It is not an easy transition from the parish pastorate to hospice chaplaincy. In the early days of hospice parish pastors took care of hospice patients and their spiritual needs. As hospice began to develop and became more of an industry than a movement, professional Chaplaincy became the standard. Making the transition is not easy by any means.
There are at least five guideposts that will assist you with your transition.
1. A hospice Chaplain must have a well-developed Pastoral Care Theology. It is assumed that a parish pastor will have this. Unfortunately, in many cases this is not true. In hospice chaplaincy it is an absolute necessity. Here is my statement:
My theology of ministry has its roots in the Person and Work of the Holy Spirit. Three words come to mind in my theology of ministry: Comfort, Counsel, and Companioning. These three components of my theology seem so necessary in hospice chaplaincy. My patients and their family members need comfort; at times they need counsel; and, always, need my companionship on their hospice journey. Do I dare to think that my Person and Work has the same authority as that of the Holy Spirit? I would be foolish to think so. Yet, I feel equipped to provide these aspects of spiritual care as a mature and seasoned Chaplain. Because I am settled and secure in my own faith journey, I am able to provide spiritual support to those of other faith groups. I do not compromise my belief system in order to do my work. Therefore, I am able to provide spiritual care to Christians, Jews, Muslims, Buddhists, Hindus, atheists, agnostics, followers of Eastern religious systems, Wiccans, and those who have other belief systems that are more secular.
In reading Professional Spiritual & Pastoral Care, edited by Rabbi Stephen B. Roberts, Skylight Paths Publishing: Woodstock, Vermont, 2013, I came upon an illuminating article by Rev. Dr. Martha R. Jacobs. Her article is titled “Creating a Personal Theology to do Spiritual/Pastoral Care”. She states, “My theology has to be large enough to accept the theology of those whom I serve, whether they are Christian, Buddhist, Jewish, Muslim, Sikh, Catholic, Humanist, or Atheist. If I cannot support a patient (or family member or staff person) in his or her theology, then I cannot serve as a multifaith chaplain, I need to be secure in my own belief system. I also need to be able to be open to understanding and interpreting [my patients’ theology] or that of family members, or staff persons with whom I come into contact. I have to be open to other people’s theology and help them through using their belief system, not my own.”
Have you put to pen and ink your theology of pastoral care? Those of us who have gone through the rigors of Board Certification can reflect upon the hours of work spent thinking through and reflecting upon this subject and then putting those thoughts and reflections on paper. I urge you to take the time for this project. You and those you serve will benefit greatly from it.
2. Emotional Intelligence is a newer term that has absolutely grabbed hold of the human resources world and business world. And, it makes sense as EI or EQ whichever you prefer has a good bit to do with how an employee perceives him/herself as well as others. It is built upon the concept of self-awareness. You, as a Chaplain, ought to be very familiar with the concept of self-awareness since having up to 1,200 or 1,600 hours of supervised clinical training through Clinical Pastoral Education. A lot of CPE is based on self-awareness. Self-discipline and discernment are also key elements of EI. A fun EI test to discover your level of emotional intelligence is found at this site: http://www.queendom.com/tests/access_page/index.htm?idRegTest=3037. I completed it and found that while I had a high level of EI, there was much I could do to grow. This ‘test’ would make a good discussion starter in Chaplain meetings. There are three benefits a Chaplain will gain from improving EI:
* Emotional Intelligence helps us to “read a room”. How many times have you been in a patient’s hospital, facility, or other room with family and friends in it and the dynamics were both subtle and obvious. What were you learning about those persons surrounding the patient? What did you think was happening with the dynamics? Did this information assist you in relating in a more effective manner with the family? The hospice Chaplain must be keen in this skill.
* Emotional Intelligence helps the Chaplain to be aware of his or her own emotions and not let them ruin a visit. There will be those times when it would be very easy for the Chaplain to get caught up in an emotional situation and lose effectiveness. As I interviewed a candidate for a position, I noticed that in discussing the loss of his father, he broke down and wept. It was clear his mourning was not complete. This really could get in the way of his work with family members who were in the process of losing their father to death. A Chaplain must be aware of his emotions or risk losing his ability to serve. Now, I am not saying that a Chaplain cannot weep with those who weep. I am saying that transference and projection are not acceptable for the Chaplain.
* Emotional Intelligence helps the Chaplain understand the emotions of the patient and family/caregiver(s). People need to feel understood. People, at times, exhibit strange emotions. People at end-of-life are allowed to exhibit challenging emotions. If the Chaplain cannot understand the patient or the family caregiver, then an opportunity to assist these folks is lost and their inner peace is at risk. The hospice Chaplain has a lot riding on her connection with the patient or family member. When the Chaplain connects and conveys understanding and shows it with appropriate body language, the patient feels able to unburden a potentially deeply burdened soul.
3. The transitioning parish pastor should be able to identify the pitfalls of the pastorate and seek to diminish their impact on his person and work as a hospice Chaplain. Some of the more obvious pitfalls include these syndromes:
“Out of my way, I’m in charge”
“I’m the leader, I have all the answers”
“I’m the one responsible here”
“I’m the one who makes it happen here”
“I’m the final authority on faith and doctrine”
These are all “I” messages. Unfortunately, in this era of the church it is common for the parish pastor to feel he is the sole leader of the church. This has led to an epidemic of forced terminations of thousands of parish pastors. Denominational affiliation has little to nothing to do with this trend. Many pastors are fleeing the parish pastorate for hospice. While that is complementary to the field of hospice chaplaincy, without cleaning out the closet of the above syndromes, little will change. Yes, I have come upon hospital and hospice chaplains who missed the unit on self-awareness and are filled to overflowing with the “I” messages. The above won’t work in hospice any better than they worked in the pastorate, however.
4. Embrace the “we” messages of hospice chaplaincy. The “we” messages must be embraced as much as the “I” messages must be jettisoned. Here are several:
“We are a Team”—It is not up you, Hospice Chaplain, to make the final decisions about anything. You serve with a Team and must be a Team player.
“We work together”—As a team player you function as a critical cog in the workings of the Team. No, there is no spotlight on you as there was in the church setting. You are one of many team members. Shine in your discipline.
“We serve”—Our work is servant based ministry. What we do has a primary focus on the patients and their needs. We do what do to serve their needs, not our own.
“We plan”—At each IDT meeting we participate in a process of quality improvement as we update and edit our Spiritual Plan of Care along with the rest of the Team.
“We are accountable”—There is not a lot of accountability in the parish pastorate. Perhaps there should be. There are goals to be met, Care Plans to write, visit requirements to meet. Each of these is deadline based. You are accountable. Also, if you defy accountability you won’t last long as you will cause the hospice organization to be in violation of CMS rules and may cause the organization to be fined severely.
Here are practical tips on how to make the transition and embrace “we” messages:
Major on relationships. You will be in many meetings with your IDT. Get to know each by name and develop enduring relationships with them. You will be visiting the same patients and may need to negotiate times and days when you will be visiting so you don’t bump into one another on the same day and time. One responsibility you have is to provide spiritual and emotional support to your team. You may be asked to officiate at the funeral of an IDT member’s loved one or officiate at an IDT member’s wedding or provide brief pastoral counseling sessions. The relationships you build can last for the entirety of your hospice career. Embrace your team and allow the relationships to build along a natural path.
Win over your Team Manager and your nurses. I am talking about skill in this rule of thumb. Your Team Manager and nurses need to know that you are informed and skilled at what you do. They do not expect you to know everything about medical jargon and disease processes, but it helps if you have a basic understanding of the process of dying. Keep your nurses informed if you notice severe and quick decline in your patients. They appreciate your phone call. Be supportive of your nurses. Complement them. Encourage them. One day you might happen upon them cleaning up a bloody death scene when the patient’s aneurism burst and claimed that person’s life while you are bringing comfort to the family. You might happen upon a nurse whose visit took extra-long as they were cleaning the patient whose bowels let loose or the patient was in need of care after vomiting. Their work is hard. They need to know the Chaplain notices and extends appreciation their way. All that you do in a positive manner finds its way back to the Team Manager. When you speak in an IDT meeting, be brief, be detailed, and be informed in your comments.
Participate in the IDT meeting. The IDT meeting is not a time when you catch up on your computer work. It is a time for focus and contribution. You will be called upon to give a short spiritual care synopsis. Make it count. Remember, in every meeting you are building credibility. Be prepared to explain how your actions are achieving the Goals/Expected Outcomes of your Spiritual Plan of Care.
Excel with your patients and families. I won’t be naïve to think that every patient and family caregiver will get along perfectly with you. There will be those challenging patient and/or family caregivers that will give you heartburn. Just keep in mind that these people are at the end-of-life, they have lost control over just about everything, and they are just trying to live another day. With that said, excel in your spiritual care giving. Always remember, we do not bring an agenda with us. The patient sets the agenda. We are there to serve.
Complete your computer work. A Chaplain in the healthcare environment is going to do computer work of some kind. The documentation at Cornerstone Hospice (my hospice) uses Allscripts. Among all the matters that need to be addressed, the Clinical Note, pain score, decline observation are among the top matters that need to be addressed with clarity and excellence.
5. Get very familiar with two cautionary statements:
“Be careful what you think you know.”
“You don’t know what you don’t know.”
The first will keep you from assuming. The second will keep you from crashing and burning. I will let you write you own story related to these statements. Circumstances will appear where you will bump your head on both.
It is my hope that you will succeed in your transition. It will take work and it won’t happen instantly. Be open to the transitional elements. Be a blessing to all you meet on the IDT and in the field of service.