recognises that in a small way. These small gifts do more than just boost morale in a very demanding and at times thankless job. They reinforce the reasons why i became a nurse in the first place. Not for the organisations that want to ban such a practise but for the patients that see our jobs as one to be appreciated.

Posted by: Meg | Jun 1, 2008 2:47:51 PM

Patients give gifts because that is what we do in our society to convey thanks to others. 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. Nominal gifts, i.e.: candy, flowers should be acceptable and in most cases should be shared with the team of caregivers. Gift giving and receiving is a problem when the value of the gift implies a significant shift in the relationship. Not all caregivers/professionals are capable of drawing the line to prevent this shift and thats why hospitals or other professional organizations/groups have policies that guide/limit gift acceptance. These policies are a GOOD idea.

Posted by: Judy Canham | May 31, 2008 3:41:17 PM

WHAT are you thinking, even suggesting that we stop accepting small gifts of graditude from our patients would hurt the one we are supposed to help. When a patient give a small gift to the nurses he is giving part of himself. To refuse would be the ultimate insult.
I have been a patient many times and always show my graditude in a small way. As a nurse any thank you is most appreciated. It is do seldom that we get thanked ,it means more than I can possibly express here, what their small tokens mean. Should nurses stop accepting small gifts from their patients? NEVER!!!

Posted by: Sandi | May 30, 2008 10:56:38 PM

When I was working as a home health nurse, I had a patient who was having a difficult time managing her multiple chronic illnesses and all the medications that went with them.

I checked after her each visit to make sure her medications were set up correctly. If she had made a mistake, I gently told her she missed one and she promptly corrected the mistake.

I also listened each visit to her many problems with her physical limitations but not to excess. She was lonely and her husband wasn't always the best companion.

A month after I started with her, she pulled a cup out of her cabinet with my name on it with all the attributes of "Anna". She said she really appreciated how patient I had been with her over the last month as she adjusted to setting up her med box herself.

To me these small gifts are more valuable than gold. It's a small reward for what can sometimes be a thankless job and it tells you that you are doing what a nurse should always do---provide the very best care he/she can give regardless of the circumstances.

To not accept these small expressions of appreciation is insulting to the giver as well as the receiver of such gifts.

Posted by: Anna Lucas | May 30, 2008 5:17:54 PM

There seems to be a fine line between what constitutes a gift and a show of appreciation for services rendered to patients, and in the facility where I work, they allow staff to receive tokens of appreciation, such as chocolates, candies, fruit and cookies, especially during the holidays.
It is not an acceptable practice to accept gifts on an individual basis, and the patients that come through our rehab facility are grateful for the care they receive. The patient’s state that they would like to repay the staff somehow and we inform them that it is a team effort that made their progress a success and it includes their families and support system as well as all the staff members. The patients are informed that it is with the three musketeers’ mentality, except in this case it is 50 musketeers, one for all and all for one.

Posted by: Judith Hahn | May 30, 2008 1:46:33 PM

I am an ICU nurse in a local hospital and I don't see anything wrong with receiving food/goodies from family members. 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. It also boosts the morale of the unit as a tangible thank you for a job well done. I feel that it would be rude to turn down a gift that truely comes from the heart.

Posted by: Jackie | May 30, 2008 6:17:05 AM

I would agree with the other comments. In the early days when hospitals were not well established the nurse in exchange for her service would recieved housing, or food or something along those lines and then in appreication maybe a loaf of homebaked bread or a sack of flour. It's not really different today, people are appreciative of the care they recieve and want to acknowledge it. When my mom pasted away we asked the nursing staff what they would like, of course they said nothing...we bought the unit a blood pressure monitoring unit and then of course chocolates and roses, we couldn't thank them enough for the care they provided my mom and us....and we wanted them to know how much we appreciated it...even when they said no, we insisted because it was something we felt WE needed to do.

I worked with a nurse who was disciplined for accepting gifts. The family was crazy wealthy and that was just thier way of showing appreciation, she often said no to their gifts, the staff got upset because they felt she wasn't the only one nursing the patient and that she shouldn't be accepting the gifts.....that was so petty by the staff as far as I am concerned.

I really don't understand the whole issue of not being allowed to accept gifts...I have never been given a clear and concise rationale for this....as you say we see doctors getting gifts and free trips all the time...and when reps from companies come in they bring cookies, pens and provide lunch...are we now to say no to this as well?

Posted by: SmalltownRN | May 29, 2008 12:39:02 PM

I think if the patient wants to give us something to say a "special thank you" we should accept the gift. I have had a patient give me flowers when I have helped them achieve their breastfeeding goals. It was special to me that they felt deeply enough to go the extra mile. It would be an insult to them if we could not accept their show of gratitude.
Now if it was an all expense paid trip to the Bahamas that might be a little to much!They feel a bond with us and desire to show it and small gifts are okay.

Posted by: PTWynn | May 29, 2008 10:57:30 AM

I have been a nurse for 25 years in all clinical settings and I believe to turn down a gift from a patient or family is like saying the opposite of thank you. There is a policy at my workplace that a give over $100.00 can not be accepted. I think that can be explained to the giver without insult because they understand how that could get out of control.

I recently lost my older brother to cancer. I live in Texas and he lived in Washington State. I had many an opportunity to visit with his nurses over the 8 years of his treatment, but never met them in person. When I showed up after his death at their office and brought food baskets it was an offering of my appreciation that I knew would be accepted well. We all cried and shared stories. I knew they recognized that I was a caring sister across the miles and heard stories of things he said about me. My gesture broke the ice of not knowing one another, but they knew I was a true nurse when I brought food for them! It also came at a good time because they were moving clinic locations that day! This was a very healing time for us all.

Posted by: Marnette Winner, BSN, OCN | May 29, 2008 8:27:47 AM

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