by Vickie Leff, LCSW, BCD, Center for Clinical Social Work board member
In many hospitals, the role of clinical social work is disappearing, replaced by case management. This dangerous trend is occurring at the peril of patients and hospitals, which cannot afford to lose the unique skills and approach of clinical social work.
Recently, the importance of clinical social work in the hospital was affirmed by Susan Blacker, et al, in their article “Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice” in the Journal of Social Work in End of Life & Palliative Care.1 The authors describe the barriers to and strategies for interprofessional collaboration in palliative care.
This collaboration is exemplified by debriefings facilitated by clinical social workers as a means of (1) enhancing resilience for nurses (and other health care providers), (2) modeling clinical social work perspective and problem solving, and (3) increasing the understanding of roles by clinical social workers and medical providers. This strategy can be implemented quickly and have an enduring impact.
As a clinical social worker in Palliative Care, I work with providers across the acute-care system. I’m happy to see more emphasis on physicians managing the emotional impact of our work2—but I don’t see programs and papers about the bedside nurse or other direct-care providers. MDs are the beneficiaries of structured in-hospital programs that are a buffer against burnout and compassion fatigue3. Why are these programs not extended to nurses? In my job, I do a lot of talking with nurses about our patients, teams, impact of care, ethical decisions, and more. Nurses at the bedside spend many hours with patients and families; often, they become the most trusted partner in care, witnessing a variety of physical and emotional difficulties.4 There is, however, surprisingly little emotional or educational support for processing the impact of this charged work. They have no break in the day, no protected time; and so we must “meet them where they are”—the most basic of all clinical social work precepts.
In a recent article, I discussed the importance of clinical social workers facilitating monthly debriefings for house staff.5 This program led to the institution of nursing debriefings: 30-45 minutes of a facilitated, confidential session, led consistently by a clinical social worker familiar with the culture and the staff. Nurses on the unit can participate in these voluntary meetings, which are not “support groups” and are supported by the unit nurse manager. The debriefing begins with the statement that, “This is an opportunity to give voice to the difficult nature of the work you do and the impact it has on you.”
The outcomes of the debriefings are many:
- CSW and RN management work together to implement the program.
- Increases understanding of the RN role and the CSW role.
- Provides resilience strategies for staff including self-awareness; availability of resources; normalization; and education on burnout, compassion fatigue, and secondary trauma.
- They learn from each other, breaking down stereotypes and communication barriers.
- Teaching the importance of identifying our own issues and learning how to avoid imposing these on our patients and/or families.
This style of debriefing showcases the expertise of clinical social workers; it is what we do very well and is a wonderful opportunity for interprofessional development. We have been holding these meetings at Duke Hospital for 3 years in a variety of settings: in-patient oncology, pulmonary step down unit, cardiac intensive care, medical intensive care, general surgery, pediatric ICU, and more5. Each has its own cultural barriers and openings. Use your clinical skills to tailor your approach for success.
At a time when clinical social work is losing its footing in many hospitals, these debriefings are an opportunity to expand our essential role, highlight our professional background, and impact the “bottom line” by decreasing burnout. I encourage clinical social workers in health care to invite themselves to this table and offer the program. Don’t wait to be asked; very often, other providers don’t know we can do this!
What has been your experience in the hospital setting? Can you share some experiences with us as to how to play a more valued role? We can learn so much from each other!
- Blacker S, et al. Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice. Journal of Social Work in End of Life & Palliative Care. 2016;12(4):316-330.
- Back A. Building Resilience for Palliatie Care Clinicians: An Approach to Burnout Prevention Based on Individual Skills and Workplace Factors. Journal of Pain and Symptom Management. 2016;52(2).
- Kamal A. Prevalence and Predictors of Burnout Among Hospice and Palliative Care Clinicians in the U.S. Journal of Pain and Symptom Management. 2016;51(4).
- Boyle D. Countering Compassion Fatigue: A Requisite Nursing Agenda. Online J Issues Nurs. 2011;16(1).
- Leff V, Klement A, Galanos A. A Successful Debrief Program for House Staff. Journal of Social Work in End of Life & Palliative Care. 2017:1-4.