Here's where I've been

So, when I started this blog, my hope was to post once or twice a week with my thoughts and experiences as a young social worker working in a rural hospice. The last month has just gotten away from me and I must admit, I haven't found too much that I really want to write about. Life is just hard right now. Our hospice program is understaffed, and I found myself handling volunteer coordination, bereavement efforts, hospice social work patient care, and home health social work patient care. In other words, trying to do about four people's jobs while going to graduate school. So making the time and the clarity of mind to sit down and write a blog post has not been high on my priority list.

Here's what has been on my priority list: I found out that my out-of-state tuition will be higher than what the program advertised. Instead of $6,000 a semester (expensive, but reasonable... it's only for 3.5 semesters and I'm willing to shell out 20 grand for this program), it will be $10,000 a semester (outrageous, and somewhat unreasonable... there's a big difference between going into debt $20,000 for school and going into debt $40,000 for school). Crap. One of the reasons I chose this program, despite the fact that it is an awesome program at a great university, was because of its reasonable out of state tuition rates. So much for that plan.

I have been trying to locate a field placement that will allow me to continue to work at my job. On top of all of that, my job has continued in it's tumultuous pattern. Last week our director and one of our nurses resigned within hours of each other (for unrelated reasons). Now we are short two staff members and they have already told us that they will likely not be hiring to replace them. It's not been the most pleasant work environment these past few weeks.

So I have to come up with an unplanned 20 thousand dollars, and at the same time I will also most likely have to cut back on my hours at work (or find another job altogether...a hospice in a neighboring town contacted me last week for a part time position, so we'll see what happens there) to do my field placement. Oh, and I found a field placement that I would like to do... I just need to figure out the logistic of it. If I were to do this particular placement, I would be working in a day treatment center for children and adolescents. Then this blog would likely become a combination of hospice social work/child and adolescent mental health/MSW program blog. I can handle that. Lots of things to think about.

Oh well. I'd say life is still good. I'm counting my blessings and am grateful for the fact that I have a job. A job, by the way, that I am falling in love with. I never, not even for one second, wanted to do medical social work. When I went into social work, I imagined working for a non-profit organization doing macro-level social work and community development in some urban neighborhood. But can I just say, I love the hospice program? I really do. I love holding patients' hands and talking with them about life after death. I love that this is a field where I can be open about my faith and my belief in God without feeling like I am stepping on toes (I moved here from Utah, and discussing religion in a public way is a no-no there, so it is very refreshing). Ultimately, I love the fact that families are willing to allow me to be a part of their lives during a time in their lives that is so sacred, and when they are so vulnerable.

Oh, and I started teaching an early morning religion class at my church. I meet three teenage boys every morning at 6:30 am to study the scriptures. It's good times. No, really, it is. But it does occupy much of my time and mental energy that I once channelled toward blogging.

All of that said, the new semester of school begins in t-minus three hours. Now that it is costing me almost twice as much as I budgeted for, I am feeling slightly more motivated to succeed. And the new semester will give me even more interesting things to write about. I will put forth every effort to not go for this long without posting ever again.

"Fix her for me, will you?"

Source

It seems like the general public’s perception of the social work profession is that we are around to solve everyone’s problems. I can’t tell you how many times a nurse has wandered into my office, handed me a patient’s file, rattled off a list of problems, and wandered back out. I don’t mean to be critical of nurses or of anyone else in these helping professions; Heaven knows we are all overworked and exhausted. But I am getting tired of the idea that I am the resident problem solver. This guy needs Medicaid, get it for him; this lady needs to stop spending her money on cat food and start spending it on medicine, make her do that (and get her the drugs she needs in the meantime); this family needs to pay their mortgage, get them the money. And be sure you do it by today because they might be dead by tomorrow.

I love the concept of Social Work. I love the idea of helping people acquire the resources they need to improve themselves. What I can’t figure out is how to navigate between coworkers expectations of “help” and a client’s idea of “help.” They are two different things.

Many people seem to think that a social worker is not doing a good job if a client still has a messy house, still lives alone, still has denial issues, still has an unpaid mortgage, etc, even whilst working with a social worker. What is not taken into account is the will of the person. I’ll happily help a client make arrangements for a housekeeper or a sitter, or I’ll help a client apply for financial assistance or Medicaid if they would like. But I can’t just go into their home and wave my magic wand and solve their problems for them. And even if I could, there is no section of the Social Work Code of Ethics that give us permission to use magical powers. If no one is in immediate danger, there is not reason to solve problems that clients don’t care about. On the contrary, social workers “enhance clients’ capacity and opportunity to change and to address their own needs.” (NASW Code of Ethics)

“Address their own needs.” Not address the needs that the nurses, the chaplain, or even the social worker think are important. But the client/family’s own needs. What has the client identified as important? What does she need help with? And what effort is she willing to make to get there? If I give her the resources and the support, can she give the effort? Those are some of the questions I ask myself when I am assessing a client.

Empowerment. Sometimes we forget this concept. Or maybe sometimes we think that to empower someone is to make them like us. To introduce them into our culture and our reality. To make them give high priority to the same things that we give high priority.

That doesn’t seem terribly effective.

Boundaries- Cross at your own risk

I've been wondering about boundaries that as social workers are generally hammered into our heads. Do other disciplines and other helping professions receive the same boundary awareness training that we social workers receive? I can't quite figure it out.

• A therapist brings his wife and children to a patient's house to clean it for her.
• A chaplain adds a patient's adult daughter as a friend on Facebook
• A professor sleeps with a student.
• A doctor sleep with a resident.
• A (fill in the blank) sleeps with a (fill in the blank)
• A nurse buys groceries for a patient because his fridge is empty.
• An aide invites a patient who got kicked out of his home to come and stay at her place.
• A volunteer spends the night at a patient's house because "I just felt like she needed me to be there."
• A nurse notices a patient's mattress springs are poking out of a patient's bed, so she purchases a new mattress for her and delivers it personally.
• A volunteer gives a patient a suppository. ("I just decided that I was his friend for a few minutes and not his volunteer").
• A social worker sleeps with a client. ("I just decided that I was his lover for an hour and not his social worker").

In some agencies, this type of work is lauded and considered very praiseworthy. It is even expected. To me (and hopefully any professionally trained social worker), it screams "INAPPROPRIATE!" Seriously. We are taught from day one not to get too involved, and to maintain professional boundaries. On a personal level, I struggle with this. I become very invested in the lives of my friends and family members. It is a weakness most of the time. But on a professional level, I have no problem (thus far in my career) with maintaining boundaries.

In my opinion, the majority of people who choose to do the actions listed above (all of them made up. Any similarities to actual persons, living or dead, is purely coincidental) do it not to meet the need of the patient or client, but to meet their own needs. In an agency where things like that are expected and even encouraged, the need might be to seek after praise or recognition, or to combat the fear of losing one's job in the uncertain economy. Those who choose to respect professional boundaries may be seen as callous or jaded or out of touch with what the client "really" needs. I think what most clients need are professional, kind people who know how to get them in touch with their needed resources.

When I worked in foster care, I met kids and families that I just wanted to take home with me. Heck, when I taught swimming lessons, I met kids and families that I just wanted to take home with me. Why didn't I? Well, aside from the fact that I would not survive as a foster parent at the moment... duh.. boundaries. I'm sure we've all met people who we love and want to do anything for. But in these cases, it is best to keep our professional distance.

Boundaries protect us. Just like boundaries in our personal lives protect us (choosing not to drink alcohol protects me from drunkenness; choosing to wait until marriage for sex protects me from STDs; choosing to fasten my seat belt protects me from many injuries). We draw our own boundaries in our personal lives. In our professional lives they are drawn for us. At least I thought so.

Give a man a fish

An old (I believe it's Chinese) proverb of some sort says something to the effect of “give a man a fish, feed him for a day. Teach a man to fish, feed him for the rest of his life.” Or something like that.

We’ve all heard it a whole lot of times. I was helping a friend write a paper a month or so ago. I’m kind of anal when it comes to spelling and grammar and punctuation errors in writing, so after I basically picked his whole paper apart with a fine tooth comb and corrected all his errors, I sent it back to him. He texted me saying something to the effect of “wow, you’re feeding me; I’m not fishing,” in reference to that proverb. A week or two later, I was sitting in class and one of my classmates referenced the same proverb and how it relates to social work: that one of the purposes of social work is to teach people how to fish so that we do not have to do all their fishing for them.

I don’t know about you, but I know that I am in the best place to learn right after a good healthy breakfast while my belly is full. If I am hungry, I have a hard time focusing on the tasks of the day. I don’t disagree with the concept of proverbially teaching people how to fish. But I’ve often wondered if we occasionally allow someone to starve to death while they are learning. Case in point: I had a patient who refused to get medications that she needed because she couldn’t afford the $4 that her insurance didn’t cover. This was a little frustrating because the woman is spending probably a good $20 a week on gourmet cat food and kitty litter. I pondered bringing in some information on creating a budget and helping the women figure out where she could cut back. Problem was that helping an old women create a balanced budget wouldn’t make any difference if she didn’t get the medications that would keep her alive and healthy through the weekend.

As annoying as it is to me that people choose to put luxuries for their pets before necessities for themselves, teaching this woman how to prioritize financial resources and allocations (teaching her how to fish) needed to take a back burner to securing her needed prescriptions (giving her a fish).

I think that we do that at times. We spend so much energy focusing on the long range goals that we forget to make a plan for short term needs. Short term needs are important. They are what keep people around long enough to accomplish their long term goals. Maybe I shouldn’t have spent so much time fixing my friend’s paper. Maybe I should have sent him a grammar book and made him fix it himself. But if a good grade on a paper or two will give him the boost he needs to continue to progress in school, I feel it is worth it. Maybe I shouldn’t have helped that patient get her medications. But I feel it is necessary to keep patients alive first, and give them financial advice second.

Hmm… It gives me something to think about. Do I teach a starving man, or do I feed him first, then teach him while his belly is full?

Leadership

So I might be slightly venting at the moment.... I'm not sure. I flew home to Utah last weekend for my grandpa's funeral. It was a beautiful service, and it was nice to see friends and family that I haven't seen since I moved out here. I came back, and on my first full day back, the Chief Nursing Officer of our hospital came in to our case conference to make A Big Announcement.

The Big Announcement was that our boss had gotten fired and left the company. Funny thing about this particular boss. See, he'd been with the company about 6 months. During that time, he had basically pulled our company out of the red, earned a lot of money for the company by debating certain reimbursement claims from Medicare. Not to mention the fact that he increased company morale pretty significantly.

Now, I know that things probably went on that I don't know about relating to his termination, but it still seems a little fishy to me. I have been with the company for three months. My direct supervisor (who at the time had been there 3 months) was fired my third week on the job. Shortly thereafter, we hired a new nurse who was promptly fired a month later. And now the director of the program is no longer with us. All of them had been with the company less than six months. I've been there three. My sister has been an occupational therapist at the same company for about seven months.

I'm a brand new social worker. I never really got any training when I joined this company. I make mistakes all the time and for the most part I don't really even feel bad about my mistakes, given my lack of experience and training. My bosses knew of my inexperience when they hired me and accepted it with patience. The two managers who are now fired are the ones who hired me. I'm not going to lie; I'm nervous. Who is next to get fired; and why wouldn't it be me?

Waiting to adopt

My friend Rachel and her husband Jon are trying to adopt their second child. They have a little boy, Sam, who is just so handsome, and who will make a great big brother.

Read their official adoption profile here, and learn more about their sweet family here.

If you or anyone you know is looking for a very loving adoptive family, please explore their profile. I could not identify a family more well-equipped with love and happiness to place a child with.

Here's some family photos if you need more convincing.

Out for a bike ride around the neighborhood Boating at Flaming Gorge

First official day of graduate school

After two weeks of orientation, on Friday May 14, 2010, I celebrated my first official day of my MSW program. I will now bring your attention to the first page of notes I have taken as a graduate student...

Drumroll please...

Looks like my note-taking skills... um... leave something to be desired.

Oh well... I'm working on it. When I moved out here three months ago, I spent a lot of time wondering if I was big enough for all the responsibilities I was given. As the only social worker in an already floundering hospice, I consistently find myself bombarded with any project that is even vaguely "social worky." It is demanding, yes, but I am learning new things every day.

Now that I have officially started graduate school, I feel the same way. Am I really "big enough" to be a graduate student? In 1.5 years, will I really be "big enough" to be an MSW? So many questions on my mind. But for now, I have to get to work writing my paper and about twenty case notes in preparation for the coming week.