By Michele LeDoux Sakurai
In this climate of ongoing change, more voices bemoan the shifts in healthcare. It often comes as, “When the sisters were here, …” or, “But we have always done it this way,” or, “Where is the mission in this?”
What many staff/caregivers don’t understand is that realities outside the local setting often dictate change. For instance, the Centers for Medicare and Medicaid Services came to one of our sites to visit the long-term care unit. They found that although the door from long-term care to the chapel required a key for entry, the door from the chapel to the outside was not locked. This meant that an unattended resident in the chapel could wander into the street and be placed at risk. CMS now requires this door to be alarmed, and this is causing great angst for those who attend weekly Mass from the community. The community members view this change as lacking hospitality, for it now requires friends/family to use a different (and less direct) entry to the chapel. Even when the rationale is explained, staff and guests alike still struggle to understand. This isn’t how they have historically experienced mission.
This is but one example of new expectations or rules, and employees are feeling the burden and the consequences. Yes, everyone is doing more with less, and as the future impinges on the present, staff seem to be always having to let go of the past. As a result, chaplains are more often being invited to hear and respond to the distress. Chaplains are trained to be empathetic, but it is not enough to rely solely on presence.
Learning to cope with this kind of change is one purpose of the new competency 305.3, “Articulate an understanding of institutional culture and systems, and systemic relationships.” Chaplains who are attuned to an institution’s bigger picture, as well as the concerns of the person in front of them, can help but produce better outcomes for everyone.
Two months ago, the chief nursing officer called me into her office. She shared with me that the chaplains’ empathy was helping to embed the nurses’ sense of victimization. That made me aware that chaplains must become more conscious about how our responses are being read. Even silence can be read as agreement, and this can lead to misunderstanding.
The training of chaplains places them in the perfect position to help staff move toward empowerment. Through reframing, we do this on an ongoing basis with patients. To provide staff support, this simply means transferring these skills to staff interactions. A model that might be helpful is one that begins with the empathetic response by the chaplain, “It sounds as if this has been hard for you.” The chaplain then moves to help the staff person identify their own strengths and options, with questions such as:
- You (the staff member) have identified the frustrations of this change, so how are you choosing to respond?
- Do you understand the reason for the change? What do you need to feel comfortable moving forward?
- What tools do you have to address these frustrations?
- Have you spoken with your supervisor? (If the staff balks at this question, then ask questions 5-8.)
- Sometimes these conversations are better placed in a larger setting. Have you considered taking it to your unit-based council?
- What are the barriers that keep you from moving your concerns forward?
- Would the employee/caregiver assistance program be helpful at this time?
- Would HR be useful in this conversation?
If the staff person indicates only dissatisfaction and no positive response, invite him/her to consider these questions. A staff person who persists in discontent may be in the process of a discernment to a different place. Where do they find themselves being pulled? Is there a greater good that they need to consider? Each of us is called in unique and wonderful ways. So, too, are our institutions. We live on the edge of uncertainty and mystery. We live in faith that our service and voice can make a difference. This requires resilience, prayer, and trust in the words of our most gracious God.
“For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.” (Jeremiah 29:11)
Michele LeDoux Sakurai, BCC, is manager of spiritual care at Providence Health Care-Stevens County in Colville, WA.
