Please explain how a social worker can be a patient advocate when the clinic manager/administrator is his/her supervisor/boss as well as being paid by the facility. This is a direct conflict

Having worked as a social worker in dialysis and transplant settings for about 18 years before working as a social worker in health education, I always felt it was my responsibility to define my role and explain what my skills and training allowed me to do to my administrator. I set limits on what I would and would not do. There were times that I perceived that something I was asked to do conflicted with the therapeutic relationship with my patients. For instance, I told my administrator I would help patients get or keep health coverage but I would not ask patients for money or serve as a bill collector.

I felt it was important for me to focus my time on the functions that Medicare mandates that social workers do in the Conditions for Coverage. If you haven't read them, you should definitely do that. Your clinic or ESRD Network should have a copy. New draft regulations were published in February 2005 and the comment period closed in May. It could take up to 3 years before final regulations are published. Until then 42 CFR 405 Subpart U remains in effect.

Even though your administrator is your boss and your "supervisor," it doesn't mean that he/she knows anything at all about what social workers can do, should do, should not do or what makes a social worker job satisfaction and retention high or low. He/she may not know how a social worker performing clinical social work (vs. paperwork) can help an administrator look good through improving outcomes. It's your responsibility to show that. You might want to visit the website for the Council of Nephrology Social Workers (www.kidney.org/professionals/CNSW/index.cfm). This organization has provided a wealth of information and support for me throughout my career. There are outcome training programs that CNSW has done that can help you show how to do small studies with significant impact. Project Solidarity is a website promoting the appropriate role of social workers.

In case you haven't read it lately, here's a link to the Social Work Code of Ethics (http://www.socialworkers.org/pubs/code/code.asp). In it, it says, "Social workers' primary responsibility is to promote the well-being of clients."

It also has this section among many others that you may find interesting.

3.09 Commitments to Employers

(a) Social workers generally should adhere to commitments made to employers and employing organizations.

(b) Social workers should work to improve employing agencies' policies and procedures and the efficiency and effectiveness of their services.

(c) Social workers should take reasonable steps to ensure that employers are aware of social workers' ethical obligations as set forth in the NASW Code of Ethics and of the implications of those obligations for social work practice.

(d) Social workers should not allow an employing organization's policies, procedures, regulations, or administrative orders to interfere with their ethical practice of social work. Social workers should take reasonable steps to ensure that their employing organizations' practices are consistent with the NASW Code of Ethics.

(e) Social workers should act to prevent and eliminate discrimination in the employing organization's work assignments and in its employment policies and practices.

(f) Social workers should accept employment or arrange student field placements only in organizations that exercise fair personnel practices.

(g) Social workers should be diligent stewards of the resources of their employing organizations, wisely conserving funds where appropriate and never misappropriating funds or using them for unintended purposes.

You can be a patient advocate while being a good employee and co-worker.