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When I was working on my MSW, I read a statistic that would not let go of me, “Nearly 40% of patients on dialysis had diabetes.” I began to wonder what dialysis was like and how a person who struggled to manage one chronic illness would now cope with a second chronic condition. I sought an experience that would complement my interest in helping people with chronic illness to manage their disease and engage in their care. My prior experience had been with diabetes education and support. Now it was time to go to the next step. I asked our field coordinator if she had any contacts with dialysis clinics and whether I could do my second year MSW field placement there. She had never had a student do an internship at a dialysis clinic, but was open to the idea.
I contacted the largest provider in our area and enquired about an internship. The details were worked out over the summer before my second year and I began my internship in the fall. I can say that the experience made me proud to be a social worker and inspired me to continue my education. There are some elements of the internship that I believe could be replicated for other students.
Interdisciplinary Experience
The dialysis clinic provided an interdisciplinary experience. I began my training over the summer when I took the Kidney School online training provided by the National Kidney Foundation (NKF). I learned about the physiology of kidney disease, dietary needs and restrictions, and the emotional aspects of care. I was encouraged to work with nurses, dieticians, physicians, and office personnel to know what role each discipline played in caring for patients. I got to know patients in deeper ways than if I had just devoted myself exclusively to a social work orientation. It was apparent that caring for a dialysis patient was a complex endeavor and required an army of people.
Multiple Social Workers Allow Interns to Find Their Own Way
I worked closely with five different social workers during my yearlong internship. This was invaluable, as a dialysis social worker has a long list of responsibilities and a variety of ways for accomplishing those responsibilities. Seeing different ways of performing the same job allowed me to find “my way” of being a nephrology social worker. The social workers were open to my doing a variety of duties and gave me freedom to organize and accomplish tasks in my own personal style.
Mistakes are Just Learning Experiences in Disguise
I was affirmed even in my failures. My first day at a new clinic, I spent half an hour updating a yearly review with a patient. My social worker had come by to see how things were going and she smiled when she left. It wasn’t until I was ready to begin the educational part of my visit that I realized I was meeting with the wrong patient! I had called the patient by the wrong name for the entire visit and he never corrected me! I excused myself and hurried to apologize to my social worker; she just smiled and said, “Well, what did you learn about Mr. Smith?” Then we discussed the importance of confirming the identity of a patient. I never made that mistake again!
Variety is the Spice of an Internship
My tasks varied with each new clinical experience. I was involved in planning and facilitating monthly support group meetings, providing information about Advance Directives and Living Wills, conducting intakes with new patients, and updating insurance and contact information.
One of my favorite tasks was administering Kidney Disease Quality of Life (KDQOL) surveys to patients. After administering the surveys, I scored them, recorded the scores, compared past scores, and prepared patient information sheets. I would follow up with patients by reviewing the results and creating an individualized intervention to improve areas of poor functioning. I learned a great deal about patients through these conversations; many were very happy to have someone who would actively listen and help them to improve their functioning. My skills as a clinician were improved with each interaction. The KDQOL later became an instrument used in my MSW research project.
Internship as it Relates to Other Areas of Social Work
The internship became the launching point for class learning projects. I presented the history of dialysis Medicare policy in my policy class. This was made possible when my field educator suggested that I call the Director of Advocacy and State Government Affairs, who was a social worker and lived in another state, to discuss policies regarding dialysis and end-stage renal disease (ESRD). The director was more than happy to talk with me and sent me written information and articles to aid in my education. She even requested that I send my completed class paper to her. I learned a great deal about policy and actually found it far more fascinating than I ever thought possible.
Let the Intern Do Meaningful Research
My MSW research project was supported at all levels of the company. I reviewed the current goals of the company and found that effectively treating depression in ESRD patients was a primary goal. I read company materials and watched patient videos to better understand the unique challenges of treating depression in this population. My supervisor referred me to an experienced social work researcher within the company who was a Regional Lead Social Worker over a two state area. She expressed interest in what I might want to do to as a research project. The Regional Lead Social Worker put me in touch with NKF and a researcher in Atlanta, GA. We discussed my interest in treating depression and NKF suggested some CDs they had produced that may be able to provide consistent information for patients. From that conversation, I chose to organize depression support groups that would provide the CD information and discussion along with a control group that would simply listen to the same information without professional intervention.
I was able to obtain enough copies of the CDs for each social worker in the area to have a copy at his or her clinic to use with patients. I was encouraged to share my results at a regional social workers’ meeting and inform social workers about how the CDs could be a tool to improve patient functioning. I eventually wrote a paper for publication about the pilot study and have been invited to provide a poster presentation at three conferences. To this day, I remain in contact with the Regional Lead Social Worker who inspired me to dare to treat depression in a tough population.
How Can Other Internships Create an Exemplary Experience?
Find out why the student chose this internship and what they hope to gain from the experience. Try to meet their expectations along with your agency’s needs. The easiest answer when someone wants to do something is an emphatic, “No.” Resist the urge and instead ask, “How can I help?” Take genuine interest in what classes the student may be taking, and look for ways to augment that learning experience. There may be agency materials that would provide further insight or articles you have read that could enhance the class project. Take advantage of teachable moments to inspire the student about the social work profession.
Being exposed to a broad view of the social work profession at the clinical, local, regional, advocacy, and policy levels can be done with some planning in other internships. Invite the intern to join you for meetings with social workers and others impacting clients from other areas of your company. Look for opportunities to “lend” the intern to other social workers in your agency for a short-term assignment. When an intern asks a question, consider facilitating a phone call or an email to a knowledgeable social worker when his or her expertise may be superior to your own. Talk with the intern about the policies that are having an effect on the clients you serve. Discuss how you and the intern might advocate for better policies. It may be as simple as writing a letter or sending an email to a government official expressing the needs of your clients and the effect that the policy would have on them.
Implications for field placement offices
Field placement offices need to have a variety of intern experiences available. Building quality relationships with the community and social service agencies is necessary to achieve satisfaction for all parties involved. Training field educators in the development of appropriate relationships with student interns is vital to the success of the field education experience. Training should include negotiating the learning experience, a focus on providing a safe environment for students to learn (and to fail), and how to handle common problems as they arise.
Being a field instructor provides a unique opportunity to inspire the social workers of tomorrow. With planning and a student-centered mindset, the field internship can provide an exemplary experience for everyone involved. The intern can be of benefit to the agency by providing energy and curiosity that can be contagious and inspiring to those who have been working in social work for a long time. It is always possible that the intern may be a colleague in the near future.
Field education is a valuable tool for developing competent social workers. Students need to be involved in their own learning experiences. A learning contract that includes the specific skills and a timeline for learning those skills needs to be carefully developed and executed throughout the internship. This begins with developing an effective working relationship with the field educator and engaging in planning the field experience with the field educator. Students need to negotiate the learning experience and to dialogue about what they want to do while working at the agency. The internship can be an enriching experience that gives students practice in utilizing the information they have learned in a classroom.
Evaluation of field learning needs to be individualized and flexible. The contract can be renegotiated as opportunities arise to enrich the learning experience that may not have been available earlier. This contract becomes a rubric for evaluating the field instruction and the student. Both the student and the field instructor should be given an opportunity to provide specific feedback about the field experience at intervals along the way. This allows for corrections in the course of the internship and revisions to the learning contract. The field placement office should obtain confidential evaluation of the agency experience. If an agency is failing to provide an enriching learning experience, then the field placement office needs to clearly communicate what changes need to be made in order to retain a field education relationship with the university.
Conclusions
The field placement office is responsible to students to facilitate an enriching social work internship that prepares students for future employment in the social work field. This must be the first priority. The field educator is the primary means to this end. Having well-trained, competent field educators, who desire to mentor future social workers, are valuable partners in this endeavor. While agencies may benefit from the extra labor working to provide services to their clients, this is not the priority of the field education program. Clear communication and preparation that focuses on preparing students is necessary in achieving a quality field education program. Preparing tomorrow’s social workers through great internships is challenging, but worth the effort, as students become experienced social workers that mentor other students, completing the cycle and giving back to the profession in a meaningful way.