Dilemma 3 - Nina

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You overheard a conversation between Nina’s mother-in-law and a health care assistant who is also of the same culture. Nina’s mother-in-law praised the care that the HCA is giving Nina. She states that how she and Nina values her help and patience unlike the rest of the staff. She presses an envelope into the HCA’s hand, saying ‘I don’t want you to feel obliged or embarrassed or anything. See you next week,’ and rushes away. The HCA notice some currency notes and put the envelope into her pocket without being aware of your presence.

-- Anonymous, November 18, 2001


Decline any offers of gift, favours or hspitality which might be seen as an attempt to obtain preferential consideration

-- Anonymous, November 20, 2001

a nurse should avoid taking gifts or money from patient or patient's relatives, as these people may see it as a right to ask for special favours to the nurse which might not be beneficial to the patient. The patient and relatives may find the acceptance of gifts from nurse as them having precedence over other patients.

-- Anonymous, November 20, 2001

I will apprehend the HCA and tell him/her that we as staff are not allowed to accept any thing from clients because we are doing our job and we do not have to accept gifts from them because if we do then the clients and their relatives think they have to pay us all the time to provide care, and this is not right.After doing that i will then go to the charge nurse or manager and report the incident.

-- Anonymous, November 20, 2001

Health proffessionals and care givers are not allowed to accept any gifts from patients and their relatives.The HCA was wrong in accepting the money for Nina's care

-- Anonymous, November 20, 2001

The HCA is not governed by the ukcc as they are not registered care givers.There is nothing wrong with accepting the gift but the HCA should be aware of the fact that not all people would agree with this and if he is comfortable with this then its all good - self discipline and awareness are the key to solving this dilema

-- Anonymous, November 20, 2001

I feel the HCA should inform the members of staff that she has received this little parcel. This was clearly a gift and should be considered as that. Look at it as a tip a waitress gets from a willing and grateful customer.

-- Anonymous, November 20, 2001

l feel that there is nothing wrong with the HCA accepting the gift,because he or she did not solicit forit and HCA are not bound by the UKCC Code of conduct

-- Anonymous, November 20, 2001

the HCA should have informed someone (staff member) that she had received some money. Health Professions can accept gifts from patients or their relatives, be it chocolates or money!

-- Anonymous, November 20, 2001

HCA positions are currently being reviewed by the UKCC which is also currently under review itself. However, eventhough, HCA are not currently answerable to the UKCC it is still ethically wrong to accept gifts in the line of duty. Most Trust have their own policies regarding conditions of employment. However, the UKCC code of Profesional Conduct (1992)(15) clearly states Nurse's should refuse any gift, favour or hospitality......... which might be interpreted as seeking to exert influence to obtain preferential consideration ..." This I feel is an important issue. In that Nina's mother may have felt that the qualified nurses in this particular case, did not " recognise and respect the uniqueness and dignity of each patient and client, and respond to their need for care, irrespective of ethnic origin, religious beliefs, personal attributes, the nature of their health problems or any factor" UKCC Code of Professional Conduct (June, 1992)

-- Anonymous, November 20, 2001

The UKCC Code of Conduct 1992 states that, as a registered Nurse....,

Clause 15 - refuse any gift, favour or hospitality from pateints or clients currently in your care which might be interpreted as seeking to exert influence to obtain preferential consideration.

Yes, it could be argued that the HCA is not a registered nurse, but in terms of the guidelines of professional practice (1996), 'if you delegate work to someone who is not registered with the UKCC, your accountability is to make sure that the person who does the work is able to do it...'It could then be argued that as the registered nurse, you are accountable if the HCA, does not "refuse any gift, favour or hospitality from pateints or clients currently in your care which might be interpreted as seeking to exert influence to obtain preferential consideration". The reason being that Nina's mother in Law is praising the HCA, "unlike the rest of the staff" and this can be interepreted as seeking to influence the HCA for Nina to obtain preferrential consideration. The accountability bit of the registered nurse comes from the context of "making sure that the person who does the work is able to do it", because if they are able to do it, there is no need for payment in cash or in kind for the care they are providing.The fact that the HCA does not approach members of staff with this issue of the envelope, raises questions one has to 'safeguard and promote the interests of the patient' and 'uphold and enhance the good reputation of the profession'.In doing so, i will have to approach the HCA and explain to her that we are not allowed to accept gifts in cash or in kind from clients as this breaches the policy of the ward, (and besides, this HCA is being paid alot of money, working for an expensive agency, so she should not be accepting gifts). I would take this issue to the nurse in charge also, so that i don't get accused of omissions of my part. the most likely action to be taken, is to explain to Nina's mother in law, when she returns, that staff are not allowed to be given gifts in cash or in kind, and then return her money to her.

-- Anonymous, November 20, 2001

I think the behaviour of HCA is not acceptable. Caring for people is job, HCA can't take the money from the relative of the patient or even patient herself. I'll report HCA.

-- Anonymous, November 21, 2001

I feel that taking money is not acceptable but I feel that the HCA should have told Nina's mother in law that she can accept something like a card, flowers or chocolates if she really wants to express her gratitude.I feel that the money could have been donated to a mental health charity otherwise

-- Anonymous, November 21, 2001

I think that the HCA should avoid accepting any gift including money from client relatives. The UKCC code of conduct does not allow nurses to accept any gift or money from clients or relatives, although they are not nurses this should apply to all health care professionals.

-- Anonymous, November 22, 2001

clause 15 UKCC code of professional conduct 1992.. if she informs me or the authorities that be then she can take her gift.

-- Anonymous, November 23, 2001

HCA's Like all other staffs Should under no circumstance accept any gift from patients or their carers. Hence I will report the incident to my line manager!

-- Anonymous, November 23, 2001

is breach of professinal code of conduct as aresult i will report this issue

-- Anonymous, November 23, 2001

In respect to the UKCC code of professional conduct, staff under no circumtances should accept gifts from patients or their relatives. I will therefore report it to the manager.

-- Anonymous, November 23, 2001

There is nothing wrong with care givers accepting gifts from patient`s relatives, what matters is the motive behind the giver.If they are giving a gift in return for special favours and the recipient is aware of this and continues to accept gifts then thats wrong,but if gifts are given with no strings attached then thats perfectly fine.It will be good practice though to inform other members of staff if any gifts are given, that way care givers can cover themselves. i would tell the HCA that it will be better for her next time not to accept gifts in privacy especially if others are aware of it .

-- Anonymous, November 23, 2001

Once the HCA declares the cash to a superior, then there's no problem! However, I feel that I have a duty to broach this subject with her tactfully.

-- Anonymous, November 23, 2001

I believe if the motive was to act as a bribe to provide a special care to Nina, then I will ask the HCA to return the gift. However, if it's just to show an appreciation, I don't really see any thing wrong.In some African cultures, most people show their appreciation be giving money since the recognised and acknowledge the hard work done by staff.

In soo many instances, relatives of patients have left cards, chocolates and biscuits to staff and in all instance, they have been consumed as this seems to be the culture in UK.

-- Anonymous, November 26, 2001

Even though the HCA is not registered with the UKCC, She should not accept any gifts from patients as she is considered as a healthcare professional.

-- Anonymous, November 28, 2001

Unfortunately health care assisstants are not regulated by any professional body but I would advise him not to take any gifts or monies from patients and relatives and ask him if possible to find out why ninas mum gave her that money. Otherwise the intensions could be very different ie seeking special preferences for nina from him or her depending on the sex of the HCA.

-- Anonymous, December 06, 2001

Accepting a gift from a patient relative is seen as morally wrong but it depends on the nature of the gift. Before deciding whats wrong and whats right it is best to check the hospital's policy on accepting gift from patient.HCA's may not be goverened by UKCC Code of conduct but it does not mean they are seperate entity from qualied staff because they are acting in the best interest of the patient. I cannot think of any set precedents or case law in parliament that states 'staff should not accept gift from patient'. ' one person's moral might be somsbody's else's punishment'. Good for the HCA, you deserve it and your work as a dedicated staff is recognised and appriciated. If all relatives offer an envelope of appriciation we will have a wealthy NHS and better staffed.

-- Anonymous, December 09, 2001

The health care assistant should not accept the money given by Nina's mother in law. Probably in their culture it is natural giving gifts to health professional, expecting a better deliver of care. But if I oveheard, being a nurse on the ward I feel that is necessary to talk to the HCA, informing or reminding her of the hospital policies. Also I would consider discuss with Nina's mother in law such policy, also ask her if she has any comments or suggestions to make, she is welcome to do, as her comments would help us to reflect in our stardard of care.

-- Anonymous, December 14, 2001

I would indicate to the HCA that I had seen what had taken place,and ask her what she intended to do about it.If she indicates that she was going to talk to someone senior,well and good but if she was not,I would refer her to clause 15 of the UKCC and discuss it in detail with her.

-- Anonymous, January 13, 2002

l would advise the HCA to let the other staff know about the gift and if the others approve then she can keep it. l would also stress to her that under ukcc guidelines we should not be accepting gift from patient or relatives for care provided.

-- Anonymous, February 09, 2002

i think the fact that you are a nurse does not give the right to stop the HCA receiving gifts. some people also point out that HCA are not gorvened by the UKCC. i would only ask this individual to say why they are receiving these gifts and reiterate trust policy to them and document everything

-- Anonymous, February 21, 2002

The HCA is not covered by the ukcc code of conduct this will depend on the hospital protocol on accepting gifts.

-- Anonymous, February 23, 2002


-- Anonymous, March 12, 2002

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