"Are We Violating Our Own Code of Ethics?": Hospital Social Workers' Challenges and Solutions to Improve Worker Retention and Patient Care

Background and Purpose: Hospital workers have faced enormous challenges throughout the COVID-19 pandemic. Healthcare workers, including social workers, are the largest workforce in the city of Pittsburgh. The Pittsburgh Wage Study team has been researching the experiences of hospital workers since 2017. In 2022, we conducted a survey of over 2,000 local hospital workers to better understand the challenges they face. We published survey results in a 2022 report, which included the disturbing finding that 93% of hospital workers are thinking about leaving their jobs. To understand how to better support hospital workers to stay in their jobs, we determined that conducting focus groups and interviews could provide more context and a deeper understanding of the challenges and solutions workers hope to implement.

This presentation is based on analyses of these qualitative data, examining how social workers in healthcare settings negotiate a medical model that can conflict with social work ethics. We highlight the challenges they face and the solutions they hope to implement that are rooted in their professional training and practice, with the goal of improving the quality of life for workers, thus promoting the recruitment and retention of the hospital workforce and, as a result, benefiting patient care.

Methods: This study utilized semi-structured focus groups and in-depth interviews with 42 currently or previously employed hospital workers, including 14 social workers, in the Western Pennsylvania region. Interviews and focus groups provided social workers space to share workplace challenges, the impact on their work and patient care, and suggestions for employers and policymakers to improve worker and patient conditions. Focus groups and interviews were transcribed verbatim. Transcripts were coded and analyzed inductively in NVivo through a collaborative team process.

Results: Social workers face unique challenges due to their positionality within interdisciplinary teams. Specifically, they navigate a space where their job is not wholly understood by other team members, leading to both over and under utilization. Additionally, many have faced job title changes that are not reflective of their role or had to face tough decisions regarding patient advocacy within a model that prioritizes discharging. Further, social workers navigating this space and advocating for clients operate within a medical model that frequently contradicts social work ethics. While both ethical models are rooted in patient care, practice implications are more nuanced, creating rifts within workplace culture. Lastly, despite these barriers, social workers presented solutions aimed at improving working conditions and patient care, such as clearer job descriptions, opportunities for advancement, and greater accessibility to payment plans for patients.

Conclusions and Implications: Findings highlight that social workers in healthcare settings deal with unique challenges based on their positionality within a medical model. The solutions they provide and hope to implement are rooted in their social work ethics and can provide a framework for hospital administrators to draw from when recruiting and retaining healthcare workers across departments.