School doesn’t teach you everything you need to know to succeed as a hospice social worker, but this is true of many fields of social work. School provides a theoretical background in social work that we can make use of in hospice, but it doesn’t teach us:
- what to accomplish during daily hospice visits,
- how to navigate office politics or how to adapt continually to changing documentation expectations,
- how to advocates for your patient in the presence of colleagues with agendas,
- or how to work well with some of the challenging individuals that hospice agencies attract.
In my experience, hospice agencies don’t provide enough training or orientation to fill these gaps either. I have worked for four hospices, and each provided minimal preparation. In my first hospice experience, I got some training from the DON (director of nursing) and rode along with a nurse and with the spiritual counselor. There was no social worker already there who could show me her tricks of the trade, so I had to get busy making friends with hospice social workers in the community to learn how to do my job.
A social worker was physically available to train me in my second role, but he was in too much of a rush to get out to give me much preparation beyond a warning to keep quiet and under the radar. In my third hospice position, I received orientation along with a new nurse and rode along with a marketer. In my fourth position, the veteran social worker didn’t care to teach me anything, but had fun mocking my enthusiasm and seriousness about doing the job well. (I’ll admit it–I’m funny!)
Hospice is as challenging as it is rewarding at the beginning of one’s career. Only explicit coaching and planning can prepare someone who is new to hospice for how to overcome these challenges.
Hospice social workers face challenges
There are no standard best practices or expectations for visits. Management may not bat an eye if in a single day a hospice social worker makes one visit in which she only assesses for pain, one in which she only asks how everyone is holding up, and one in which she offers to help a patient receive a donation from the Dream Foundation. This book will help you know how to do your job in a more thorough manner that what any hospice–and most hospice social workers–would expect.
Hospice workers are a tricky bunch. I once conjectured to a DON I know that 80% of hospice nurses are completely nuts. She asserted to me that percentage is actually quite higher, and I believe she meant it. We work closely with hospice nurses, so it is important to focus on developing effective and harmonious relationships with them if we are to feel comfortable in our roles. Hospice teams also face challenges such as the often not-explicitly-clear role boundaries that are frequently overstepped and the office gossip that makes the office manager who answers the phones and does the filing one of the most influential members of the team.
The scope of our work is broad and nebulous. Part of the reason why nurses and spiritual counselors sometimes step in and do social work while we are standing right there thinking, “hello! I’m right here!” and then complain about how there’s not enough time in the day to handle their caseload and documentation, is that they don’t necessarily know what hospice social workers do. This is not an attack on them because many people don’t know what a hospice social worker does. Sometimes there are administrators or DONs who don’t really know what hospice social workers are supposed to do, even though they are responsible to supervise us.
We can try to help them learn about what they can leave to us, but first we need to know really well what that is. We are the licensed counselors, the resource advocates, the conflict mediators, and the professionals responsible to assess psychological wellness and social functioning. This becomes more complicated in hospice because nurses are considered the professional service managers for each patient, and they sometimes take this to mean that it is their job to assess for whether or not patients need a social worker, or how frequently they need one. They forget, or never learned, that social workers went to school anywhere from twice as much to three times as long as they did to become the only discipline in hospice that is qualified to assess what psychosocial needs exist. The aim of this book is to help you understand what your job is so that you can do it well, and when necessary assert appropriate role boundaries.
Death. Most people will find that working closely with the dying will change them. This book will support you so that the changes are positive (increased wisdom, patience, resilience, acceptance of impermanence) instead of negative (stale, crusty and ineffective living as a result of cumulative unaddressed and unresolved grief and existential anxiety).
The mission: raise the bar for hospice social workers
We can strengthen hospice as a positive institution by empowering fellow social workers to fully and confidently embrace the entire scope of their domain. This is hard to do in a field where there are very few specific University preparation programs, very few confident hospice social worker mentors, and very few hospices with robust hospice social worker skill development programs.
The aim of this writing is to help social workers know what their role is in hospice and how to succeed in that role: for patients, for their team members, for the field of hospice in general, and for their own career development and personal satisfaction.
The aim of this writing is to make hospice better by making the hospice social workers stronger, by empowering you to do consistently outstanding work.