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TuffOne Asked February 2017

Is it legal or ethical for a nurse practitioner to accept gifts from patients that are dying and/or who have passed away?

Gifts such as homes, vehicles or money.

Llamalover47 Feb 2017
Homes, vehicles or money? No, not so much.

freqflyer Feb 2017
Riley, I agree, if the patient was incompetent, the patient may think the caregiver is her "daughter" or "grand-daughter" thus would give jewelry to the wrong person.

Then the caregiver should consult the family and ask what to do.

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Riley2166 Feb 2017
I just replied above "Riley 2166" - I meant to say if the patient was INCOMPETENT, then there will be a major problem and I'd say no.

Riley2166 Feb 2017
I think it entirely depends on the circumstances and the types of gifts involved. If the gift is something simple, like costume jewelry, or a painting, something of not a high value, I think it would be a nice gesture. But I would have the family give the caretaker something in writing that the gift was being given out of gratitude and love and the family has no objection. In other cases, it is much more difficult. For example, if the caretaker is very kind and loving, and the family is not that way. The patient should have the right to gift if it is wished but with some common sense. If it includes large sums of money or property, a professional should be called in to prepare whatever legal paperwork, i.e. a will, is needed. If the patient is competent, well, then you have a major problem and I'd probably say no to the gifts.

Edna317 Feb 2017
No. NO AND NO!
A box of chocolates maybe to be shared by all who participated in her care.
OTHERWISE NO NO NO

Midkid58 Feb 2017
Working in Elder Care (and no, I was not a nurse) my clienst would frequently want to "gift" me something. Usually some ancient lotion that had turned skunky or some such thing. Since it was not a hospital setting, rather, this woman's home, I would dutifully trot out to the daughter and ask her what she thought. Inevitably she'd look at the item and say "Oh. Mother wanted to clean closets today. That's fine." Money tips at Christmas came from the family's oldest son and were obviously "cut" from the checkbook he used for mom's care. I questioned the ethics of it once and he said "We'd pay you 100xs what you make to keep mom happy as you do."
Still, this was ONE situation and I was more a member of the family than professional caregiver. It really didn't happen again with any other clients.
As far as a hospital setting? I routinely took cookies in to the transplant "wing" of the hospital where hubby spent so much time. Not one person said anything other than "Can I get that recipe?"

Countrymouse Feb 2017
See also Hilaire Belloc's Cautionary Tale about John Vavassour de Quentin-Jones. Would you "accept" Miss Charming?!

Countrymouse Feb 2017
That's an interesting comparison you make, Castle. But it does touch on a hot topic in business at the moment, where there has recently been a whole palaver about the grey area between incentives and relationship building merging into bribery and corruption. So practices that used to be not just common but de rigeuer, like hospitality and gifts, are increasingly being banned by compliance departments precisely because of the difficulty of proving that they are not part of a general culture of backscratching, sweeteners and all the other euphemisms for "crooked as heck!" I read yesterday that Lloyd's of London, the insurance marketplace, has forbidden its direct employees to consume any alcohol at all during the working week, and it's not because they're afraid somebody might misplace a decimal point after too good a lunch - it's about no more friendly deals over a pint of bitter or a bottle of claret at Balls Brothers wine bar.

Getting back to our planet (!) - professionals in all walks of life are held to a higher ethical standard when they occupy a position of trust, and that's the problem here. When a caregiver has been part of the family, perhaps for years, and the client's will, drawn up by his attorney, includes "to Mary, in grateful recognition of her exemplary care and compassion, I leave etc." nobody is going to have a problem. But when an elderly lady with dementia presses a valuable item of jewellery on you, how are you going to be sure she meant you yourself to have it and that she wasn't under the impression that you were her granddaughter? Especially, how are you going to prove that if somebody challenges you? Hence the regulatory authorities tend to apply Occam's Razor - the simplest solution being the best - and say no gifts, no tips, no incentives. Then there can be no doubt.

Castle Feb 2017
Exactly freqflyer. I think it is not only OK, but ethical. What on earth is ethics, other than an attempt to bring respect, exchanges within a possible range as related to time and attention given - I think the conversation tends to end with the broader discussions of nursing - where the bulk of activity is for shorter time periods and interchangeable people, as if calm, encouragement, humor, meaning, reliability and support, did not also improve healing.

Many times men are accustomed to giving tips and rewards, where women will look around at others and ask others first, "is this OK?" - where men are more accustomed to working in a broader work world where exchange of physical services are routine, and where proportional rewards are valued.

freqflyer Feb 2017
My Dad asked me before his finals days to please remember his two caregivers who had been with him for over a year..... as the caregivers were outstanding, patient, and always brought a smile to Dad's face every day... plus they would bring in balloons and small gifts for my Dad for his birthday, Christmas and for any holidays.   Christmas 2015 I gave them both, plus other semi-regulars, Target gift cards but first I checked with their Agency, it was ok.

Thus, after Probate is finished, I will forward checks to these two wonderful Caregivers.   Since my Dad is no longer their client, I feel it is ok to do this.

Castle Feb 2017
I find this attitude of blame and assumed harm to be extremely oppositional and prejudiced.

A case where cold uniformity is expected to be preferable to warmth and humanity, as if being "professional" is to minimize the value of those.

It is a case of standards for one part of a profession are applied with such a blind prejudice towards other parts, set up totally differently.

Yes, in a setting with interchangeable professionals, it makes no sense for an ill person to gift one of them. Yes there is a vulnerability and potential for time of life change of plan - and family are the key relationship, yet in today's and fragmented rushed world where so many drugs are given as routine practice, it can be harder to retain relationships of meaning with relatives who become "visitors" - not actively involved in daily care.

Difficult choices and realities, but interchangeable caregivers do not represent not the whole picture, and I cry for the people who DO spend extensive time helping one particular patient over years at times - only to be set aside by that person's family and by their own profession, who also do not know the patient as they work hard to do.

I believe any gifts should be given openly; I was left money in a will after 3 years of being lead home caregiver for an elderly man with one daughter who lived across the country.   I lived in his home for half the week, the other caregivers the other half.  Yes, money managers should be involved.  The other 2 caregivers also received monetary gifts in the will, proportionate to their time and roles.

My interest, ingenuity, life wisdom, humor, and close monitoring of details and shifting adaptations as his needs, strength and care options evolved - so that I noticed and caught up with errors of professionals even, who arrived part time, and thus did not focus on follow through care by using observation, they only asked him and checked their records, but patients are not always strong self advocates - someone alert and familiar helps.

A few times, I saved the man's life and certainly his comfort, brought him to all MDs, and drove him through the area to renew old relationships. Nobody expected him to live more than a few months but he lived 3 more years, and in that time, he also made up with several cut-off family relationships, which I worked deliberately to support. The relationship was positive, and I considered my professionalism not in choosing to remain distant, but in putting the trends in my patient's health first, and making sure I communicated about any changes or options.

When I placed my youngest brother in a rural environment, after taking him from home but seeing that he felt lost in the urban setting where I lived, I managed his care from a distance. And I was totally relieved and grateful to find someone whose attitude towards care was more familial and human in nature, than providing lists of services. Standards on paper might be fine in brief stays in a hospital, or for people who have caring families nearby.

They are sorely lacking for anyone who does not - but few plans are made in healthcare to support ongoing prevention and support, to prioritized stable, close attention for those with those with distant families.

For many elders, it is possible to leave them with a bank account, with limited funds in it. That way, they can pay for some odd gifts or to get their hair done - and tip the hairdresser as usual, without risking their whole legacy.  Any later gift in a will, can get family approval, again, within the limit of a certain range or % of what is available.

The professional conversation needs to move beyond the one-size-fits all throwing around of cautions that overlook the criteria of steady human relationships, and teach families to learn to know caregivers better, instead of analyzing the whole care process with a traditional economic focus, and assumptions based on outdated memories, always in the lead. The world needs to value and support human attention, not legal battles.

aimeejo55 Feb 2017
My older sister gave a visiting nurse to our mom's home a $15 tip! The following week this nurse came with her husband because mom "was so nice". Totally unethical!!! I couldn't find out the nurse's name or I would have turned her in. After this "husband and nurse visit" mom had jewelry missing. What a shame!

arianne777 Feb 2017
ohmeowzer -- Thanks for posting. You've validated my feeling that one should not give gifts to professionals like RNs. Purrr.

ohmeowzer Feb 2017
You,should go,to the nursing site called allnurses and ask , I'm a RN and it's unethical to accept any gifts at anytime ,,, people will buy our unit a pizza and that's as far as it goes now if they buy you a pizza 🍕 or cookies or shower gel ok but usually nothing else ..no money no big gifts ..you can be turned into the board and lose your license ...

arianne777 Feb 2017
Aside from legal or ethical considerations, I feel that giving money to a nurse practitioner is insulting to their professional status.

Countrymouse Feb 2017
Pam Stegman makes a good point about the possibility of being a beneficiary: there would be nothing necessarily wrong with a legacy. But the OP cites major items, and "patients" plural, and one has to wonder how many specially close relationships this practitioner can have forged with her patients.

Countrymouse Feb 2017
It might be technically legal, but it's massively unethical and definitely going to breach professional guidelines. So no. And you might remind her about Harold Shipman, who didn't get caught until he forged a patient's will.

pamstegma Feb 2017
If the patient is still alive, it would be unethical. If the patient has passed and named their medical person as beneficiary in a Will , it would not be unethical. However the Will could be challenged in court by the decedent's children if they were left out of the Will.

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