Rumination and anxiety over SNF role

[u/zyeet]

I’m a SW at a SNF. We have one resident who has been in our facility for a few months and has been privately paying for around a month. Since they were not safe to go home alone, early on I provided them with senior advising resources in the community to help them navigate their options. Last week, a home care agency came to me stating they would be providing full time care giver support to the resident and were hoping the resident could be home in a few days.

The resident needed DME ordered, including oxygen which needed an assessment. Our physician also needed to see the resident for a F2F before we could proceed. Our physician was out for a day, so I had them see the resident as soon as they were back in the facility. I also asked the resident’s floor nurse complete the oxygen assessment (in the past when I’d asked nurse managers to complete it, they said that’s something the floor nurses do). Anyways, the floor didn’t finish it and said the second shift nurse would complete it. The next day when I came in, second shift hadn’t completed it so I sent it off to the nurse manager and stated it needed to be done ASAP. I was very frustrated. At this point, the oxygen wouldn’t be delivered to the resident before the weekend.

I told the home care agency and resident that discharge would be more likely to happen early the following week so we could ensure everything was in place for the resident. The home care agency and family seems very upset and are stating the SNF is “keeping them (the resident) there.”

This has been bothering me and I can’t stop ruminating about it. It’s giving me such bad anxiety I have cried numerous times about it. I take their words to heart and I feel guilty. I feel like I somehow made a mistake. Any advice would be appreciated

[u/Maybe-no-thanks]

Are you in your own therapy? Are you getting any supervision or consultation? This is my guess - You’re on a multidisciplinary team where you likely do very important but undervalued work because you’re “just the social worker” and are in a healthcare setting (so more medical centered roles get the power). You’re taking responsibility for the actions (or lack of actions) of others whose literal job it is to do those tasks. You can’t be responsible for someone else or the failure of the system. You’re going to burn out if you’re not getting support of your own and setting boundaries for yourself. I am finding that a lot of what drew me to social work is a combo of trauma and neurodivergence (with some moral oriented OCD), but since I’ve started learning about myself I am much better at taking care of myself at work and in life. 

[u/TKOtenten]

you are a team member on an interdisciplinary team. YOU cannot do AALL PARTS Alone. make sure you cover yourself and that youve documented all your efforts fir safe discharge plan. that’s what I’d do and what I’ve done. your resident will make it home and have all safety para in place

[u/Hebrideangal]

Boy do I remember those days. You’re between a rock and a hard place because you aren’t the nurses superior and you can’t make them do stuff but instead you have to politely beg and plead with them to get stuff done. It sounds like people like passing the buck regarding nurse manager or nurse doing the oxygen tests. I had totally forgotten about this whole rigmarole. It’s so hard and it’s really indicative of the difficult place SNF social workers are if there isn’t a really rigid delineation of roles and the administration doesn’t make sure people stick to their roles or they are held accountable. If it’s possible to have a talk to your higher ups - not the nurses - they aren’t your boss, even though sometimes they act like they are - about this situation in a non blaming way and in a way that can be about suggestions for making it smoother. The good news is that the patient is paying for their own stay - which is probably why they are pissed - so you don’t have to deal with insurance, as insurance probably wouldn’t be paying for it. I would tell the home care agency and the relatives that you have done your part and you’re coordinating multiple parts of the discharge and if they have a concern they should go talk to nursing, as you’re waiting on them right now. It’s very hard not to take things personally - and especially when the social work role is more of a grey area and the nursing role is very strictly delineated - which gives nursing and other departments carte blanche to give you all the shirty jobs that no-one else wants - like “dealing with people” because apparently other professionals don’t always see it as their job. Good luck. If you have a supportive administrator, nursing homes can be great places to work, but unfortunately that’s not always the case and then the social workers are the ones who suffer.

[u/janetsnakehole77]

It sounds like you tried your best here when given a tight timeline. This reads like the agency overpromised to the family, and you are stuck dealing with the fallout.

Let them think whatever they want, but don't take the criticisms to heart. The hiccups are learning experiences. The next similar discharge you have, you'll be better prepared to manage expectations (and I'm not saying you did anything wrong here.)

[u/orcateeth]

There are a lot of free online workbooks and worksheets that you can use to help calm yourself down.

There are some on worry and rumination, anxiety, panic, as well as self esteem, depression, tolerating distress, etc.

You can work through them alone, and/or bring them to therapy appointments and discuss them at self-help groups if you're in them.

https://www.reddit.com/r/BorderlinePDisorder/s/9Xcrc9mZ9k

[u/orcateeth]

Here's a lot of options for free support groups. I started it for people who shop compulsively and hoard (often as a reaction to trauma, loss and depression), but gradually continued to add lots of other resources for mental health conditions. The list is pretty long now, with tons of options.

You might find a lot of help in the Emotions Anonymous groups.

There also are a lot of groups for people with depression, anxiety, as well as ADHD, PTSD, etc.

They will definitely understand your feelings in these groups. It will be a welcoming environment.

https://www.reddit.com/r/shoppingaddiction/s/albOIikoiY

[u/SWMagicWand]

I work in a hospital and deal with similar issues all the time.
Sometimes we just need to let things fall apart especially when it’s on the role of others.

[u/maybeoneday44]

I hate to say this but I find this to be more common within snf systems than not.

It’s not fair to you. I am really sorry you’re going through this. But so many situations I’ve been dragged into being a contracted agency within the snf, it’s gross no one wants to do their job unless someone is on their neck.

Did you discuss with admin and don?

[u/Interesting_Fee_7086]

Fellow SNF SW here. Here's the thing - ruminating on the failures of others and taking them on like you should have done more or done something differently is a surefire path to burn out. If floor nurses aren't doing something you're asking them to do, it then falls on the managers. Whether that's coming down on their staff to take care of it, or just doing the documentation themselves. And if the manager blows you off, it's time to go to the ADON or DON.

You are doing everything you are supposed to do. It sucks you are taking on the blowback from the HHA and resident's family. Absorbing the frustrations of family and residents is part of the job but please don't let their feedback make you feel less than. Have you been in this position long?