The bulk of my job consists of discharge planning, which basically consists
of tasks like ordering durable medical equipment, reserving a bed at a skilled
nursing facility, arranging home health care, and calling an ambulance to
transport a patient. Not sure why social
workers get relegated these tasks, as they're not really social work
related. Part of me feels like the
hospital administrators are using us as nurse case manager secretarial
assistants until drug overdose or abuse case walks through the door.
I think the most frustrating part about discharge planning is getting inundated with medical-related questions that I am not equipped to
answer. Here are a few examples:
Coworker Nurse: So, what did they say in rounds about the patient in room X?Me: [Looks at my notes with misspelled names of meds, lab readings I don't understand, and medical procedures I'm not familiar with] Uhhh... they said the patient has high potassium levels. I guess that means the patient can't go anywhere?Coworker Nurse: What do you mean? Why can't they give the patient <mystery drug> and monitor him at the nursing home?Me: Uhhhh...
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Skilled Nursing Facility: Do you know what is being done to address the urinary tract infection?Me: The patient is on antibiotics.Skilled Nursing Facility: Do you know why the doctor ordered <antibiotic x> instead of <antibiotic y>?Me: Uhhhh...
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Patient: Can you tell me exactly why I'm still here in the hospital?Me: Uhhhh...Family member: What exactly are you doing to treat my mother's medical condition?Me: Uhhhh...
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Home Health Agency: Can you tell me if the patient is still vomiting?Me: (Frantically flipping through chart) I don't see anything saying that.Nurse Case Manager: (Points to an indecipherable scribble) Says "vomiting" right there.
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-------------------------------------------------Dialysis Clinic: Can you explain what's being done to address this abnormality in the patient's labwork?Me: Uhhh...Dialysis Clinic: Can you call me back when you have your stuff together? [click]
Assisted Living Facility: Can you explain to me why the patient needs 10mg instead of 5mg of <mystery medication>?Me: Uhhh...
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Me: Hi, I'm calling to obtain authorization for home health.Insurance company: Alright, but can you first explain how this patient is meeting insurance criteria for this inpatient stay?Me: Uhhh...
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Nurse Case Manager: Do you feel that from a medical standpoint, the patient is ready to discharge home?Me: Uhhhh...
I don't know how many times I've had to use the phrase, "Sorry, I'm
not a nurse/doctor/pharmacist/physical therapist/etc." in response to
these questions. Another favorite phrase
of mine is, "Sorry, that's outside my scope of practice." Regardless, the tone of the person I'm taking
to changes when they find out I'm not well-versed in medicine, as if they're
saying, "Oh, I can't trust this idiot because she doesn't know what she's
talking about." I oftentimes wonder
if the medical professions around me consider social workers the dumbest
masters-level employees at the hospital.
The fact that certain employees with associates and bachelors earn tensof thousands of dollars more than me seems to reinforce this idea.
One day, I brought up my concerns to my nurse mother and her nurse friend
over dinner. Her nurse friend said,
"Well, the problem is that sometimes the social worker thinks that he/she
can be a nurse when that is not the case."
She then brought up an example of how a social worker once approached
her about a coughing patient, stating that she needed to be treated for
pneumonia. Of course, my mom agreed with
her friend and laughed at idea of social workers "pretending" to be
nurses. Mildly offended, I responded,
"Well, another problem is that nurses think that they can be social
workers when they lack social work training. Furthermore, social workers are often placed positions where they
expected to answer nursing/medical related questions." My mother's sensible nurse friend agreed with
the points I made. My mother, on the
other hand, pretended she didn't hear a word I said.
Social workers are not trained in nursing.
Hence, we really should not be responsible for nursing knowledge. That is, unless they want to pay us to go
back to school for a nursing certificate and then pay us nursing wages (sound
familiar?).
I suppose by creating more definitive boundaries between job tasks we
should and should not do, we social workers can demonstrate to our co-workers
and patients that we are knowledgeable and proficient practitioners.
I understand your frustration. The biggest thing I am dealing with right now, is including our nursing staff in discharge planning. Since I'm "just a social worker" their medical expertise is necessary. But if I ask them for help, they tend to get resentful for adding more work or because they don't want to be the person making the decision if it is felt the person is not stable enough for discharge. But I have learned my lesson about how crazed they get if I DON'T include them in the discharge planning. It's one of those situations where you're damned if you do, damned if you don't!
ReplyDeleteI'll often use the phrase "sorry, that's a little above my pay-grade". Thankfully, the nurses on my floors are pretty cool, though I can tell that there are a few of them who think I'm an idiot. Admittedly I've had to learn a little more about blood work, chemistry, medication, and treatment plans than I've ever wanted to. And the truth is that I really shouldn't have to, since I'm not licensed to give medical information. But in order to save time and avoid repetition, I've found it easier just to learn it on my own, especially since those who are in a position to more adequately address these questions may not be available when I need them. And in the event they are, and humble themselves long enough to oblige my modest inquiry, I'm made to feel like some kind of moron for not knowing in the first place.
ReplyDeleteIn order to get an idea of what social workers could do to make a difference, I decided to go to the source - a journalist. social work college
ReplyDeleteI work in a "long term care" setting and I laughed out loud at your examples of talking to doctors and nurses. I have the same issues, and I especially love the look of supreme irritation on their faces when I don't know the difference between two types of antibiotics. Just remember, the next time a wack-a-doo family comes in, or a client is having some of those messy, messy emotions they'll be super glad the social worker is there to clean up. Hope you don't mind that I linked this on my blog post (is it rude to put the address? http://www.breakthenice.com/what-do-people-think-of-social-workers/)
ReplyDeleteToday was a rough day for me at the hospital and as a medical social work I thought it would be wise for me to research ways to over come burnout... then I ended up on your page. You words made me laugh out loud in excitement when I read your posts. Everything you write is comparable to what I have to go through day-in and day-out. I would like to thank you for your honesty and the reality you set with this stressful job we share together. I will continue to follow your blog. Just it's good to remember that you are not alone.
ReplyDeleteThank you so much! I really appreciate the positive feedback. Glad I can provide some much needed humor and relief!
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