some questions

[andrea]

Hi all, hope I'm posting in the right place. 

I wanted to jump right in and ask for some advice from the wonderfully experienced patients here on the forum. As I said in my intro, I am a social worker and have just started my first job in renal, so I have plenty of questions!

Since I started, I've learned that the previous social worker didn't really do her job. According to the other staff, she stayed in her office with the door shut and the overhead lights out, and patients had to tell their nurse/tech if they wanted to talk to her. The nurse or tech would then slide a note under the social worker's door, and she would come out if she felt like dealing with the patient. Personally, I think that's a horrible way to operate - I maintain an open door policy, and I truly want the patients to feel like they can walk right in when they need to talk. However, I think some of them are gunshy, both because they don't know me and because of the previous worker's way of doing things.

So I'm trying to think of ways to make them feel more comfortable with me. These are the things I've already done:

• Sent out a letter introducing myself and the services I provide (I think some of the patients don't really know what I'm here for)
• Passed word to the nurses and techs that if a patient has a need, either send them to me or let me know and I'll come talk to them  on the floor
• I make rounds with the doctor every week (he rounds once MWF and once TTS weekly) to check on the patients and ask them how they're doing
• I make a point to talk to patients and family members in the waiting room, which is right by my office

I feel like I'm trying very hard to be friendly and inviting, but so far only a couple of patients have talked to me, and they only did so because of a HUGE pressing need. Is there something else I should be doing? Or do I just need to give it more time? I've only been here 5 weeks, and I know most people aren't going to jump at the chance to talk to a stranger about their personal lives, but I'm scared that some of them have needs that they aren't expressing. I just don't want anyone to go without something they need to be happy, healthy, and comfortable.

If anyone has suggestions, I'd love to hear them!

[Hawkeye]

Sounds to me you are doing just about everything you can at this point.  I say give it some time and keep up with what you are doing.  If they want / need to talk to you they will in their own time.

[jasperkat]

Andrea,
Welcome to our family!  Just a few comments about Social Workers on the Renal Unit.  My experience with Social Workers has not been real positive.  Just a couple of hints to make it easier for you.  Please don't interview me or my husband about finance, health or other personal issues in the hall or lobby.  Don't assume that my husband is "confused" because he wants me to do the talking for him.  He has enough to deal with so I take on the insurance and any other issues.  Just because the situation is not how you percieve it, again, does not mean he is confused.  He told the Social Worker I was his wife.  The social worker decided I was actually the daughter!  Some people are able to manage their own appointments, transportation and referrals.  Those people probably won't ask for assistance.  I am sure you will do a great job as long as you are sensitive to peoples differences and preferences.

[stauffenberg]

Keep in mind that you are coming into a situation where the patients hate the way the clinic is run for the convenience of the staff and the institution, but not for them; where they hate the way the nephrologists either ignore them or pester them with useless tests; where they hate the way the nurses and dieticians boss them around and scold them for non-compliance with a regimen the staff themselves could never adhere to; where they hate the way the Medicare system underfunds dialysis treatment so patients cannot have all the treatment time they need; and where they hate the way the organ allocation system is so foolishly inadequate, when many simple measures could speed it up but are simply not implemented.  So the patients live very much with an 'us' against 'them' mentality, and you, as part of the staff, will initially be regarded as one of 'them' and part of a system which does not put the patients first as it should.  If you can break through that barrier and show yourself to be on the patients' side, that will be the key to getting them to open up to you.

[KICKSTART]

Social worker ? whats a social worker !. I know we do have them in the UK but they are never mentioned on the renal unit.

[RichardMEL]

Andrea,

Sounds like all good things you are trying to remedy the situation the previous social worker left you (and the unit) with.

The only thing I'd add is to perhaps not try too hard or push yourself onto them. I'm sure you now that anyway.. I mean be there and available and I am sure they will warm to you and if/when they feel you can offer them something they will come to you.

good luck Sounds like you are a breath of fresh air in there.

My mother was a social worker so I know it can be a tough job!

[andrea]

Thanks for the responses, guys. I really felt like I've done enough at this point, but I wanted to make sure there wasn't some key element I left out. As much as I can read about dialysis and empathize with what the patients are going through, I'm not the one sitting there hooked to a machine, so I don't want to make assumptions. It's hard to walk into a job where no one really knows what I'm supposed to do - I'm the only social worker here amongst a bunch of nurses, so I'm sort of on my own. My coworkers are supportive, but they just don't understand what I'm here for and what I need to be doing.

I will say that it frustrates me not to have a good way to talk to patients when I need to. Many of them don't want to come in early or stay late (and I don't blame them!), so I've been told to just talk to them out on the treatment floor. But I don't like doing that because those chairs aren't very far apart! Personally, I would die of embarrassment if someone started talking to me about my finances or my emotional problems in front of other people. I try to catch the patients when they're in the waiting room, but that isn't always possible.

I guess at least the fact that I'm trying (and care enough to try) is better than what they had before, so hopefully they'll start to feel more comfortable soon.

[kitkatz]

You need to make rounds on your own and talk with patients.  Sometimes the docs only talk meds, you can talk other parts of their lives with them. Put together a renal resource book for your area so patients have phone numbers of people to call for assistance.

[okarol]

I will say that it frustrates me not to have a good way to talk to patients when I need to. Many of them don't want to come in early or stay late (and I don't blame them!), so I've been told to just talk to them out on the treatment floor. But I don't like doing that because those chairs aren't very far apart! Personally, I would die of embarrassment if someone started talking to me about my finances or my emotional problems in front of other people. I try to catch the patients when they're in the waiting room, but that isn't always possible.

Andrea, you are right, no one wants to spend extra time at their clinic, and talking during treatment is awkward and inconvenient for most patients. If you can give the patient your direct phone line, and a time when they can call you for a phone appointment, I think you'd have much better luck. Being available and willing to communicate, AND actually following through with promises is rare when it comes to social workers, in my opinion.

[thegrammalady]

don't subscribe to a cookie cutter point of view. we are not all the same and one size does not fit all. i overheard our nutritionist tell a patient and his wife that his phos would never come down if he ate any cheese. now that's just plain bull!! our social worker is a nice gal who realizes i'm going to question just about everything she says. she doesn't feel threatened by the fact that i can think for myself. about the only thing i need for her to do is set up treatments for me when i travel. occasionally she comes around and asks me if i know about thus and such, which i don't mind. the folks at your center will loosen up as soon as they realize you're actually ready to help. it sounds like you're doing a good job of getting to that point.

[Zach]

Keep in mind that you are coming into a situation where the patients hate the way the clinic is run for the convenience of the staff and the institution, but not for them;

Get a grip, man!