Much has been written about frontline healthcare workers tirelessly providing essential services to COVID-19 virus patients. Within these essential services are the many social workers who have become the liaison between dying patients and the family members forbidden to see them. Compared to other healthcare professionals, little has been written about the role of social workers in the hospital setting.
Julie Tyler, a Medical Social Worker at the All-American Hospital in Memphis, Tennessee, experienced the COVID-19 crisis from the beginning. I was excited to have the opportunity to interview Julie so others could understand the important role social workers have been playing.
What was your position at the hospital before the pandemic?
I was working on the Lake Unit where things happened very quickly.
When someone experiences a traumatic event, they come to the Lake Unit (similar to an Emergency Department–but on steroids). Then they are immediately seen by a team of providers, taken to get CTs and MRIs, and are either stabilized and discharged, stabilized and admitted, or emergently go to the operating room. As the Social Worker on this unit, I cover a wide variety of micro issues and macro systems. The majority of my time was spent assisting patients with discharge plans, ensuring they have a safe place to go home to, have assistance at home if needed, and are aware of the benefits and resources in their area to help them after their injury.
Other duties included assisting with identifying patients, identifying next of kin, providing resources and referrals, conducting assessments, transportation, providing documentation, counseling for patients and families, and everything in between.
What changed during March 2020?
COVID-19 first began affecting our daily professional lives when we were required to wear masks in patients’ rooms. As restaurants and non-essential businesses were closing in the state, resources we regularly referred patients to (social services, shelter, food resources, therapy and crisis intervention services) were changing the way they operated. Most services were moving from in-person to online, decreasing the number of clients they were taking, and modifying the services provided. I spent a lot of time scouring the internet, checking county governments’ sites for updated mandates, and calling programs for updated information regarding their hours, services, and criteria. We were trying to educate ourselves with our patients’ needs in mind, as they were evolving with the pandemic.
It was not long before elective surgeries and visitor restrictions were implemented to decrease the number of non-essential people in the hospital. This is when I felt our work lives became engulfed by Zoom. We were not only using it to assist patients communicate with their families, but to also hold family meetings with providers, for providers to talk to COVID positive patients, and for us as social workers to conduct assessments and provide support to patients and families.
In late March 2020, we began to do “COVID staffing”. That meant instead of working our normal Monday – Friday, 9-5pm schedule, we would be working three 12-hours shifts per week (Sunday-Sunday) with a fourth 8-hour shift every other week. Our jobs as social workers in the hospital cannot be done – in its full capacity– at home. This new shift-work schedule allowed for less people from our department to be in the hospital at one time.
I think this is when working during a pandemic started to take a toll in the workplace. My team consists of four social workers, and during this special staffing, there were only two of us covering five floors every day, sometimes only one worker if it was a weekend (like a “normal” on-call weekend). Honestly, it was a lot of work. There were shifts when I did not sit down, eat, or take a mask break. The few days off in between were spent sleeping so my body could recover and to prepare my mind to do it all over again.
Please describe a typical day in your role during the height of the pandemic.
During the COVID shift scheduling, I worked my normal units and covered the Beach Unit, our Intensive Care Unit for COVID positive patients. On this unit, instead of going to patients’ rooms to interact with them and their families, everything I did was either over the phone or on an iPad via zoom.
I had a cell phone that was only used to contact patients’ families who had loved ones on the Beach Unit (the ring tone still triggers me today).
Social workers were instructed to not go into COVID positive rooms, and quite frankly, we would not have been able to interact with these patients anyway. Every patient on this unit was intubated and sedated and needed the highest, acute, level of care. Every patient had an iPad in their room that faced them. Their iPads were connected to another one in a room full of iPads where nurses/providers inside the room could interact with providers outside the ‘containment’ part of the unit. Here, I would go into the room full of iPads and coordinate with the nurses about which of their patients had Zoom calls with their families. For these calls, I would always prepare the families for what the patient looked like (usually had a tube in their mouth to breathe and were hooked up to a bunch of machines). Then, the family would spend time with the patient, telling them how much they loved them, praying over them, and giving them well wishes for them to get better. This was the hardest part of my career so far. Most of these patients did not survive the virus.
I still remember my first patient. I was involved in their care from the day they were admitted until they passed. I spent a lot of time with their spouse on the phone, their family over Zoom, and in family meetings talking about the next steps and goals of care. I will never forget the conversation I had with the spouse after the patient’s passing. In the spouses’ grief, they told me how grateful they were for the care and services provided, including my job as their social worker. Working in trauma and on the COVID units, I believe it is a privilege when someone allows you to be with them during their most vulnerable moments. COVID-19 elevated that experience for me; I will forever be a part of these families’ last moments with their loved ones. Their names and sound of their voices I will never forget. I wholeheartedly believe this a beautiful way to practice Social Work and I am forever grateful for this experience.
What is it like at the hospital now, and what self-care strategies do you recommend for new social workers?
Today, I cover the Beach Unit from time to time. I have adjusted to my new referral “go-tos,” I’ve become faster using interpreter services and Zoom, and better at teaching others how to use the same. We continue to wear our masks and goggles all day every day. I still work on my normal units and have recently started covering the Sea Unit. The Sea Unit is for COVID-19 positive patients, but is an Intermediate Care Unit, meaning these patients are getting better and will discharge to rehab or home in the near future. These patients are living. It’s weird to say, but it is an adjustment, one I am overjoyed to make.
All social workers have been challenged with the restrictions of COVID-19, and the additional stress has been difficult to process. Many of us are finding that we are not able to process COVID experiences since they are still happening. It is critical to use time off to rest and cater to your physical self. To maintain mental stability, it helps to reflect on the silver linings. For me this was the increased teamwork and heightened use of my clinical skills. Another silver lining is the deep appreciation I feel for all hospital staff–from the medical team to maintenance and security. Most importantly, I remember that each patient and their families benefit from the collective work of many people and social workers like me are a vital part of that experience.
*While this is a true story, the names of the social worker, hospital, units and location have been changed per the request of the interviewee.
Guest Author Hannah Parker is a social work student intern at Jenerations Health Education, Inc. for the 2020-2021 academic year. She will graduate from Salisbury University this spring and plans to attend graduate school.
FUN FACT: Hannah played basketball from the time she was five years old until her freshman year of college as a point guard. For the last several years she has coached boy’s and girl’s recreational basketball at the elementary and middle school level.