The evolving role of the nephrology social worker: A Q&A with Vernon Silva

In honor of March being Nephrology Social Worker Month, NephrologyNews.com is featuring a special Nephrology Expert interview with Vernon Silva, member of the executive committee of the Council of Nephrology Social Workers of Greater Los Angeles. Silva was awarded Social Worker of the Year for Outstanding Achievement in 2006 and currently serves as chapter co-chair.

Question: How has the role of the nephrology social worker within the renal care team evolved over the last five years or so? How do you think the field will change in the future?

Answer: Our sub-specialty had already been moving towards an outcome-driven model thanks to our colleagues Stephanie Johnstone and Mary Beth Callahan who had developed an evidence-based training series offered yearly at the NKF Spring Clinical Meetings. However, changes in our practice methods were streamlined even further with the release of the new ESRD Conditions for Coverage (CfC) in 2008.

Quantifying our work became the rule which has resulted in practice that now requires tracking and trending data and collaborating with the rest of the medical team. Social workers used to function rather independently and our duties and responsibilities varied from facility to facility; now our role centers around the administration of a quality of life survey, participating in facility-wide quality improvement projects, and sharing a comprehensive interdisciplinary patient assessment.

Since nephrology social workers find the new regulations challenging in terms of time management and documentation compliance, the future role of the nephrology social worker will most likely contain the emergence of practice methods that factor in time constraints. This would include Symptom Targeted Interventions (commonly called STI), an efficient solution-focused therapy that was created by our colleague Melissa McCool, which addresses symptoms of depression.

Q: What would you say are the most attractive aspects of being a nephrology social worker, and why should people consider it as a career choice?

A: Nephrology social workers are given the extraordinary opportunity to develop unusually long provider-client relationships – sometimes lasting several years. As agents-of-change, this extended exposure affords us the ability to implement significant interventions and, better yet, actually see many of our goals come to fruition and our cases stabilize on many levels.

This could include seeing a dialysis patient experience a successful kidney transplant and all that comes with it; or live out the last stage of life with dignity and a sense of satisfaction and closure. In other words, whether the outcome may be extended life with a new kidney or the end of life, we contribute towards improved quality of life over a much longer timeframe than most other social work specialties.

Another plus is that we are given the chance to address all conditions and situations – our scope is hardly limited. We provide clinical interventions that cover all aspects of psychological conditions and every element of the human experience. Each patient's case is unique biologically, psychologically, socially, culturally and environment-wise so we develop an enormously wide set of skills in order to be able to address each and every issue, need, and condition, and to serve each patient’s unique situation effectively – which altogether is very, very rewarding.

Because of this unique circumstance, federal regulations mandate that social workers must have earned a master's degree from an accredited college, have at least two years of experience, and maintain a clinical license. In addition, the NKF offers certification in nephrology social work “NSW-C” that specifies over 30 competencies necessary to practice at a maximal level in this field.

Q: What are the greatest challenges facing the field?

A: Our greatest challenge? That would be defining our role to the rest of the kidney community. We social workers currently find ourselves in the unlikely position of fighting to be recognized for the very reason that we were hired – as clinicians who counsel the patients.

Since the birth of nephrology social work more than forty years ago, it has been widely recognized that our role is to facilitate patients’ psychosocial adjustment to the multiple intense stressors and losses associated with the need for chronic renal replacement therapy. It is widely accepted that social workers are present in order to build and sustain the coping skills of our patients through counseling. However, as time has passed social workers have taken on more and more concrete duties. Adding those has impeded our role and has actually caused the opposite effect since taking the time to address nonclinical issues takes away valuable time social workers could spend providing clinical interventions. Concrete duties such as arranging transient treatments, coordinating transportation services, and addressing insurance issues, could all be accomplished by clerical staff instead and would actually be much more cost effective to dialysis organizations.

Q: March is also National Kidney Month, and World Kidney Day is in March. Is there any collaboration in efforts or events? Does the nephrology social worker have a role in raising awareness about kidney disease?

A: Nephrology social workers are involved in all aspects of the kidney community and kidney care. Many people may not be aware that not only did social workers contribute the most public comments as a group during the revision of the CfC in 2008, but they also volunteer at NKF KEEP events and NKF Kidney Walks; they provide education and support by doing research to create best practices; they conduct presentations at all major kidney community conferences; they lead support groups in the community; and, they serve as social justice activists advocating for the interests and needs of our unique population at various legislative levels.

Q: How is the month used/honored throughout the renal care community? Is it common for dialysis clinics to honor this month?

A: Social Work Month celebrations are common and vary from place to place. In my area, the Greater Los Angeles chapter of the Council of Nephrology Social Workers (CNSW) holds our semi-annual meeting in March specifically to honor one of our members with the Social Worker of the Year award which recognizes outstanding achievement in our sub-specialty.

In Michigan the MCNSW holds a symposium and provides gifts for all attendees. This year's topics are “Mindfulness Based Stress Reduction” and “A Multidisciplinary Approach to Pain Management”. The Mile Bluff Medical Center in Wisconsin is having an open house to help educate staff and the public on what social workers do. They will also have a social services potluck lunch in appreciation of the social workers. And at Fresenius Medical Services in San Diego, a Social Work Month luncheon is planned and the managers take their individual social workers to lunch as well.

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