The Interprofessional Practitioner. Changing Professional Identity in Social Work.

Dave Sims. University of Greenwich, d.sims@gre.ac.uk, tel. 44 (0) 208 3319445

Interprofessionalism‘Being a professional today means becoming interprofessional’

Meads and Ashcroft (2005:3).The Case for Interprofessional Collaboration. Blackwell

Interprofessional Education

• Aims to improve collaboration in practice• Increasing complexity of practice• Failures of professionals to work together• Results from service change but also drives it• Impacts on professional identity and roles

Workforce Remodelling

• Barr et al (2005) observe that IPE remodels the workforce. New identities and discourses can emerge from it.

• Change in healthcare is driven by a number of factors which include the demands of practice and rising public expectations. Education responds to this, but it is also dynamic.

• It ‘initiates, as a change agent in its own right’ (Barr, 2004:vi)

Long Stay Hospitals for People with Learning Disabilities

Joint Training

• Began in 1988• Hospital closure• LD Nursing and Social Work curricula were

substantially similar• Could one practitioner combine roles and

provide holistic care/support?• ‘Leap of faith’ that combining trainings would

facilitate service change

The Research

• Postal survey of ex students (n =47) from 5 universities in England

• Semi-structured interviews with 25 self selecting respondents

• Information and support from Course Leaders• Focus on influence on practice, identity and

skills used

The Literature

• Interprofessional Education• Professionalism, socialisation and professional

identity • Bernstein’s theory of the social construction of

pedagogic discourse

How have professions established themselves and why the changes now ?

classification - strong and weak ‘singulars’insulation – ‘crucial space’ between disciplinesregionalisation of knowledge – shared knowledge

Where graduates workedSocial Services Departments - 23The NHS - 19The independent/voluntary sector - 4Other – 1

Which profession?25 were in Social Work17 were in Learning Disability Nursing5 Were in other posts (two in CAMHS)

Professional Identity

0

5

10

15

20

25

30

Employment

Perceivedidentity

Themes Emerging from the Survey

• Breadth of Knowledge

• Duality of perspective

• Constructing identity comparatively

• Catching up time needed

• Risk of losing skills

• No recognised posts as a ‘joint practitioner’

Prepared for Interprofessional Practice?

010

2030

40

well preparedsocial issues

well preparedhealth issues

insuff. Either insuff. Social insuff.Nursing

The 25 Interviews – the key findings

• Influence of their ‘alternate’ discipline on practice• Those working as social workers were

strongly orientated towards health needs assessment

• Those working as nurses talked about enhanced awareness of social needs

• Belief in own capacity to work interprofessionally – ‘bridge builders, boundary crossers and peacekeepers’

Why bang your head against a brick wall when you can walk round it?

Social Workers using Nursing Skills

• These were most frequently used in assessment (n=8)

• ‘I think I am more holistic, yeah……definitely more holistic. We have assessment tools which guide us in what we do, but you get to the end of them. But I think further than what is on the assessment for the social care…I think about people’s health needs’.

Another social worker said…..

‘I have been able to look at areas around how people managed their medication and the kind of impact of not having medication on people who have been affected by their epilepsy…… so that would have had an impact on their behaviour…….you know social work colleagues wouldn’t have known there was a partial seizure going on’.

Reactions from others

“If I wanted a plumber I would call a plumber not someone who could fix my windows as well”

“So you are half a nurse and half a social worker?”

The multiskilled professional

Constructing Professional Identity –things people

said:• I used to say I was a joint practitioner but there

are no jobs• I don’t rely on a specific identity to feel confident• My identity is quite fluid – I have always been

one to ignore the profession and concentrate on the role

• I identify with both though I practise as nurse at present

• I guess from now on in I am more of a nurse than a social worker

Professional Identity

• ‘I see myself as both a nurse and a social worker - a kind of hybrid practitioner’

• ‘I’m a social work enhanced nurse’

• I call myself what I am doing at the time

Positives Disadvantages

• Holistic practice• Communication and

professional empathy• Transcultural

understanding - systems, services, roles and perspectives

• Confidence• Assertiveness• Less defensiveness -

‘sharing skills not owning them’

• Divided loyalty• Having to choose one

path and leave the other behind (and lose some skills learned?)

• Lack of recognition and understanding about their training by others

• Pressure to stay within boundaries

• Couldn’t find nursing jobs

Paradoxes

• LD Nurses having to make referrals to other LD nurses in the same team

• Social workers discouraged from reporting health needs in their assessments

• Do jobs exist for jointly trained practitioners?• Uncertainties, ambiguities and tensions

have helped graduates to develop critical perspectives on practice

To conclude………

• Confidence and assertiveness in communication, relationships and networking

• Looking at practice critically

• Using the dual knowledge

• Clear about roles but flexible in identity

• Able to practise interprofessionally

ReferencesBarr H. (2004). ‘Introduction’, in Meads G. and Ashcroft J. (2005) The Case for Interprofessional Collaboration in Health and Social Care, London: Blackwell/CAIPE.

Bernstein, B. (2000). Pedagogy, Symbolic Control and Identity. Theory, Research, Critique. Revised Edition. Lanham: Rowman and Littlefield.

Gilbert J. H. V. (2005). ‘Foreword’, in Freeth D., Hammick M., Reeves S., Koppel I. and Barr H. Effective Interprofessional Education. Development, Delivery and Evaluation. London: Blackwell/CAIPE.

Meads G. and Ashcroft J. (2005). The Case for Interprofessional Collaboration in Health and Social Care. London: Blackwell/CAIPE.

Sims, D. (2007). The Influence of Joint Training in Learning Disability Nursing and Social Work on the Professional Identity, Skills and Working Practices of Graduates. EdD Thesis. Institute of Education

Dual Professionalism

• Freidson (1994, p. 10) defines a profession as‘an occupation that controls its own work, organized by a special set of institutions sustained in part by a particular ideology of expertise and service’

• A working definition of dual professionalism: an ideology of expertise and service which is drawn from two occupations, which are organised by two special sets of institutions.