The Festering Crisis of Inadequate Nephrology Social Work Staffing: What are the Options for Improvement?

Abstract

Staffing has long been identified as a structural measure of quality in healthcare. In spite of this, it has not been accorded prominence in the CMS End-Stage Renal Disease (ESRD) program. Among the major consequences has been the absence of research on dialysis clinic staffing which could serve as a basis for developing evidence-based standards. In lieu of such standards, there has been a widespread arbitrariness in decision making about staffing, which has contributed to adverse patient outcomes and distress among the different disciplines trying to provide care. Largely ignored in these evolving developments has been the festering crisis in nephrology social work staffing, its ramifications for patients’ psychosocial concerns not being addressed, and concomitant potential for the exacerbation of medical issues. This study provides a broad overview of these issues with social work staffing, and also suggests some pragmatic alternatives that could help mitigate the problem.