Peer Perspectives

Be Present — A Reminder

By Natalie J. Brunone-Stewart, MSW, LSW

It is common, especially upon entering a new field or profession, to have feelings of insecurity, uncertainty, and general anxiety regarding the process of learning a new role and all the responsibilities that come with it. This is an accurate description of the shoes I walked in about a year ago when I transitioned from counseling in victims services to hospice social work: insecure, uncertain, and anxious ... but also very excited and hopeful.

Many in this field, if not most of us, have the genuine desire to make a real difference in people's lives. We go to school; we invest our time, energy, and money, making countless sacrifices to become a social worker. We continually develop the knowledge and skills we need to grow in our profession.

We learn the history of social work, theories and practice modalities, social work policy, roles and functions of the social worker, levels of social work practice and intervention, and the many subdisciplines and fields where competent social workers are needed. We are needed in federal, state, and local government, in nonprofit organizations, county services for adults, children and youth, foster care and adoption services, hospitals and doctors' offices, and as mental health providers. We are needed from the beginning to the end of a life, and all that is in between and after.

The Challenge of Newness
I have been a master's level social worker for nearly 10 years. I have worked in a variety of settings and roles, and I have enjoyed the growth and challenges associated with them all. In my most recent position, acquired last spring, I became a hospice social worker at an adult inpatient unit for my area health network. I was—and continue to be—very proud of this position and the responsibilities I learn and assume every day.

Death and dying is a topic most people do not want to discuss. The hospice social worker performs ongoing psychosocial assessment of patient and any family or loved ones. The hospice social worker assesses coping, strengths, and needs of each individual and family unit. We work collaboratively as part of the hospice team alongside doctors, nurses, aides, chaplains, unit managers, hospice liaisons, and other hospice teams, advocate for patients and families, assist in conflict resolution, and help facilitate communication when needed. We broker important resources, assist in discharge planning, provide comfort and support on an ongoing basis, chart progress notes, and uphold the standards of not just our profession but also our organization and department.

In beginning this role, it was overwhelming and exciting at the same time. I remember sitting at my new desk, my head swirling with all the information I was trying to retain from new employee orientation ... and all the information I wanted to integrate into practice from previous experiences and graduate school. I recall the first time I met a dying patient; the family was present in the room. I knew that I could not serve them well if my head was swirling with all this information. I had to stop. Breathe. Be fully present. And I did.

In those very moments, what I identified that mattered the most was my being present. One can be present without actually being fully present. This, too, is a skill that we must develop along with the other skills we've learned and practiced. Just as in life, we can become so consumed by the to-dos, the lists, the expectations we (or others) place on us that we can miss it totally.

In the process of feeling new to it all, I knew I could offer my full presence in those emotional moments of vulnerability, questioning, uncertainty, and turmoil that the patient and family were experiencing. I was able to push away my professional agenda to be with this patient and family whose loved one was dying. In not even saying much, my intervention was the supportive, comforting, "present presence" that I provided. That is actually what mattered most at that time.

I smile as I look back at this past year. Every day I learn new things. Yes, I have my ongoing list of areas I'd like to grow and mature in and I have the topics I still want to research more (such as advanced directives and complicated bereavement). But I also realize how effective and successful I've been without being an expert just yet. Over and over, I've given the gift of being present. And with that, I have been able to assist my families in all the other processes they've experienced because I have built that foundation of presence characterized by warmth, concern, trust, and connection.

It will come. The knowledge and skilled practice application will come. The verbiage and terminology will come. The confidence you gain in speaking as a professional in your new field will come. Just remember ... you already have a lot to offer ... but don't forget about the gift you can give others by simply being present.

— Natalie J. Brunone-Stewart, MSW, LSW, is a hospice social worker and psychiatric case manager for St. Luke's Health Network in the Lehigh Valley, PA.