Gifts From Patients: Accept or Reject?

It’s gift-giving season again—although for oncology nurses, managing material expressions of gratitude happens all year long, not just during the holidays. This can be a complex issue for all healthcare providers but especially oncology nurses, who develop a special, unique bond with patients and their families, who often want to show tangible appreciation for their care.

Do you or don’t you accept a gift from a patient? Is a certain type of item or dollar amount OK? What about baby gifts or wedding presents?

The short answer: maybe. Although it is never appropriate for a nurse to accept a gift of a large monetary value—be it an item or cash, a gift card, or tickets to a concert, the theater, or sporting events —smaller tokens of appreciation might be acceptable. Consider the following situation.

When I was in my first year of practice as an oncology clinical nurse specialist (more than 30 years ago), my patient Lin offered me a personal gift. Sure, I had been the recipient of many gifts— flowers, chocolate candies, homemade food—but all had been shared with the entire staff. This situation was different: She was presenting me with a small, hand-embroidered hankie. No note, no verbal thank-you—just a smile and a bow. I had first met Lin about 10 months before, when she was diagnosed with acute lymphoblastic leukemia. She had worked long, hard hours as a housekeeper; had a devoted husband and 2 beautiful boys, both in elementary school; and barely spoke English. I was the nurse who helped her understand her diagnosis, her access device, and her complex 2-year chemotherapy protocol, with all its adverse effects. She had just finished her initial phase of intense treatment and was transitioning to maintenance therapy.

I carefully and quickly evaluated the situation based on some of what I had learned in nursing school about accepting gifts:

• Monetary value: The small gift was clearly inexpensive.
• Homemade versus purchased: It definitely was homemade. I wondered how Lin had done such beautiful needlework, considering her peripheral neuropathy.
• Stage of relationship: We had a long-term but always professional relationship.
• Timing: Her gift was offered as she completed initial treatment.
• Intention: I truly believed it was a heartfelt thank you and not a quid pro quo.
• Cultural consideration: Rejecting her gift could be perceived as devaluing it and being rude or impolite.

I accepted her gift with a sincere “thank you,” and then shared the situation at my next meeting with my manager. This incredible leader simply asked, “Would you do anything differently next time?” What I have since learned is that I need to ask myself additional questions:

• Could the gift be viewed by others as a tip, bribe, or favor?
• Is the giver seeking preferential treatment?
• Would accepting the gift change my professional, therapeutic relationship with this patient or any of my other patients?
• Could accepting this personal gift affect my relationship with my colleagues?
• What do my organizational policies or professional standards say?

We want our patients to know that we treat all patients equally, regardless of their ability to pay or give gifts. The receipt of anything other than a token gift of low monetary value could compromise a professional, therapeutic relationship. The challenge is defining “token gift,” which can be very subjective.

Many employers have created policies in an attempt to prevent any perceived conflict of interest. For example, one healthcare organization states in its code of conduct that employees “will never accept gifts of money or cash equivalent, including gift cards from patients or their families.” The National Council of State Boards of Nursing states that “accepting inappropriate gifts (beyond a thank-you card or a gift of food to the unit, etc) is a warning sign in crossing professional boundaries.”

So how can you handle the offer or presentation of a gift? If it is expensive or could be perceived as more than a token gift, then politely decline it. Let the giver know that accepting gifts is against your employer’s policy. Suggest that they instead:

• Bring popcorn, cookies, a meat and cheese tray, or fruit to share with the entire staff (divided into 2 or 3 platters so all shifts can enjoy).
• Complete an employee recognition form (provide the document or link) or write a letter.
• Make a contribution to the clinic, unit, or facility; often, a foundation has a fund.
• Donate to their favorite cancer charity in honor of you or the clinic or unit.

If you have any questions about receiving a gift or concerns about a colleague who accepted one, start by reviewing your organizational guidelines. Have a direct discussion with your colleague or your manager, explaining the reasons for your concern and the potential impact for the patient, other patients, and staff.

Consider championing a proactive approach at your facility to clearly communicate that staff are not allowed to receive monetary gifts or the equivalent. Create a statement—e.g., “It is our policy that staff may not accept gifts of any kind”— that can be shared with new patients in their information packet about the facility, parking, visitors, etc, and suggest alternatives for redirecting gifts.

Remember that most patients just want to show their appreciation and that for some people, visible symbols of caring and love speak the loudest. And yes, I still cherish my hankie from Lin, who died a few months after I received my gift.