Healthcare Social Workers' Scope of Practice during COVID-19

Background. The COVID-19 pandemic has changed the U.S. healthcare system. Since the start of the pandemic, reliance on telehealth increased (Myers & Liu), the healthcare workforce declined (Cantor, Whaley, Simon, & Nguyen, 2022), and medical providers practiced across state lines (Cutler, Nikpay, & Huckman 2020). However, there is little research on how social work practice has been impacted in hospitals, dialysis facilities, skilled nursing care, and other settings. The aim of this qualitative study was to examine healthcare social workers’ scope of practice during COVID-19.

Method. Participants were recruited through email announcements, social media posts, and snowball sampling. Semi-structured interviews were conducted using the Zoom platform. The initial interview guide was developed based on previous qualitative studies examining medical professionals’ scope of practice. The questions were based on characteristics of their roles described in the literature, and broadly focused on skills, knowledge, and interactions. Two members of the research team met after completing six interviews to refine the questions. We used a thematic analysis approach to data analysis to identify key ideas related specifically to social workers’ scope of practice.

Results. In this sample of fifty women and four men social workers (N=54), the majority of participants were White (59.3%) and between ages 26-40 (64.8%). These social workers were primarily masters-trained (98%) and licensed (84% were LCSW/LSCWA, LMSW, or ACSW). They had worked in their settings from 9 months to 19 years. There were five scope of practice-related themes: workload changes, pre-COVID versus post-COVID roles, changes in the social work-patient relationship, social workers not viewed as essential workers, and outside of scope responsibilities. For example, participants consistently stated that while nurses, doctors, and other professionals were lauded as essential workers, they were often overlooked. Also, participants performing tasks outside of their scope recognized that “a lot fell on the social workers” because of how busy other team members had become with their existing tasks.

Implications. Previous research about the experience of healthcare social workers report a lack of understanding of social work’s role and scope, a lack of respect from colleagues, differences in compensation and working conditions, and that healthcare settings prioritize physical health interventions over psychosocial interventions. This study’s findings revealed the same. As social workers are redefining the boundaries and thresholds of where social works starts and ends, physicians, nurses, and other team members should expect to respect those boundaries by developing a better understanding of the social work role. Furthermore, just like other professionals with clear guidelines and language, social workers welcome allies to advocate for clearer language in Medicare Conditions for Coverage.