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10 Things I Learned From My First Year as a Social Worker

June 1st officially marked the end of my first year as a social worker. If you don’t know much about medical social work, check out this post. It’s been a rough year in many ways, but it’s also been one that resulted in significant growth for me, both professionally and personally. I was reflecting on the past year and decided I want to share a few things I learned in my first year as a social worker.

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1. Expect the unexpected. From personally delivering (aka riding) a motorized scooter to a patient’s room to being screamed at by patients about the hospital food to arranging an inpatient marriage ceremony  — you just never know what will happen or what you’ll be called to do.

2. Unconditional positive regard is the name of the game. I see a lot of people on some of the worst days of their lives. Either they or their loved one are sick enough to require hospital care. Due to stress, fear, exhaustion, personality, or some combination of these, people are understandably upset and perhaps not their most congenial selves when I meet them. And that’s OK. They don’t have to like me.  Frankly I don’t have to like the patients that I work with, nor approve of their actions. I just need to meet them where they’re at, without judgment. I try to be respectful and compassionate, and I always try to keep in mind that I know almost nothing about the person’s struggles and problems that led them to the moment I started working with them. Unconditional positive regard is something that I will constantly be working on, but I feel like I gained a greater understanding of its importance over the past year.

3. Burnout and compassion fatigue are real.  They aren’t just concepts in a textbook. I knew I was starting to get burnt out a month ago when I found myself feeling tired and overwhelmed and getting annoyed when patients or their families needed my help with complex social situations. I just wanted to do my assessments and get them out the door. That may sound harsh, but it’s the truth. If you’re finding it more difficult to care, you’re probably getting burned out.

4. Self-care, self-care, self-care. To be honest, the emphasis on self-care during graduate school always felt fluffy or overplayed, but I understand the importance of it now. The best way for me to combat burnout or compassion fatigue (see #3) is to take care of myself. The basics — healthy eating, adequate sleep, and exercise — make a HUGE difference for me. I also found that pursuing interests outside of my work, such as writing this blog or volunteering with Make-A-Wish, is especially helpful when work is frustrating. Finally, making sure that I leave on time has been a game-changer for me. It gives me a greater sense of control and helps me feel like work isn’t taking my time and energy away from me.

5. Advocacy is the most important part of my job. Whether it’s identifying systems-level issues that need to be addressed (like increasing access to palliative care options) or making sure that a patient’s voice is heard, advocacy is essential. In medicine especially, I feel like I need to hand out bumper stickers that say, “People have the right to make bad decisions.” I may not agree with someone’s choices, like when patients with an alcohol use disorder choose to go home instead of to a treatment program, but as long as they have the capacity to make their own decisions I will vehemently defend their right to do so.  There’s been more than one occasion when I had to talk to the medical team about self-determination because they were holding up a discharge to push patients to choose the option they felt was best. The medical team’s intentions were good, but it was still paternalistic. Sometimes this kind of advocacy doesn’t exactly make me popular on the multidisciplinary team, but I feel that it’s necessary to respect the patients’ decisions, regardless of my own opinions.

6. Social work skills are just as useful for coworkers as they are for patients. My role in the multidisciplinary team is as important as my direct role with patients. As a medical social worker, my work with patients does not exist in a vacuum. It’s not one-on-one work with a patient. I’m working with the patient, doctors, nurses, physical therapists, occupational therapists, speech therapists, nutritionists, etc. I often end up using the basic skills I learned (i.e., active listening, reflection, boundary setting, empathy, etc.) as a facilitator and to help smooth disagreements between disciplines.

7. Gallows humor is necessary. Like many people who work in healthcare, my coworkers and I make jokes about death and disease. The humor isn’t cruel, and as one physician in an article on Medscape put it, the difference between gallows humor and derogatory humor is like “the difference between whistling as you go through the graveyard and kicking over the gravestones.” Our jokes aren’t at the patient’s expense; they’re a coping mechanism to help deal with the constant stream of macabre circumstances.

8.  The work will never be finished. Everyday I make a list of all the things I should work on, and inevitably I never complete my list. Every time I cross a few things off, a couple more are added on. It has taught me to prioritize and to accept that I will never be done. One of the best adjustments I continue to work on is letting go of the expectations I have for the day. I only get frustrated if I have an idea of how things are “supposed to go.” It’s best if I approach my days with curiosity, wondering what crazy things will happen that day.

9. Life is short. A small but significant number of patients I work with either die in the hospital or leave the hospital on hospice. And sometimes it’s completely unexpected. I recently had a younger person come in for what they thought were gallstones, but it turned out to be stage IV pancreatic cancer. His prognosis is about 6 months. Seeing how quickly life can change is a constant reminder for me to stay in the present and enjoy it and to make the most of the time I have with the people I love.

10. People’s strength and resiliency is amazing. For all of the death, loss, anger, and family disputes happening around me, I am always impressed and inspired by the strength demonstrated by patients and their families. I’ve seen a son step up to care for his estranged father who he hadn’t seen in 15 years. I’ve seen a man move heaven and earth to get his partner home so he could pass away with his beloved cat at his side. And I’ve seen a patient fight his way back from a devastating stroke, regaining the ability to swallow, walk, and speak, in order to live independently again. For all of the negative things that can happen, it’s imperative to remember these moments; people truly are resilient.

A Swift Kick In The Butt {Fun Friday}

Hallelujah, it’s Friday!!! Work was absolutely crazy this week. Obviously I know that protecting confidentiality is of the utmost importance, but sometimes I REALLY wish I didn’t have to abide by HIPAA regulations. You would not believe some of the things I see and hear with my cases. My friends Brittany and Caroline, who are also social workers, devised a plan for us to write a book called I Can’t Make This Sh*t Up. We can all attest to the cliché that truth is stranger than fiction.

Anywayyyy, on to some Fun Friday stories, pictures, and videos!


Let’s get this party started with a dog video. (I have a dog video problem.)

He is so perplexed by that fountain.

Next up is a “Lip Flip” segment from The Tonight Show. Have you seen this yet? This one with Jimmy Fallon and Billy Crystal is by far the funniest one to me.

I find it unsettling and hilarious.

Below is an amusing Calvin and Hobbes strip that I want to put up in my office.

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Sometimes we all need one. 🙂

Finally I want to share an NPR segment called, “Beyond Charity: Turning The Soup Kitchen Upside Down.” While charity is certainly necessary in the short-term, it is often not the best way to help people long-term.  Robert Egger, the founder of DC Central Kitchen, noticed that many of the individuals eating at local soup kitchens were battling addiction and facing incarceration in addition to dealing with unemployment and homelessness. Egger decided to take a “teach a man to fish” approach and created a culinary job training program, which teaches individuals how to cook and earn a food handler’s license. The individuals in the job training program help produce approximately 10,000 meals each day. About 5,000 meals are sent to local nonprofit organizations and another 5,000 meals are distributed to local, low-income schools.

My graduate school classmate Allison is starting up a non-profit with a similar model in Chapel Hill, NC. It’s called Made With Love Bakery. Made With Love Bakery is a “faith-based transitional employment bakery sharing the love of Jesus Christ with individuals experiencing or at risk of homelessness, giving them a second chance at employment and equipping them with the training and support they need to overcome poverty.” You can find out more on the website or her blog.

Sheesh, I’m supposed to turn off the social work for these posts. What can I say? I love seeing people find creative ways to address social issues. It inspires me.

Have a great weekend!!

Health Equity {Social Justice Issue}

I am FINALLY posting another piece in my social justice series. I love social justice posts, but they take longer to write than most of my posts. If you haven’t read Food Deserts and Swamps yet, read this one first. This post provides a broad overview of the relationship between social justice and health. It helps explain my perspective on health and well-being, and sets the stage for future social justice posts.


Health Equity

What is health equity? 

Healthy People 2020 defines health equity as “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”

Health Equity

What is the difference between health equity and equality? 

Health equality focuses on fairness and involves equal distribution of health-related resources to all people regardless of pre-existing differences. Health equity focuses on people attaining the same optimal level of health, which often means that some people get more assistance or resources than others. Particular attention is paid to groups that have experienced major obstacles to health associated with being socially or economically disadvantaged. The image below is helpful for understanding the difference between the two.

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Source: theequityline.org

Unlike health equality, a health equity approach acknowledges that some individuals have a better chance of attaining optimal health than others. Therefore, the goal of health equity is to level the playing field so that everyone has the same opportunity to be healthy. An essential component of leveling the playing field and ultimately eradicating health disparities is addressing social determinants of health.

What are social determinants of health? 

According to the World Health Organization (WHO), social determinants of health are “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.”

In simpler terms, social determinants of health include a person’s

  • socioeconomic status,
  • neighborhood,
  • employment conditions,
  • education,
  • access to healthcare,
  • race,
  • ethnicity,
  • sexual orientation,
  • gender,
  • and personal behaviors.

The video below illustrates social determinants of health by using “Chad” and “Jeff” as examples.

For another example, as I pointed out in my last social justice post on food desserts and swamps, people who live in low income neighborhoods or communities are less likely to have access to affordable and nutritious food. And as we all know, a healthy diet is absolutely essential for overall health.

Why does health equity matter?

Health is a basic human right, and it affects every part of our lives. While some factors of health are beyond human influence, we have the power to address the social injustices that lead to health disparities. By building on individuals’ strengths and mitigating the effects of social and economic disadvantages, we can work towards equal opportunity for optimal health and well-being.

Resources and Additional Information

Healthy People 2020

WHO – Social Determinants of Health

To Be Alive Is To Be Vulnerable

Hope your week is off to a good start! This week’s quote focuses on vulnerability. Along with the quote, I am posting a TED talk by social worker Dr. Brené Brown called, “The Power of Vulnerability.” I’ve posted it on Brown is the New Pink in the past, but it’s worth posting again. Brown’s talk is approximately 20 minutes long, and I promise that it will be time well-spent to watch it.

Brown’s TED talk and Madeleine L’Engle’s quote below summarize the seemingly paradoxical truth that has been on my mind: vulnerability is what makes us stronger. Choosing to be our genuine, imperfect selves fosters better and more authentic connections with others and helps develop self-compassion. As I go through the numerous transitions of young adulthood I am continually learning how important it is to be myself, even if that means revealing my fears, doubts, and perceived inadequacies. To pretend like everything is perfect and certain is a disservice to myself and those around me. While I will certainly continue to practice gratitude and maintain a positive outlook, I also strive to own my vulnerability. I want to show my true self to others and to contribute to the message that everyone is worthy of love and belonging despite our imperfections.

“When we were children, we used to think that when we grew up we would no longer be vulnerable. But to grow up is to accept vulnerability, to be alive is to be vulnerable.” – Madeleine L’Engle

Graduation

It’s hard to believe that I graduated with my Master of Social Work (MSW) degree a little more than a week ago.

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The big moment: receiving my master’s hood!

It took 2 years, more than 60 credit hours, and over 1,000 hours in the field to earn my degree. It wasn’t easy, but I had a lot of support along the way. My grandpa, aunt, and uncle all have advanced degrees. They showed me that the extra work pays off and always made sure I knew the value of education.

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From left to right: my grandpa (who turns 90 in September!), my mom, my dad, Derek, me, my aunt, and my uncle.

My parents supported my dreams despite the fact that I was taking on debt and going into a difficult field where I will likely be underpaid and overworked. It means the world to me when I hear them proudly tell people that their daughter is a social worker.

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My lovely parents.

My husband supported me each and everyday. Even though he is a busy, stressed out medical school student he always had time for my moments of panic over the workload, depressing stories from field, and angry rants about all the wrongs in the world. Whenever I needed it, he provided an optimistic perspective and reminded me why I chose social work in the first place.

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My handsome husband Derek.

Finally, I could not have completed the degree without support from my amazing classmates. They challenged, inspired, and enlightened me. It is a privilege to know such hardworking, passionate people. Whenever I get frustrated with the way the world works I need to remember that there are wonderful people out there fighting to change the things for the better.

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Some of my favorite ladies from school.

Particularly these two ladies. They are sweet, smart, down to earth, and never fail to make me laugh. My favorite memories from grad school involve cocktails and gallows humor. I will miss seeing them each week!

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Thank you to everyone who supported me! Congratulations to my fellow 2014 graduates; we are finally social workers!

Ali Brown Pinkerton, MSW

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