job satisfaction: how do social workers fare with …

OMEGA, Vol. 49(4) 327-346, 2004

JOB SATISFACTION: HOW DO SOCIAL WORKERS

FARE WITH OTHER INTERDISCIPLINARY

TEAM MEMBERS IN HOSPICE SETTINGS?

JACQUELYN MONROE, L.S.W., M.S.W., Ph.D.

ROENIA JITTAUN DELOACH, L.M.S.W., M.S.W., Ph.D.

The Ohio State University

ABSTRACT

The purpose of this study was to investigate job satisfaction among hospice

interdisciplinary team members, which included social workers, nurses, and

other professionals (i.e., home health aides and spiritual care providers.)

Interdisciplinary team members (N = 76) from four hospices in the midwest

participated in the study. One way analysis of variance (ANOVA) revealed

that significant differences in satisfaction resulted in the areas of distributive

justice, autonomy, and opportunity between social workers, nurses, and other

interdisciplinary team members.

Collaborations between interdisciplinary members have been a part of hospice

settings since Cicely Saunders of England first developed the “team” concept

in 1967 (Kulys & Davis, 1986). Joint efforts of this nature between diverse

professionals and organizations are essential in the provision of quality services to

ill individuals and have been found to be an important element in improving

service delivery (Cheung, 1990; Fowler, Hannigan, & Northway, 2000). This is

particularly true for terminally ill patients and their families who are involved

with hospice organizations. Since its inception in the United States in 1974,

hospices have utilized interdisciplinary teams, which are typically composed of

the social worker, nurse, chaplain, physician, volunteer director, and patient care

coordinator (Kulys & Davis, 1986). Over the years, however, the allied health

327

� 2004, Baywood Publishing Co., Inc.

professionals on these teams have evolved into what many view as primary

members, while social work has evolved into what some view as ancillary to

these professionals (Abramson, 1993; Reese & Sontag, 2001), which may have

implications for job satisfaction for the social work professional.

This study investigates job satisfaction—the degree to which an individual

experiences pleasure in his or her work (Price & Mueller, 1986a) among social

workers, nurses, and others (i.e., home health aides and spiritual care providers)

who work as interdisciplinary team members in hospice settings. Specifically, the

degree of job satisfaction among social workers in hospice settings is compared

and contrasted with other interdisciplinary team members. The authors also make

recommendations to hospice organizations on how to increase job satisfaction

among social workers in hospice settings based on statistically significant job

satisfaction variables: distributive justice, autonomy, and opportunity.

HOSPICE ORGANIZATIONS

According to the National Hospice and Palliative Care Organization (NHPCO),

there are over 3200 operational hospices in the United States including the District

of Columbia, Puerto Rico, and Guam (NHPCO, 2003). Hospice’s mission is

to meet the multitude of needs and desires of those who are terminally ill for

whom acceptable curative medicinal options have been exhausted. Distinctive to

hospice’s mission is its subsumption of the palliative care philosophy. Palliative

care in hospices is centered on physical, psychological, spiritual, and psycho-

social symptom relief (Kulys & Davis, 1986; NHPCO, 2003). Palliative care

service delivery by hospices is considered the gold standard in care for the

dying patient whose life expectancy is usually six months or less (Ferrell &

Borneman, 2002; Walter, 2003; Wright, 1999). Hospice’s goal is to ensure a “good

death,” which requires allowing for client self-determination while maintaining

the integrity of the whole dying process (Wright, 1999, p. 136). Contrary to

popular belief, hospice’s focus is not on death; hospices actually focus on life

during a person’s last days.

Like all organizations, hospices have evolved over time. These changes involve

trends in service delivery and organizational characteristics (Abel, 1986;

Banaszak-Holl & Mor, 1996; Jennings, 1997; Kaye & Davitt, 1998; Paradis &

Cummings, 1986; Tehan, 1985). In the past, hospice was viewed as unique in that

it offered services that the traditional health care system had neglected, which

included: 1) being a safe haven for the terminally ill; 2) providing supportive

services for the dying patient and his or her families; and 3) delivering services

specific to the needs of dying patients (Rutledge, 2003). Abel (1986) reports that

hospices have become part of the mainstream heath care system nowadays and

consequently have lost some of their uniqueness. Banaszak-Holl and Mor (1996)

list four different types of hospice programs that have emerged. They tend to be

either hospital based or free standing, or centered on skilled nursing or home

328 / MONROE AND DELOACH

health care. Regardless of the type of hospice program, most hospices actually

serve patients in a variety of settings which include patients’ homes, long-term

facilities, and hospitals. All Medicare certified hospices that are regulated by the

Joint Commission for Accreditation of Healthcare Organizations (JCAHO)

mandate that hospice interdisciplinary teams consist of the following core

members: the social worker, registered nurse, pastoral or other counselor, and

physician (Kovacs & Bronstein, 1999; U.S. Department of Health and Human

Services [USDHHS], 2003a, 2003c, 2003d, 2003e, 2003f). The home health aide

is also considered to be an important member of the interdisciplinary team.

Encompassed under “other services” in Medicare terms, these members must

work with registered nurses on interdisciplinary teams to meet the needs of

patients (USDHHS, 2003b).

INTERDISCIPLINARY TEAM MEMBERS (IDT)

In hospice organizations, social workers, nurses, home health aides, and

spiritual care providers tend to be core members on interdisciplinary teams

because they provide direct care on a day-to-day basis. The physician, volunteer,

and medical director are also part of the direct care team, but are not considered

to be core team members because their involvement tends to be on an as needed

basis (Dove, Schneider, & Gitelson, 1985; Hospice Institute of the Florida Sun

Coast, 1996). The IDT provides a variety of services whereby each team member

provides services based on their professional or instructional training. This care

emphasizes communication and collaboration between the patient, family, and

hospice IDT members, which is consistent with the holistic approach to care

(Fowler et al., 2000).

Social Workers

Operating from the social systems perspective whereby the impact of the larger

social system on the client system is always taken into consideration when

working with the individual (Reese & Sontag, 2001), the licensed and oftentimes

Master’s level social work professional provides psychosocial support to patients

and the family in health care settings (Foliart, Clausen, & Siljestrom, 2001;

Mizrahi, 1992). Officially recognized as a “licensed health care profession” by

both Medicaid and Medicare (Mizrahi, 1992), the hospice social worker also

makes clinical assessments, provides referrals, facilitates discharge planning,

ensures continuity of care, serves as an advocate, offers crisis intervention, and

serves as a counselor (Kulys & Davis, 1986). Conducting assessments along with

supportive and therapeutic counseling of patients, in particular, is seen by most

social workers in the social work profession as a primary responsibility (Cowles &

Lefcowitz, 1995). Therapeutic counseling in hospice settings, however, tends to

be minimal due to the debilitating nature of the illness of most hospice patients.

DIFFERENCES IN SATISFACTION / 329

Supporting counseling in these settings is the norm. Other responsibilities of

hospice social workers involve assisting families to constructively cope with

issues surrounding death and dying, which includes helping the family to utilize

community, financial, and legal resources (Dane & Simon, 1991; Hospice Institute

of the Florida Sun Coast, 1996; Rusnack, Schaefer, & Moxley, 1988).

Nurses

The nurse’s primary responsibility is to provide for the patient’s physical

condition and comfort. Therefore, hospice nurses must be highly skilled in

physical assessments and symptom management. They also help to transition

dying patients from curative treatment to palliative treatment (Rutledge, 2003;

Wright, 1999). Using the medical model as a framework, hospice nurses view

illnesses from the disease model.

Responsibilities of the hospice nurse include educating the patient and family

on physical care, medication administration, skin care, nutrition, and equipment

management (Munley, 1983). They also engage in crisis intervention tasks,

advocacy work, and psychoeducational responsibilities like relaying infor-

mation on advanced directives (Kaye & Davitt, 1998; Kulys & Davis, 1986).

Moreover, some function in the role as a therapeutic counselor, the direct care

giver, and a discharge planner in hospice settings (Cowles & Lefcowitz, 1995;

Lafferty, 1998; Wright, 1999).

Home Health Aides

The home-health aide or nurse’s aide provides physical care when there is

a need. From a hierarchal perspective, they are the least trained of nurses. They

typically acquire 75 or more hours of instruction in the basics of health care service

delivery from a high school, vocational-technical school, or community college.

At this level of nursing, home-health aides are required to be certified when

employed by agencies receiving reimbursement from Medicare (Bureau of Labor

Statistics, 2004-05) as in the case of hospice organizations. This team member

tends to provide personal care assistance with activities of daily living (ADLs).

Their duties may include bathing, grooming, mouth care, skin care, and transfers.

Home-health aides may also provide light housekeeping, shopping, and respite

for caregivers. Educating family members on basic care is also one of their

responsibilities as well as providing support and relief for the primary caregiver

(Buckingham, 1985; “RNS, LPNS, and NAS—Oh My!” 2001; Sankar, 1991).

Spiritual Care Providers

Due to Dr. Cicely Saunders’ vision of the connectedness between medicine and

religion, a spiritual component has been part of hospice since its early beginnings

(Driscoll, 2001). Although the professional chaplain has become a key player for


spiritual care delivery in hospice settings, spiritual care delivery still tends to be

the responsibility of the whole team. This explains why some hospice social

workers and nurses feel that pastoral or bereavement counseling is one of their

many responsibilities as interdisciplinary team members (Carroll, 2001; Kulys

& Davis, 1986; Reese & Sontag, 2001). The official spiritual care providers on

most health care teams, nonetheless, tend to be board-certified chaplains who are

called to offer spiritual care and education to patients, their relatives, and staff

(Driscoll, 2001; Wright, 2001). They are responsible for direct counseling,

coordinating care with the patient’s own clergy, offering prayers, assisting in

rites and rituals (e.g., baptisms) of the patient and his or her family, as well as

bereavement services for the dying (Foliart et al., 2001; Lentz, 1999; Sankar,

1991; Wright, 2001).

Although Christian chaplains still dominate the landscape of most organizations

in this country, including the prison system, the military, police departments,

universities, and hospices, they all have started to recognize the diversity

of humans’ spiritual needs (Bellandi, 2000; Coeyman, 2000; Friedman, 2003;

Lapwood, 1982; “Navy Chaplain Named to Serve US Senate,” 2003; Zoba, 2000).

According to chaplains’ code of ethics, chaplains employed in secular institutions

like hospices must refrain from proselytizing or attempting to convert patients to

their faith, but instead they are charged with offering hope and encouragement

to those of any faith or no faith at all (Driscoll, 2001). Spiritual care in hospice

transcends religions and faiths. Hospice’s philosophy of spiritual care is non-

judgmental and focuses on healing, forgiveness, and acceptance (Munley, 1983).

Even an atheist or agnostic can be spiritual according to hospice’s philosophy

(Carroll, 2001). Therefore, the spiritual intervention in hospice is geared toward

helping the patient and family address, deal, or wrestle with spiritual concerns,

questions, or crises (Derrickson, 1996).

METHODS

Agency Selection and Participation

Interdisciplinary team members from four Medicare certified and JCAHO

accredited hospices in the Midwest were asked to participate in the study. These

particular hospices were selected for this study because they were the only

organizations in the area that were adult-based and adhered to the regulatory

guidelines mandated by Medicare and JCAHO. IDT members from these agencies

were also direct-care practitioners who worked with patients in diverse settings

which included the home, long-term care (LTC) facilities, and hospitals. By

selecting these particular hospices, the researchers increased the likelihood of

accessing interdisciplinary team members from all four disciplines (e.g., social

work, nursing, spiritual care, and home-health aide) for inclusion in this study.


During team meetings at each respective hospice, a total of 65 IDT members

completed a self-administered survey. Eleven members who were absent during

initial team meetings mailed in their completed surveys. The final response rate

was 90% (n = 76).

Sample

Seventy six participants completed surveys. As shown in Table 1, females made

up 89.5% of the respondents, while males made up 10.5% of the respondents.

African Americans represented 5.3% of respondents and Caucasians constituted

94.7% of the sample. Nearly 60.5% of the respondents indicated that they were

nurses, 18.4% were social workers, while 21.1% were either home-health aides

or spiritual care providers.

Instrumentation

For the purposes of this study, the dependent variable job satisfaction was

measured using a six-item index adapted by Price and Mueller from Brayfield and

Rothe’s (1951) 18-item index. This instrument measures the global aspect of job

satisfaction. The statements included in this scale were: 1) I find real enjoyment

in my job; 2) I like my job better than the average worker; 3) I am seldom bored

with my job; 4) I would not consider taking another job; 5) Most days I am

enthusiastic about my job; and 6) I feel fairly well satisfied with my job. Response

options on this scale are: 1 = Strongly Agree to 5 = Strongly Disagree. The scores

were summed. The scores ranged from 6 to 30 with a low score (<15) indicating

a high degree of job satisfaction and a high score (15+) indicating a low degree

of satisfaction. Convergent validity and the reliability of this scale have been

established in the literature (Agho, 1989; Price & Mueller, 1986b; Wallace, 1992).

Agho (1989) reported a high level of reliability (Cronbach’s alpha = .90).

The independent variables in this study were pay, distributive justice, internal

labor market, supervisory support, autonomy, integration, opportunity, task sig-

nificance, work motivation, positive affectivity, negative affectivity, role over-

load, role conflict, role ambiguity, and routinization, along with demographic

variables (i.e., age, race/ethnicity, job title,1 education, length of time in current

position, number of years working in hospice settings, employment status, sex,

and ethnicity). Table 2 is an illustration of the variables, definitions, measurements

and the number of items included in the instrumentation used to operationalize

the variables in this study.

As seen in Table 2, several measures were used in the operationalization of

the variables in this study. For the sake of brevity, however, only three of the


1 Home-health aides and spiritual care providers were subsequently combined for the purposes of

data analysis and recoded as “other” because of their low representation in the sample (N = 16).

variables will be examined here. They include distributive justice, autonomy,

and opportunity.

The distributive justice variable was measured using the four-item index

developed by Price and Mueller (1986b) which included questions like: 1) When

compared to the other employees on your team, how do you relate to the fairness

with which you have been treated by your employer in the distribution of the


Table 1. Description of Sample

Respondents N Percent Respondents N Percent

Sex

Females

Males

Total

Ethnicity/Race

African American

Caucasian

Total

Age

26-34

35-44

45-54

55-64

Missing

Total

Job Title

Social worker

Nurse

Other

Total

Level of Education

Advanced

Non-advanced

Total

Employment Status

Full-time

Part-time

Contingency

Total

68

8

76

4

72

76

9

23

32

11

1

76

14

46

16

76

19

55

76

61

11

3

76

89.5

10.5

100.0

5.3

94.7

100.0

11.8

29.3

42.7

14.7

1.3

100.0

18.4

60.5

21.1

100.0

25.0

72.9

100.0

80.3

14.5

3.9

100.0

Number of Years Working

in Hospice Settings

Less than 1 year

1 to 5 years

6 to 10 years

More than 10 years

Total

Length of Time in

Current Position

Less than 1 year

1 to 5 years

6 to 10 years

More than 10 years

Total

Pay (in dollars)

0-5,000

5,000-9,999

10,000-19,999

20,000-29,999

30,000-39,999

40,000-49,999

50,000-59,999

60,000+

Missing

Total

12

29

19

16

76

13

37

17

9

76

2

1

5

12

20

19

11

4

2

76

15.8

38.2

25.0

21.1

100.0

17.1

48.7

22.4

11.8

100.0

2.7

1.3

6.7

16.0

26.3

25.3

14.5

5.3

2.7

100.0

Tab

le2

.D

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Vari

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nity

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Dis

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)

6 4 3 4 4 5 4 6


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Inte

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Pay

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Th

eext

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can

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up

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(19

89

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on

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88

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88

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3 4 3

Cate

go

ries

5 4

10

10


following rewards?; and 2) When compared to other employees not employed

by hospice, how do you rate the fairness with which you have been treated by

hospice in the distribution of rewards? Questions were computed into one scale.

The scores were summed. The reliability (Cronbach’s alpha of .95; Agho, 1989)

as well as the convergent and discriminant validity for this index have been

demonstrated in the literature (Agho, 1989; Brooke & Price, 1989; Iverson, 1992;

Price & Mueller, 1981).

Autonomy was operationalized using a three-item index adapted by Iverson

(1992) from Tetrick and LaRocco’s (1987) six-item index. Statements for this

scale included: 1) I never control the scheduling of my work; 2) I have little or no

influence over things that affect me on the job; and 3) I have a lot of input in

deciding what tasks or parts of tasks I will do. Statements were computed into

one scale. The scores were summed. The reliability and validity of this scale are

supported in the literature (Iverson, 1992; Tetrick & LaRocco, 1987). Jo (1995)

reported a moderate to high level of reliability (Cronbach’s alpha of .70).

The opportunity variable was measured using a four-item index developed by

Price and Mueller (1986b). Questions for this scale included: 1) How easy would it

be for you to find a job with another employer in this geographical area that is as

good as the one you now have?; 2) How easy would it be for you to find a job with

another employer in the local job market that is better than the one you now have?;

3) How easy would it be for you to find a local job market that is as good as the one

you now have? and; 4) How easy would it be for you to find a job with an employer

outside the local job market that is better than the one you now have? Statements

were computed into one scale for this variable as well. The scores were then

summed. The reliability (Cronbach’s alpha of .87; Agho, 1989) and discriminant

validity of this scale have been demonstrated (Agho, 1989; Iverson, 1992; Price &

Mueller, 1981, 1986a).

RESULTS

Table 3 shows the means, standard deviations, and ranges for all of the vari-

ables. According to Table 3, respondents reported experiencing a high degree of

satisfaction with their jobs (M = 11.45, SD = 4.64). The possible range for the

measure was from 6 to 30 with a low score (<15) indicating a high degree of job

satisfaction. Specifically, social workers had a mean of 12.57, nurses had a mean

of 11.46, while other professionals had a mean of 10.38. This means that other

team members (i.e., home-health aides and spiritual care providers) as a whole

expressed the most satisfaction with their jobs while nurses followed. Social

workers, however, although satisfied as a whole, were not as satisfied as their

counterparts.

After determining that hospice workers were indeed satisfied, these researchers

sought to determine if differences existed in the degree of job satisfaction

between social workers, nurses, and other professionals (i.e., home-health aides


and spiritual care providers) on hospice interdisciplinary teams. Therefore,

ANOVA statistics were generated. The one-way ANOVA is used to determine the

significance of the mean group differences (Levin & Fox, 1991). The job title

variable which referred to the different disciplines was the variable selected

for analysis. Job titles were coded as 1 = nurse (n = 46), 2 = social worker (n = 14),

and 3) as “others” (i.e., home-health aides and spiritual care providers; n = 16)

for statistical purposes. ANOVA statistics were executed to determine if there

were significant differences between the mean scores of the social worker, nurse

and “others” on the degree of job satisfaction and the independent variables. Of the

15 job satisfaction variables analyzed using job title, only three were significant.

They included: distributive justice, F(2,73) = 7.41, p < .001; autonomy, F(2, 73) =

8.43, p < .001; and opportunity, F(2, 73) = 3.51, p < .035. (See Table 4.)

Distributive Justice

Distributive justice refers to fair and equitable rewards and punishment based

on an individual’s contributions to an organization (Homans, 1961, as cited in


Table 3. Means, Standard Deviations, and Ranges for

Dependent and Independent Variables

Variables Mean

Standard

deviation Range N

Job satisfaction

Opportunity

Autonomy

Role ambiguity

Role conflict

Role overload

Distributive justice

Supervisory support

Internal labor market

Task significance

Integration

Routinization

Work motivation

Negative affectivity

Positive affectivity

11.45

14.67

9.74

5.36

9.54

8.69

9.86

17.20

10.29

5.88

9.33

12.07

15.66

17.75

34.46

4.64

2.86

1.83

2.17

2.53

1.99

3.70

3.23

2.43

2.10

1.23

2.44

3.07

6.17

6.40

6-30

9-20

3-13

3-13

3-15

3-15

4-20

14-30

3-15

4-15

7-13

7-17

4-20

10-38

13-46

76

76

76

76

76

76

76

76

76

76

76

76

76

76

76

Price & Mueller, 1981, 1986b). Individuals contribute to the organization in a

variety of ways such as hard work, experience, and education. The number of

rewards and punishment is not the important element in distributive justice.

Rather, it is the relationship between the two and the individual’s input that

signifies distributive justice (Price & Mueller, 1981). Increased distributive justice

increases the likelihood of an individual being satisfied (Agho, 1989; Price &

Mueller, 1981).

For the relationship between job title and the extent of distributive justice, the

mean was 8.65 for nurses, 11.00 for social workers, and 12.19 for “others.” The

range was 4-20. Low scores mean that the participants perceived the allocation of

benefits to be fair. Therefore, the mean for nurses indicated that this group

perceived the benefits to be the most fair. Nurses, unlike social workers and the

other professionals on the interdisciplinary team felt very satisfied with the way

they were rewarded or penalized (distributive justice) for their contributions to the

agency. This means that these IDT members felt like their contributions to

the agency were equitably rewarded. Social workers and other professionals,


Table 4. Analysis of Variance by Job Title and Satisfaction Variables

Variables Job title / Means

Sum of

squares df

Means

squared F Sig

Distributive

Justice

Social worker / 11.00

Nurse / 8.65

Other / 12.19

Between

Within

Total

171.90

846.87

1018.78

2

73

75

85.95

11.60

7.41 .001

Note: Scores for distributive justice ranged from 4-20 with a low score suggesting fair

distributive justice and a high score suggesting that distributive justice is not fair.

Autonomy Social worker / 9.43

Nurse / 10.33

Other / 8.38

Between

Within

Total

46.96

203.29

250.25

2

73

75

23.48

2.78

8.43 .001

Note: Scores for autonomy ranged from 3-15 with a low score denoting low autonomy

and a high score denoting a lot of autonomy.

Opportunity Social worker / 16.14

Nurse / 14.67

Other / 13.44

Between

Within

Total

54.66

567.76

622.42

2

73

75

27.33

7.78

3.51 .035

Note: Scores for opportunity ranged from 4-20 with a low score suggesting a lot of

opportunity and a high score suggesting little opportunity.

however, did not feel as positive about how they were being rewarded for their

contributions to their respective agencies. They appear to have felt devalued to

some degree.

Autonomy

Autonomy is defined as the degree to which an individual is free to make

decisions about his or her work environment (Van de Ven & Ferry, 1980).

Furthermore, autonomy is viewed as the perceived power that an individual has in

determining how to do his or her job. An individual is perceived to have low

autonomy if others within the organization have control over what and how the job

is done (Agho, 1989). For example, a hospice social worker who is able to

determine how he or she will provide service to a particular patient with little to no

input from a supervisor demonstrates a fair amount of autonomy. In contrast, a

hospice social worker who is instructed on how and when to offer services to

patients demonstrates little autonomy.

For the relationship between job title and the degree of autonomy, nurses had

a mean of 10.33, social workers had a mean of 9.43, and “others” had a mean of

8.38. The range was 3-15. A high score on autonomy means that a participant

believed that he or she had a lot of autonomy. Thus, nurses reported having

the most autonomy while social workers ranked second. The gap between the

means between IDT members for this variable, however, was narrower. Thus,

the means for this variable suggest that social workers and other profes-

sionals (i.e., spiritual care providers and home-health aides) appeared to feel

as though they did not have the same freedom as hospice nurses when it came

to controlling their work environments and making decisions on how to do

their jobs.

Opportunity

Opportunity is referred to as the extent to which jobs are available in the

organizational environment (Price & Mueller, 1986b). The amount of opportunity

that is available depends on the external labor market. The organization in which

the individual is employed has no control over the availabilities of outside jobs.

However, the individual’s personal qualifications may have an effect on the

number of job opportunities available to him or her (Agho, 1989; Price & Mueller,

1981). The literature suggests that few opportunities negatively influence job

satisfaction (Iverson, 1992; Price & Mueller, 1986b).

For the relationship between job title and the degree of opportunity, social

workers had a mean of 16.14, nurses had a mean of 14.67, and “others” had a

mean of 13.44. The range was 4-20. A high score here means that participants

felt that they had few opportunities in the external labor market. Hence, social

workers reported having the least opportunity among the three groups. Thus,

they were the least of the three groups to voice satisfaction about external job


prospects in the organizational environment. Subsequently, many felt that job

opportunities were limited outside their current positions and therefore would

most likely remain in their current positions.

DISCUSSION

According to the Revised Casual Model of Job Satisfaction (Agho, Mueller,

& Price, 1993), which was adapted from Price and Mueller’s Model of Job

Satisfaction (1986b), the following variables contribute to job satisfaction. They

include those that are economical (e.g., pay, distributive justice, and internal labor

market), sociological (e.g., supervisory support, autonomy, integration, oppor-

tunity, and task significance), psychological (e.g., work motivation, positive

affectivity, and negative affectivity), and physiological (e.g., role overload, role

conflict, role ambiguity, and routinization) in nature. In other words, this con-

ceptual framework purports that hospice IDT workers are more likely to be

satisfied with their jobs when they are pleased with their salaries, feel rewarded

for their contributions to the agency, and have potential for other jobs in the

agency. Having supportive supervisors while having flexibility in job respon-

sibilities, having collegial relationships with co-workers, having opportunities

for advancement in one’s skills, and feeling that one’s roles are valued are

also contributors to job satisfaction according to this model. Moreover, being

motivated to work, having positive emotions toward work, having manageable

caseloads, and having distinct roles and a variety of job responsibilities have

also been linked to job satisfaction according to Price and Mueller’s Job Satis-

faction Model.

The purpose of this study, then, was twofold. First, the researchers wanted

to determine if social workers, nurses, and other team members (i.e., home-health

aides and spiritual care providers) were satisfied with their jobs in hospice settings,

and second, to determine if any one group of team members was more satisfied.

The results revealed that all hospice interdisciplinary team members in this

study were satisfied with their jobs, but social workers were the least satisfied

of the three groups. Using ANOVA statistics, significant differences between

professionals emerged along the lines of distributive justice, autonomy, and

opportunity. Specifically, social workers did not feel as satisfied about how

they were rewarded for their contributions to the agency as some of their

counterparts, nor were they as satisfied as their nursing counterparts in their

degree of autonomy. They also reported that they did not feel like they had

as many opportunities for gainful employment external to the organization as

their counterparts. Consistently nurses were more satisfied than social workers

on all three variables. In summation, hospice social workers in this study were

satisfied as a whole, but they did report less satisfaction than their counterparts

on most occasions.


Implications for the Social Work Profession

and Hospice Organizations

The results of this study have implications for the social work profession and

hospice organizations. These implications lie in the practice, administration,

and research arenas. At the practice level, the social worker is vital to the

interdisciplinary process as a core member of hospice interdisciplinary teams. This

is evidenced by Medicare’s requirement of their participation on IDT teams

(Kovacs & Bronstein, 1999). Moreover, social workers perform vital roles in

hospice settings—which include but are not limited to conducting assessments,

counseling, making referrals, advocating for needed services, and discharge

planning (Cowles & Lefcowitz, 1995; Kulys & Davis, 1986)—which are essential

services to terminally ill patients and their families. Therefore, it is important

that individuals with responsibilities of this nature enjoy their work so that

high quality services can be delivered to the patient and his or her family.

As previously mentioned, social workers reported feeling less rewarded

(distributive justice) than their nursing counterparts for their contributions to the

agency. With this in mind, it is critical that interdisciplinary-based agencies like

hospices work harder to validate the paradigm and practices in which social

workers adhere to by developing a healthy appreciation for the unique training

and expertise that these licensed and highly trained social workers bring to the

table as counselors, brokers, advocates, and educators. The development of an

appreciation for social workers’ value system as well as other interdisciplinary

members’ value systems can be achieved, for instance, through interdisciplinary

education. Interdisciplinary education has shown to be an effective strategy for

developing knowledge, appreciation, understanding, and clarity of professional

identities between interdisciplinary team members (Fowler et al., 2000). Increas-

ing social workers’ sense of distributive justice can also be potentially achieved

through 1) higher salaries, 2) professional recognition in the form of awards and

announcements, and 3) professional recognition via acknowledgments at the

agency and/or collegial level, which suggests that social workers’ contributions

are significant and vital to the overall functioning of the organization.

Second, the degree of autonomy in how the professional conducted their affairs

also resulted as being significantly different between IDT members in this study.

Having autonomy is certainly central to social workers, as it is to all IDT members,

due to the fact that a large amount of documentation is required of them due to

Medicaid and Medicare requirements. When hospice agencies allow for autonomy

in the workplace, this energizes practitioners because it conveys a sense of

confidence in the clinician’s abilities and it allows for creativity in intervention

strategies. This ultimately contributes to job satisfaction.

Last, social workers reported that they had fewer opportunities for career

advancement outside their organizations than their colleagues. As a remedy,

hospices must re-examine the medical hierarchy inherent in its agencies and


develop ways to increase the marketability of all of its team members. Specif-

ically, offering opportunities to improve clinical, research, administrative, and

leadership skills of social workers are ways to achieve this. In-services at the

agency level or within the community are also ways to build social workers’ skill

levels. Supporting IDT members’ attendance at local, national, and international

conferences is an excellent venue in which to improve social workers’ skill levels.

Diversifying job responsibilities like appointing more social workers to adminis-

trative posts in hospice settings would also help the social work clinician to

develop a more marketable repertoire of skills.

Recommendations for Future Research

Most studies on hospice settings tend to focus on nurses and other medical

personnel resulting in a major gap in the literature on issues and concerns of social

workers. At this juncture, the literature is scant with information on social workers

in hospice settings despite their preeminent roles on hospice interdisciplinary

teams. Large scale studies are highly suggested as well as qualitative efforts.

Qualitative studies in particular will help the researcher to glean into the core

issues and concerns of hospice social workers. Thus, studies of this nature and

magnitude may be instrumental in helping administrators to better meet the needs

of hospice social workers employed in their organizations, which may have

implications for service delivery.

Limitations

The findings in this study should be judiciously interpreted due to the limita-

tions imposed by the study’s design. For instance, the use of only four adult-based

hospice organizations in the Midwest limits the generalizability of the study.

Any generalizability to hospice interdisciplinary team members in hospices other

than those selected in this study are based on the reader’s interpretation of

similarities and applicability. The researchers involved in this study had no way

of knowing if participants were representative of the many hospice interdisci-

plinary team members employed in hospice settings across the nation. Moreover,

combining home health aides with spiritual care providers and subsequently

re-coding them as “others” because of their low representation in the sample

prevented the researchers from differentiating between members in the final

analyses. Therefore, the results of the study do not reflect the differences in

satisfaction that may or may not exist between these IDT members.

Despite these limitations, these researchers feel that this study is rich in content

and has raised a number of significant issues related to job satisfaction among

hospice social workers and other IDT members. Replication of this study using

more hospices and a larger sample of IDT members from each discipline is

recommended.


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Direct reprint requests to:

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