SALT LAKE CITY, UT – Attempting to leave on time for the first time in two years, Jen was on her way towards the elevators before noticing Carol, a dedicated hospitalist talking to her computer. “GI bleeding, altered mental status, anemia, consult GI and psych; next patient, must discharge.”
With patient loads for hospitalists surging to 45 patients/day to pay for administrators’ new summer homes, Jen the unit clinical social worker was used to hearing the hum of the hospitalists talking to themselves while they were charting. However, today, Jen noticed that Carol was staring into a blank computer screen (frozen probably from the new EHR upgrade), her eyes were bulging and her stethoscope around her neck was just a little too tight for Jen’s comfort.
Immediately using her mad clinical social work assessment skills (including the person-in-environment perspective) she diagnosed Carol with DSM Code 3232.1 Overworked hospitalist breakdown, early stages. Something needed to be done to prevent further decompensation. Carol needed to make it! Carol never asked Jen to play secretary or find a magical home for homeless patients by tomorrow. Carol actually put in consults that allowed Jen to use her training and therefore drink slightly less whenever she sat down to pay her outrageous student loans.
First attending to the Carol’s safety, Jen asked permission to remove the stethoscope. Carol nodded while she continued to report H&P information into the tip of her blue pen. Jen prodded Carol to stand up and when in the most private corner of the nurses station, asked Carol to put her hand on her diaphragm and breathe slowly in and out following the telemetry beeping of the bradycardic 91-year-old patient in room 356.
Carol’s eyes came alive and her speech shifted from mostly acronyms to full word sentences. After 4 more rounds of various therapeutic grounding and relaxation strategies, Jen completed her intervention by pulling out her iPhone to show a video of a cat playing with a baby penguin.
Carol’s color came back and she was overwhelmed with appreciation. “Thank you so much for not letting my breakdown progress any further. John (the hospitalist) had to take a 5th FMLA leave after smashing the computer after he couldn’t close 200 encounters in EPIC due to a nutrition student needing him to cosign her notes. Administration said that patient care was really suffering due to his inability to be efficient. He just lost it and to think, that could have been me!”
Jen came in the next day and learned that to pay back her kindness, Carol had asked the DOM to prohibit useless consults that demean clinical social work wisdom and morale. Jen doesn’t have much faith that anything will change, but the gesture made all the difference. Absent salary increases, which Jen knew without a doubt would never come, the mere possibility that clinical social workers would be appreciated and valued slightly more in her hospital was enough to get her through the first 10 consults of the morning.
Sharing this experience in supervision (confidentiality protected of course), Jen’s manager appointed her to the hospitalist burnout prevention initiative, a cost-saving measure with multiple sub-committees which would prevent Jen from having any hope of leaving on time ever again.
