Academic journal article Health and Social Work

Nurse Social Work Practitioner: A New Professional for Health Care Settings

Academic journal article Health and Social Work

Nurse Social Work Practitioner: A New Professional for Health Care Settings

Article excerpt

Hospital systems are merging, cutting back, and dismantling as a result of the shift in delivery of care to ambulatory settings and the continuing shift to managed care (Berkman, 1996; Pecukonis, Cornelius, & Parrish, 2003). Cutbacks and downsizing are occurring at a greater rate than hospital social work leaders predicted (Mizrahi & Berger, 2005). Social workers are often frustrated and challenged by increasing demands of a health care system in crisis. As a result of the market-driven cost-containment strategy that hospitals are adopting, many social workers are forced to either adapt or leave their jobs. The social workers who remain must do more with less, with an eye on the bottom line. Even field education of social work students in hospitals has been compromised by these changes (Globerman & Bogo, 2002).

Along with the threats to social work has come a call for a more integrated health care workforce, with fewer silos of practice and an emphasis on how the patient (consumer) experiences the system (Institute of Medicine of the National Academies, 2003; O'Neil, 2005). The present silo system is burdened with a multitude of differing scopes of practice and responsibilities for delivery of patient care. The integration of the varied health care professions, including social work, is made more difficult by the early discharge of patients from acute care facilities requiring coordination with continuing care settings such as nursing homes, and the increasing use of outpatient departments and surgicenters for serious and extensive surgeries that used to require inpatient days both before and after surgery.

The traditional roles of social work within health care settings are at risk of becoming obsolescent unless social work adapts to the changing health care settings. Increasingly, patients do not suffer from acute simple diseases that require short-stay hospitalization, but from multiple, chronic health problems that require predictable episodic need for care (Berkman, 1996). Social workers can meet the challenges of the "new patient" by restructuring their scope of practice to include more emphasis on community care and case management services to help patients access the myriad of health and social services, as well as by helping patients deal with the accompanying psychological and social issues and empowering patients to make knowledgeable choices (Cowles, 2003).

The University of Southern California's (USC) School of Social Work has developed a transdisciplinary educational option, the nurse social work practitioner (NSWP) that will meet the demand of the new health care service system. USC is currently the only school of social work with this option. We define transdisciplinary, as the fusion of knowledge and practice techniques from multiple disciplines. This transdisciplinary role is client focused rather than provider focused and differs, therefore, from interdisciplinary education and practice wherein connections are made but each provider retains his or her own distinct disciplinary approach (Massey, 2001). The NSWP option was developed in 2004 to recruit registered nurses (RN) with baccalaureate degrees as students in the Master's of Social Work (MSW) program. Thus Far, we have admitted 11 students, three of whom graduated in May 2006. The program was designed to meet a community need and not to increase the numbers of MSW applicants, because it is anticipated that the number of RNs applying for this program will remain low. An integrated case management curriculum was created to bridge the health and social welfare worlds to holistically meet the needs of patients, families, and communities. Community health care agencies helped shape the educational program, develop the practice roles, and design the curriculum.

THE CHANGING ROLE OF SOCIAL WORKERS IN HEALTH CARE SETTINGS

The Society for Social Work Administrators in Health Care and NASW commissioned a study in 1994 to look at the changes that were occurring in hospital social work departments (Berger et al. …

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