Advice on hospice social worker role

[Spidey's mom, ADN, BSN, RN]

Good morning - I need some advice but I'll give you the scenario first.

I opened a new patient two days ago. The social worker always goes with the nurse so we get everything done on the first visit. We are also a small rural hospice with 3 nurses and at the most 12 patients. We only have 3 right now.

This patient is over 400 pounds, with weeping edema to his legs, groin, abd. After the social worker did her thing, I began my physical assessment. Part of the assessment was to take the blanket off (he was naked due to the fluid running off his body). I asked him first, was it ok if the social worker stayed during the assessment. He said ok. As I moved in front of him I was between the sw and the patient and said with a smile, "I'll be blocking most of the view".

Today, the social worker and the manager talked to me about the sw being a team member and it was ok if she helped with patient care. My response was that was fine but I was going to ask the patient's permission first. I'm the patient advocate and my role is to protect his privacy. The sw continued the conversation saying I shouldn't have said I would be blocking the view as that hurt her feelings, since the patient had ok'd her being there.

Now, I've never had a person have their feelings get hurt because my goal was to protect the privacy of the patient.

Do your social workers help with patient care? (I'm actually ok with that as long as the patient is ok).

Did I do anything wrong to the social worker?

steph

[tntrn, ASN, RN]

No. Not a thing. It sounds like a clear case of the SW thinking their role is different than what it really is. Being present during a physical assessment is one thing. Watching it all is something else.

BTW: I made that meat loaf last night to rave reviews! Thanks.

[Spidey's mom, ADN, BSN, RN]

No. Not a thing. It sounds like a clear case of the SW thinking their role is different than what it really is. Being present during a physical assessment is one thing. Watching it all is something else.

BTW: I made that meat loaf last night to rave reviews! Thanks.

Thank Progresso.

Well, as to the social worker's role . . .yesterday she went to the patient's home with the manager (who also takes call and sees patients) and helped her bath the patient and I think this conversation came up then and that she is a team member and can help the RN's.

Yes, but . .. . the day she was with me, she was there in a suit as the social worker.

steph

[tntrn, ASN, RN]

Yes, but . .. . the day she was with me, she was there in a suit as the social worker.

steph

I just decided I would post that our social workers are not in scrubs, or in other appropriate attire for doing the kind of patient care you described. Sometimes you'll see them in the classic heels/clipboard/powersuit.

[Spidey's mom, ADN, BSN, RN]

I just decided I would post that our social workers are not in scrubs, or in other appropriate attire for doing the kind of patient care you described. Sometimes you'll see them in the classic heels/clipboard/powersuit.

Well, she wasn't in scrubs yesterday either. Our social worker does not wear scrubs ever. She does the suit/clipboard but no heels.

steph

[rnchpn]

I think it is inappropriate for the SW to provide personal care I would think it is out of her scope of practice. I would of asked a SW to leave room while I do a body assessment.

[tnbutterfly - Mary, BSN]

Steph.....I think you handled the situation very professionally.

You are right......one of your major roles is that of patient advocate. You were trying to maintain a level of dignity for the patient. I'm sure he appreciated that. Perhaps the social worker needs to take a look at her job description. If she maintains that she is part of the team, she needs to realize that the focus of care of that team is the patient and his/her needs......not the needs of the social worker.

OK........climbing off my soapbox.

[leslie :-D]

frankly, this entire scenario sounds highly inappropriate.

had it been a nsg asst, then help w/bathing is fine and even expected.

but for a sw to assist?

no (*shaking head*).

sure, it may be incorporated into this specific facility, the 'one for all, all for one' philosophy...

but let's keep it in perspective.

steph, i would have a private 1:1 with the boss, and share your concerns.

they are reasonable and valid.

i think i'd be likely to make a professional stink about it, myself.

this should be all about the pt and their right to privacy/dignity.

if the sw feels hurt, then someone/boss needs to put it in perspective for her.

let us know what happens.

leslie

[shrinky]

While the MSW may be a part of the team, she/he is not that part. Our MSWs would never think of giving personal care such as a bath. Honestly I don't believe thay learn how to do that in school or in their orientation. I would have asked the patient the same question, I don't believe a Social Worker as well as a chaplain would want to assist with personal care or see a patient naked. Ours would leave the room to talk with the caregiver and really don't like that bodily stuff, that's why they went into social work and not nursing. Keep up the good work that you do, your patient I'm sure appreciated your concern.

[Spidey's mom, ADN, BSN, RN]

Well . . . . . I met with her and our boss.

I started with I just wanted to clear the air and get rid of the "gorilla in the room". Funny thing was there was a huge life-sized stuffed bear there for our Teddy Bear Clinic along with the health fair tomorrow and she thought I didn't realize the bear was a bear.

We sat down to have lunch together in the office and I simply said that my only concern was to ask the patient if he was ok with the social worker staying while I did my assessment as I would have to expose his entire body by removing the blanket. And the patient was fine with it. It was that simple.

She started to talk and I asked her to let me finish. I told her that my role as an RN was to be the patient advocate and assure the patient's privacy rights. I mentioned some of the things you all said - standard of care, Nurse Practice Act, etc. That should have been it.

She said that she has had more training in hospice than me and the hospice philosophy reigns over my nursing regs - and that is we are all team members and are allowed to be involved with patient care if needed. She said I didn't know enough about hospice to make a correct decision.

I said that I'm an RN first and foremost and I'm bound by the Nurse Practice Act. She disagreed - hospice comes first. (I can see that she really doesn't get the legal aspects of nursing). And today she said I asked the patient 4 times if it was alright and that was wrong to do . . .well, that is simply not true. He kept saying over and over that it was alright - but I only asked once.

I mentioned that she has on occasion crossed the line and told me how to do my RN job - she said that she should have the right to say things about a nurse's role as long as it wasn't a med question.

It escalated to her attempting to make a big deal over a very simple issue.

Finally, we decided to leave it alone. I can't convince her and she can't convince me.

steph

[tnbutterfly - Mary, BSN]

What did the supervisor say to all of this???

I am just not believing this. Good grief!

[Ms.Hobbes]

That was my question also. How can a nursing supervisor not recognize and support standard of practice, scope of work, etc. When I worked in home health and filled in for our hospice nurses we never had the SW doing patient care. That is just simply not their role.

Maybe you should pole other hospice nurses and see if they have SW's helping them. SW's are part of the interdisciplinary team, but each peace of the team does something a little different. Maybe you should ask your pastorial staff to start giving bed baths?? LOL

Good luck, hope it resolves itself quickly :-)