Wednesday, November 01, 2006

The Latest in the Chaplaincy Debate

PlainViews, "the e-newsletter for chaplains and others," just posted this article, by Chaplain DW Donovan of Richmond, Virginia, arguing against the use of volunteer chaplains.

This debate has been going on for a while now. I've written about it here and here. It closely parallels the controversy in nursing over whether people without advanced degrees, even if they've been caring for patients for decades, can claim the title "nurse;" you can read Mother Jones RN's scathing take on that subject in her post News Flash: Clara Barton Was a Nurse.

Here's the section of Donovan's article that really dismayed me:
If we are serious about providing pastoral care as an integrated part of healthcare . . . then we have to ask what training is sufficient to meet the identified needs of our patients and families. Over the years, and for very good reasons, four units of Clinical Pastoral Education, together with a masters degree, has become the gold standard for chaplaincy. . . . while I’m delighted that my friend and colleague Chaplain John Stangle first came into contact with professional chaplaincy through volunteer work, there is a reason for the additional training . . . one needs it in order to be effective.
One unit of CPE is 400 hours.

Staff chaplains are now expected to have four units -- 1,600 hours of training -- plus a masters degree.

I need sixteen hundred hours of training to be an effective chaplain? To date, I've logged a measly 372.5 hours at the hospital. Nonetheless, there have been many situations in which patients and staff told me I was effective. There were people who found me effective during my first shift. (There've also been people who found me ineffective, but not everybody likes professional chaplains, either.) Sure, I might very well be even more effective with 1,600 hours of training plus a related masters degree, but you know what? I'm not going to do that. I don't have the time.

During many of the hours I've spent at the hospital, I've been the only chaplain in the building. So the question then becomes, which is better: a) the caring, albeit possibly-in-some-ways-less-than-effective presence of a volunteer, or b) nobody?

I've said it before and I'll say it again: The "real" chaplain is the one who shows up.

As in nursing, this debate is driven largely by staffing issues. Here's another relevant quotation from Donovan. Commenting on how long it's taken him to respond to a previous article, he says:
The fact that I’m so far behind in my reading might suggest that additional staffing in our pastoral care department would be welcome -- but I have to agree with those who have argued that such help should not come in the form of volunteer chaplains.
In other words, given the choice between a) the caring, albeit possibly-in-some-ways-less-than-effective presence of a volunteer, or b) nobody, Chaplain Donovan will choose b.

He'd rather patients receive no pastoral care than "ineffective" pastoral care.

Does that sound like a caring, pastoral attitude to you? Or an effective way of helping patients?

I have a very strong hunch -- and I'm sure this holds on the nursing side of things, too -- that Donovan and others are so resistant to people with supposedly insufficient training not because we're bad at the work, but because at least some of us are good at it.

Because, after all, if a volunteer does good work with patients and families, if a volunteer is "effective," then that whole four-units-of-CPE-plus-a-masters edifice starts to look a little shaky, doesn't it? Outsiders might start wondering if all that training, rather than conferring necessary skills, really only hones and develops and deepens skills that were there in the first place. The Emperor might start looking a little, well, wardrobe-challenged.

I think CPE is an incredibly valuable program. I wish I'd had time to finish the unit I started, and I'm sure I'd be better at what I do if I had been able to do that.

But I wasn't able to. Nonetheless, having me at the hospital is much, much better than having nobody. I hone my skills with every shift. CPE would have allowed me to do that more quickly, but requiring CPE -- even one unit, let alone four -- places the bar out of reach of many people who'd be excellent at the work.

I hope that in my case, this is all merely academic, but it may not be. The hospital where I volunteer is undergoing some organizational changes; the training requirements for staff chaplains are becoming more stringent, and I've been wondering if there's going to be a trickle-down effect to volunteers. The most convincing answer I've gotten when I've asked is, "We honestly don't know yet."

I'll keep you posted.

In the meantime, I'm wondering if I should try to write my own piece for PlainViews, defending volunteer chaplains. I don't think I will, though. I doubt it would convince anyone who didn't already agree with me, and I really don't want to get into an argument with people who don't even want me to exist.

9 comments:

  1. CEUs are a great way for teachers to pay their bills, especially since, once you have forced an organization to require them, you have a captive customer base.

    I'm not a huge fan of them, as you might guess.

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  2. You've got to have the paper. If you don't have the paper, the bureaucrats can't produce their MI, and everyone knows that MI is far more important that doing anything at all.

    Sorry, just the tag end of a very angry rant.

    On the nursing side, Cathie has more qualifications than she can shake a stick at and regularly comes home bemoaning the fully if newly qualified nurses who cannot do anything practical. They have the paper but cannot do the job. Before she was awarded her RN she'd spent 6 months in charge of wards overnight. The paper was a sign she could do the job rather than she was ready to be officially let loose to learn the job.

    Pastoral care isn't a profession, its a calling. If you've heard the call you follow it, however many hours you have or don't have.

    It may be a rickety contrivance, but you're doing good, and an arbiter far more qualified than any of us knows it.

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  3. I'd rather have a caring volunteer than no one any day. E.D.'s are scary places, especially when you don't feel well.

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  4. Anonymous6:35 AM

    Well, as you might imagine, I'm going to back in it again. I'm pointing folks both to the PlainView's and to this post. I'll have my own comments soon.

    And, you know where I stand with volunteers.

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  5. Everytime I see one of your posts on this topic my stomach twists and knots. It's like "they" want to turn a calling into a beauracy, and as a way to "weed people out", not because a person isn't qualified but because not many people who volunteer can turn a calling into a full-time job. Which in my opinion is counter-intuitive to the whole premise of Pastoral Care. The other reason for the stomach upset is that I'm nearly finished with my Community of Hope training, and it makes me wonder what I might come up against, when all I'm hoping to do is to provide some comfort to someone in a time of need.

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  6. Hey, everybody. Thanks for the comments (and Martyn, thanks for the lovely compliment).

    Marshall: Yes, I do know where you -- and my own hospital -- stands on volunteers. This is the sensible, rational approach: "there's a lot they can do, even if they can't do anything." I'm increasingly convinced that people who disagree are driven more by fear and self-protection than by logic, which means that the more volunteers say or do to demonstrate our effectiveness, the more scared they'll be.

    This is why I'm not writing anything for PlainViews myself. The emotional core of the issue isn't about what volunteers can or can't do: it's about staff chaplains' fear that they'll lose their jobs. And unfortunately, the way hospitals often operate, that fear isn't unrealistic.

    JSD: Yeah, it ties my stomach into knots too. But if your area has Community of Hope, that means they have an established and well-recognized system for using volunteers, which means that you'll probably be fine.

    The bottom line, as I mentioned in one of my earlier posts in the subject, is that very few hospitals could function very well without their volunteers (in all capacities). Most of them know that. Mine certainly does, for which I'm very grateful!

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  7. Anonymous7:20 AM

    jsd, Community of Hope is a great program. And, since it was created by hospital chaplains (valued colleagues of mine as Episcopal chaplains, in fact), it has more currency with them.

    There is a point to the concern about integrating chaplaincy into the healing team, and into the structure of the institution. I've worked in a place where chaplains were clearly considered a luxury - a valued one, certainly, but not a necessity - and it doesn't make for a good environment for spiritual support. Moreover, in the multicultural world we live in, having someone around with training in addressing those issues is valuable, more valuable than some realize. That said, there's no way one chaplain can do it all; and integrating into the warp and weft of the institution is something few volunteers can commit the time to, if they are allowed the opportunity at all. So, there is grounds for professional, clinically trained chaplains, jsd. I just remain convicted there is also plenty of room for compassionate and prepared volunteers to offer their ministry, too; and that we need to focus on doing that together, rather than independently.

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  8. Amen, Marshall! There's no reason it has to be an either/or situation: both/and is much healthier for everybody.

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  9. I recently left a chaplain training course due to the fact that the educated chaplain referred to Wicca as Satanist and one of his greatest experiences was delivering a Jew to Christ. When I informed him that Wicca would be classified pagan and predated Satan by a few thousand years another pastor supported me. I then asked him why he was meeting patients off hospital grounds as my understanding as well as training in ethics prohibited such a relationship, he said because the patient requested the meeting. Now I come from the field of addiction and we are forbidden of having contact for a 2 year period. My conclusion is that letters after a name does not always guarantee a calling. Having worked in psychology as well in sociology I can guarantee you there are full blown idiots out there with degrees. I am currently graduating from another program and I am not sure if I want to work there either due to the fact that a chaplain there was in the middle of a decision between the medical team and the family deciding on whether it was the end of life. What keeps me there are the nurses....and the relationship I have with them. Thank God for nurses!!!

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