Wednesday, May 18, 2011


Do you ever have one of those days/weeks where everything and everyone just seems to be out to piss you off?  Maybe this is one of those weeks for me.  Or maybe I'm just feeling extra-sensitive - it's a full moon and I have my period.  The two most wacktastic times of the month are in full alignment for me this month, and it ain't pretty.  I feel cranky, tired, annoyed, and fat. 

The way things are set up in my hospital is that the social workers are in the department of Clinical Resource Management.  This means that we are in the same department as the nurse case managers, who do the insurance reviews to make sure the hospital gets paid.  When I first started here, over 4 years ago, the social workers did all the discharge planning - set up home care, ordered equipment, arranged placements, setting up transportation, ordering was a lot, and things fell through the cracks.  We were totally overwhelmed.  About 3 years ago, the set up changed a little bit in that the home needs fell to the nurse case managers, so now they do the insurance reviews plus arrange home care and order equipment.  The theory behind this was that it would provide the social workers more time to do what we're trained for - to provide supportive counseling for patients and families.  It hasn't done that, but it was a nice thought.

Anyway.  Where I'm really going with this is that it can be very difficult to be paired with someone whose job is basically about the bottom line.  The case manager's job is to make sure we - the hospital - is getting paid.  Which means they have to find reasons to prove to the insurance companies that the patient needs to be in the hospital.  If the patient no longer meets "hospital level of care," it's time for him/her to go.  They also have to make sure that the patient's discharge plan is "safe," which sounds very altruistic and lovely, but really, it just means they need to make sure we're doing everything we can to keep the patient from getting readmitted, because if a patient comes back to the hospital within 30 days for the same reason, we (the hospital) don't get paid. 

While I understand that making sure the hospital is getting paid is important (I'd like to keep getting a steady paycheck, too), my first priority is to see that the patient's rights are being respected and upheld.  And this is where the social workers and the nurse case managers fall off the same page.  And me and my nurse case manager?  We may as well be in different books.  Social workers operate based on a core code of ethics and values.  The biggest one of those is to support the patient/client's right to self-determination.  And I take that value very seriously.  I feel like it is my job to advocate for the patient's right to make her own decision (so long as the patient has the mental capacity to do so).  If the doctors recommend placement for a patient, I am happy to discuss it with her.  But if she tells me that he wants to go home, that's her choice.  My job is to provide patients with the knowledge and choices to make an informed decision.  After that, it's up to the patient.  And we have to respect that, whether or not we agree with it.  Everyone has the right to fail.  But at least they failed with their dignity in tact. 

My case manager and I butt heads on this a lot.  And I get very frustrated with her very quickly.  She is constantly trying to get involved in cases that I am working on.  If I have established a relationship with a patient or family and am working with them to help them make a decision about home care services or rehab placement or (and this is my pet peeve!) hospice services, but the family is not deciding fast enough, she gets involved and puts pressure on me and on the family.  It's completely inappropriate and it makes me really angry.  I have discussed it with her and with our boss, but it never corrects.  It's her personality and unfortunately, my personality is the complete opposite.  We do not work well together and it's very difficult.  I am currently in discussions with my boss, who has just hired someone new, to change up the assignments a bit and put a new nurse case manager on my floor.  It's not a healthy work environment for either of us, and I fear that we do a disservice to our patients because we're so frustrated with each other.  But I worry that because she's so busy undermining me and then I'm trying to clean up the mess she inevitably causes, we're just confusing and frustrating the patients.  And as far as I'm concerned, it's ok to piss me off, but when you start affecting my patients, then it's not cool anymore.  I am here, as a social worker, to fight for my patients and to support their wants and needs.  If someone is interfering with that, it offends me. 

There are many other things about our working relationship that frustrate me.  She sends me emails throughout the day, telling me things about my patients that I already know because I've already established a relationship with them!  She makes inappropriate remarks about our patients.  She tries to drag me into situations where I do not need to be.  She tries to pawn work off on me.  She tries to make me feel guilty when she stays late and I leave (relatively) on time [somehow the fact that she sits around and gossips with other staff rather than getting her work done means I should be helping her out].  Luckily, my frustration (and let's face it, disdain) with her does not outwardly show, thank goodness (I asked a friend of mine who used to be a floor nurse on our unit). 

What do you think?  How do you deal with coworkers who you just cannot seem to mesh with?


  1. Ugh. What an obnoxious situation! I can't imagine how difficult it must be to constantly have to constantly work with someone who was most concerned about the bottom line instead of the patient's well-being. It sounds like you are handling it the best way you can! Just remember that you can only do your best and you just can't control her--she sounds like a real witch!

  2. What a fantastic situation you're in. NOT. Sorry. I had similar problems (different field though), and for whatever reason I learned how to deal with those over time. However, it is not easy nor fun. You seem to handle this though the best way you can, and I think this is the main thing you need focus on. You know you're doing something right and that is really all that counts. Believe in and know what you do is best. It is not easy to have someone constantly make you feel negative. You should not feel this way. Inappropriate remarks about patients though is what I call incredibly rude!!! What the heck?
    But what I learned is to do your thing, and make sure it gets positively recognized. And once the time is right (it took some guts!) tell her. Tell her how you feel. Nicely of course. And even if this is not working, go to some higher work power and see what they can do about it. It's not talking bad about a person, but with this you not only confuse the patients you do confuse yourself, and then everything good you do will not be recognized at all. People will only notice the confusion you're in and that's not what you want.
    I'm sending you lots of hugs. And yes, hang in there!!! Your shining day will come!!!


  3. I'm so sorry you have to work with someone like that. My co-worker is constantly negative and butting in, offering to help CONSTANTLY in a condescending way (like I don't know what I'm doing). I'm able to go to my manager about it but your situation sounds tough.

    Try sticking it out and if it becomes a bigger problem, try going to a higher source? :(