The Life of a PRN Social Worker

Hospital social work includes so many different aspects. Generally, there is a social worker for every floor/department. Depending on the hospital, you may have two social workers for a department. Here's the thing... hospitals don't close. You never get to say "Sorry, we're closed, please come back in the morning", and people never have their emergencies at reasonable hours! So hospital coverage out here in terms of social work looks something like this: full time social workers work Monday-Friday from 9am-430pm. Yes, they are working 7.5 hours including lunch. That's pretty swell. But that's definitely not a normal schedule for them to get off at 430 because, like I said, people don't plan their emegencies ... and doctors love to discharge patients as soon as you're wrapping up your day. Now, the hospital has to be covered 24/365. So what happens during those other times. Enter the PRN social worker. The hospitals are then covered by either oncall shifts (every night and, for some hospitals, weekend days) or onsite coverage (busier hospitals on the weekends). And if any of the full time social workers call in sick or goes on vacation, PRN social workers will cover their department. We're like substitute social workers.

I love being on call but I also miss having a regular schedule. I love working in the ED (emergency department) and seeing the psych crises that come through and being able to help the patients. What I don't like is the uncertainty of my future. We schedule one month in advance and never know what the following month will bring. In December, I had four days and four nights. That's it. While I enjoy free time, I still need to be able to pay my bills. It's always a feast or famine approach. I can't deal with that. I need hours. Some of the other PRN social workers are married and have another income or they have a full time job. I'm trying to get a full time job with this hospital network so it doesn't make sense for me to get another job to just quit in a couple months. I tend to sign up for all the shifts I can just in case the next month is a repeat of December. So far I've been lucky. The only downside is that it takes up ALL my time. Currently, I'm involved in a pilot program at a newer hospital trying to determine if there is enough need to warrant the hiring of a full time social worker for the ED and perinatal services (babies!). This means that I'm getting to work full time ... however, my future is not guaranteed. They could say that there isn't enough work and then I'm back to square one.

In order to compensate for the uncertainty, I've been signing up for on call shifts just to give me a little cash cushion ... and I'm losing sleep and free time. I was on call last night and spent the majority of the night in the ED. I'm glad I was there and was able to help those patients but I'm now operating on three hours of sleep.... and working all day. Normally, I could probably deal with this but ....... I'm on call again tonight and working all day tomorrow. Yay? I'll survive, I know that much. I'll definitely sleep great tomorrow night though! What I've noticed lately is that it affects my social life and reinforces my hermit lifestyle. In anticipation of being called in, I go to bed ridiculously early. For example, tonight I will wash my hair as soon as I get home and probably be in bed by 5pm. Doesn't really leave a lot of room for social gatherings.

And it's these social gatherings that are so important to combat job fatigue and the risks of burnout. I moved out here to Podunkville on a whim and am slowly making friends which has been good. One friend that I have been hanging out a lot with is a night shift nurse. This has a tendency to affect when we can hang out. They only work, on average, three nights a week. But if I've picked up on call shifts, it limits the overlapping free time. I've started to notice how important hanging out with friends can be. I think it's taken for granted a lot of times but it's so vital for ones health. The question comes down to where is one willing to make adjustments in their life for the sake of their health? Is this why social work burnout is so high? We pour ourselves into work without taking the time to focus on ourselves? Our work can directly impact people's lives, more attention needs to be paid to our health so that we can provide the best for our clients. I'm starting to feel like something's got to give ....

Time in the ED

Today was .... chaotic, nonstop, never ending, insane. I didn't even have a chance to go to the bathroom. I was in the ED all day long but I loved it. I never thought that psych would be where I found a passion but I have. I love working on call at night because I know that if I get called in it's for that. Schizophrenia, Schizoaffective, Bipolar Disorder, Suicide Attempts, active hallucinations and delusions - these are all my usual calls. I really thought that I would detest psych and even passed on a job interview because of that but I feel like I have found a department where I fit. I love oncology but I'd be happy in the ED or a psych ward too ..... as a social worker, not a patient.

Hmm, maybe I should go back to school for psychiatry instead of PhD in social work??

Tales from the Trenches....

Let's have story time, shall we? How about the story of the social worker who had a long night in the emergency department that included said social worker having a breakdown? That sounds like a good one .....

When I'm on call at night, I cover more than one hospital in the area. On this particular night, I received a call to one of the emergency departments (ED) asking me to come in because they had a patient who was brought in by the police for a suicide attempt. He was at the ED under a 72 hour mandatory hold and needed to be transferred to a psychiatric facility which is the job for the social worker. As I headed out to the ED, I got a call from a children's hospital asking me to go there and talk with a family that was having a really hard time coping. Generally, the only reason I get called to the children's hospital is for a death. I really didn't know what was going on because the person who called me in wasn't the best at answering my questions.

Whenever, I get called for multiple patients, I have to triage (prioritize) them. The children's hospital becomes top priority. I called the ED and let them know that I was headed their way but I had to go to the children's hospital first. The clerk at the ED said ok and then asked me how long I was going to be. Are you kidding me? People in the hospital know that death is the reason you go to the children's hospital 99% of the time at night. They didn't need to know the reason why I was going to the children's hospital, they only needed to know that I was going. I t was completely unbelievable that they were asking me how long I was going to be.

Anyway, I shrugged it off and kept on my way. Five minutes later, the ED doc called and said they knew I was going to the children's hospital and wanted to know how long I was going to be. I simply answered I didn't know and I would get there as soon as possible. I went to the children's hospital and met with the family. After spending time with them, I said a prayer and thanked God for my career and helping me find what I truly believe I'm called to do.

As I drove to the ED, I got ANOTHER call asking how long I would be. Now this is what gets me, the ED clerk was calling and said I know you're at ******* but we just want to know how long you're going to be. There is a good chance that everyone at the ED thinks I'm dealing with a death which then means that they know they are interrupting me. Could you be any more inconsiderate? I stated I was on my way and then hung up on them. Yep, I did.

I walked into the ED and the first thing I hear is "You're FINALLY here".

To which I promptly responded:

"I'm sorry but I'm pretty sure I let you know that I had to go to ******* because I have to triage my cases and that one took priority. I let you know that I was going to be here as soon as possible and, yet, you called several times asking me how long I would be. Tell you what, the next time this happens, I'll pass the phone to the parents of the kiddo and you can ask them to hurry up their kid's death so you don't have to wait. Or better yet, why don't you just tell them to take their kid out back and shoot them? That would probably get me here faster."

**Awkward silence**

Yes, yes, I did.

Sums it up...

Who needs sleep?

It's 4:30am, and I'm sitting in the emergency department at one of the hospitals here in town. I've been here since 11pm. I'm not waiting to see a doctor or anything like that. In fact, I'm on the other side. I'm one of the medical professionals. I'm the social worker ... problem solver ... miracle worker ... transportation coordinator. I go by many names here. I'm on call for two different hospitals tonight which means from 4:30 pm until 8 am, I'm at their beck and call. Normally, I'll get called out for some minor things. Tonight was not one of those nights. However, those stories are not important. Forgive my rambling, it's been a long day and I've almost been up for 24 straight hours. I'm at 23.

I find the behavior of other medical professionals interesting in the hospital. Generally, social workers are seen as either super helpful or a waste of time. The opinions vary from person to person and especially situation to situation. If I agree with the doctor, social workers are great. If I don't agree or can't help (seriously, the patient lost their purse - I don't know where it is so stop asking), then I'm a waste of time. I feel that when I get called in for psych crises, medical professionals turn into vultures looking for a juicy story. Now, don't get me wrong, I love nurses and the other people here. They can be a social worker's best friend. I just don't have an appreciation for the way they talk about some patients or how the hover around when there's an "interesting patient". If CPS or APS is involved, they can't wait to hear what's going on. Suicide attempts, they always want to know the plan.

My problem with this is that we all know about HIPAA. Generally, health information is on a need to know basis. If it's not your patient, you don't need to know. If it is your patient, generally, you still don't need to know the specifics of what I'm discussing. It's confidential information. Granted, I understand that it's the middle of the night and it's boring. Emergency departments could be their own soap opera or tv show (oh wait, that was ER). Gossip is horrid here. I always feel bad when a patient pours their heart out to me and has had a tough life or experience and it turns into the latest fodder. I usually tell the doctor's what's happening and limit the amount of information that I share with the nurses. However, if it's a "juicy" story, soon everyone knows. It's a little upsetting. I need to work on how to answer when people push me for details.

But for now, I really would like CPS to call me back.