Identity, competency, and autonomy of medical social workers in acute care settings

This study examined the sense of identity, competency, and autonomy of stafflevel medical social workers in acute hospital settings. A purposive sample included social workers in decentralized settings, combined departments, and centralized departments without social work supervisors and those with social work supervision. The methodology combined concept mapping using the Concept System© and Interactive Qualitative Analysis, a participatory qualitative research method, to reveal a theoretical model grounded in data from focus groups. Fifteen themes in the participants’ daily work were compared for frequency, importance, decision-making autonomy, and educational preparation across departmental structure, the supervisor’s professional affiliation, and the social workers’ characteristics. The primary organizational structure found for social work in hospitals was a merged department. Organizational structure influenced professional preparation for competent practice, activities defining social work identity, and professional autonomy with negative correlations for those with nurses as supervisors. Findings suggest that social work identity, competency, and autonomy are in serious jeopardy in hospital practice, and the profession is adrift. Medical social workers are not clear how to impact organizations undergoing change. Social workers in health care are isolated, not connected across hospital systems or with professional organizations. Findings indicate social workers do not function as interdisciplinary team members, nor do they increase their professional leverage. The implication from this research is that leadership, team membership, and an understanding of organizational dynamics are missing from hospital social work practice. Social work education and the social work profession have failed to provide a base for building a strong identity in health care. The mental health, or private practice, model is the dominant professional identity and that hospital social workers were not involved in research or community change. This research suggests that clinical practice skills, such as Short term counseling, only developed under social work supervision. Despite rapidly expanding technological capabilities to treat disease, there is less attention to developing resources and competencies that address psychosocial needs for both individual and community health. Bilingual social workers were more involved with professional development, consultation, and communication with administration. The implications for social work practice and social work education are discussed.