Issues with therapists/social workers on the unit? (Long)

[can'twait2B1]

I work on an inpatient behavioral health unit, we have 20 beds at this time. The days are very scheduled and we as nurses spend most of our day in the rec room with our patients whether it is meal time, activity group time or free time. We also have social workers on staff who do a circle group or a process group. Everybody works well together and usually a nurse and tech will be in every group for safety reasons and to pull a patient who is disruptive, its always worked this way on this unit.

Well last week was a different story, a coworker of mine said that a patient who has BPD really railroaded the circle group with her behaviors and complaints, this significantly upset several patients, she said she didnt feel that she was allowed to remove this patient because the lead therapist did not want nursing to step in.

Being the charge nurse, I took it upon myself to ask the social worker what was expected of nurses during these types of situation because we had always helped out and removed them for some one on one time to get the group back on track,

He was very offended and said "the groups only need one facillitator, you guys are just there to watch and listen" He went to the lead therapist and told her the situation

Keep in mind this is just a professional courtesy type question.

The lead therapist came to me in private and said, "My social workers have master's degrees, if they want someone out of a group they will tell you and then you can take them out" "you are supposed to sit in there and listen quietly":eek:

Well, I got ticked :mad:because I felt like she had downgraded nurses in general, and said basically that I would not be attending anymore circle groups and if they social workers had master's degrees then surely they know how to remove a patient themselves, :argue:

I worked outpatient clinic psych before this and it was the same way, social workers and therapists are higher ranking and nurses are treated like crap,

Does this happen in all psych facilities, because I love psych but I don't need to be made feel worthless because I don't have a master's degree.

We are the one's with patient's all the time, more than one hour a day in a circle group and we don't get to leave at 4pm, we don't get every weekend off. I just feel very underappreciated. :angthts:

I am leaving the unit anyway just as soon as I can find a new job, I just need to know if I am being petty. I do respect our social workers I think they are great, but we have some great nurses too and they are not treated well.

As one of my co-workers said, "I hope the social workers have a nursing degree too because they are going to be running the unit by themselves":hpygrp: Sorry so long, had to rant, :oornt: thanks in advance for your replies.

[elkpark]

Sorry, I'm with the social workers on this one. The process groups are their groups, and, if nursing staff are in the group, they are there as observers or group members. I was a staff nurse in psych for many years before I went to grad school (and have been a psych CNS and psychotherapist since then), and, if a staff nurse attempted to direct anyone to do anything in a group for which I was the lead therapist (including directing someone to leave the group) without my say-so, I would have a real problem with that. I agree that it is the therapist's responsibility to deal with any problem clients or situations that arise in group.

It's not that nursing staff are "worthless" -- it's just that the two groups have different roles and responsibilities. I'm sure you would not like the social workers to interrupt you while you were doing something that's your responsibility and interfere with your interaction with the client.

I've only ever worked in one facility (in 25 years of psych nursing) where the nursing staff sat in on the therapy groups, and it was v. clear there that the nurses were only in the group so that we would be aware of what had gone on in group in case that was something it would be useful to know later on in the day on the unit. In my experience, your unit's nursing staff expectations about the groups are definitely outside the mainstream. In most places, the nursing staff appreciate having a break from the clients during the therapists' groups! :)

I don't know what else is going on on your unit, or if this is the reason you've decided to leave for another job, but, to answer your specific question, I do think you are being "petty" (not a word I would have chosen, but the word you used) about this particular situation.

[can'twait2B1]

Thanks for your reply.

I am going to just steer clear of the social worker's daily group and mind my own business and bide my time until I can find something else.

[elkpark]

I am okay with the social workers calling the shots in their groups, i just don't see it necessary to have been talked down to by the lead therapist or why its necessary for nurses to be present, a tech being present could do the same thing. I just didn't realize that nurses had to take orders from social workers too.

Maybe I am in the wrong profession.

I don't understand how this would be considered "taking orders from social workers." I don't know how the practice of nurses and techs attending the process groups got started on your unit in the first place, but it's definitely unusual. I don't even see why it would be necessary or appropriate for a tech to attend the psychotherapy groups. In my experience, the nurses do their thing and the social workers do their thing, social workers and nurses aren't telling each other what to do, and everyone gets along fine. Actually, as a staff nurse and as a psychotherapist, I would have concerns about the previous social worker you mention who did want to have staff taking people out of group. That's not something I've ever encountered before in my career, and I don't see it as a therapeutic position for the therapist to take. It may be that it was that person who started the unusual practice on your unit.

I hope that your unit will be able to work this out so that everyone will be comfortable with the system. In most settings, nursing staff would never be involved in the process groups in the first place, and they enjoy having that break from the clients.

ETA: I was writing this at the same time you edited your last post -- when I posted it, I saw that your entry has changed.

[can'twait2B1]

I think my biggest complaint was the tone/way the lead therapist (who is also the program manager) addressed my question. Had she said, "Hey I heard you had a question about the nursing role during process group, and I would prefer that you guys just let the social worker handle it if someone is disruptive and they will let you know if they need your help, but thanks for asking", then it really wouldn't have bothered me.

The way it was addressed definitely "put me in my place" but it also offended me. I work really hard for my unit and I really care for my patients and co-workers, I really wasn't trying to start a ruckus.

As far as editing my post I figure that less is more. Thanks for your imput.

[Davey Do]

canywait2B1:

Basically, this situation sounds like it involves team members in a power struggle, putting personalities before principles, with individuals not aware of their role in the therapeutic process.

Responsibilities, roles, guidelines, and boundaries need to be established before any therapeutic intervention takes place. Otherwise, the result can be conflict, as in your scenerio.

Once the logical approach is abandoned, emotions creep in and personalities become involved.

The best we can ever be for anybody is a role model. It's up to the individual to to follow another's belief or opinion. And that's all therapy is: a perspective with advice or guidance.

Conceptually speaking, what troubled individual is going to follow the advice of a group of professionals who can't agree on an approach?

Dave

[bekindtokittens]

To the OP--I understand. I've had similar problems with some of the therapists who lead groups on my unit. We as staff don't sit in group, but we listen as we work so we can anticipate any changes in the "vibe" of the milieu afterwards.

If the patients act out during group, then it's my fault as the charge nurse because I wasn't paying enough attention and should have stepped in.

If the therapist starts using non-therapeutic communication and after the group you ask the therapist why, you're told that you aren't educated and don't know what you're talking about. (I've had therapists tell patients to turn to Jesus and they would be fine, disclose way too much personal information, etc)

I got tired of being talked down to. I began to listen carefully to groups and document my butt off for my supervisor. Slowly but surely, things are changing.

[LaRN]

If the patients act out during group, then it's my fault as the charge nurse because I wasn't paying enough attention and should have stepped in.

If the therapist starts using non-therapeutic communication and after the group you ask the therapist why, you're told that you aren't educated and don't know what you're talking about. (I've had therapists tell patients to turn to Jesus and they would be fine, disclose way too much personal information, etc)

lol oh so true. There are some wonderful social workers out there, but there are some that have more personality disorders than a stack of DSM's.

To the original poster, that silly social worker ruined the group for the other patients, but at least it wasn't a total loss- the BPD patient had an audience, and we all know they love that.

[mystory, BSN, RN]

Unfortunately, it's the same story at my facility. We do not sit in on groups that we are not leading, but at team meetings the nurses are expected to be unassuming and quiet, fetch the charts, and take notes. I have been interrupted and ignored in those meetings, needless to say my comments have gotten fewer and further between. I just laugh to myself as I am getting paid more than most of them, despite their almighty masters degrees.