By Jim Manzardo
A code has been called, and as doctors and nurses tend to the patient, the family is falling apart in the room. A senior attending launches into a tirade about a resident doctor’s care decisions. Office staff are grieving the news that one of their colleagues just died. A medical team is distressed about a family’s decision for aggressive care for their infant. A bedside nurse, overcome with sadness by the death of a baby, sits alone in tears. NICU staff feel that a particular space has held one too many traumas and deceased patients and needs a cleansing. A respiratory therapist is stunned by the angry outburst a parent directed at her.
Daily, in addition to direct patient and family care, chaplains respond to staff who are stressed and need support. But our institutions and administrators seek evidence that our chaplaincy is valuable. Anecdotally and from research,1 we know that chaplains add to the effectiveness of healthcare systems and contribute to patient satisfaction, but little research has been done on the impact of our support of staff. Anyone needing to do some research?
A recent National Public Radio story spoke of why healthcare and education costs rise so much more than anything else. The answer: because their customers expect, want and need the time and presence of those providing a service. But financial pressures and institutional expectations greatly limit the time availability of many who work in healthcare. We chaplains strive to accommodate these chronos time pressures while hearing the call of the sacred kairos moments when, as Madeleine L’Engle writes, “we are BEing…and are freed from the normal restrictions of time.”
We chaplains often must be creative to balance the demands of patient and family care with staff care needs. Some years ago, during the daily morning conference call for all leaders, our manager began announcing overnight patient deaths, the impact those deaths were having on the unit staff, and the supportive staff role the chaplain played. The latter two were a revelation to many leaders and increased their awareness of our role.
My chaplain colleagues and I at our urban pediatric hospital have long been well supported by our institution, demonstrated especially through increased staffing over the years. That support has grown in large part because of our support of staff, both indirectly and directly.
Chaplains indirectly support staff through our care of patients and families. We respond to staff calls and show up in times of crisis. We enter into and hold distressing, traumatic, grief-stricken spaces. We witness and engage those spaces and the people in them. We listen and respond to the breadth of spiritual distress that patients and families often begin to express to staff. We bring a calm, grounding, compassionate presence. We remain as long as we assess our presence is necessary and as long as our time permits. We both empower patients and families to advocate for themselves and serve as their voice and mediator when they cannot.
Through these actions, we free up staff to focus on their tasks. But we also model a quality of care which staff can and do bring to their encounters with patients and families. See this recent study about how nursing staff provide spiritual care. Yes, we know everyone in healthcare has the opportunity to treat the human spirit.
We also support staff directly in one-on-one and group settings, in planned and spontaneous encounters, in times of personal and institutional crises and in times of celebration. Staff tell us how much they value our informal check-ins and more formal debriefings, especially following very challenging situations, such as a patient or staff death, traumas or codes, and when family members project their stress onto staff. Nearly every time an employee has died, we chaplains have met with the deceased’s colleagues, witnessed to and held their grieving, and facilitated reminiscing. As one prone to move quickly through back hallways and, I know, missing kairos moments, I am inspired by a chaplain colleague whom staff seek out because she is more attuned to these sacred moments. The more we are available, the more they request our services.
A few years ago, I initiated a weekly chaplain-facilitated 20-minute meditation in our hospital chapel. The mostly behind-the-scenes hospital staff appreciate this restful and rejuvenating pause. Some chaplains have supported staff for many years through our hospital’s orientation for new nurses. During their first 18 months, the new nurses meet periodically in small groups, facilitated by a chaplain and experienced nurse, to share their joys and struggles. We bring encouragement as these new, and often young, nurses realize they are not alone, we extend affirmation as they face and overcome their worst fears, and we celebrate their accomplishments. We also affirm the spiritual care they provide patients and families, through their empathic listening and compassionate care.
We minister to and support staff whenever we take interest in their lives, their families, their joys and their struggles; in our praying with them and providing them with religious and spiritual resources; in providing them with opportunities in our institutions for nurturing their spiritual life and practicing their rituals such as meditation, Muslim prayer, ashes, Communion.
As we are pressed to prove the value of our time, we must promote the positive impact of our ministry to staff within our places of employment. The more content and well cared for staff feel, the better they can provide their very best care.
Jim Manzardo, BCC, is clinical care coordinator chaplain at Ann & Robert H. Lurie Children’s Hospital in Chicago.
Flannelly, K., Galek, K., Bucchino, J., Handzo, G. F., & Tannenbaum, H. P. (2005). Department directors’ perceptions of the roles and functions of hospital chaplains: A national survey. Hospital Topics, 83(4), 19–28.