quote:

Originally posted by Beth Witten:
The Conditions for Coverage mandate that social workers in dialysis and transplant facilities have an MSW degree unless the experienced social worker was hired by the dialysis or transplant facility before 9/1/75 AND is supervised by a social worker with an MSW degree. These regulations mandate that the MSW social worker does psychosocial assessment, casework and group work (counseling), patient care planning with the multidisciplinary team, and helps patients and families know and access resources.

In spite of increasing vulnerability of kidney patients due to age, multiple comorbidities, and increasing incidence of depression, social workers have been asked take on more clerical tasks because other staff are "too busy." I want to know what clinical tasks are social workers performing and how have you advocated with administrators for time and support to do these?

quote:

Originally posted by Beth Witten:
The Conditions for Coverage mandate that social workers in dialysis and transplant facilities have an MSW degree unless the experienced social worker was hired by the dialysis or transplant facility before 9/1/75 AND is supervised by a social worker with an MSW degree. These regulations mandate that the MSW social worker does psychosocial assessment, casework and group work (counseling), patient care planning with the multidisciplinary team, and helps patients and families know and access resources.

In spite of increasing vulnerability of kidney patients due to age, multiple comorbidities, and increasing incidence of depression, social workers have been asked take on more clerical tasks because other staff are "too busy." I want to know what clinical tasks are social workers performing and how have you advocated with administrators for time and support to do these?

quote:

Originally posted by Beth Witten:
It's not surprising that non-social workers (administrators, physicians, nurses, technicians, dietitians) may not know how social workers are trained and the expertise that social workers have to improve facility outcomes. If the clinic had another social worker before you who overfunctioned and did every clerical task unquestioningly, this is how the staff came to expect all social workers to function. It is likely that the patients see this as the social work role too.

This is where you come in. Make a plan to collect data and offer an inservice to staff and clinical directors on the role of the social worker in improving patient outcomes.

One place to start is to make notes about the education that you received and the skills that you have. If you worked as a social worker previously, don't forget to include those skills as well. It's amazing how many people don't understand that MSW social workers do most mental health counseling in the U.S. and that we have the skills to address common issues that people with kidney disease face: grief and loss and adjustment to chronic illness, end of life planning, dysfunctional relationships, sexual problems, vocational planning, effective communication in resolving disputes, etc. Allowing social workers time to deal with these issues could help patients feel and do better.

Review the tasks mandated in the regulations. When you do, you will see that they are all clinical in nature. No where in the mandated tasks does it say anything about social workers should do clerical tasks that no one else wants to do (or has the time to do).

Join CNSW if you haven't already. This organization offers an opportunity for mentoring, continuing education, advocacy, networking, and support. Buy a copy of CNSW's Standards of Practice. If you're a member, you get a discount. Also, CNSW members are now receiving a copy of a new social work advocacy booklet. There are a number of other publications that you can find on the CNSW web site. Also look there for the CNSW mentoring program. Mentors are interested in helping people like you in efforts like this.

If you work for a corporation, check to see if there is a social work advisory board. If no, advocate for one. If there is one, talk with someone on that board about what the company's expectations are for social workers and advocate for a clinical vs. clerical role. Just because someone hands you a task to do doesn't mean that leaders in the corporation expect social workers to do that task.

Read articles on psychosocial issues of people with kidney disease and how psychosocial interventions improve outcomes. You can find abstracts on PubMed at www.ncbi.nlm.nih.gov/entrez/query.fcgi. You'd be surprised how many articles there are. There have been studies using patient self-report surveys that link mental health with missed treatments, hospitalizations, and survival. Also, there have been studies that link social support and survival. Interestingly, some of these have been published by well respected nephrologists (Peter DeOreo, Ed Lowrie, and Paul Kimmel). Many more have been written by social workers like Wendy Schrag, Mary Beth Callahan, Stephanie Johnstone and others. Think about things that you do that could impact patient functioning and well-being. Although clinical directors don't always think of this, when patients are doing well, they're not hospitalized and when they're not hospitalized, not only meaning that the chair doesn't sit empty, but meaning that Medicare and insurance can be billed. Keeping the clinic full means more revenue.

Start collecting data on your interventions and outcomes. Track the time it takes you to do the various activities you do. After you've done your inservice where you've discussed how you can improve clinical outcomes of patients, take the list of activities to your clinical director and ask him/her how you should prioritize your time. Finally, it may make you feel better to learn that some clinics are starting to hire social work case aids to take on some clerical tasks so social workers can get back to doing what social workers are trained to do.