The Interprofessional Practitioner. Changing Professional Identity in Social Work.

1. The Interprofessional Practitioner. Changing Professional Identity in Social Work. Dave Sims. University of Greenwich, d.sims@gre.ac.uk, tel. 44 (0) 208 3319445

2. Interprofessionalism ‘Being a professional today means becoming interprofessional’ Meads and Ashcroft (2005:3).The Case for Interprofessional Collaboration. Blackwell

3. 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

4. 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)

5. Long Stay Hospitals for People with Learning Disabilities

6. 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

7. 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

8. The Literature • Interprofessional Education • Professionalism, socialisation and professional identity • Bernstein’s theory of the social construction of pedagogic discourse How have professions established themselvesand why the changes now ? classification - strong and weak ‘singulars’ insulation – ‘crucial space’ between disciplines regionalisation of knowledge – shared knowledge

9. Where graduates worked Social Services Departments - 23 The NHS - 19 The independent/voluntary sector - 4 Other – 1 Which profession? 25 were in Social Work 17 were in Learning Disability Nursing 5 Were in other posts (two in CAMHS)

10. Professional Identity

11. 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’

12. Prepared for Interprofessional Practice?

13. 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’

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

17. 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’.

18. 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’.

19. 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?”

20. The multiskilled professional

21. 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

22. 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

23. 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 Positives Disadvantages

24. 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

25. 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

26. References Barr 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

27. 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.