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How Satisfaction with Hospital Field Work Affects Social Work Students' Willingness to Accept Employment in Hospital Settings Nancy Showers DSW
a
a
Assistant Director, Department of Social Work Services, Mount Sinai Medical Center, New York, NY 10029 Published online: 26 Oct 2008.
To cite this article: Nancy Showers DSW (1992) How Satisfaction with Hospital Field Work Affects Social Work Students' Willingness to Accept Employment in Hospital Settings, Social Work in Health Care, 16:4, 19-35, DOI: 10.1300/ J010v16n04_02
To link to this article: http://dx.doi.org/10.1300/J010v16n04_02
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How Satisfaction with Hospital Field Work Affects Social Work Students' Willingness to Accept Employment in Hospital Settings Nancy Showers, DSW
ABSTRACT. This study of 238 social work students in 27 hospital lield work programs exarnincd how student satisfaction with field work affects their willingness to accept employment in host hospitals. Job willingness was positively correlated with five measures of student satisfaction. Factors predictive of each mcasurc were identified. Findings suggest strategies that can be used by hospital social work managers and field work supervisors to enhance student satisfaction with the field work experience, in order to maximize thc bcncfit of providing field work education as a way of recruiting graduating students for employment in hospital settings. Hospital social work departments face heightened needs for social workers who can function effectively in a rapidly changing field of practice (Rehr, 1985). At the same time, however, there is concern about future competition for a shrinking pool of social workers (Ewalt, 1991). In this context, social work managers must give greater priority to recruitment and retention of social workers in hospital practice. For most social work departments, the major recruitment source is new graduates. Accordingly, managers are concerned with the educational effectiveness of masters level field work programs and Nancy Showers is Assistant Director, Department of Social Work Scwices, Mount Sinai Medical Center, Box 1252, One Gustavc L. Lcvy Place. New York, NY 10029. Social Work in Heal* Care, Vol. 16(4) 1992 O 1992 by The Haworth Press, Inc. All rights reserved. 19
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SOCIAL WORK IN HEAL7.H CARE
their impact upon graduates' willingness to work in hospital social work departments. Social work agencies provide field education in part because it gives them a pool of job applicants already trained in policies, procedures, philosophy and fundamentals of agency specific practice (Wilson, 1981). Presumably, students who are satisfied with the education provided in field work placements will be likely to accept employment following graduation. Providers who gain a reputation for offering quality field education should attract graduates from other field work programs (Schutz and Gordon, 1977). Accordingly, hospital field work programs that produce satisfied students should yield higher numbers of employee recruits, and those recruits should be prepared for entry level practice. There is scant literature about the range of field work program designs in health care settings, their educational effectiveness, or how field work programs affect social work department recruitment and retention of competent students as employees. Absence of research on hospital field work makes it difficult for hospital social work departments to develop strategies for recruitment of staff. This article reports on a study of 27 field work programs in teaching hospitals in New York City which examined student demographics, characteristics of field work programs, students' and program leaders' perceptions of the quality of field work programs, and student satisfaction with field work. This paper describes students' perceptions about the extent to which programs met educational objectives and how those perceptions influenced their satisfaction with field work and their willingness to accept employment in host hospitals. METHODOLOGY Study Sample
The study was conducted during the spring of 1987 in 10 voluntary, 6 municipal, 2 Veteran's Administration, and 2 state psychiatric hospitals located within New York City. All hospitals were affiliated with medical schools, providing teaching of medical stu-
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Nancy Showers
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dents and intemlresidency programs for physicians as well as social work field work education. Selection was based on likelihood of cooperation by hospital field work program coordinators, who are senior hospital social work staff responsible for organizing and administering programs within hospitals. The 20 hospitals had 27 distinct field work programs, which ranged in size from 3 to 27 students. In all, 27 program coordinators (100%) and 238 of 278 (85.6%) masters level social work students in field placement at the time of the study completed questionnaires. Program coordinators were included because their knowledge of organizational characteristics, school-hospital relationships, and program structure was assumed to be more complete than students'. Most coordinators in this study carried the organizational title of assistant director of social work, spending from 5% to 50% of their time in the field work endeavor. In addition to organizing and managing field work programs, they supervised field instructors, taught seminars for field instructors and for students, and participated on school committees. Students from 8 schools of social work participated in the study. About 80% students were female, 63% single, and 85% white. The median age was 29, with a range from 21 to 66 years.
Study Instruments The Graduate Social Work Student Satisfaction Questionnaire and the Hospital Field Work Coordinator questionnaire, both treated for the study, were used as instruments. Questionnaires contain three major sections and an open ended question asking for comments. The first section of each questionnaire covers student and program demographic variables, the second section 5 overall ratings of respondent satisfaction, and the thud section ratings of the extent to which 50 aspects of field instruction were present. Satisfaction ratings were on a 5 point scale from "Very Dissatisfied" to "Very Satisfied." Ratings of field work aspects were on a 5 point scale from "Much Too Little" to "Much Too Much." Cronbach's alpha was used to test internal reliability of the student instrument scales, yielding alpha coefficients of 3 5 for the satisfaction scale and .75 for the field work rating scale.
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SOCIAL. WORK IN HEALTH CARE
The student questionnaire contains an additional section, in which students were asked whether they would recommend the placement to other students, whether they would accept a job at the placement hospital, and whether they thought a job would be offered. To establish face validity, the student questionnaire was pre-tested with 4 recently graduated social workers who had been in hospital field work placements the previous year and the coordinator questionnaire pre-tested with 4 hospital field work coordinators. Both instruments were revised accordingly. Questionnaires then were mailed to coordinators for self and student administration or administered on site by the investigator. Follow up questionnaires were distributed by coordinators or mailed by the researcher to students who did not respond. Study limitations include a failure to establish content validity, less than desirable internal reliability of instrument scales, and probable weakness in inter-rater reliability due to variations in instrument administration. FINDINGS Study findings indicate that social work students placed in hospitals experience high levels of satisfaction with field work, and that satisfaction is positively correlated with willingness to accept employment. Rates of satisfaction are: satisfaction with learning, 85%; field work experience, 79%; field instructors, 75%; field work program, 74%; and with the hospital, 56%. Ninety three students (39%) said they would accept a job at the host hospital if offered, 23% (N = 55) said they didn't know whether they would, and 26% (N = 60) said they would not. The remainder said they would do so only if they were desperate (N= 12), or gave other responses (N = 15). During the time of this study, hospital recruitment efforts intensified throughout the Metropolitan area, as a shortage of social workers worsened. That shortage probably accounted for the large number of students (N= 188, 79%) who expected to be offered a job. Some of the Don't Know responders may have been shopping around for the best hospital job available. Responses were dichotomized, with unqualified yes responses placed in one category and all other responses combined in the
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Na~lcyShowers
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second. Biserial correlation analysis was done to determine associations between satisfaction scores and willingness to accept employment. All 5 satisfaction scores were positively associated with employment willingness at p < .05:satisfaction kith hospital (r = .41, n = 235); overall field work experience (r = .40, n = 235); field work program (r = .35, n = 235); field instructors (r = .31, n = 234); and learning (r = .23, n = 234). Student and program coordinator ratings of the extent to which program characteristics were present were examined in order to identify program aspects associated with satisfaction. Thirty five of 50 field work items listed in Table 1 were rated as "Just Right" by at least half of the students, indicating a general perception that programs performed well in most areas. Responses deviating from the "Just Right" category tended to fall into the "Too Little" side of the scale. On the "Too Much" side of the scale, more than half thought there were too many d e s , red tape and administrative details involved in the hospital (64%) and that they had experienced too much stress (58%). Coordinators rated field work characteristics as present to an ideal extent more frequently than did students. Factor analysis of student responses to the 50 item rating scale was done to identify item clusters. Fourteen factors with eigenvalues greater than 1.0 were selected, together accounting for 65.6% of the total variance. All items loaded at least .40 on at least one factor, and so were included. Table 1 shows the grouping of item stems into factors according to strength of loading. Student factor scores were established by averaging item scores on independent factors. Table 2 shows correlations between factor scores and satisfaction items. Nine factors were positively correlated with all aspects of student field work satisfaction, meaning that students were more satisfied in all areas as their perceptions of program characteristics approached "Just Right." These factors are: "Field Instructor Relationship Characteristics," "Learning Assignment Opportunity Characteristics." "Field Instructor Teaching Characteristics," "Stress," "Field Instructor Expectations," "Program Organization Characteristics," "Autonomy," "Number of Field Instructors," and "Accessibility." Factors of "Orientation," "Faculty Field Liaison," and "Student Contact" were correlated with less than 5 satisfaction measures.
SOCIAL WORK IN HEALTH CARE
Table 1 STUDENT RATING FACTORS
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FACTOR 1: SUPERVISORY RELATIONSHIP CHARACTERISTICS
Items Fairness in evaluation of student performance Instructors' openness to student opinions Instructors' objectiv7ty in dealing with students Student freedom to disagree with instructors Degree of student involvement in evaluation of own performance Instructors' helpfulness when student has difficulty Instructors' feedback when student d7d good job Instructors' making expectations clear at beginning of placement Support students receive when they make mistakes Instructors' helpfulness in student's learning about social work practice Chance for student to make use of abilities and skills FACTOR 2: LEARNING ASSIGNMENT OPPORTUNITIES Variety in student assignments Number of different services/program areas student assigned to Number of different practice methods student used Number of learning experiences student was given Opportunities to learn about and develop skills in social work practice Opportunity to participate in selection of learning experiences Relevance of assignments to student's learning goals
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Nancy Showers
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FACTOR 3: SUPERVISORY-TEACHING CHARACTERISTICS Opportunity to watch field instructors work
.65
Instructors' attention to student's integrating class and field
.61
Instructor helpfulness to student in learning to work wlth other
.55
disciplines Instructors' attent~onto teaching student about community resources .A5 Instructors' organization in presenting material to student Security students feel in offering new and original ideas A: ORIENTATION CHARACTERISTICS FACTOR -
Orientation student received about field program Orientation student received about hospital policies h procedures Orientation student received about role of hospital social workers Student contact with program personnel prior to first day of field work FACTOR 5: FACULTY FIELD LIAISON CHARACTERISTlCS Field liaison's helpfulness in student's class/field integration Field liaison's helpfulness to student in deal~ngwith placement Coordination between field instructors and field
llaison
FACTOR 6: STRESS Rules, administrative details and red-tape Amount of stress experienced in placement Student's feeling of accomplishment from work FACTOR I : FIELD INSTRUCTOR EXPECTATIONS Instructors' offering of constructive criticism Overall amount of work expected Instructors' sensitivity to student's educational needs
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SOCIAL WORK IN IIEALTII CARE Table 1 (continued)
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FACTOR 8 : SUPPORT FROM OTHER SOCI&WORK
STUDENTS I N PROGRAM
W i l l i n g n e s s o f s t u d e n t s t o h e l p each o t h e r Amount of peer support experienced FACTOR 9 : PROGRAM ORGANIZATION C o o r d i n a t i o n between s t u d e n t ' s f i e l d i n s t r u c t o r s Degree t o which f i e l d work program i s organized FACTOR 10: AUTONOMY WITHIN THE ORGANIZATION Contact s t u d e n t had w i t h o t h e r d i s c i p l i n e s S t u d e n t ' s o p p o r t u n i t i e s t o make d e c i s i o n s on own FACTOR 11: QUANTITY OF STUDENT CONTACT Number o f o t h e r s o c i a l work s t u d e n t s i n f i e l d work Number o f seminars f o r s o c i a l work s t u d e n t s FACTOR 1 2 : NUMBER OF FIELD INSTRUCTORS ASSIGNED TO Number o f f i e l d i n s t r u c t o r s s t u d e n t was assigned t o FACTOR 13: QUALITY OF SOCIAL WORK STUDENTS Q u a l i t y o f s o c i a l work s t u d e n t s i n placement h o s p i t a l FACTOR 1 4 : ACCESSIBILITY Student o p p o r t u n i t y t o p a r t i c i p a t e i n d e c i s i o n making r e g a r d i n g p o l i c i e s and procedures r e l a t i n g t o s t u d e n t s I n s t r u c t o r s ' a t t e n t ~ o nt o s t u d e n t ' s understanding and use o f s e l f O p p o r t u n i t y f o r s t u d e n t t o see f i e l d i n s t r u c t o r when the need a r i s e s
.dl
r a t h e r than w a i t i n g f o r conferences
Congruence in Perception
Ratings of student/coordinator pairs were examined to see whether there was a relationship between congruence in pairs' perceptions about field work program aspects and students' field work satisfac-
Table 2
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CORRELATIONS BETWEEN STUDENT PERCEPTION FACTORS AND STUDENT SATISFACTION ITEMS Satisfaction With
...
-
Field
Field Factor
InStruCtOrS
Supervisory
.61
Relationship Learning Opportunities Supervisory Teaching
(210) .38 (211)
.64 (203)
Orientation
.l8
Faculty Field
.11
1189)
Liaison Stress
(197) .30 12201
Expectations
.65 (2331
Peer Support Program Organization Autonomy
ns 1 8
(158) .25 (2241
Learning Proqram
Hospital
Experience
Work
SOCIAL WORK
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IN HEtUTI-I CARE
Tablc 2 (continued)
-
.-
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S a t i s f a c t i o n With . . . Field Factor Student Contact
Instructors
F i e l d Work Learninq
Proram
ns
ns
.38
.15
2 6
.15
.29
(221)
(221)
(222)
(222)
(222)
ns
ns
.30
.10
ns
Hospital ns
Experience .14
(210) Number of Instructors Student Quality Accessibility
ns .52
ns .33
ns
.P8
r correlation
(number) p < .05
tion. For example, if a coordinator believed that variety in learning opportunities in the program was just right, but a student thought that there was too little or too much variety in hisher own assignment, was this incongruence associated with lower student satisfaction? Findings indicate that congruence in pairs' ratings generally affected student satisfaction in the same way as did student ratings alone. Pair scores were established for individual field work items, using the absolute distance between the student's rating and the rating of the coordinator. A score of 0 therefore reflects congruence, and scores of 2 and 3 show increasing incongruence. Pair congruence factor scores were derived by averaging item scores in the 14 factor clusters shown in Table 1. Table 3 shows that all correlations between pair factor scores and satisfaction scores were in the negative direction, meaning that student field work satisfaction increased
N a ~ ~ cSl~owers y Table 3
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CORRELATIONS FOR CONGRUENCE I N RATINGS OF COORDINATOR-STUDENT PAIRS AND STUDENT SATISFACTION SCALE ITEMS .-
- .
Satisfaction With ... Field
F i e l d Work
Projram Supervisory Relationship Learning Assignment Supervisory Teach~ng
-.63
(197) -.32 (211) -.38
(19'31
Orientation
ns
Faculty Field
ns
Liaison Stress
-.Zl
Supervisory
-.59
(2031
Expectattons
(2331
Peer Support
ns
Program
ns
Organization
Hasor ta 1
Experience
SOCIAL WORK IN I-IEAL.TH CARE Table 3 (continued) ---
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S a t i s f a c t i o n With
...
Field
Autonomy
Learning
Program_
-.23
-.28
-.33
(224)
Student Contact Number of Instructors Student Q u a l i t y Accessibility
F i e l d Work
Instructors
ns
-.32 (221) ns
-.43 (202)
(224)
(225)
Hospital
- . 29 (2251
Experience
- . 33 (225)
ns
ns
ns
ns
-.I4
-.23
. I 3
-.28
(221)
(222)
(222)
(222)
ns
ns
ns
ns
-.27
-.28
-.I8
-.36
(202)
(203)
(203)
(203)
r correlation
(number 1
as incongruence in pairs' perceptions about field work factors decreased. Comparison of Tables 3 with Table 2 reveals similarities in patterns of statistical significance and in correlational strength of student and pair congruence factor scores associated with student satisfaction. On 10 of 14 factors, if the student factor rating score was significantly associated with a satisfaction measure, the studentlcoordentlcoordinator pair factor rating score also proved significant. Where both the student and pair factor proved significantly associated with a specific satisfaction measure, strength of correlations usually was similar. For example, the correlation strength between student ratings of the Supervisory factor and their satisfaction with field instructors was .67, and the pair r score for the same factor and outcome measure was -.63.
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Predictors of Satisfaction Stepwise multiple regression was used to determine which factors are most predictive of 5 satisfaction aspects. Significance level was less that .O1 for all primary predictors. "Supervisory Relationship" was most predictive of satisfaction with field instructors (Variable R* = S6); "Supervisory Teaching" of learning satisfaction (Variable R' = .40); "Opportunities in Learning Assignments" of program satisfaction (Variable RZ= .41) ; "Stress" of satisfaction with the hospital (Variable R2 = .40) and "Program Organization Differences" of the overall field work experience (Variable Rz = .45).
DISCUSSION This study identified 5 areas of student satisfaction that are correlated with student willingness to accept employment in host hospitals and the program factor most predictive of each. Improvement in performance on any of these predictive factors should produce increased student satisfaction and accordingly increase recruitment potential. Social work departments can evaluate their performance on an ongoing basis using the factor classification presented here, and develop strategies for enhancing student satisfaction in their own settings accordingly. They can identify potential areas for improvement by obtaining and ranking student ratings on one or more factors. Strengthening performance on lowest ranked items should result in higher factor ratings. This study found that the "Supervisory Relationship" factor was most predictive of satisfaction with field instructors. All 11 items constituting that factor were rated "Just Right" by a majority of students in study programs. Strength on this factor is probably attributable to the relative ease with which clinical relationship skills can be adapted for the educational endeavor. Hospital programs with inexperienced field instructors can facilitate transition to the educational role by teaching new field instructors how to apply professional relationship skills most appropriately in the unfamiliar educational role. One efficient method could be enlistment of experienced field instructors to mentor inexperienced ones. The "Supervisory Teaching" factor was most predictive of satis-
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SOCIAL WORK IN HEALTH CARE
faction with learning. Study programs did not perform as well on this factor as on the relationship factor, with only 1 of the 6 items comprising the factor rated as "Just Right" by a majority of students. Since instrumental educational skills are not part of the professional armament, this reflects a general need for field instructors to develop new skills in order to perform well in the educational role. Although field instructors from all study programs had participated in school sponsored seminars for new field instructok as a condition of field instruction, those seminars were not sufficient. Field instructors need to learn and hone educational skills throughout their teaching careers (Showers, 1988; Showers, In Press). Providing ongoing hospital seminars involving both new and experienced field instructors can be a powerful strategy for developing and strengthening teaching skills. The "Learning Assignment Opportunities" factor was most predictive of satisfaction with field work programs. Performance on this factor is instrumental in attracting the most capable students for subsequent years, as well as enhancing recruitment of employees from the current group. Study programs performed well on this factor, with all 7 items rated "Just Right" by a majority of students. This probably reflects the richness in learning opportunities inherent in teaching hospitals, as well as programs' conscious efforts to offer social work students diverse and relevant learning experiences. Environmental richness makes it relatively easy for programs that are performing poorly on this factor to achieve substantial improvement in student satisfaction. Strategies for providing variety in assignments, diversity in program/services areas, multiple practice methods, etc., generally can be implemented using existing structures. Maximizing available resources and tailoring their use to individual student needs is an effective and efficient means of increasing student satisfaction. The "Stress" factor was most predictive of student satisfaction with hospitals. In this study, ratings of satisfaction with hospitals were considerably lower (56% satisfied) than for other satisfaction measures (74%-85% satisfied), while showing stronger correlation with willingness to accept employment than other satisfaction measures. Student satisfaction with hospitals, therefore, must be of concern in shaping recruitment strategies. In study programs, 66% of students rated their feelings of accomplish~nentas "Just Right";
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however, 58% said there was "Too Much" stress, and 64% said there was "Too Much" red tape, rules, and administrative detail. These results support the contention of others (Nelson, 1974; Bracht, 1978; Rauch, 1984; and Berkman, Kemler, Marcus, and Silberman, 1985) that hospital settings inherently are stressful. It seems unlikely that social work departments can decrease student stress related to the hospital's mission, highly complex organizational structure, discipline hierarchies, accountability systems, or impact of illness. Experiments with structures such as peer support groups within or across hospital programs can be undertaken in an effort to find ways to mitigate the effects of hospital related stress. Social work departments also can seek ways to modify their own demands on students. For instance, partial or total shifts to narrative or summary recording early in the school year could reduce pressures while providing educational benefits. Further study about hospital field work stress is critically needed. Hospital social work departments need to learn more about which factors contribute to stress, which students experience most stress, and what effect stress has on recruitment. Lastly, congruence in ratings by student-coordinator pairs' on the "Program Organization" factor was most predictive of overall field work satisfaction. This is surprising, given that the social work education Literature scarcely mentions the existence of agency field work coordinators, focusing on the field liaison/field instructorlstudent triad as the key unit for education (Fellin, 1982; Gordon, 1982; Hamilton and Else, 1983; Rosenblum and Raphael, 1983). Yet in this study, hospital coordinators were not only found to be central to all aspects of field education, but to have a substantially greater influence upon student satisfaction than faculty liaisons (Showers, 1988: Showers. 1990). The finding that a studentlcoordinator pair congruence score was most predictive of overall satisfaction raises question as to how coordinators' views interact with students' perceptions to affect student satisfaction. When views differ, does student satisfaction decrease regardless of whether coordinator ratings of program performance are better or worse than student ratings of their individual experiences of the same factor? Examination of scores on the two items constituting the Program Organization factor suggests that it is the fact of incongruence rather than its direction that influences
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SOCIAL WORK IN HEALTH CARE
overall field work satisfaction. On the item of coordination between students' field instructors, in 60% of pairs ratings were the same, in 32% student ratings lower than coordinators, and in 8% student ratings higher. However, on the item of degree to which the program was organized, in 48% of pairs ratings were the same, in 22% student ratings higher than coordinators, and in 30% student ratings lower. It therefore seems that incongruence in pair perceptions is a marker for diminished satisfaction, regardless of its direction. Comparison of coordinator and student views at specified points during the academic year could help social work departments identify and deal with problems in field work satisfaction as they emerge. Given the general robustness of findings in this study regarding congruence in pair ratings, it can be concluded that hospital staff coordinators have a substantial impact upon students in hospital field work placements. Finding ways to enhance this function, therefore, is critical to maximizing the recruitment benefit of providing field work education in hospitals. Hospitals programs that lack coordinators can add them. Hospital programs with coordinators can join forces to develop expertise about this vital role.
CONCLUSION This study shows that there are ways in which hospital social work departments can increase student satisfaction with field work, thereby increasing their ability to recruit their own students for employment. It is in their interest to begin doing so, given increasing competition for competent social workers who can function effectively in hospital settings.
REFERENCES Bcrkman, B., Kemler, B., Marcus, L.. & Silbeman. P. (1985). Course Contenl for Social Work Practice in Heallh Cuc. Journal of Social Work Educatiorr. 21(3). 43-51. Bracht. N. F. (1978). Building a Health C u e Concentration: Curriculum Guidelines for Schools of Social Work. In N. F. Bracht (Ed). Social Work in Hcalrl~ Care: A Guide lo Professional Practice (pp. 327-336). New York: The Haworth Press, Inc. Ewalt, P. (1991). Trends Affecting Recmilment and Retontion of Social Work Staff in Human Services Agencies. Social Work. 36(3). 214-217.
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Fellin, P.A. (1982). Responsibilities of the School: Administrative Support of Field Instruction. In B.W. Sheafor & L.E. Jenkins (Eds). Qualify Field Instruction in Social Work: Program Developn~entand Maintenance (pp. 101-115). New York: Longman, Tnc. Gordon, M.S. (1982). Responsibilities of the School: Maintcnancc of lhe Field Program. In B.W. Sheafor & L.E. Jenkins (Eds). Quality Field Instruction in Social Work: Program Development and Maintenance (pp. 116-135). New York: Longman, Inc. Hamilton, N., & Else, J.F. (1983). Designing Field Education: Philosoplry. Structure, and Process. Springfield, Ill.: Charles C. Thomas Publishers. Nelson, J.C. (1974). Teaching Content of Early Fieldwork Conferences. Social Casework. 147-153. Rauch, J.B. (1984). Helping Students to Begin Hospital Field Placemen~s: An Active Learning Approach. Social Work in I-lcaltlr Care. 9(3). 63-69. Rehr, H. (1985). Mcdical Care Organizations and the Social Service Connection. Health and Social Work. lO(1). 245-257. Rosenblum, A.F., & Raphael, F.B. (1983). The Role and Function of the Faculty Field Liaison. Journal of Educarion for Social Work. 19(1). 67-73. Schutz, M.L., & Gordon, W.E.(1977). Reallocation of Educational Responsibility Among Schools, Agencies, Students and NASW. Joirrnal of Edrtcation for Social Work. 13(2). 99-106. Showers, N. (1988). Factors Associated will1 Graduale Social Work Studcnt Satisfaction in Hospital Field Education Programs. DSW Disscrtation. City University of New York. Showers, N. (1990). Hospital Graduate Field Work Programs: A Study in New York City. Health and Social Work. 15(1). 55-63. Showers, N. (In Press). What Ficld Instructors of Social Work Students Need from Hospital Field Work Programs. Social Work in Health Care. Wilson, S. (1981). Field Instruction: Teclrniqucs for Suprrvisors. New York: The Free Press.
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How Satisfaction with Hospital Field Work Affects Social Work Students' Willingness to Accept Employment in Hospital Settings Nancy Showers DSW
a
a
Assistant Director, Department of Social Work Services, Mount Sinai Medical Center, New York, NY 10029 Published online: 26 Oct 2008.
To cite this article: Nancy Showers DSW (1992) How Satisfaction with Hospital Field Work Affects Social Work Students' Willingness to Accept Employment in Hospital Settings, Social Work in Health Care, 16:4, 19-35, DOI: 10.1300/ J010v16n04_02
To link to this article: http://dx.doi.org/10.1300/J010v16n04_02
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How Satisfaction with Hospital Field Work Affects Social Work Students' Willingness to Accept Employment in Hospital Settings Nancy Showers, DSW
ABSTRACT. This study of 238 social work students in 27 hospital lield work programs exarnincd how student satisfaction with field work affects their willingness to accept employment in host hospitals. Job willingness was positively correlated with five measures of student satisfaction. Factors predictive of each mcasurc were identified. Findings suggest strategies that can be used by hospital social work managers and field work supervisors to enhance student satisfaction with the field work experience, in order to maximize thc bcncfit of providing field work education as a way of recruiting graduating students for employment in hospital settings. Hospital social work departments face heightened needs for social workers who can function effectively in a rapidly changing field of practice (Rehr, 1985). At the same time, however, there is concern about future competition for a shrinking pool of social workers (Ewalt, 1991). In this context, social work managers must give greater priority to recruitment and retention of social workers in hospital practice. For most social work departments, the major recruitment source is new graduates. Accordingly, managers are concerned with the educational effectiveness of masters level field work programs and Nancy Showers is Assistant Director, Department of Social Work Scwices, Mount Sinai Medical Center, Box 1252, One Gustavc L. Lcvy Place. New York, NY 10029. Social Work in Heal* Care, Vol. 16(4) 1992 O 1992 by The Haworth Press, Inc. All rights reserved. 19
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SOCIAL WORK IN HEAL7.H CARE
their impact upon graduates' willingness to work in hospital social work departments. Social work agencies provide field education in part because it gives them a pool of job applicants already trained in policies, procedures, philosophy and fundamentals of agency specific practice (Wilson, 1981). Presumably, students who are satisfied with the education provided in field work placements will be likely to accept employment following graduation. Providers who gain a reputation for offering quality field education should attract graduates from other field work programs (Schutz and Gordon, 1977). Accordingly, hospital field work programs that produce satisfied students should yield higher numbers of employee recruits, and those recruits should be prepared for entry level practice. There is scant literature about the range of field work program designs in health care settings, their educational effectiveness, or how field work programs affect social work department recruitment and retention of competent students as employees. Absence of research on hospital field work makes it difficult for hospital social work departments to develop strategies for recruitment of staff. This article reports on a study of 27 field work programs in teaching hospitals in New York City which examined student demographics, characteristics of field work programs, students' and program leaders' perceptions of the quality of field work programs, and student satisfaction with field work. This paper describes students' perceptions about the extent to which programs met educational objectives and how those perceptions influenced their satisfaction with field work and their willingness to accept employment in host hospitals. METHODOLOGY Study Sample
The study was conducted during the spring of 1987 in 10 voluntary, 6 municipal, 2 Veteran's Administration, and 2 state psychiatric hospitals located within New York City. All hospitals were affiliated with medical schools, providing teaching of medical stu-
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dents and intemlresidency programs for physicians as well as social work field work education. Selection was based on likelihood of cooperation by hospital field work program coordinators, who are senior hospital social work staff responsible for organizing and administering programs within hospitals. The 20 hospitals had 27 distinct field work programs, which ranged in size from 3 to 27 students. In all, 27 program coordinators (100%) and 238 of 278 (85.6%) masters level social work students in field placement at the time of the study completed questionnaires. Program coordinators were included because their knowledge of organizational characteristics, school-hospital relationships, and program structure was assumed to be more complete than students'. Most coordinators in this study carried the organizational title of assistant director of social work, spending from 5% to 50% of their time in the field work endeavor. In addition to organizing and managing field work programs, they supervised field instructors, taught seminars for field instructors and for students, and participated on school committees. Students from 8 schools of social work participated in the study. About 80% students were female, 63% single, and 85% white. The median age was 29, with a range from 21 to 66 years.
Study Instruments The Graduate Social Work Student Satisfaction Questionnaire and the Hospital Field Work Coordinator questionnaire, both treated for the study, were used as instruments. Questionnaires contain three major sections and an open ended question asking for comments. The first section of each questionnaire covers student and program demographic variables, the second section 5 overall ratings of respondent satisfaction, and the thud section ratings of the extent to which 50 aspects of field instruction were present. Satisfaction ratings were on a 5 point scale from "Very Dissatisfied" to "Very Satisfied." Ratings of field work aspects were on a 5 point scale from "Much Too Little" to "Much Too Much." Cronbach's alpha was used to test internal reliability of the student instrument scales, yielding alpha coefficients of 3 5 for the satisfaction scale and .75 for the field work rating scale.
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SOCIAL. WORK IN HEALTH CARE
The student questionnaire contains an additional section, in which students were asked whether they would recommend the placement to other students, whether they would accept a job at the placement hospital, and whether they thought a job would be offered. To establish face validity, the student questionnaire was pre-tested with 4 recently graduated social workers who had been in hospital field work placements the previous year and the coordinator questionnaire pre-tested with 4 hospital field work coordinators. Both instruments were revised accordingly. Questionnaires then were mailed to coordinators for self and student administration or administered on site by the investigator. Follow up questionnaires were distributed by coordinators or mailed by the researcher to students who did not respond. Study limitations include a failure to establish content validity, less than desirable internal reliability of instrument scales, and probable weakness in inter-rater reliability due to variations in instrument administration. FINDINGS Study findings indicate that social work students placed in hospitals experience high levels of satisfaction with field work, and that satisfaction is positively correlated with willingness to accept employment. Rates of satisfaction are: satisfaction with learning, 85%; field work experience, 79%; field instructors, 75%; field work program, 74%; and with the hospital, 56%. Ninety three students (39%) said they would accept a job at the host hospital if offered, 23% (N = 55) said they didn't know whether they would, and 26% (N = 60) said they would not. The remainder said they would do so only if they were desperate (N= 12), or gave other responses (N = 15). During the time of this study, hospital recruitment efforts intensified throughout the Metropolitan area, as a shortage of social workers worsened. That shortage probably accounted for the large number of students (N= 188, 79%) who expected to be offered a job. Some of the Don't Know responders may have been shopping around for the best hospital job available. Responses were dichotomized, with unqualified yes responses placed in one category and all other responses combined in the
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second. Biserial correlation analysis was done to determine associations between satisfaction scores and willingness to accept employment. All 5 satisfaction scores were positively associated with employment willingness at p < .05:satisfaction kith hospital (r = .41, n = 235); overall field work experience (r = .40, n = 235); field work program (r = .35, n = 235); field instructors (r = .31, n = 234); and learning (r = .23, n = 234). Student and program coordinator ratings of the extent to which program characteristics were present were examined in order to identify program aspects associated with satisfaction. Thirty five of 50 field work items listed in Table 1 were rated as "Just Right" by at least half of the students, indicating a general perception that programs performed well in most areas. Responses deviating from the "Just Right" category tended to fall into the "Too Little" side of the scale. On the "Too Much" side of the scale, more than half thought there were too many d e s , red tape and administrative details involved in the hospital (64%) and that they had experienced too much stress (58%). Coordinators rated field work characteristics as present to an ideal extent more frequently than did students. Factor analysis of student responses to the 50 item rating scale was done to identify item clusters. Fourteen factors with eigenvalues greater than 1.0 were selected, together accounting for 65.6% of the total variance. All items loaded at least .40 on at least one factor, and so were included. Table 1 shows the grouping of item stems into factors according to strength of loading. Student factor scores were established by averaging item scores on independent factors. Table 2 shows correlations between factor scores and satisfaction items. Nine factors were positively correlated with all aspects of student field work satisfaction, meaning that students were more satisfied in all areas as their perceptions of program characteristics approached "Just Right." These factors are: "Field Instructor Relationship Characteristics," "Learning Assignment Opportunity Characteristics." "Field Instructor Teaching Characteristics," "Stress," "Field Instructor Expectations," "Program Organization Characteristics," "Autonomy," "Number of Field Instructors," and "Accessibility." Factors of "Orientation," "Faculty Field Liaison," and "Student Contact" were correlated with less than 5 satisfaction measures.
SOCIAL WORK IN HEALTH CARE
Table 1 STUDENT RATING FACTORS
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FACTOR 1: SUPERVISORY RELATIONSHIP CHARACTERISTICS
Items Fairness in evaluation of student performance Instructors' openness to student opinions Instructors' objectiv7ty in dealing with students Student freedom to disagree with instructors Degree of student involvement in evaluation of own performance Instructors' helpfulness when student has difficulty Instructors' feedback when student d7d good job Instructors' making expectations clear at beginning of placement Support students receive when they make mistakes Instructors' helpfulness in student's learning about social work practice Chance for student to make use of abilities and skills FACTOR 2: LEARNING ASSIGNMENT OPPORTUNITIES Variety in student assignments Number of different services/program areas student assigned to Number of different practice methods student used Number of learning experiences student was given Opportunities to learn about and develop skills in social work practice Opportunity to participate in selection of learning experiences Relevance of assignments to student's learning goals
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FACTOR 3: SUPERVISORY-TEACHING CHARACTERISTICS Opportunity to watch field instructors work
.65
Instructors' attention to student's integrating class and field
.61
Instructor helpfulness to student in learning to work wlth other
.55
disciplines Instructors' attent~onto teaching student about community resources .A5 Instructors' organization in presenting material to student Security students feel in offering new and original ideas A: ORIENTATION CHARACTERISTICS FACTOR -
Orientation student received about field program Orientation student received about hospital policies h procedures Orientation student received about role of hospital social workers Student contact with program personnel prior to first day of field work FACTOR 5: FACULTY FIELD LIAISON CHARACTERISTlCS Field liaison's helpfulness in student's class/field integration Field liaison's helpfulness to student in deal~ngwith placement Coordination between field instructors and field
llaison
FACTOR 6: STRESS Rules, administrative details and red-tape Amount of stress experienced in placement Student's feeling of accomplishment from work FACTOR I : FIELD INSTRUCTOR EXPECTATIONS Instructors' offering of constructive criticism Overall amount of work expected Instructors' sensitivity to student's educational needs
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SOCIAL WORK IN IIEALTII CARE Table 1 (continued)
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FACTOR 8 : SUPPORT FROM OTHER SOCI&WORK
STUDENTS I N PROGRAM
W i l l i n g n e s s o f s t u d e n t s t o h e l p each o t h e r Amount of peer support experienced FACTOR 9 : PROGRAM ORGANIZATION C o o r d i n a t i o n between s t u d e n t ' s f i e l d i n s t r u c t o r s Degree t o which f i e l d work program i s organized FACTOR 10: AUTONOMY WITHIN THE ORGANIZATION Contact s t u d e n t had w i t h o t h e r d i s c i p l i n e s S t u d e n t ' s o p p o r t u n i t i e s t o make d e c i s i o n s on own FACTOR 11: QUANTITY OF STUDENT CONTACT Number o f o t h e r s o c i a l work s t u d e n t s i n f i e l d work Number o f seminars f o r s o c i a l work s t u d e n t s FACTOR 1 2 : NUMBER OF FIELD INSTRUCTORS ASSIGNED TO Number o f f i e l d i n s t r u c t o r s s t u d e n t was assigned t o FACTOR 13: QUALITY OF SOCIAL WORK STUDENTS Q u a l i t y o f s o c i a l work s t u d e n t s i n placement h o s p i t a l FACTOR 1 4 : ACCESSIBILITY Student o p p o r t u n i t y t o p a r t i c i p a t e i n d e c i s i o n making r e g a r d i n g p o l i c i e s and procedures r e l a t i n g t o s t u d e n t s I n s t r u c t o r s ' a t t e n t ~ o nt o s t u d e n t ' s understanding and use o f s e l f O p p o r t u n i t y f o r s t u d e n t t o see f i e l d i n s t r u c t o r when the need a r i s e s
.dl
r a t h e r than w a i t i n g f o r conferences
Congruence in Perception
Ratings of student/coordinator pairs were examined to see whether there was a relationship between congruence in pairs' perceptions about field work program aspects and students' field work satisfac-
Table 2
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CORRELATIONS BETWEEN STUDENT PERCEPTION FACTORS AND STUDENT SATISFACTION ITEMS Satisfaction With
...
-
Field
Field Factor
InStruCtOrS
Supervisory
.61
Relationship Learning Opportunities Supervisory Teaching
(210) .38 (211)
.64 (203)
Orientation
.l8
Faculty Field
.11
1189)
Liaison Stress
(197) .30 12201
Expectations
.65 (2331
Peer Support Program Organization Autonomy
ns 1 8
(158) .25 (2241
Learning Proqram
Hospital
Experience
Work
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IN HEtUTI-I CARE
Tablc 2 (continued)
-
.-
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S a t i s f a c t i o n With . . . Field Factor Student Contact
Instructors
F i e l d Work Learninq
Proram
ns
ns
.38
.15
2 6
.15
.29
(221)
(221)
(222)
(222)
(222)
ns
ns
.30
.10
ns
Hospital ns
Experience .14
(210) Number of Instructors Student Quality Accessibility
ns .52
ns .33
ns
.P8
r correlation
(number) p < .05
tion. For example, if a coordinator believed that variety in learning opportunities in the program was just right, but a student thought that there was too little or too much variety in hisher own assignment, was this incongruence associated with lower student satisfaction? Findings indicate that congruence in pairs' ratings generally affected student satisfaction in the same way as did student ratings alone. Pair scores were established for individual field work items, using the absolute distance between the student's rating and the rating of the coordinator. A score of 0 therefore reflects congruence, and scores of 2 and 3 show increasing incongruence. Pair congruence factor scores were derived by averaging item scores in the 14 factor clusters shown in Table 1. Table 3 shows that all correlations between pair factor scores and satisfaction scores were in the negative direction, meaning that student field work satisfaction increased
N a ~ ~ cSl~owers y Table 3
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CORRELATIONS FOR CONGRUENCE I N RATINGS OF COORDINATOR-STUDENT PAIRS AND STUDENT SATISFACTION SCALE ITEMS .-
- .
Satisfaction With ... Field
F i e l d Work
Projram Supervisory Relationship Learning Assignment Supervisory Teach~ng
-.63
(197) -.32 (211) -.38
(19'31
Orientation
ns
Faculty Field
ns
Liaison Stress
-.Zl
Supervisory
-.59
(2031
Expectattons
(2331
Peer Support
ns
Program
ns
Organization
Hasor ta 1
Experience
SOCIAL WORK IN I-IEAL.TH CARE Table 3 (continued) ---
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S a t i s f a c t i o n With
...
Field
Autonomy
Learning
Program_
-.23
-.28
-.33
(224)
Student Contact Number of Instructors Student Q u a l i t y Accessibility
F i e l d Work
Instructors
ns
-.32 (221) ns
-.43 (202)
(224)
(225)
Hospital
- . 29 (2251
Experience
- . 33 (225)
ns
ns
ns
ns
-.I4
-.23
. I 3
-.28
(221)
(222)
(222)
(222)
ns
ns
ns
ns
-.27
-.28
-.I8
-.36
(202)
(203)
(203)
(203)
r correlation
(number 1
as incongruence in pairs' perceptions about field work factors decreased. Comparison of Tables 3 with Table 2 reveals similarities in patterns of statistical significance and in correlational strength of student and pair congruence factor scores associated with student satisfaction. On 10 of 14 factors, if the student factor rating score was significantly associated with a satisfaction measure, the studentlcoordentlcoordinator pair factor rating score also proved significant. Where both the student and pair factor proved significantly associated with a specific satisfaction measure, strength of correlations usually was similar. For example, the correlation strength between student ratings of the Supervisory factor and their satisfaction with field instructors was .67, and the pair r score for the same factor and outcome measure was -.63.
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Predictors of Satisfaction Stepwise multiple regression was used to determine which factors are most predictive of 5 satisfaction aspects. Significance level was less that .O1 for all primary predictors. "Supervisory Relationship" was most predictive of satisfaction with field instructors (Variable R* = S6); "Supervisory Teaching" of learning satisfaction (Variable R' = .40); "Opportunities in Learning Assignments" of program satisfaction (Variable RZ= .41) ; "Stress" of satisfaction with the hospital (Variable R2 = .40) and "Program Organization Differences" of the overall field work experience (Variable Rz = .45).
DISCUSSION This study identified 5 areas of student satisfaction that are correlated with student willingness to accept employment in host hospitals and the program factor most predictive of each. Improvement in performance on any of these predictive factors should produce increased student satisfaction and accordingly increase recruitment potential. Social work departments can evaluate their performance on an ongoing basis using the factor classification presented here, and develop strategies for enhancing student satisfaction in their own settings accordingly. They can identify potential areas for improvement by obtaining and ranking student ratings on one or more factors. Strengthening performance on lowest ranked items should result in higher factor ratings. This study found that the "Supervisory Relationship" factor was most predictive of satisfaction with field instructors. All 11 items constituting that factor were rated "Just Right" by a majority of students in study programs. Strength on this factor is probably attributable to the relative ease with which clinical relationship skills can be adapted for the educational endeavor. Hospital programs with inexperienced field instructors can facilitate transition to the educational role by teaching new field instructors how to apply professional relationship skills most appropriately in the unfamiliar educational role. One efficient method could be enlistment of experienced field instructors to mentor inexperienced ones. The "Supervisory Teaching" factor was most predictive of satis-
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SOCIAL WORK IN HEALTH CARE
faction with learning. Study programs did not perform as well on this factor as on the relationship factor, with only 1 of the 6 items comprising the factor rated as "Just Right" by a majority of students. Since instrumental educational skills are not part of the professional armament, this reflects a general need for field instructors to develop new skills in order to perform well in the educational role. Although field instructors from all study programs had participated in school sponsored seminars for new field instructok as a condition of field instruction, those seminars were not sufficient. Field instructors need to learn and hone educational skills throughout their teaching careers (Showers, 1988; Showers, In Press). Providing ongoing hospital seminars involving both new and experienced field instructors can be a powerful strategy for developing and strengthening teaching skills. The "Learning Assignment Opportunities" factor was most predictive of satisfaction with field work programs. Performance on this factor is instrumental in attracting the most capable students for subsequent years, as well as enhancing recruitment of employees from the current group. Study programs performed well on this factor, with all 7 items rated "Just Right" by a majority of students. This probably reflects the richness in learning opportunities inherent in teaching hospitals, as well as programs' conscious efforts to offer social work students diverse and relevant learning experiences. Environmental richness makes it relatively easy for programs that are performing poorly on this factor to achieve substantial improvement in student satisfaction. Strategies for providing variety in assignments, diversity in program/services areas, multiple practice methods, etc., generally can be implemented using existing structures. Maximizing available resources and tailoring their use to individual student needs is an effective and efficient means of increasing student satisfaction. The "Stress" factor was most predictive of student satisfaction with hospitals. In this study, ratings of satisfaction with hospitals were considerably lower (56% satisfied) than for other satisfaction measures (74%-85% satisfied), while showing stronger correlation with willingness to accept employment than other satisfaction measures. Student satisfaction with hospitals, therefore, must be of concern in shaping recruitment strategies. In study programs, 66% of students rated their feelings of accomplish~nentas "Just Right";
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however, 58% said there was "Too Much" stress, and 64% said there was "Too Much" red tape, rules, and administrative detail. These results support the contention of others (Nelson, 1974; Bracht, 1978; Rauch, 1984; and Berkman, Kemler, Marcus, and Silberman, 1985) that hospital settings inherently are stressful. It seems unlikely that social work departments can decrease student stress related to the hospital's mission, highly complex organizational structure, discipline hierarchies, accountability systems, or impact of illness. Experiments with structures such as peer support groups within or across hospital programs can be undertaken in an effort to find ways to mitigate the effects of hospital related stress. Social work departments also can seek ways to modify their own demands on students. For instance, partial or total shifts to narrative or summary recording early in the school year could reduce pressures while providing educational benefits. Further study about hospital field work stress is critically needed. Hospital social work departments need to learn more about which factors contribute to stress, which students experience most stress, and what effect stress has on recruitment. Lastly, congruence in ratings by student-coordinator pairs' on the "Program Organization" factor was most predictive of overall field work satisfaction. This is surprising, given that the social work education Literature scarcely mentions the existence of agency field work coordinators, focusing on the field liaison/field instructorlstudent triad as the key unit for education (Fellin, 1982; Gordon, 1982; Hamilton and Else, 1983; Rosenblum and Raphael, 1983). Yet in this study, hospital coordinators were not only found to be central to all aspects of field education, but to have a substantially greater influence upon student satisfaction than faculty liaisons (Showers, 1988: Showers. 1990). The finding that a studentlcoordinator pair congruence score was most predictive of overall satisfaction raises question as to how coordinators' views interact with students' perceptions to affect student satisfaction. When views differ, does student satisfaction decrease regardless of whether coordinator ratings of program performance are better or worse than student ratings of their individual experiences of the same factor? Examination of scores on the two items constituting the Program Organization factor suggests that it is the fact of incongruence rather than its direction that influences
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SOCIAL WORK IN HEALTH CARE
overall field work satisfaction. On the item of coordination between students' field instructors, in 60% of pairs ratings were the same, in 32% student ratings lower than coordinators, and in 8% student ratings higher. However, on the item of degree to which the program was organized, in 48% of pairs ratings were the same, in 22% student ratings higher than coordinators, and in 30% student ratings lower. It therefore seems that incongruence in pair perceptions is a marker for diminished satisfaction, regardless of its direction. Comparison of coordinator and student views at specified points during the academic year could help social work departments identify and deal with problems in field work satisfaction as they emerge. Given the general robustness of findings in this study regarding congruence in pair ratings, it can be concluded that hospital staff coordinators have a substantial impact upon students in hospital field work placements. Finding ways to enhance this function, therefore, is critical to maximizing the recruitment benefit of providing field work education in hospitals. Hospitals programs that lack coordinators can add them. Hospital programs with coordinators can join forces to develop expertise about this vital role.
CONCLUSION This study shows that there are ways in which hospital social work departments can increase student satisfaction with field work, thereby increasing their ability to recruit their own students for employment. It is in their interest to begin doing so, given increasing competition for competent social workers who can function effectively in hospital settings.
REFERENCES Bcrkman, B., Kemler, B., Marcus, L.. & Silbeman. P. (1985). Course Contenl for Social Work Practice in Heallh Cuc. Journal of Social Work Educatiorr. 21(3). 43-51. Bracht. N. F. (1978). Building a Health C u e Concentration: Curriculum Guidelines for Schools of Social Work. In N. F. Bracht (Ed). Social Work in Hcalrl~ Care: A Guide lo Professional Practice (pp. 327-336). New York: The Haworth Press, Inc. Ewalt, P. (1991). Trends Affecting Recmilment and Retontion of Social Work Staff in Human Services Agencies. Social Work. 36(3). 214-217.
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Fellin, P.A. (1982). Responsibilities of the School: Administrative Support of Field Instruction. In B.W. Sheafor & L.E. Jenkins (Eds). Qualify Field Instruction in Social Work: Program Developn~entand Maintenance (pp. 101-115). New York: Longman, Tnc. Gordon, M.S. (1982). Responsibilities of the School: Maintcnancc of lhe Field Program. In B.W. Sheafor & L.E. Jenkins (Eds). Quality Field Instruction in Social Work: Program Development and Maintenance (pp. 116-135). New York: Longman, Inc. Hamilton, N., & Else, J.F. (1983). Designing Field Education: Philosoplry. Structure, and Process. Springfield, Ill.: Charles C. Thomas Publishers. Nelson, J.C. (1974). Teaching Content of Early Fieldwork Conferences. Social Casework. 147-153. Rauch, J.B. (1984). Helping Students to Begin Hospital Field Placemen~s: An Active Learning Approach. Social Work in I-lcaltlr Care. 9(3). 63-69. Rehr, H. (1985). Mcdical Care Organizations and the Social Service Connection. Health and Social Work. lO(1). 245-257. Rosenblum, A.F., & Raphael, F.B. (1983). The Role and Function of the Faculty Field Liaison. Journal of Educarion for Social Work. 19(1). 67-73. Schutz, M.L., & Gordon, W.E.(1977). Reallocation of Educational Responsibility Among Schools, Agencies, Students and NASW. Joirrnal of Edrtcation for Social Work. 13(2). 99-106. Showers, N. (1988). Factors Associated will1 Graduale Social Work Studcnt Satisfaction in Hospital Field Education Programs. DSW Disscrtation. City University of New York. Showers, N. (1990). Hospital Graduate Field Work Programs: A Study in New York City. Health and Social Work. 15(1). 55-63. Showers, N. (In Press). What Ficld Instructors of Social Work Students Need from Hospital Field Work Programs. Social Work in Health Care. Wilson, S. (1981). Field Instruction: Teclrniqucs for Suprrvisors. New York: The Free Press.
