Saturday, September 09, 2006

The Great Chaplaincy Debate

Marshall Scott, Episcopal Chaplain at the Bedside, left a very helpful comment on yesterday's post about HIPAA. He mentioned that he's writing a series of posts -- which you'll find here, here, and here -- about volunteer chaplains. So of course I went and read them.

It turns out that a lot of people are ardently opposed to using volunteer chaplains in hospitals. According to these folks, volunteers don't have enough training, can't be trusted not to try to convert patients, can't respond effectively to crises, and generally do more harm than good.

Not surprisingly, the people who feel this way are professional chaplains, the ones with the training and credentials.

Marshall, who's been a professional chaplain since God was a pup, weighs in very sensibly on all of this: "A volunteer with sufficient training to do no harm can in fact often do good simply by being present and interested."

My own history with this issue is extremely complicated. I'm certainly aware of the harm done by clueless chaplains. I've had my own bad experience with a clueless chaplain, described here. Probably more to the point, I've written here about my struggles with status issues in the hospital. As a volunteer, I'm at the bottom of the institutional pecking order; don't think I don't know it.

And so reading about the debate pushed every button I have. Just the title of Marshall's post, Volunteers in Chaplaincy: Doing What? sent me into one of those furious tailspins where I was pacing around the house, ranting at some hapless -- and completely imaginary -- strawperson of a Professional Chaplain:

"You want to know what I do? Here's what I do. And here's what else I've done: I've guided a family through the process of removing a loved one from life support. I've comforted grieving families, including a small child who looked up at me and sobbed, 'Why did my aunt have to die? She promised she'd be at my birthday party next week!' I've prayed with relatives over the dead bodies of their loved ones. I've helped suicidal patients rediscover their sources of hope and strength: several people who arrived at the ED in the fetal position have sat up and smiled and laughed after talking to me. I've made phone calls to social-service agencies to get information and referrals for desperate families. I've called patients' pastors to alert them that members of their flock were in the hospital. I've written scores of notes to the Spiritual Care Department asking them to visit patients with specific spiritual needs being admitted to the hospital. On one occasion, I asked a staff chaplain to come talk to an ED patient, because that chaplain had both personal and professional experience with the patient's medical condition. To me, this was the hand of God at work: I was in the right place at the right time to refer the patient to an excellent resource. But the staff chaplain didn't see it that way. The staff chaplain scolded me for not handling the situation myself. So I'm in a no-win situation here, aren't I? If I don't make appropriate referrals to professionals, I'm insufficiently trained; if I do make appropriate referrals, I'm displaying insufficient initiative."

Whew. Emotional and defensive much, Susan?

But that's exactly the point. Chaplains, either volunteer or professional, are probably the last people who should be deciding this debate, because they have too much at stake. Volunteers feel threatened by professional chaplains who consider our work insignificant or incompetent and who want to ban us from the hospital. Many (not all!) professionals feel equally threatened by volunteers, and they probably feel more threatened the more competent and effective we are. If volunteers can do a good job even without CPE and fancy professional accreditation, the professional fortress starts seeming a little shaky, doesn't it? Hospitals are always looking for ways to cut their budgets, and the last thing hard-working professional chaplains need is to be fired and replaced by volunteers. I don't blame them; I'd feel threatened, too.

What pulled me out of my tailspin last night was reminding myself that it doesn't really matter what far-flung professional chaplains think of me. The opinions that matter are the opinions of ED patients and ED medical staff, the people who see my work firsthand. I'm not going to claim that I never goof or make mistakes -- everybody does, even professional chaplains -- and I'd certainly never claim to know as much as people with decades of experience. I have a lot to learn; don't we all? Nonetheless, many patients and staff appreciate me very much indeed. I can't tell you how many hugs I've gotten from patients, how many fervant thanks. I treasure the memory of a patient who said, "It was worth getting hurt tonight, just to meet you," and of another patient and her daughter who told me, "When we count our blessings tonight, you'll be one of them." I treasure the fact that on the bulletin board of my ED, among all the compliment cards written by patients to nurses, doctors, and admitting clerks, there's one to me. I treasure all the times when busy ED staff have thanked me or told me I make a difference. I treasure the fact that a superb and extremely high-powered volunteer chaplain -- someone who puts in many more hours than I do and who's completed CPE -- once told me, "You do really good work. I see some of your patients after they've been taken upstairs, and they talk about you."

Yes, I'm clearly biased. Chaplains are probably the last people who should be deciding this debate, because we're all too biased. The opinions of patients and other hospital staff ultimately matter more. So, patients and staff, what do you think? Have you had good or bad experiences with volunteer chaplains?

If you've had bad experiences, please share them, so everyone can learn from them. But if you've had good experiences, please share those, too.

Both sides in this debate need to hear from you.


  1. Good post, Susan. (Yeah, I've got my defensive points, too; but this isn't one of them.)

    Sounds to me like you're a good chaplain. And there are professional chaplains who are useless. Those of us that pursue the education, that pursue the certification, hope that all of that means we say stupid things less often; that we get caught in our assumptions less often; that we're better prepared to deal with "all sorts and conditions of persons," rather than falling into our own habits - at least less often.

    But part of professional education for chaplaincy is precisely what goes beyond the bedside. You're in an Episcopal diocese dedicated to "Total Ministry." My own perspective is to say that my role is not simply to care for patients myself, but to create a more compassionate culture in which we're all caring for patients spiritual needs in one way or another. I'm very interested in how I can support the ministries of others while they're providing patient care.

    Give me a few days and check again. My next blog will be from my most intense respondent yet to the PlainViews article. I think you'll find it interesting.

  2. Hi, Marshall! Thanks for this comment, and also for the one on the Memorex post.

    One of the things I love about being a volunteer is having minimal involvement with paperwork, politics, and procedural minutiae. Administration isn't my gift, so I'm delighted to leave it to the pros! And my hospital's very supportive of volunteers and very invested in creating a "compassionate culture;" I'm grateful to be there.

    As for your blog, I'll definitely be checking back. You're on my sidebar now, which means I'll be visiting regularly!



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