Is it me or are Social Workers running the show?

[ShayRN]

Our social worker has a lot of say over who stays GIP, respite and who goes home. Yes, the theory in hospice is one of a team approach and the Medical Director has the final say, but honestly he usually does what she says. On another thread I see that a social worker was insisting a patient be medicated when the nurse felt it wasn't necessary. Is anyone else seeing a trend where the social workers are having more and more control in the inpatient settings? Is it about money? What is going on? (I should also say I do like the social worker at my place, just think that those on the front lines that are clinical people are better able to judge who is too sick to go home.)

[SunDazed, BSN, RN]

The social workers in the hospice where i am vary some. Two will very clearly say symptom management is nursing and medical. Two or three others will basically talk over the nurse, exclude the nurse in GIP discussions, and/or request patient family's call them for symptoms... so that they can notify the nurse. Seriously?

I have noticed that one wants to be in charge of everything, but doesn't share with the team what she is doing in conversation, meetings, or email. Her desire to be in charge though comes to an abrupt halt at 4pm or any school holiday. Then the nurse who doesn't have any of the same information has to find a way to get the patient home from GIP, or work late to catch up all the charting... this SW wants to do everything but won't chart anything. Yet the charting must be done. Right? The medical director is asking me why the patient wasn't required to revoke for the aggressive treatment... I have no idea... they have not updated me on any aspect of the case. Ridiculous.

My boss thinks I will volunteer for too much overtime and quit... because we aren't covering all the patients all the time in flu season. I won't quit for that reason... I will quit because the SW leaves me hanging way too often.

[SunDazed, BSN, RN]

I think Hospice is unique regarding your question - maybe this would be better in the Hospice forum.

One thing I notice is that some social workers forget that nurses have a role in the psych/social welfare of patients and it is part of our nursing practice. However, they don't have a role in the medical side of patient care. That can get sticky.

I'm interested in hearing others thoughts on this.

Hey Steph.

I do chart more to the psych/soc than I did while I was orienting. Part of that was because the person training me always skipped it. When I got my own patients, I noticed the SW on the same case charted on the patient and family once at first visit, then not again ever. Really? So when the family situation is evolving and we need to justify Respite or something else... it isn't obvious from the documentation. So as with all new areas of nursing I see my own charting evolving to match what I am doing... because though it is a team approach, the SW appearently is not required to document?

I also posted elsewhere that one SW really thinks she is in charge, and the nurse case manager is just someone she uses when she can't find a way to work around it.