Self-Deprecating

I wasn't very nice to myself today.  And it pissed me off.

One of my coworkers asked me today if I am a nurse, too.  I replied, "No, just a social worker."  Just.  A lot of weight is in that one little word.  Just.  As in only.  As in not important.  As soon as the words were out of my mouth, I was disappointed with myself.

There is nothing just about being a social worker.  About all the work I put into becoming a social worker.  About having the kind of personality it takes to be a social worker.

The decision to be a social worker isn't typically one that one just makes.  You either are a social worker or you're not.  It is like a gene, buried somewhere deep inside of you.  It is not something you do, it is something you are.  It is a part of you.

While obtaining a degree in social work may not be the most grueling process in the world, it is not easy, either.  It is a 2-year Masters degree program that includes classes and field placements.  A full-time program encompasses 5 3-credit classes plus a 24-hour per week placement per semester.  It takes commitment.  A lot of reading.  A lot of writing.

Going into the field of social work, while it is something you are inherently destined to do, is still something to seriously consider.  It is exhausting work.  It is emotionally overwhelming.  It is high-stress and low-pay.  We social workers like to say, "We don't do it for the money!" because, um, we'd be crazy if we did.  With a Masters degree, most of us make less than others with Bachelors degrees or even Associates degrees.  "We don't do it for the money," but it'd be nice if we were paid according to our work and stress levels.  My boss is constantly telling us that she wishes she could pay us more, because it kills her to see how low our pay is for all the shit we put up with.

In my position in particular, as a hospital social worker, we are the ones who get yelled at by overwhelmed and frustrated patients.  We are the ones who get blamed with discharges don't happen quickly enough.  We are the ones who take the heat when the nurses aren't happy.  We take the brunt of everyone's unhappiness...and we do it with a smile.

We appear to have thick skins but we have soft hearts.  We put up with all kinds of abuse.  We have conversations with people about death and dying.  We provide support to patients who are scared about their diagnoses.  We reassure families who are feeling guilty about placing their loved ones in nursing homes.  We encourage drug addicts who are looking for sobriety.

There is nothing just about being a social worker.  It is a noble, important, and necessary profession in this crazy world, and I am damn proud to be one.

Sometimes I need to remind myself of that...


*Images from my Pinterest

Hold on Tight

Alternate title: Why Social Work Will Take You on the Ride of Your Life...Every Day

I mentioned that Friday was a crazy day, right?  There are many reasons why a day in the life of a hospital social worker can be crazy.  But Friday was a particularly special kind of crazy. 

Not only did I have multiple discharges to arrange (which means making referrals, finding an accepting facility, getting insurance authorization, setting up transportation, and communicating all of the above to the patient and family), but I also had a patient who refused to do anything without my "permission" (more on that in a minute), and a psych placement.  With out-of-area insurance.  Who was refusing to go to inpatient treatment, despite the fact that she was under involuntary committment and therefore legally couldn't refuse.  It's unnerving to have to tell someone, "I'm sorry, but, um, tough shit, you're going to get on that ambulance stretcher and go to treatment."  Legal committment or not, it's not pleasant to force someone into treatment.  We actually had to call security at one point because she threatened to walk out.  I had to stand there and have a discussion with her about the fact that she was being committed against her will and she had absolutely no choice in the matter.  Not. Fun.

But that's not the part that made my day so roller-coaster-y.  (Yep that's totally a word).  I had another patient who, when he first came into the hospital, you could not have a rational conversation with him.  He was delusional and paranoid.  I know, it sounds like I work on a psych floor, doesn't it?  I promise, I don't.  He was delusional due to a medication toxicity - he'd accidentally/unknowingly overdosed on one of his home medications, and it caused him to go a little wacky for a bit.  Once his toxicity level came down, he calmed down and was able to have a real, meaningful, purposeful conversation. 

This patient had been (through his perception) abused by the system his entire life.  He was distrusting of everyone in the hospital.  He threw several doctors and nurses out of his room.  The first time I met with him, I had to walk away because he was so abusive.  But somehow, I got through to him and he grew to trust me.  He felt like, for his whole life, he'd been promised things that were never delivered.  I did what I told him I'd do, and I think he felt like he finally had someone on his side.  He needed help at home but refused to sign the paperwork necessary to get the help at home because a) he is illiterate and b) he was afraid they'd take his house (a very common misconception, unfortunately).  Once I explained everything to him, he agreed to have the caseworker come back and to sign the paperwork...only if I was present for the meeting and explained anything he wasn't sure about. 

So I was and he signed everything.  It was kind of a proud moment for me.  As a social worker, it is incredibly fulfilling to know that you gained the trust of a man that so few others could not.  He signed the paperwork.  He agreed to go a nursing facility for rehab ("for one week!"), even though the facility that accepted him was outside the city.  I had everything arranged for him to go on Saturday.  I left work exhausted but feeling like I had done some real social work. 

I came in this morning and received a voicemail from his insurnace company saying that he'd never arrived at the nursing facility.  I called the facility and they told me that they'd received word that he'd left the hospital AMA, meaning Against Medical Advice, before his discharge.  I checked the chart and, indeed, he had signed out AMA. 

I have to admit, I'm a little heartsick over this.  I thought I had done some real work.  I thought I had made progress and made a difference in this man's life.  I thought we had a deal.  The nurse practitioner who was on service the day of his discharge is not here today, nor is the nurse who discharged him, so I can't find out what exactly went down until later in the week.  I ended last week on such a high, and this is a pretty major blow.

In my heart of hearts, I know that I do good in my job.  But things like this make it hard to see the forest for the trees.

Rant

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 medications...it 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?

Sometimes...

Sometimes one little thing is all it takes to turn a crappy day upside down and make it a happy day.  That just happened for me.

Ok, so the day started off well enough.  I woke up a little before my alarm and decided rather than lay in bed and torture myself, I'd go downstairs and see if I could catch any of the Royal Wedding shenanigans.  I turned it on just in time to see them recite their vows.  Kate looked just beautiful, and Wills was so handsome in his military uniform.  It was wonderful to watch them recite their vows.  They both look so nervous, and Kate was clearly trying so hard to keep herself together.  It was just adorable when the Bishop officially pronounced them as husband and wife - Kate flashed a big smile then seemed to catch herself so as not to show too much emotion.  Girl, it's your wedding day and you just became a freakin princess - smile away!

Anyway, I got to work and the world sort of exploded.  I have two patients who are dying and I'm trying to quickly arrange hospice services for them so that they and their families have support.  One of them is a 47-year-old man with a 4-year-old daughter.  Brutal.

I also was bombarded with families and patients who have lots of questions and concerns about discharge plans.  And everyone seems to need to talk to me right now.  It's hard having to juggle all of that. 

I have multiple placements to work on, including a psych placement.  One psych placement alone has the ability to eat up several hours of your day, so when I found out about this one in rounds at 11am, I was none too pleased. 

BUT.  A friend of mine let me in on a secret that my favorite band is coming to Philadelphia.  I already missed the opportunity to buy tickets for their first show, so when she told me about this one, I joined the fan club so I could get pre-sale tickets.  They went on sale today at noon.  After some issues with my computer, I went to my phone and ordered them using the browser on my phone.  Success!  Come Friday, August 5, I will be sitting at the Mann Center enjoying the music of my favorite favorite favorite - Death Cab for Cutie!  Ben Gibbard's voice is just angelic, and I'm also secretly hoping that his wife, Zooey Deschanel, will make an appearance, sit next to us in the audience, and become my new BFF.  Because I just love her. 

So that totally turned this day around for me.  I'm going to see Death Cab!!!!!   I cannot wait!

One of my favorite DCFC songs - The Sound of Settling

Sharing My Desk

Kate, over at Marsh Mellow Goodness, decided to share her work environment today, and I thought it was kind of fun, so...here's where I park myself on a daily basis!

That beautiful orchid was a gift from on my vendors.  I was having a really bad day, and she called and delivered some more bad news.  She showed up later with that orchid and told me she thought she'd made me cry.  [for the record, she hadn't]  In this picture, you can also see the walker that we have had in our office for over a year.  A patient left it behind, and told us she'd come back for it.  I'm guessing she's not.

Here you can see my water bottle and the folder I use on a daily basis.  That folder contains all the important phone numbers I need - nursing facilities, home care agencies, insurance companies.  It is like my bible.  I cannot do my job without it.  You can also see my respirator mask.  I need to use that when I go speak to patients who are on isolation precautions for things like TB and the flu.  Yup, the flu.  You also get a good look at my calender, which (if you zoom in) has phone numbers and notes scribbled ALL over it.  On top of my calender is where I keep/write on my daily census report (flipped over to protect patient identities). 

Here is a close-up of my bulletin board.  It's got pictures of Matt, my sister, my best friend Steph, my mom and Jeff, and my dad.  It also has some silly comic strips from my friends, plus a thank-you card from one of my patients' families.  It also has some Dove wrappers - one says "You're allowed to do nothing."  Another one says, "Love is always the perfect gift."  And the last one says, "It's not onlyokay to be different, it's fantastic!"  It feels mildly sacriligious to be putting Dove wrappers on my wall (Dove is a Mars product.  Remember, kids, I'm from Hershey), but...they're just too good to not look at every now and then!  There are also some recognition certificates from coworkers, and a note about a patient's funny name.  Because my coworkers and I are 10.

Here you can see our messy shelves.  They're over my desk, but all 3 of us in the office use them.  They contain mostly brochures from the various facilities and agencies we deal with.  Plus some other crap.

The social work button.  I sometimes have to fight the urge to actually point at this when some people are in our office. 

This is my top drawer in my desk.  It houses my pens (they have to be hidden - we get too many nice pens from our vendors, and they tend to disappear if they're on my desk), my business cards, my tea, and the office's supply of cab vouchers and SEPTA tokens.  Cab vouchers and SEPTA tokens are the baine of my existence as a hospital social worker.  A tip for all my blog friends out there - if you go to the hospital, have a ride home.  Just because we have vouchers, doesn't mean we give them out, nilly-willy.  Every time I give one out, I hear about it from my boss.

Kate talked about her food drawer.  I don't have a food drawer.  But I do have a shoe drawer!  I walk 8 blocks each way to get from the train station to the hospital and back.  And I don't do that in heels.  So I wear my sneakers to and from work, and change into my heels when I get to work.  Oh, and those fuzzy purple things are my USB boots - they have a warming strip in the bottom of them and when you plug into the USB port in your computer, it warms up the strips and you have instant toasty feet!

So that's it.  My office.  My desk.  What does your work space look like?

You Can't Make This Stuff Up!

Sometimes, it seems like I work in a psychatric hospital rather than a medical hospital.  Some of the things we see here are just...well, they're beyond words. 

~ A patient told a nurse who went to check on him: "I'm manic!  You better back the f*ck up!"

~ A patient called me 6 times over the weekend, filling up my voicemail.  She left these long, rambling messages about how she needed to talk to the President because she couldn't find her book and only Obama would know where it was.

~ A patient painted the walls with his poop.

~ A patient refuses to take "real" medication, preferring his herbal medications.  He claims they work better.  His ejection fraction (the percentage of blood pumped out of the heart with each beat) is 20%.  In a healthy individual, it's around 65%.  Clearly, his herbs are not working.

~ A patient claims he can't afford to purchase his medications ($4 each at Target).  In his room, he has an iPhone, new Nikes, and he came in stinking of booze and positive for cocaine.  Priorities, much?!

~ A patient is ready for discharge.  Her family takes a cab to get here to accompany her.  They demand a cab voucher for the ride home.

~ A patient continues to have heart attacks and chest pain.  He comes in about once a month.  Each time, he's positive for cocaine.  He wants a new heart.  Umm...quit snorting coke!

~ A patient swallowed a bunch of coins because she thought it would make her rich.
 
~ A patient was brought in by the police.  They found him wandering around on I-95.  He was looking for his sheep.

Say what I want about my job, at least it gives me some stories to tell!

Workplace Dress Codes

The dress code where I work has always been a bit...ambiguous.  I work in a hospital that's part of a pretty major health system.  Even though it's part of the big health system, it feels like a small community hospital.  It serves mainly a population that comes from the geographical area immediately surrounding the hospital.  Because of this small, community feel, the staff are generally pretty nice, happy, and good at their jobs.  And also because of this commnity feel, the dress code has not been too "stuffy."  The only people who can be seen wearing suits on a daily basis are the people at the very top of administration - the CEO, CFO, CNO, etc.  Everyone else dresses pretty business casual, and some on the more casual end of that (guilty!).  All along, we've been told no sneakers, no capris, no tank tops.  But that's been the extent of our no-nos; otherwise, pretty much anything goes.  We've even been allowed to wear open-toe shoes.  It's always surprised me, but I went with it.  During the summer, I can be seen in strappy sandals most of the week.  Love. It.

But a new administration is in place and they are shaking things up.  Soon, we will no longer be allowed to wear open-toe shoes.  Even peep-toes will be outlawed.  We will not be allowed to wear khakis.  A couple of years ago, we were given the option to purchase fleeces with the hospital logo and our department/title on them - we'll no longer be allowed to wear those, either.  If I get cold, I can put on a white sweater.  Those are not absolutely terrible changes.  I'll miss my peep-toes, but I'll live.  I'm a little annoyed that just a year ago I spent $35 on a fleece that I can't wear anymore, but I'll get over it.

But it's not just the professional staff who are getting changes.  The nurses are being handed a pretty shitty deal:

This is actually titled "Old Fashioned Nurse"

All white scrubs.  Yup, nurses, who have to deal with body fluids and puke and blood and whatever else.  They have to wear white scrubs and white sneakers.  Plain white with nothing on them.  What a pain in the butt.  Not only do they have to buy all new scrubs, but they will have to buy all new underwear - there's only certain things you can wear under white scrubs that won't scream "I'm wearing panties!" 

The new CNO based this decision on a survey done in 2006 that found that people feel that they got better, more professional care from nurses in all-white uniforms.  What she failed to mention is that the survey results were actually that 55% of men over the age of 70 reported that; other age groups reported no difference in care.  And another study, done in January 2011, found that across all age groups, people responded that nurses in colorful scrubs with small print/pattern delivered the best care and were the most empathetic.  But the CNO chose not to use that study, and instead used the 5-year-old study based on a survey of 800 patients from one hospital.  Hmmm...

Anyway, needless to say, the nurses here are not happy.  Many are starting to band together and come up with ways to fight this.  Several have written letters.  I can't really say I blame them.  While I do love my white pants in the summertime, I would not want to wear them day in and day out, on days when I have my period (flashback to middle school period checks!)....and certainly not if I were spending my day cleaning up people's piss and shit.  I intend to fully support the nurses, however I can. 

What do you think?  Nurses in white: a throwback to the 40s, a dirty male fantasy, or actual better care?