Welcome to Social Work Stories, a podcast exploring social work practice through stories and critical reflection.
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But for now, on with the episode. Hello, everyone.
Welcome to the Social Work Stories podcast.
I am Dr. Min Fox and I am here with my lovely friend and colleague, Liz Murphy.
Hi, Liz. Hello, Mim. Hello, everyone. It's so good to see you, Liz.
I'm not sure about you, but where I'm recording, it is blustery freezing cold weather is that what's going on for you yes indeed it yeah I love how we talk about weather.
I know. It's one of those go-to touchstone topics, isn't it, for you and I?
It's like us warming up. into I know I know I guess stuff but you know start with the weather but well it's not just starting with the weather because for me I sit here and in front in my study in the computer and I'm working and the rain outside and you know what I do I psychologically go back to COVID days Like I actually go back to that feeling of this is the world that I'm in.
It's kind of a weird experience. I think that's why today I'm very conscious of this weather.
Very aware. Unlike the COVID days, Mim, I'm glad to see you're not in the cupboard.
I'm not in the cupboard. I do remember those recording days in the cupboard.
I know, so fondly. And talking about you and I recording, Liz, this is a really interesting episode because I hear we've got this special guest. unbelievably fabulous storyteller.
I hear that it is you. Am I right? You are correct.
I'm calling it the quaint little story is mine.
I love it. And... I did it because one, I'm forever asking other social work colleagues and friends to do it.
So I thought I should try a dose of my own medicine.
And also I've found since I've retired, I have more space to reflect and just stories bubble up.
And this one, has been bubbling around in my heart and my head for quite some time.
So it asked to be written and it just spilled out of me.
So, look, I feel like I'm part of a special little group now.
I've told a story and we're going to reflect on my story.
Just to reassure everyone, lots has been de-identified.
But I took your advice, Mim. Totally de-identified it.
Yeah. But it's a little story about one of my encore shifts.
Yeah. And I thought before we get to it, I wanted to find out from you, did you ever do encore as a social worker?
I did. I did it for years. And... And look, I loved on-call work.
I know it's not for everyone. I know that there are some people who adore it and are, sign themselves up for every single overnight shift they can and others who avoid it like the plague.
And I was one of those people who just really genuinely enjoyed it and looked forward to it.
Right. I mean, I think the ones that I know who, there are two groups that sign up for it.
There are the adrenaline social workers who just adore a good crisis.
There are those people who have got a mortgage.
Now, I was not an adrenaline social worker, did have a mortgage.
But really, I could have found other ways to pay for that mortgage if I had a choice.
But the reality is that with many of the hospitals that social workers work for, it's just... part of working there, which you know what?
I feel like ripped off because you work in a hospital eight to five, whatever.
...and you're dealing with crisis and hospital work day in, day out... ...and you're the bunnies that get to come back and do on-call...
Because I've been the community social worker that possibly could have done with a bit of adrenaline every so often.
Those social workers don't get to do it.
I don't understand this. And they probably would want to, some of them, right?
They've all got mortgages. Yeah, that's right.
And they may be adrenaline junkie social workers in hiding.
Look, so look, I fessed up in the story that I'm not a great encore fan.
Yeah. And even when I was doing backup, so that is just being the senior that that other social workers would ring up if they're on call, if they wanted some advice.
Yeah. I still would be staring up at the ceiling unable to sleep.
I just, I never relaxed into it. I did years of it.
And, yeah, it was never an easy place for me.
But one thing that I took from my training was was that, generally speaking, an on-course social worker will make a bad situation slightly better.
And that's exactly what I saw in all my shifts.
And what I heard back from my friends and colleagues who are on call.
We make a slightly better situation. Sometimes we make a significant difference, but yeah, it's good that we're in there. despite many of us despite many of us preferring not to be.
I think as well, Liz, there's a magic that can happen in the middle of the night or the early hours of the morning.
And that's what your story actually really made me think about.
So why don't we listen to your story and then have more of a chat.
This story is about an on-call shift I did many years ago which involved a sudden, though not unexpected, death. of a woman in a busy emergency department.
The way her family and community reacted to her death and the role myself and two nurses played in supporting the family.
Before I get to this story, I want to talk a little bit about what an on-call shift for an Australian social worker can be like.
Most large hospitals in Australia have an on-course social work service, which operates after hours, including weekends. and which respond to category one referrals, which include sudden deaths, domestic violence, child protection matters, traumas like car accidents, victims of crime, coroner's cases, poor prognoses. and pregnancy losses.
In other words, if you get called in as an on-course social worker, it's challenging crisis intervention work.
I did on call for several years in three different hospitals and full confession, I always found it stressful.
I think the main reason for my stress was the not knowing what was gonna be served up on my shift.
And to cope with the unpredictable nature of the work, I developed a series of rituals which I'll reveal to you in the hope you won't judge me too harshly.
Well, actually, I don't really care because I've heard from quite a few colleagues and friends that they also have various rituals they perform before their encore shift.
If I was on call during the week, I would delay leaving work to avoid being called back on my way home.
This also enabled me to get a handover from a social worker who may have had a situation that was going to go into the night.
Then I would head home where I would lay out my clothes.
I like to wear scrubs, possibly because I felt like pyjamas and my encore bag. which had my on-call resource folder in, pens, notepaper, coffee bags and a snack.
I'd make sure I had an early dinner and I'd try to get to bed early with my phone right beside me and a notepad and pen to write down referral details.
And as I crawled into bed, I would ask the on-call goddess to be kind and at least let me get some sleep.
Apparently, most on-call referrals occur before midnight, but I prefer the early morning ones, say around 2 or 3 a.m.
I think it's because I'm an early morning person.
My mind is more alert at this time. Plus, there's something really nice about seeing the sunrise after a call out.
Now back to my story. It was around 2am on a Sunday that I received a referral to come in to support a family of a woman who I will call Mrs Saliba, which is not her real name, who was dying.
The large family were highly distressed.
And the emergency nurse manager wanted me to attend to them as the ED was very busy.
When I arrived, I noticed the waiting room and corridors around the ED were filled with people of all ages. wailing and crying.
All the women wore hijabs, so I realised that the family were Muslim.
I headed straight to the shift manager who was seated at the main station in the emergency department and who had called me earlier.
She then explained that Mrs Saliba had died and her body had been moved to a private room. and the doctor was ready to go and speak with the family and wanted me to accompany her.
I found the doctor, who I will call Siobhan, also not her real name, She was an Irish doctor on a working holiday.
We had a brief discussion on how to conduct the conversation and what our roles were.
Siobhan was going to explain the reason for Mrs Saliba's death and answer any questions the family had, and then I would provide support.
I really like it when the doctor and social worker partner up to break bad news.
I just wish it was standard practice. Siobhan explained to me that Mrs Saliba had been living with a chronic and terminal condition for many years.
And although she and the family were aware that there were no further possible treatments, the expectation was that she had approximately a year's prognosis.
However, earlier in the week, Mrs Saliba had contracted some kind of virus and had deteriorated very quickly.
By the time she was brought into ED... She was unresponsive and sadly died in the resus bay.
We entered the family room to find nine people crammed into the space.
These were Mrs Saliba's three sons, four daughters and her sister and brother-in-law.
Siobhan introduced herself for me. and then she offered her condolences.
She then explained what had happened to Mrs Saliba and how and why she had died.
As Siobhan was talking, I scanned the room for the person who was in charge.
Just as an aside, when I was training to be an ED social worker, the senior social worker who was training me called them the bereavement pack person. so-called because this was the person in the family who was in charge and most able to take on the role of organising the various tasks after the death of their loved ones. and who we gave our bereavement information pack to.
The bereavement-packed person in this situation was Mrs Saliba's eldest son, Michael.
After Siobhan spoke with the family, she left me with them.
I offered for the family to spend time with Mrs Saliba's body And it was then that Michael explained that because they were Muslim, they needed to organise to bury Mrs Saliba before sunset.
He also explained that it was important for the women in the family to be allowed to sit with Mrs Saliba's body as they would not be attending the funeral.
This was the first time I had ever had to organise a Muslim burial, let alone one within a few hours of death.
So I did what any social worker without a clue does and excused myself, promising to return as soon as I checked out a few things.
I found Siobhan and asked if it was possible for Mrs Saliba's body to be released.
Fortunately, because she had been a patient of the hospital's oncology service, A death certificate was signed off.
Sometimes sudden deaths have to be referred to the coroner to verify the cause of death. but fortunately this was not necessary.
I also checked with the nurse manager that we could use the private room for the family to view Mrs Saliba.
And thankfully, because the ship had quietened down, we were allowed to do this instead of moving her all the way to the hospital mortuary.
I returned to update Michael, who'd been conferring with his family about a Muslim funeral director.
At the suggestion of his aunt and uncle...
They had chosen and contacted a suitable funeral director who was on his way to the hospital.
I then went to check on the family. who were with Mrs Saliba's body.
I was expecting to find her daughters and sister, but what I walked into was a room with over 30 women crying over Mrs Saliba.
At one point I had to try and pull out a woman who had collapsed.
I soon realised I needed help to manage the crowd. who were becoming increasingly distressed, and I asked two wonderful nurses to help me.
In true nurse form, they took control. and explained only five people could be present for a set time before the next group were allowed in.
An hour or so later... the funeral director arrived.
He was a small bearded man of an indeterminate age.
He was dressed very casually and under his arm he carried an old canvas and wood stretcher.
He then asked Mrs Saliba's sons to help him carry their mother outside to his van.
This was very different to the other times I'd been present when a person died in hospital.
Usually after a person dies, a covered trolley is brought up by our hospital orderlies and and the deceased person is transferred to the mortuary where they will be picked up by the funeral director.
My nursing buddies assisted to make sure Mrs Saliba was covered up and before her body was moved out of the room...
The other emergency department nurses all quietly pulled the curtains around the patients in surrounding beds. and stood quietly with lowered heads Mrs Saliba was then quietly carried out of the emergency department and placed into the van Siobhan The two nurses and myself waved the van off just as the morning sun was creeping up.
This story has stayed with me, possibly because it was so different to any death I had been present for.
It is also testament to the unpredictability of an on-course social work shift and the need to think and react quickly to what is required. and to lean into the support of others when the job is too big for one person.
In finishing, I want to say that despite the challenges of encore social work, it is important and privileged work where we bear witness, hold space, and provide support for people at their most painful moments.
And sometimes we even get to witness moments of grace. like the quiet respect in the emergency department when Mrs. Saliva's body was taken away.
Liz. For me, this story is very much about the quiet dignity that the right healthcare staff can bring. to an awful tragedy. in the middle of the night.
And I really loved how you structured this story and told it.
Because it really, like I said before, it brought to me the magic of that can actually happen when the rest of the world is asleep and here you are in the middle of the night dealing with the most awful moment that this family has.
And I wish I could be the person that you're referring to with quiet dignity because it was anything but from my point of view.
From my point of view, I was the duck on the pond with the paddling feet.
And I think... there was the sheer numbers of people in high distress that really threw me for a six.
But as I said in the story, So much of what I had seen previously with regards to a hospital death, And so that also threw me.
And like I mentioned that in the story, that classic social worker just going, just stepping out for a minute.
Yep. going out and having a slight panic attack, going, what the... Yeah, but I don't think you needed to have the dignity.
It's about making the moment have dignity. for the family members.
Yes, look, I think you're right. But I think the dignity, the quiet dignity was...
The nurses, to be honest. Yeah, of course.
And these were real long in the teeth. nurses that you just think, gosh, they've been in ED for such a long time, and what I learnt from them was, yes, that, but also... just marvelled at the fact that they can squeeze out that quiet dignity at the end of a shift after many, many, many years of working in emergency departments.
They are my unsung heroes, Mim, who I've learned so much about and who just knew. when to kind of pull the authority card um with heart and i yeah they were they were a marvelous team It's funny, you know, like Encore, that's the other thing.
You make instant teams for that one shift.
They're your people, whether it be a couple of nurses and a doctor in intensive care or...
You know, a police officer and an orderly and another.
You intensely grab onto these people because they're your team for that shift.
And I really could not have done that on my own just because there were so many people that needed to. spend time with Mrs Saliba and Yeah.
So, yeah, it was like I could have chosen lots and lots and lots of stories, I have to say, but that was the one. that spoke to me and it also showed me about They don't go in with any expectations when you do on call because it just is so unpredictable.
And I found, Mim, you and I have talked about this, the training that I have had over the years has And I think I speak on behalf of a lot of social workers.
I think we could do a better job. I think we could train our on-call social workers a hell of a lot better and you and I, you know, we are the pin-up girls for simulation and I think... this is a space for that kind of learning.
I agree with you, Liz. I think that there are some things that can be book-taught or classroom taught. and there are other things that you have to actually experience.
And whether you experience it because you are thrown into the deep end on a placement, or in a new graduate role, or ideally you experience it in the classroom via simulation. there's something about encore work that I think it's so experiential You have to be amongst the sounds the smells the noises the idea of that team gathering together for a common purpose.
You need to actually live that and experience to then be able to learn from it.
And part of what I used to see happen in the hospitals is people would start the job and then be thrown onto the on-call roster With no real training, maybe a half an hour conversation about child protection procedures or homeless resources.
And that was it. And then suddenly there they were on their own at night, having to respond. to really substantial situations in people's lives.
And occasionally now I do hear about hospitals that are doing some shadowing.
But often the shadower is not paid. It's a senior member of the team.
And I think there's a disincentive to actually training people properly.
And this, for me, is one of those areas of clinical practice where people would really benefit from proper experiential learning.
So my platinum model, Min, is... intensive simulation training around all of those category one referrals.
And not just with social workers, but with some of the professions that you might actually be working with. sudden death, who are you going to be working with?
You're going to be working with the doctors so that Siobhan, she was more the exception than the rule. kind of had a corridor conversation about how the conversation was going to go.
No, you'd be simulating that. You'd also be simulating the working on the deceased person, whilst the family are sometimes in the room and what that can be like, but doing it like a multidisciplinary simulation.
There would be, like you say, a shadowing system.
So someone actually has a more experienced person with them as they're on their L plates.
And then. regularly you'd be case discussion, you'd be doing more simulation, maybe you've had a whole run of a particular type of referral.
Maybe it's been child protection for the month of June.
You might be doing some case discussions around that and maybe even doing some simulation around what it's like when you know parents become highly distressed at the suggestion that they might have been neglectful of their child, whatever it is.
But the training's ongoing. And the baptism of fire approach is like...
We don't use that. We don't use that with our social workers.
That's right. So I think that's the ideal for professional development and what's happening on the ground when people are working.
What I would like to see an extension of that is that it's introduced in the qualifying programs.
So in the bachelor or the master's program where they actually do. do a simulation in there where they have to experience the environment outside of normal business working hours. because even being in a hospital, when it's the middle of the night is a very different experience for anyone.
And if you've never done that before, you've never had to go down to the morgue in the middle of the night.
You've never actually had to walk corridors where the lights are dimmer and that there's less staff around.
It is a very different feeling. I actually think students should be exposed to that.
And the problem with placement is often that's where they're exposed and for the first time they're exposed and suddenly they're freaking out.
Yeah. Yeah. And also the postgrad, you know.
Yeah. I agree, Mim. I think that would be a wonderful undergrad, postgrad learning experience.
The other thing that gets under my craw, Mim... and I can say this now because I don't work there, is the interpretation of the award around on-course social work.
Okay. And this is my big plug for social workers joining a union. because there's some pretty interesting interpretations of the pay and also the rest periods and the award. from Core Social Work.
And you do have some hospitals that do have paid shadow people.
So that was, I was lucky to be in that hospital.
But for some, you may not. So I think if ever on-call shift would be one of my primary reasons for joining joining encouraging people to join the union yeah i think that makes a lot of sense but anyway social workers should be joining their unions Because actually somebody's got to be agitating for positive industrial change, right?
And if it's not a social worker, I'm curious as to why not.
Ah, that's just my little platform. No, no, get on that milk crate because it's worthwhile.
But bouncing around, so recently I've been, as you're aware, I've been doing workshops with social workers. around memory making.
Yes, and everyone will remember some of our previous episodes that have really focused in depth on memory making and the practice of memory making in the death and dying space.
It's been an absolute pleasure and privilege to work with social workers. around memory making.
But I met a beautiful social worker last week and she told me about using memory making in the on-call space.
And I'll change the story up a wee bit so that it doesn't Again, we respect the privacy.
But what happened was it was an on-call shift where, again, it was a sudden death. high level of distress from the family, like really, really high level.
And it was one of those situations, a social worker walks in and the medical staff go, oh, thank God, thank God you're here and, you know, quickly disappear.
And this social worker used, suggested the idea of memory making. which the family talked to.
They really agreed to this. And it de-escalated them beautifully.
And it just calmed and made this space. So what she ended up doing was... um bringing in little tea light candles to put around the i think it might have even been a recess bay So she made the space, she de-clinicalized it and made it a more quiet, maybe,
Some people might say brought the sacredness into the space.
Oh, beautiful. And was able to use printmaking. photography, gave their little knitted hearts to the family and left one with the deceased person.
So I thought, there's another, I guess, tool for the tool belt.
Memory making doesn't have to be in a planned way.
It can actually be in the on-course space and can have very noticeably effective impact on the family.
Yeah, I love that, Liz. I love it. And I think that's also what does happen in the encore space is that you have to pull out every tool you have.
And so whether it be memory making, whether it be any other sort of creative connection points, or whether it be pamphlets and resources and whether it be getting the phone from wherever you need to get it and the tissue box from wherever you need to get it and you do what you need to do. to respond and support that family in that moment or that individual.
I love that, Liz, and I love the tying together of some of the things.
We've been talking about over a number of episodes now about how to respond to people in those really critical moments.
Mim, the last thing I wanted to have a chat with you about was a few years ago we did some research on... stress and burnout of hospital social workers yeah and one of the themes that emerged from the conversations was the stress, the added stress that on call had on social workers.
And as a result of that, There was a whole lot of work done in relation to self-care and looking after your colleagues.
Do you remember that, Mimin? Yeah, absolutely.
Things like there was a mindfulness around where you had conversations around you know, if you'd had an on-call shift and had been particularly stressful the previous night, that you don't just kind of vomit that out in the office. that you maybe make a time with your supervisor or with a trusted colleague or senior to debrief it yeah And that there was a mindfulness around how many shifts you took on a month. having a break from on-call, being very mindful about having ongoing training for staff. is there anything else that i've forgotten no no and i think yeah having the variety in the workload as well that it wasn't always the exact same thing that you were doing But, yeah, I think that's right.
And encore came out in that research as one of the key areas, didn't it, that people... really did feel a large amount of vicarious trauma and compassion fatigue from yeah yes And I think one of the hospitals that I've heard of are being very mindful about not putting new grads too quickly. onto the encore.
Oh, absolutely. And, you know, what a revelation, right?
I think... What ends up happening all the time is that people are desperate to fill a roster so they grab any live bodies they have. but actually for the health and wellbeing of our future generations of social workers.
We really do need to be thoughtful about what it takes to work on an on-call roster, what we do to support people and nourish them through that work because it is significantly different to during the day.
I think that's us. Liz, I want to thank you for giving us that gorgeous story.
It's made me think of the stories I might want to record in the future.
And I'm also thinking that if anyone out there is interested in sharing stories, they should get in touch with us because We're out there wanting to hear those stories all the time, Liz.
Especially if you're doing something new and interesting. something that you know not everyone's doing, we're keen to hear about it and spread the word.
And I would be happy to help... support you in shaping your story.
Have Microphone will travel, but also, of course, we can do it on, you know, Teams or Zoom.
That's it. This is everyone's chance to get close and personal.
With the amazing Liz Murphy. Bring it on.
All right. Take care, everyone. We hope you stay safe and well.
And we'll talk to you next time. Bye. Bye.
Thanks for listening to the Social Work Stories podcast.
All of the stories we share are deidentified to respect and protect the people involved.
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