Challenges Inherent to Hospital Social Work

Hospital social work is a very challenging sub-field of social work. It is not for everyone, but for certain social workers it is a calling and they are very well suited for the fast pace and challenges hospital social work brings. Hospital social workers (sometimes called medical or healthcare social workers) may work very long hours and witness some very traumatic events such as families reacting to the death of a loved one, the death of a long-term client, children coming into the hospital with injuries from abuse, or the suffering of patients in the hospital. Because of this, hospital social workers can experience secondary traumatic stress and burnout, but they also can have very long and fulfilling careers.

Hospital Social Worker Job Responsibilities

Hospital social workers have a variety of responsibilities including admitting and discharging patients and keeping various patient records. They may help families arrange for home health care services for elderly or seriously chronically ill relatives upon discharge or for. hospice care for terminal patients or those needing mainly palliative (pain-relieving) care. They may arrange for social workers from external agencies to work with elderly patients living alone, recovering substance abusers, or psychiatric patients transitioning to outpatient care. For patients in need of income support or other social services, hospital social workers can help patients being discharged find housing, public benefits, or job training.

Hospital social workers may make a one-time visit to patients in crisis or provide regular individualized therapy. Patients may want to talk about the impact a disease or condition is having on them or other issues. Hospital social workers also often lead therapeutic groups for patients and provide psycho-education to family members. In a psychiatric hospital setting, they may lead groups for patients recovering from severe mental illness or in a hospital oncology department they might organize support groups for patients or family members.

Hospital social workers often are involved in billing and health insurance casework and advocacy. For example, they may help low-income patients enroll in public health insurance programs. They help patients with billing problems or obtaining approval from their insurance provider for a procedure. They may act as a troubleshooter when it comes to dealing with Medicare or Medicaid. Hospital social workers sometimes have the unpleasant task of obtaining payment for procedures or treatment from patients or insurance providers .

Hospital social workers may specialize in working with certain populations such as psychiatric patients, pediatric patients, elderly patients, substance abusers, or hospice patients. Work settings vary as well, from psychiatric hospitals, to children’s hospitals, to substance abuse treatment centers, hospice facilities, and nursing homes.

Helping Patients and their Families with Ethical and Spiritual Issues

Hospital social workers can become involved in helping patients and families with ethical and spiritual issues as well. They may counsel patient’s families on advanced directives about end of life care, such as a do not resuscitate orders (DNR). Some social workers may be involved in arranging spiritual care for patients such as a visit from a clergy member. They might also conduct spiritual assessments for long-term hospital, nursing home, or rehabilitation center patients to determine what a patient’s spiritual care needs are and how they can be met while they are inpatients.

Preparing for a Career in Hospital Social Work

Social work students who are interested in going into hospital social work should do fieldwork in a hospital setting and take courses relevant to medical social work. They will also have to prepare to obtain the necessary licensure required for specific positions they are applying for. Obtaining a post-`graduate certificate is an option for those interested in hospital social work. For example, the National Association of Social Workers offers a social work certification in health care.

Some social workers believe it is beneficial for all social work students, even those  who don’t want to go into hospital social work, to get some experience working in a hospital setting. Clinical Social Worker and Certified Professional Coach Mrs. Kimberly Grocher, LCSW believes every social work student should be required to do some form of hospital social work fieldwork because she says this type of placement brings together the micro and macro; students learn to deal with the social policies, systems, and resources in the community such as in situations where patients who should be treated in outpatient setting end up being treated as inpatients due to lack of resources or systemic issues. “But students should also know hospital social work is not for everyone on a long term basis.” says Mrs. Grocher, who has worked at in several medical institutions, inpatient and outpatient, including Weill Cornell Medicine and believes being a hospital social worker greatly contributed to her growth as a social worker.

The Interdisciplinary Nature of Hospital Social Work

Those interested in going into hospital social work should be aware that they will most likely be working as a member of an interdisciplinary team providing holistic care to patients. As a member of these teams, social workers may work with psychiatrists, doctors, medical specialists, occupational therapists, psychologists, and other human service professionals, and administrative staff. Hospital social workers must be able to collaborate with others in caring for patients. They should also be able to refer clients to outside mental health services as needed. According to Mrs. Grocher, hospital fieldwork helps students learn to work on an interdisciplinary team with other medical and allied health professionals such as occupational therapists and physical therapists.

As integrated care becomes the optimal standard for healthcare, the importance of social work in medical and hospital settings comes into even greater focus (de Saxe Zerden, Lombardi & Jones (2018). Integrated care means mental and physical healthcare are provided, and both aspects of care are viewed as integral to the health of a patient. Integrated care is key to preventing and addressing many physical and mental health care problems. Social workers are familiar with integrated care and should be vocal proponents of such care in any healthcare setting including in hospitals.

There are many social determinants of poor physical and mental health including racism, poverty, and discrimination. Social workers in healthcare and hospital settings have an important role in sharing not only their knowledge about the intersection and mental and physical health but also about the various social determinants of health. They can help educate communities and healthcare providers in hospital settings about these determinants so that all can advocate for policies and programs that will improve the health of communities.

Stephanie Bosco-Ruggiero

B.A. Political Science| Vassar CollegeM.A. Urban Affairs | University of Delaware

Social Policy | Fordham University Graduate School of Social Service Doctoral Program

January 2020

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