Navigators across Systems: Rural Medical Social Workers As Interprofessional Rural Health Stewards

Background: Rural America struggles to recruit and retain both social service staff and health care providers, which presents significant challenges given that rural residents are often older and navigating higher rates of complex health issues than their urban counterparts. In hospital and clinic settings, medical social workers can play an important role in meeting complex patient care needs including case management, care coordination, transitional care, and behavioral health, yet little is known about their essential contributions in the health care field and on the health care team. This is particularly true for social workers in rural hospitals and clinics. To fill this research gap, this study aims to understand the interprofessional experiences of rural medical social workers, and the benefits and challenges of providing social work services in a rural-based hospital and clinic setting.

Methods: Twenty-five semi-structured, qualitative interviews were conducted virtually with medical social workers from June 2025 to February 2026. Social workers who had >6 months experience working in a rural hospital or clinic in the Upper Midwest were eligible to participate in the study. Rurality was identified using 2023 Rural-Urban Continuum Codes, which is a standard USDA census-designated, county-equivalent population metric. Recruitment efforts included direct contact with hospital staff and distribution of a statewide newsletter and emails. Participants were predominantly white (88%), women (100%), and had >10 years of experience as a practicing social worker (80%). The majority also lived in a rural community (88%) and grew up in a rural community (81%). Verbatim transcripts were analyzed using thematic analysis. Strategies for rigor (audit trails, memoing, member checking) were utilized.

Results: Nearly every participant discussed aspects of interprofessional collaborative practice and the unique role of the social worker on the health care team. Multiple participants discussed their role as being a navigator across systems for patient well-being and the professional skills necessary to implement this role. Generally, participants discussed the benefits of working in rural hospitals and clinics, which included the importance of relationships (i.e., personal, professional, patient-care) and the opportunity to utilize their full scope of training and knowledge in what many health care professionals refer to as practicing at the top of your license. They also discussed barriers primarily as they related to navigating patient care in low resourced rural communities, and having to develop both depth and breadth of resource knowledge to be successful in their positions. Some participants also reported complexities in navigating professional boundaries due to multiplex relationships within small communities.

Implications: Rural life is not a monolith, nor is rural medical social work practice. Understanding the dynamic interprofessional experiences, benefits, and challenges to practicing in this setting allow us to better advocate for current practitioners, and educate the future generation of social workers and health care providers. Our findings provide evidence of social workers who are uniquely positioned to act as stewards of rural health by responding to the complex person-in-environment health care needs present in rural America.