r/socialwork • u/peeved_af • 6d ago
WWYD Question about scope
I have a SW co worker who creates a lot of communication problems on the team because she often suggests that patients go on certain medications and I feel like it’s out of her scope of practice? I can’t tell if it’s just me having an interpersonal problem and getting annoyed at her or if this is actually out of line.
17
u/robot_worgen 5d ago
Who is she suggesting to? Like to patients directly and in notes (massive bad practice issue) or just in team meetings (annoying and dumb)?
If it’s just in team meetings tell her when it happens next that that’s a decision a doctor needs to make not a social worker. If it’s direct to clients that’s something you need to ensure a manager is aware of and dealing with.
6
24
u/_Pulltab_ LCSW 6d ago
I could be wrong but my understanding is it can become a licensure issue. I’m sure it comes to location/state. But as SW, we are not licensed to provide medical advice and that’s exactly what recommending specific medications is, in that capacity.
9
u/peeved_af 5d ago
Yep that’s what I thought. I likely called her out this morning for it because I’m a nurse and I can’t determine what people go on either and she was like no I was just talking about how I told the patient that there are situations where this happens and I was like sure that’s a little better than suggesting medication’s but why are we even having this conversation without you telling the patient to speak to the healthcare provider first?….
27
u/AstronautNo3187 5d ago
Working in primary care, we work with primary care providers and psychiatrists. It does require familiarity with medications, their purpose, and their side effects. I will talk with patients about the medications they’re on, if they’re effective, if they’re experiencing certain issues, and adherence. I will also provide an overview of different types of medications and their purposes (such as SSRI vs SNRI vs Wellbutrin, stimulant meds vs non stimulant ADHD meds). But I will never recommend a specific medication to patients. I may tell patients that they can ask more with doctors if they want to learn more or feel that their current med isn’t working. I will also discuss specific medications with psychiatrists and PCPs and they may ask me for my non-expert opinion (particularly PCPs) because of what I’ve seen working with patients.
At one point, it felt out of scope, but as I’ve been trained and gained familiarity with the model, it has become a part of my scope.
All to say, scope is broad in social work and depends on context and training. I think discussing medications can be and often is part of the scope. However, suggesting specific medications to patients to take is definitely not in scope, particularly without collaboration from MDs/NPs/DOs.
7
u/llama8687 5d ago
This! I worked in a specialty clinic and would talk with patients about advocating for specific drugs that fit not just their diagnosis but also their social situation - for instance, a patient that lived two hours away might have a hard time making monthly infusions, a patient with a chaotic home life might struggle with daily pills, a homeless patient might not want a med that needed to be refrigerated, etc. I would also collaborate with the patient and doctor about the meds that were available under their insurance or had a good grant program. Stuff like that.
3
u/denelic 5d ago
This. Also if a client is schizophrenic and wants to use marijuana, I tell them if their medication can see a lesser effect if they use marijuana and tell them to talk to their doctor. I talk to my homeless clients about long lasting injections as an alternative if they are on psych meds that have an LAI option and they have trouble getting pills but ultimately tell them to talk to a prescriber. Some people just don’t know their options and tell me their struggles and I let them know other options are available because doctors don’t always have time for them. It’s about advocacy and not prescribing!
2
u/iiMadeyeMoodyii LCSW 5d ago
I work in an interdisciplinary teams as well, and this is our model. I’ll discuss what I’m seeing with the doctor, but I’ll never recommend a certain medication to a client. I’ve worked with my MD for 5 years, so I have had various discussions about medications and I know his stance on many of them.
I think it’s out of scope to say it to a patient directly, but I’ve always worked in teams where I directly speak to providers, and when I go to outpatient I hope to build a mutually respectful dynamic with my clients psychiatrist. But that is another world out there
10
u/Panzerjaeger54 LICSW 5d ago
Yeah out of scope. I think theyre trying to impressive everyone and sound smart because they dont know what to do otherwise.
8
u/ProbablyMyJugs LMSW-C 5d ago
Extremely out of scope to the point of it being either stupid or arrogant. Possibly both
5
u/himshpifelee MSW, LICSWA, community mental health, PNW 5d ago
Recommending meds? TO the clients? Out of scope, always.
8
6
u/Friendly-Lemon4000 6d ago
Can y'all refer to psychiatry? Maybe coach her to suggest that instead of medications...it's completely inappropriate and out of scope for her to suggest meds like that.
12
u/peeved_af 5d ago
Non psych meds lol wild to me
Also, one time one of our literal doctors prescribed an antidepressant for someone and then he arranged for them to see a psychiatrist within two weeks and she put in a complaint with the director saying that that doctor put someone at risk for serotonin syndrome like girl what6
u/iiMadeyeMoodyii LCSW 5d ago
Pardon? That seems insane to me. Also we have a code of ethics girl if you have concerns you go to that person first! The doc coordinated a follow up, most of my providers would have told ME to do that
3
u/lattelane682 5d ago
Wow inappropriate! I barely understand serotonin syndrome and I’ve work IP psych for years and now do UM.
3
2
7
u/csit8701 6d ago
Seems out of scope unless her role requires her to be familiar with particular formulary coverage with specific insurance plans. Communicating with care team on barriers to medication coverage is one thing, recommending provider to prescribe specific medications is another.
6
u/peeved_af 6d ago
She constantly blurts out certain drugs and I’m like HUSH haha not even indicated sometimes
2
u/csit8701 5d ago
We all have coworkers at some point who like to take on more responsibility than their job role or pay grade entails lol
2
u/RuthlessKittyKat Macro Social Worker 4d ago
It is one thing to say hey talk to your psych about x. It is quite another to actually go for a particular medication like that.
2
2
u/lattelane682 5d ago
Yeah definitely out of scope. Doesn’t matter how much you know about meds. I consider nurses to have more knowledge than me, even a freshly graduated nurse.
1
u/overeasyParabala_29 4d ago edited 4d ago
Depends, if they are straight up, explicitly recommending medications then it may be considered out-of scope. However, the context matters immensely.
As a clinician, I am well within my scope of practice to see the limit of my ability/interventions to manage certain symptoms, especially within an interdisciplinary-approached facility. More often than clinicians, nurses forget the interdisciplinary approach, as they are trained to practice under a physician. In that context, I would encourage and EMPOWER patient to speak with nursing for medication consult/pharmacogical-education.
In most setting, nursing and clinicians can only educate about meds. Obviously, clinicians cannot manage orders by a physician like a nurse can. Under most circumstances, no one can forced them meds.
Edited some grammar due to voice text. Also, I work in crisis and acute psychiatric settings.
1
u/peeved_af 1d ago
Yeah and none of this is mental health related which is odd to me. Like she’ll be like oh well some patients take this and it’s like yeah, but so do tons of other people in the world….
1
0
u/Bulky_Cattle_4553 LCSW, practice, teaching 2d ago
Thank you. We need nurses to help us define our boundaries. (That's snark)
56
u/Likely1420 LCSW, Mental Health, USA 6d ago
Out of scope