Giving Gifts to Patients: Acceptable or Unacceptable?
A nurse examines whether using her own money to fulfill a need crosses a professional boundary
In the December 2017 issue of Oncology Nurs­ing News®, we explored the question, “Do you or don’t you accept a gift from a patient?” The short answer was “maybe.” Small token gifts may be acceptable, but what about giving a patient a present, either bought or handmade? That gets more complicated.
Our instinct as nurses is that when we see a need, we want to fulfill it. We simply desire to fix things for our patients or show a little kindness. For example, suppose your patient who knits needs more yarn to keep occu­pied during treatment; another is short of cash for a bus, taxi, or ride share; or a strapped care­giver craves a gourmet coffee. You happen to have cash and can easily meet this need.
However, using your own money or even lending your belongings can not only violate a professional boundary but also may be illegal. Even a small pur­chase can cause significant legal implications, because it can be seen as inducement. Laws prohibit individuals and healthcare organizations from purchasing anything that persuades or influences a patient’s healthcare. What we think of as kindness may be viewed as a type of kickback or incentive. Today’s regulatory environment is complex.
Often, the social work team or care coordina­tors and navigators work behind the scenes to help coordinate appropriate resources for all those in need. Many facilities have a patient assistance or petty cash fund to provide immediate help. But if not properly coordinated, it may be viewed as unfair or unequal treatment.
As nurses, we sometimes confuse giving some­thing to patients with providing extraordinary care. Think of the countless ways you can go the extra mile that do not involve buying something or personal spending for care.
So, what do you do if you see an unmet need or want to give a gift? First, ask yourself these questions:
- Would giving the gift change my professional ther­apeutic relationship (outside the zone of helpful­ness) with this patient or any of my other patients?
- At what point do I draw the line to meet my patient’s needs?
- Could the gift be viewed by others as inducement? Could it cause me or my organization harm?
- What happens if another patient realizes that I provided something for someone else but I am not providing it for them?
- Will I inadvertently create a difficult dynamic with team members who have a different set of bound­aries and don’t use their own money? Could this alter my relationship with my colleagues?
- Would the patient or their caregivers feel the need to give or do something in return?
- What do my organizational policies or profes­sional standards say?
Next, talk with your social work team, naviga­tors, or manager. If you see a recurring need, con­tact your manager to become part of the solution for all patients, not just the one you are caring for that day.
Consider the following real-life example: One metroplex clinic treating uninsured patients with cancer found that many of their patients did not have sneakers, so they could not participate in their survivorship exercise program. By partnering with a local professional organization and a sporting goods store, they continuously collect financial donations to provide shoes for those in need.
As a seasoned oncology nurse, I have seen the struggles of many patients with cancer and their families. And yes, I have been tempted to sim­ply share my many blessings—money, items, and time on my day off. Personally, if I did that for one, I would need to do it for all. I decided early in my career that my gift to my patients would be that I would be the best oncology nurse possible