In Long-Term Care, What’s Favoritism?

By Sheena Jones, an LPN who is in training to be an RN at Dutchess Community College, Poughkeepsie, NY

Birthday Cake/by Eggybird, via Flickr

Is it really fair when we get the favoritism speech from our superiors when we supply residents who have no family or friends with hygiene supplies? When there are two roommates and one has family and friends who visit daily and bring her all that she could need or want and the other has nothing and no one? Am I wrong for getting a couple of supplies from the dollar store for her? We all know that the hygiene supplies in many facilities are watered down and cheap. Am I wrong for buying someone some socks when they have none? We can’t share supplies or clothing between patients, so do I let someone walk around with nothing? If these people were my family or friends I would want someone to make them comfortable. They can’t leave the facility to go shopping with family or friends, and many of them have lost most of their mental capacity and have no one to help them—but that does not mean that they should walk around less put together than someone with a family? Do we just let these residents go without?

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Sunny April 19, 2010 at 10:54 am

    I agree with the anonymous donation comment. This would avoid the feeling of favoritism amongst other residents who might be more alert to the situation. However, taking some of your hard-earned dollars to help those that are less fortunate is something that I always felt was part of the basic foundation of nursing.

  2. Carole Ball April 15, 2010 at 2:43 pm

    Dear Sheena Jones,
    I too hate to see people go without basic items that could help them to feel more comfortable. I applaud your kindness.
    Douglas Olsen wrote very thoughtful, and obviously well considered comments about the ethics involved in the patient, nurse relationship. Mr. Olsen discussed the considerations that must be given to maintaining a therapeutic relationship between a resident and a nurse, as versus a friendship. I would give his comments a thumbs up!
    Looking at the issue from a practical viewpoint, i.e. the resident without would be able to receive needed items to make their life more comfortable….
    Perhaps antonymous donations could be accepted from staff and or resident’s family and friends to keep some basic supplies on hand for those without them.Those items could be distributed discretely.
    If more people were involved in helping those residents without resources, it might eliminate the taint of favoritism.
    Caring ethics can prevail!

  3. Douglas Olsen March 31, 2010 at 12:34 pm

    You raise issues that go to the very core of ethics in nursing. In our hearts, we want to say “No, you are not wrong” – your feeling for what it means to be a nurse is most certainly not wrong. Nursing and nursing ethics likes to see itself as the health care profession with a special sense of relationships and context. Nursing ethics, as a discipline, is a leader in relational and caring ethics. Nurses want to value the real relationships we form with actual patients. This means an ethics that asks the question, “What is the right thing for me to do with this patient here and now?” rather than “What should any person do with any similar patient?” An ethics that focuses on responsibilities in our connection with patients to do the best we can for each patient, not just an ethics to prevent abuses. (Some very sophisticated philosophical work has been done to address this question in nursing, See Per Norvedt, Chris Gastmans and Vangie Bergum.)

    There are questions to ask about relationships with particular patients to help you act ethically. What is the basis of your connection? If you are more connected to one patient than others based on arbitrary factors, then special favors may not be ethical. Is the patient “cute”? What about uncute patients? Is the patient verbal and pleasant about expressing needs? What about the patients less skilled at social engagement? You’ve suggested that you’re doing things on the basis of need which is more likely an ethical basis.

    Here are some other questions you can ask about relations with particular patients and acts that might seem above and beyond to help decide what is right:
    – What does this mean to the patient?
    – Could the patient be developing expectations for the relationship that you will not be able to fulfill?
    – How do others view the relationship?
    – What would my colleagues say?
    – What would other patients say?
    – Are the “extras” still within the role of nurse or am I expanding the boundaries of our relationship?
    – Am I benefiting?
    – If yes, how? – Material benefit is inappropriate, but so is feeling flattered etc.
    – Am I keeping in mind the power differential in our relationship? (It often takes student nurses time and experience to realize the patients look to them as authorities. This is unavoidable and desirable. As a nurse bring skill and expertise to the relationship, including expertise in how to use the relationship for the patients benefit.)
    – Could you end up having patients competing to get you assigned to them? (I wonder if this and other similar considerations cause concern in the administration.)

    Douglas P. Olsen is a nurse ethicist with the National Center for Ethics in Health Care at the Veterans Health Administration in Washington, DC. The views he expresses here are his alone and should not be construed as representing those of the National Center for Ethics in Health Care or the Veterans Health Administration.

Comments are moderated before approval, but always welcome.

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