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Will Health Care Bill Require Nurses Do Social Work?

tomheadBlogger Tom Head warns the Senate version of  health care reform legislation contains language that would require nurses do some duties social workers perform.

These tasks include doing home visits, reducing child abuse incidents, and helping families gain economic security. Head warns this is the wrong way to go and Congress could battle these problems by boosting spending on social services:

“Congress could address human services disparities more effectively if it adequately funded social work–but trying to subcontract social work through the health care system, creating a two-tiered system where nurses act like social workers but don’t have the power or the training to do the job right, is a recipe for disaster. It’s not even an efficient use of funds, when we consider the fact that nurses make substantially more money, on average, than social workers (an average of +/-$42,000/year versus +/-$33,000/year).”

The National Association of Social Workers is also urging Congress pass the Dorothy I. Height and Whitney M. Young Jr. Social Work Reinvestment Act (H.R. 795 and S. 686). The bill would help prevent a pending shortage of trained social workers.

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21 Comments

  1. More than a little concerned about this… nurses in MN have been trying to run SW’ers out of healthcare for a while now – this would give them legal leverage to do so. Patients and their families are the ones that pay the price for this… Time to UNITE, social workers – we do skilled, important work!!

  2. What about licensure? How can nurses be doing “social work” with a RN or LPN licensure?….Social workers would never, ever begin to be considered by nurses to fill in for them…..talk about a picket erupting outside of the hospital!

  3. Nurses have been doing social work type activities for years especially in the home setting. I do think that it is important to identify all needs including social needs by whoever is seeing the person. Under the current model of delivering nursing services in the home we have seen social workers being used less and less. When nurses and social worker work together much can be accomplished. They can compliment each other. The more nurses and others understand what a social worker can do to have positive outcomes,both social and health related in the health care setting, social workers will be used more. We need to show them what we can do and communicate that to them. We can be on the same team. Social workers must be part of the Health care system.

  4. Most of the nurses I know wouldn’t “lower” themselves to do the work that Social Workers do. Nurses already have much less time and training with much higher pay than Social Workers. I imagine they would want even higher salaries if they were also doing social work duties. And how will this help healthcare costs? It’s time for Social Workers to demand the protection that all other professions demand!

  5. Can someone from NASW or our boards explain how a social work licensure can be required if anyone, and I mean anyone can perform social work? I too, am so troubled by what I am seeing–nurses being labeled as “case managers” and “care coordinators” doing discharge planning and only referring the most difficult, complicated, time-consuming cases to the social worker…individuals with 2-year degrees or LESS, performing social work duties… what’s going on and where’s our watchdogs?

  6. There was a time when all hospitals had Social Service departments, usually independent of Utilization Review, and staffed mainly by social workers. It is difficult to find a real social worker in hospitals, today.
    In Illinois, the only protection licensing … to social workers was to protect the title mot the functions.

    In behavioral health areas, to be in compliance with CMMS regulations, the nursing program must have a Director (capital D) who has a Masters Degree in Psychiatric Nursing or be a nurse with training and experience that would be similar to that of a Masters Degree nurse. Still has to be a nurse.

    CMMS requires that there be a director (small d) of the social work function who has an LCSW, and that it the director is not an LCSW, there has to be an LCSW on staff. Consequently, most hospitals have done away with social work departments and folded the function over into Case Management departments headed by RNs and functioning under Utilization Review departments, also headed by RNs. Technically, social service /social work functions can be handled by plant operations, us long as there is one LCSW on staff.

    This may not be good for Social Workers or patients, but it looks good when you are applying for Nursing Magnet status.

  7. In general, I have noticed that a lot of Mental Health Counseling Jobs, Case Management Jobs are inclusive of RN’s, in which I am having a hard time understanding, because the social work curriculum is geared towards the “Systems Perspective”, which is more than just the “Medical Model”, but inclusive of the “Biopsychosocial Model”. Thus, social workers have a keen insight on how to function in a multi-setting, while at the sametime keeping the patient/family needs at the forefront.

    It appears that others do not understand the essence of “Social Work”.

  8. It is a travesty that Social Workers are even compromising with this mess. We are trained too hard and too long to be insulted by the system as to allow unlicensed persons, some who have done just 9 months of vocational nursing programs to hijack our work while our association leaders watch. It is time for the association to start suing nurses doing social work duties without social work licensure just like people who practice nursing without a nursing license are sued.

    Another thing that can bring about the drastic change needed is to tell insurance companies not to pay hospital bills of social work duties performed by a nurse or any other professional. We really need to do something. No offense to nurses but why would they accept to perform duties that they were not trained for? They should be able to stand firm and say no. Hospitals are making them perform two jobs on one salary just to minimize costs.

  9. I need to see the actual text of the bill that includes this before I get too upset. There are pleanty of visiting nurses, just because they do home visits, does not mean they are doing Social Work. We absolutely need nurses to be involved in the identification and prevention of child (and elder) abuse. I need to consult with nurses daily regarding the medical aspects of injuries and etiology of illnesses. Not sure about the economic areas, but like I said, need to read the text before making judgement.

    There are still some hospitals who practice social work, and based on literature in the nursing and hospital administration journals, I believe the pendulum is swinging back in that direction. I happen to work in a large private hospital with a very diverse ethnic and economic population. While social workers are part of the “care management” dept which includes nurse case managers, utilization review and bed control, the Director of Care Management is an LCSW, not an RN. We have aprox. 1 social worker to every 30 beds and there is at least one social worker on site (not on call, actually in the hospital) from 8:00 am to midnight, 7 days a week. Also, the overnight nurses complain that social work is not 24 hours on a regular basis. Also, there are 2 position levels: MSW and LCSW. MSW’s must be registered with the state board and must be actively pursuing their license. As a result, more than half our staff is licensed and the others have completed their hours and are studying for the exam.

    My point: there is hope!

  10. I don’t come from a perspective of Social Workers vs. nurses–I’ve never had an experience where a nurse didn’t want to rely on me as a Social Worker for help. In the facilities I’ve worked in, both nurses and Social Workers were overworked and underpaid and were more than glad to help each other with the insane workload and general workplace “abuses.” I do think it is a shame as to how much of health care in general is constantly slapped on nurses to the point where many of my nurse friends will report that they don’t feel like nurses any more–they’re secretaries, computer programers and mini-doctors. Perhaps the “who does what” war between the professions in a particular facility is more evident if unionization is involved? I can’t say.

    This almost makes me feel sorry for nurses. Once upon a time, before switching my major to Psychology, I was a student nurse and witnessed the absolute crap-piling of work on nurses (especially the non-union ones) “just because.” To me, the issue identified in this article yet again identifies clueless legislators who are participating in the practice of crap-piling on nurses as well as continuing the practice of ignoring Social Work as a profession. This is yet another instance of denying Social Work’s entitlement to certain aspects of health care that should NOT be performed by other professionals. Nurses should be as equally irritated about this. Ignoring Social Workers and crap-piling on nurses “just because” is insulting to both professions.

    I believe who-does-what is decided on a state level. I know when the Social Work Title Protection Act passed in my state of Pennsylvania, I lost my job and my former boss, the Dir. of Social Services who had been a “Social Worker” who had trained Social Work college students for over 34 years, was swiftly demoted. In Pennsylvania–before the Act passed, anyone with a degree in a related field (mine is in Psychology**, my former boss’ is in Family Studies, I believe) would perform the job and hold the title “Social Worker,” including LPNs. Fixing this and having Social Work acknowledged and respected as a profession with entitlement to certain aspects of health care that should NOT be performed by other professions as a substitute most likely needs to be addressed on a state-by-state basis (as Pennsylvania has done).

    **On a side note, I am back in school. I only need just a few classes to get a BSW and will have my MSW in a year after that. I believe that a BSW should indeed be the minimum requirement to hold the position of a basic SW practioner–despite the fact that I am now unemployed because of the law and my own opinion. I do feel bad that my boss could not be “grandfathered-in,” however. The world lost a valuable Social Worker with loads of experience the day that act passed.

  11. I have read over this conversation and I have to say, you guys are ridiculous, one to say that nurses are under trained, give me a break most of the time if a nurse is doing some social work duties it’s because you all are not around, you walk around with your one hour lunches and gossip sessions, while we are actually doing the work, maybe you should try one understanding you could never do our job, but we will always have to do yours, due to staffing, expense and the fact that you went and got a degree in social work and demand a place in a hospital give me a break, nurses have been doing social work since they days of old, you’re new on this block not us. you want help then ask for it don’t demand anything, your opinion of nurses education is insane and just what could you have learned and social work college that makes you so much more efficient at anything the fact you know algebra no tseeing the correlation. and a master degree for what just to say u have one, how would this make me see you are somehow better, when nurses chase a masters degree it is for pay position and knowledge, for you what changes nothing. Be careful before you bite the hand that feeds you!!!!!!!

  12. “one hour lunches and gossip sessions…”. Sorry for bursting into quotations there, but it looks like someone has an axe to grind.

    Now back to rational thought. Let the insurance companies et al try to merge as many functions as possible in health care, and it won’t just be the NASW screaming it will be the RN’s.

  13. As a former school nurse at a day treatment school, I was experience first hand how difficult and how hard the case managers worked. They were basically the hub of center connecting all the pieces together for the good of the whole.

  14. I’m not at the point of being territorial yet. Currently I work in a medical setting and the nurses do work hard and are trained well. Honestly the nurses I work with don’t want to do social work just as I don’t want to do nursing.

    I think one of the biggest differences and what could cause the most difficulty is the different perspective. Nurses -and others in healthcare – have the perspective of expert assisting the client. My nurse manager recently told me that they are working on a “new thing” called patient center care where you try to meet the patient where they are. I know when I did my BSW a million years ago I already was learning about client centered care. There is also a discrepency with values. I am the only social worker/mental health person in my medical setting. I am constantly stating that an issue is our value and we cannot put our values on the patient which the nurses I work with are used to doing. Obviously working together and educating each other and working toward the client’s needs and wants is what would be ideal.

  15. It is amazing to me that many think that nurses are not qualified to do just some of the “things” social workers do when we do some spend more than ” two years” in college to be a registered nurse with a BSN degree. Although social workers should be respected and paid more for what they do, it is no reason to belittle the ones that have one of the common goals and that is ” taking care of the patients needs.”

  16. Unfortunately, nursing is slowly taking over social work in the hospital setting in the form of RN case managers who also handle psychosocial issues. The NASW has done nothing to address this issue, and I fear things will only get worse for us social workers in the coming years.

    Let’s not get me started on the pay disparity between social workers (with masters degrees) and nurses (who only have associates or bachelors degrees). It’s such a slap in the face.

  17. I agree with all the comments of my fellow social workers. Nurses can’t do Social Work jobs effectively and vice versa. We have to take a stand before medical professions run us out of hospitals all together with this so called Case Manager Nurse. It’s a joke because they are not trained to deal with the psychosocial issues that we as Social Workers are.
    Also, to Jack who’s clearly an idiot and this is demonstrated by the many grammatical errors in that one paragraph. Number one why are you on a SW blog, we don’t get on nursing blogs. Number two, what do you mean by the silly statement, “don’t bite the hand that feeds you.” Nurses have never supported Social Workers and could care less about taking away our jobs. So your statement is asinine. For future reference, learn to spell before you try set someone straight.
    Also JAH, whatever that means, you need to finish school and work in the field before you have an opinion. For now, its all hear say.

  18. I think the problem is that social work jobs have been lumped together with discharge planning (i.e. arranged DME, skilled nursing placement, etc.). The role of a social worker should be providing counseling and psychosocial services. By forcing social workers to do discharge planning, which often required medical knowledge, the hospital system is making us look incompetent and takes away time which could be better spent addressing psychosocial issues.

    Since nurse case managers have medical knowledge, they are often seen as more effective and efficient discharge planners. This is because they can answer all the medically related questions posted by families. Perhaps hospitals see this as the same as providing “counseling services” to patients and families, which is why many nurses feel that they can be effective “social workers” as well. This is because social workers are not being used properly and being related to tasks which should be done by nurses.

    Until we get some sort of title protection in place, nurses and other clinicians will continue to overstep their bounds. Similarly, social workers will be put at risk of providing medical services and giving advice outside their scope of practice.

  19. I believe that both social workers and nurses should put clients/patients as the centered care. This is what we have learned at school and in practices. Social workers and nurses both have different responsibilities in taking a quality care for clients/patients.

    Nurses are expert in medical field. They can prescribe medications. Of course, with jobs which nurses can work outside the hospital settings, they mostly do social works because they might have to visit a patient at his/her living area. They might have more opportunities to get involve with the patient’s life

    At the other hand, social workers are trained to be a supporter for clients. Besides that role, social workers can be a mediator, negotiator, broker, counselor, advocator, etc… for clients. Even though they can’t do things like nurses such as giving medications, they still have a great effect on the client’s life. They can help a client to see what they need to get besides medications.

    I believe that workers cannot give the best quality service for clients if they have to handle many things. Nurses and Social Workers need to work together as a family. Their roles are important and unique. I view their roles as the fathers and mothers. A child cannot have a “holistic care” if he/she is missing a dad or a mom.

    Last but not least, yes, I agree that money can have a big influence in making decisions. However, money should not be the top reason for choosing a job. You need a passion for your work too. I am grateful for having nurses who take very good care for us. I know I will need a nurse someday to take care of me. :D You did very good job! Also, social workers, thank you for choosing to stay in this job (no matter what situations are happening) and helping me to get all resources I need.

    “I need you both in my family!” :P

    Email me at echnini@yahoo.com if you want to know what is my job. I will tell you more. I love my job. And I love the fact that if I can make friends and talk about things in life. ^^

  20. Nurses must be proactive and anticipate patient issues before they escalate to a crisis level.
    Social Workers and Counselors must anticipate client issues before they escalate to a crisis level. RN’s are responsible for completing all EMR work, Social workers and Counselors ask RN’s or secretaries to document in excel or other online data systems. RN ‘s administer the medications, perform the point of care tests (such as a urine drug screen or pregnancy test) on the urine that the LISW brings us. When The Joint Commission on-site surveys come, who is running around making sure there are no boxes on the floor or nothing violating the “18 inch rule?” My point is that nurses are held accountable for all manner of “housekeeping” issues that the Counselors and social workers walk right by. No way will any counselor or social worker I know carry out boxes after flattening them or get items out from under a sink… But our nurses will go do a home check or run out to a car to check on a patient. They will ( and DO daily) call and fight the pharmacy to obtain a patients medications. Do Social Workers or Counselors get the PMP sheets to see what medications a patient has actually filled? Nope, only RN’s can be the physicians proxy. Do Social Workers or Counselors use every tool in their arsenal to get that patient to go get his colonoscopy, or MRI, or biopsy, or..or…or.. How about teaching? Calling each week to check on how their “Quit smoking” program is going. Point is, both disciplines are valuable. You help me, and I’ll help you. Just learn what P.A.S.S. and R.A.C.E. Are so I don’t get yelled at when Life Safety come from the hospital to check us off. Oh, and get your CPR done!

  21. I just so happened to come across this blog and am amazed at what I see. Nancy Nurse’s comment is particularly offensive. She insinuates that social workers walk away and do not care. We in a health care setting all have to care about JCAHO. There are many times that I am “last one standing” in my advocacy for my patients. HOW DARE YOU NANCY?!!! I just so happen to be a social worker in care management. I have earned my CCM and am held accountable for documenting assessments and my many interventions re: prescription assistance, hospice counseling, deesculating crises situations when the nurse care managers were not capable, etc. There were many times that I found a way to call physicians to obtain prescriptions for medications and durable medical equipment my patient’s need to remain in the community. I have spent hours upon hours researching different resources to help patients get insurance and maintain health coverate to remain the community for as long as possible. There was even a time when nurse in rounds mentioned she was given tylenol to a patient with cirhosis of the liver to which I told her was contraindicated during the meeting. I wish that my training as a clincial social worker in my MSW program was cultivated int he hospital setting.I remember a nurse musing “nurses eat their young,” and it appears that they have no qualms in elminating an professional threat. There will aways be a place for nurses in healthcare just like there are CMAs, respiratory therapist, speech therapist, SLT, occupational therapists, dieticians, pharmacists, radiology/cardiology/ultrasound techinicians, and especially social workers. We are on interdiscplinary teams and together strive to provide holistic, comprehensive care to our patient body. Maybe the NASW and the Nurses Council need to meet together to better understand how we both are important in the healthcare setting.

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