Differences and Similarities between Social Work and Nurse Discharge Planners

Article excerpt

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For more than a century discharge planning has been a part of the practice of social work as well as nursing. Historically, both disciplines recognized the need for formalized services that reflect discharge planning and have often worked together to provide subsequent aftercare activities. To date, studies have looked at the differences between social work and nursing and the overlap of activities (Egan & Kadushin, 1995; Kulys & Davis, 1987; Sheppard, 1992). This role sharing has been noted as prospective payment systems have assigned discharge planning activities increased status and overlapping and convergence of social work and nursing tasks has led to turf battles. This article examines the similarities and differences between social work and nurse discharge planners. To highlight this relationship, we identify the tasks that consist of the essential components of discharge planning among social workers and nurses and compare demographic characteristics of discharge planners, work setting variables, and specialization differences.

THE ROLES AND TASKS OF THE DISCHARGE PLANNER

The overlap and sharing between the two disciplines of social worker and nurse has led to the question of the exact role of each. To answer this question, Egan and Kadushin (1995) surveyed social workers and nurses to ascertain what generic hospital social services tasks should be done by social workers, nurses, or both. Both social workers and nurses agreed that social workers were better qualified to provide concrete services such as setting up home equipment, arranging nursing home placement, and helping patients understand insurance and finances. However, social workers and nurses saw themselves as qualified to perform the tasks of supportive counseling.

In addition, there have been studies focusing on systematic differences between the two groups. For example, Sheppard (1992) studied the communication styles of social workers and nurses during their interactions with physicians. Sheppard found that nurses contacted physicians more frequently than social workers and the reason for contact often differed. Nurses generally contacted physicians about the patient's condition and treatment. Social workers contacted physicians about the case's outcome, the final treatment plan, or family issues.

Bennett and Beckerman (1986) believed that the 1970s brought a change of status regarding the professionals who performed discharge planning. These authors pointed out that the "drudges of yesteryear" (that is, social workers who did not avoid assignments to medical and surgical services) had been transformed into major players. Carlton (1989) and Ross (1993) commended social workers for their ability to work with elaborate systems and claimed that social workers were the best-qualified professionals to do discharge planning. Cox (1996) in a study of discharge planning with patients suffering from dementia found that social workers were the team members most involved and influential with discharge decisions and nursing home placements. Atkatz (1995) found that social workers were commonly involved in discharges of homeless people because of the problematic placement issues with this group. Social workers were also frequently involved in cases of discharge planning with HIV/ AIDS patients (Fahs & Wade, 1996; Marder & Linsk, 1995), people with mental illnesses (Gantt, Cohen, & Sainz, 1999; Tuzman, 1993), and infants with special care needs (Gentry, 1993). These studies support the importance of including social workers in discharge planning, especially when multiproblem cases occur and there is a lack of available community resources.

Several sources have claimed that nurses are the most qualified discharge planners because their medical training allows them to complete physical assessments, provide medical information with referrals, and assess the quality of health care resources and facilities (Lusis, 1996; McWilliams & Wong, 1993; "Nurse specialists make discharge planning pay," 1994; Steun & Monk, 1990; Thoms & Mott, 1978; Worth, 1987). …