Advice on hospice social worker role

And just how much NURSING training does she have??????? What would she do if you (or anyone else) tried to tell her how to do HER job?

I dont care how many years hospice she has until she gets her degree and pass her state boards she is oversteping her role, yes you are a team but the RN is the head of that team. What would happen if she was doing care and the patient got injured? Whose licences is she working under? The home health aides follow care plan made by the RN and is supervised by the RN at the first visit and then q14d verbal and qmonth observed with the patient. they can only do what is assigned by us, no more. Your boss should of sat her down and told her she is wrong. I would go to the next higher up. We support you!

I do home care and the SW on my team does alot of joint visits with me. Both of us wear street clothes ( not scrubs ) per my hospice's policy. I do all kinds of personal care and procedures in street clothes so the type of dress someone is wearing really doesn't matter. I am grateful that the SW is not squemish about assisting me when needed. We do always get the pts permission. For example: she has assisted me to turn and reposition a pt.; hold a flashlight for me to do a cath. etc. She is well aware of what she can and cannot do and is always willing to assist if possible. We have developed a great working relationship which I am grateful for. The example we set for patients and families that hospice is a "team" concept has served us well in some difficult situations. I would never expect her to bathe a patient but she certainly can assist in helping to turn and hold a patient. I always keep the patient covered except for the area I am working with. The hospice team has alot of different roles but none is more important than another. We need each other to be able to effectively meet the needs of our patients and their families. Families have told me it is reassuring to them to see us working together.

Wow. So not appropriate for that social worker....it does sound like a power trip issue. I would try to get a family member going on a social work issue, ask them both to leave while they discuss said 'important' issue (funeral plans, the parts of sw assessment that don't need the patient directly, etc.) and you do the physical assessment. I would also keep reminding sw that you have a nursing license you will protect, and you will be using your judgement to decide what is and is not appropriate in your 'territory' ie, during medically related interventions. Can you visit the patient without the social worker? That might be what I'd try to do if it were me, otherwise I'd say something that would REALLY hurt the sw's feelings.....drives me nuts when others on the hospice team try to be nurses, too...

It might be an issue that goes away by itself after a while, once the social worker knows you and knows how you work. I had a dietician who used to go so far as to tell patients to ask for all kinds of drugs and medical equipment, some of which I had no access to (like motorized scooters). She would also suggest medications to patients. But after I'd been there about a year she totally stopped doing that. I don't know if it just miraculously stopped or she was talked to about it for doing it with other nurses, but now we work well together.

You are not wrong at all, Steph. Social worker is out of line, IMHO.

I guess I am playing devils advocate here but I'm really not understanding where most of you are coming from. My experience has been that ALL hospice team members are patient advocates and protect patient privacy. As the nurse/case manager I know that I am responsible for the team but have never considered my role more important than anyone elses. In the case mentioned, once the patient agreed to have the SW present it was a done deal. I never totally uncover a patient even when I am alone with them. We need to protect their dignity and modesty. We should all have been taught this in nursing 101. I can do a complete assessment, bathe a patient and keep them covered the whole time. You only uncover the part of the body you are working with at any given time. Part of the role of a SW is to be able to identify pain, depression, anxiety, delirium and mobility when with a patient. I frequently get calls from the SW, who is with a patient, describing what they are seeing. they have called me about new skin tears, possible pain, anxiety etc. with the patient. Our aides and chaplains do the same thing. Of course they are not medical and do not do a medical assessment but know enough to call the nurse. I do feel the SW in this situation should have discussed her feelings with the nurse after the visit was over. If they could not have resolved it then they both together, should have taken it to a higher level for help in rsolving this. Hospice nursing is challenging enough without having the stress of internal team conflicts. I hope you can resolve this and let it go. Take care of yourself and appreciate that what you do can be difficult, Your team needs to be there to support each other.

My guess is your boss is not a nurse. She places both you and the sw in the uncomfortable position of exceeding/ignoring your scopes of practice. Yes, in hospice we work as a team, and there have been a few times when I've needed a sw to take the other side of the draw sheet and help me lift someone in bed, or order the 02 concentrator. But in the circumstance you were dealing with, the sw's I know would have had the good sense to excuse themselves and leave the room, or at minimum, turn away and use that time to offer support to family members while the nurse did her thing.

It has been interesting reading all the responses you have gotten. It just bothered me to hear the anger and vindictiveness in some of the e-mails. As I said before, hospice is difficult and challenging enough with patients and families without having conflicts with team membrs. I had a MAJOR disagreement with a SW a few months ago. It caused me alot of stress. the next day we went to lunch together and were able to talk about it. It wasn't easy but it was resolved and we didn't have to involve anyone else. We have a great working relationship and the incident has not been mentioned since. I hope for your sake that you are able to put this behind you. It can be challenging working with a team, lots of different personalities, beliefs systems, roles. Hope you have received some good feedback and positive support.

Maryann

The hospice team is one of the wonderful things about hospice. No one is more 'important' than anyone else, and everyone has a specific role to play. I help the aides give baths and do personal care, I pray with the chaplain when he prays with patients, I gather information for social work. I also appreciate it when they call me and say, "Mr. X is in pain and he was wondering if he could take his meds now?" or call me with any other information. The patients often tell the aides things they don't tell anyone else on the team, and I encourage that relationship.

I stink at giving baths, I am not an authority on religion, and I don't know much about what is available for ancillary services in the community for our patients. Aides, the chaplains, and social work are the experts in these areas. I would not presume to give pointers to the aides on baths as they've been giving them longer than I've been alive, I would not tell the chaplain he's not praying right, and I wouldn't tell a social worker that he/she isn't doing his/her job right. I sure as heck wouldn't get my 'feelings' hurt if I got kicked out of the room while patient had a bath or prayed, or whatever. There are times when I need to step back and let the specialist take the lead. There are times when the other members of the team have to do this, as well. It boils down to trusting the others on the team. When a new person is added to the mix, then I think the best approach is to let them use their professional judgement and withhold comment until or unless something happens to prove their judgement isn't so hot. I don't feel like I'm in charge of the team as such. I'm kind of the jumping-off point, a centralized location to organize and communicate to the team what the patient might need.

Well, from everything I've read here, Steph, I believe you were correct in your judgement and it should never have been taken "personally". I have never worked hospice, and I agree, they are a wonderful breed unto themselves, and may well do things a bit differently, and certainly do consider themselves a team. But I would have done the same as you, certainly, and I think your SW allowed herself to feel "left out" for some odd reason... don't quite understand her reaction... but I feel you did exactly right.