Advice on hospice social worker role - page 2

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... Read More

  1. by   Spidey's mom
    Quote from 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 :-)

    The main issue is whether I should have asked the patient whether she could stay or not. Since we are a team, she thinks I don't need to ask at all.

    steph
  2. by   Ms.Hobbes
    Well when I worked in home health or even in the hospital I would even ask them if they wanted the family members in the room during the more revealing assessments. It is common courtesy, sounds like the SW might be on a bit of a power trip if you ask me?
    I always found my MSW's to be very helpful, resourceful, and respectful of our different roles.
  3. by   Spidey's mom
    Quote from Ms.Hobbes
    Well when I worked in home health or even in the hospital I would even ask them if they wanted the family members in the room during the more revealing assessments. It is common courtesy, sounds like the SW might be on a bit of a power trip if you ask me?
    I always found my MSW's to be very helpful, resourceful, and respectful of our different roles.
    I mentioned that and she came back with "This is not acute care - this is hospice and it is different". And since she has more training than I do, I don't know what I'm talking about.

    steph
  4. by   leslie :-D
    Quote from Spidey's mom
    The social worker still isn't convinced that nursing rules trump hospice rules.

    steph
    it should be of no concern to her about "nursing rules".
    she should only be focused on her scope of practice and the hospice philosophy.

    i found this link that gives much insight into the role of the sw in palliative/eol care.
    i'm thinking it may benefit her to print this off and leave it on the bulletin board in the office.
    (and to make it less obvious, a printout of the nurse's role, may take the focus off of her.)

    NASW Standards for Social Work
    Practice in Palliative and End of Life Care


    http://www.socialworkers.org/practic...ds/default.asp

    you may want to scroll down to "Areas for consideration in the comprehensive assessment..."
    there is nothing remotely close that states sw part of physical assessment.
    and being part of a "team" commands respect in allowing other members, to do their job.

    leslie
  5. by   leslie :-D
    Quote from Spidey's mom
    I mentioned that and she came back with "This is not acute care - this is hospice and it is different". And since she has more training than I do, I don't know what I'm talking about.

    steph
    oh, this is such bs!
    yes, acute care is different...
    but PATIENTS RIGHTS REMAIN THE SAME, REGARDLESS OF SPECIALTY.

    yes, i was yelling.

    leslie
  6. by   Spidey's mom
    Quote from leslie :-D
    oh, this is such bs!
    yes, acute care is different...
    but PATIENTS RIGHTS REMAIN THE SAME, REGARDLESS OF SPECIALTY.

    yes, i was yelling.

    leslie

    Thank you - I tried to get that across many times but it was futile.

    The nurse's role as patient advocate and protector of privacy is the same regardless too.

    steph
  7. by   leslie :-D
    just continue to do what you've been doing.
    should she be w/you at another pt's house in similiar situation, you excuse her from the physical assessment.
    mrs. hobbes is right, in that i too, always ask spouses to leave bedside until/unless pt wants them there.

    don't change a thing, steph.
    you tell her that if she has a problem, to bring it to the boss.
    in the meantime, it may not hurt for you to start writing any interactions down.
    you just never know where this crap will lead...

    leslie
  8. by   tnbutterfly
    Quote from spidey's mom
    i mentioned that and she came back with "this is not acute care - this is hospice and it is different". and since she has more training than i do, i don't know what i'm talking about.

    steph
    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?
  9. by   rnchpn
    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!
  10. by   Maryann RN
    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.
  11. by   tencat
    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.
  12. by   Maryann RN
    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.
  13. by   jerseyRN
    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.

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