Tuesday, August 22, 2006

On Chaplaincy and Volunteers

Let me begin by calling to your attention the PlainViews web site. PlainViews is an online newletter on healthcare chaplaincy. Each issue includes a variety of articles for chaplains, usually by chaplains, along with other useful information and resources. It's worth subscribing and checking regularly.

The August 16 edition includes an article of mine (you saw that coming, didn't you?). The topic is using volunteers in chaplaincy programs. While it's not long, rather than reproduce it here, I encourage you to link and read it here. Go on. Take a minute and read it, and then come back.

Done? Okay; let's continue.

As you might guess from the colleague's comment to which I was reacting, the use of volunteers has long been a hot topic among professional chaplains for some time. I participate in a Yahoo Group of chaplains in one person departments, and it's a particularly hot topic there. Those who think it's a bad idea to use chaplains are especially ardent.

My colleagues in one person departments are divided on the topic. Many of them are in small towns in small regional hospitals. They fear administrators who do not see the distinction among clergy, much less between congregational clergy and, as I describe us, “advanced practice clergy.” They fear being eliminated by administrators who believe they can be replaced by well meaning lay volunteers, supervised by a volunteer coordinator, and trained (to the extent they are trained) by a local pastor from a church that does not require graduate education for ordination. They fear spiritual abuse of patients by folks who, while arguably well intended, don’t understand that patients are better served by pastoral support than by encouragement to conviction.

But this also leaves my colleagues in small regional hospitals in a bind. One chaplain can only do so much. And these days there is much for chaplains to be involved in. Ethics committees, programs in cultural diversity, and organ and tissue donation are all programs in which chaplains have been intimately involved. Privacy issues have become important, and chaplains have worked to defend the rights of patients to visits by their clergy, and the rights of congregational clergy to have access to their members. Chaplains, too, have all the administrative responsibilities of any other manager. There are budgets to prepare, statistics to track, and reports to prepare. And there is ministry to the staff of the institutions themselves, from the administration and medical staff to the cook and the housekeeper. These activities are no more “optional” for chaplains than they are for any other member of the institution’s leadership. Chaplains are particularly clear on the issues of being “wise as serpents and innocent as doves.”

Too, many are sufficiently remote from any theological educational institution, clinical or academic, as to make recruitment of "more trained" volunteer support difficult at best. One can be that remote either geographically or theologically. I have certainly been interviewed by students interested in chaplaincy whose background is in a small, fundamentalist Christian community with a high reverence for evangelizing (as opposed to a ministry of evangelism). They're vision of a medical crisis as an obvious opportunity for conversion excludes them from my consideration.

And so in many instances, and not all of them rural, using volunteers to extend the chaplain’s ministry isn’t a luxury but a necessity. For those chaplains, to proclaim that this undermines chaplaincy isn’t helpful. Not using volunteers undermines the ministry, the patients, and the chaplain himself or herself. Should the chaplain tough it out, either trying to do too much or telling the institution to expect little? Or, should the chaplain take the initiative and be the professional to set the standards, both of what volunteers might do, and what training they might require for those tasks? At the other end, are our "advanced practices" so different from simple Christian caring that none of them can be delegated? Or have we so delimited the definition of chaplaincy as to eliminate from consideration those functions that might be delegated?

Central to my argument is this image of "advanced practice ministry," in parallel to differences among practices of nurses, physicians, and rehab therapy professionals, and perhaps educators and attorneys, as well. Perhaps this is a place to continue this reflection. I'd love to hear from others on this. I'll let this become another ongoing project for the blog, and share what my colleagues have to share.


Susan Palwick said...

Hi, Marshall! As a volunteer chaplain who began a unit of CPE and found herself unable to complete it for personal reasons, I have very strong feelings about all of this.

The short version is this: I'm not at all sure that the professionalization of ministry is ultimately healthy for anybody, and I think it's very theologically suspect. Granted, I come from a total-ministry diocese and parish, and clearly I have some baggage around these issues, but my lived experience at the hospital is that patients appreciate my ministry more because I'm a volunteer than they might otherwise.

I've written more about this here, if you're interested.

By the way, had I completed that CPE unit, only 200 of the 400 hours would have been patient-contact hours (the rest were didactic). I've now logged many more patient-contact hours than that. At some point, doesn't experience become its own credential?

Blessings to you,

Marshall Scott said...

I appreciate the concern about the professionalization of ministry. However, I think that's a much older issue, and prevalent for all of ministry, and not just in health care. That doesn't mean that there isn't room for ministers to be professionals. It does mean that they need to do it in ways that enable other ministries, and not take them over.

BTW, as I'm sure you're aware, in any clinical education the "contact hours" include all educational activities, and not only the patient care hours. As for experience as its own credential: by and large I agree. However, I've also known folks who got into a rut, and lost track of learning from their own practice. It is one things to have many different experiences with many different patients. It is another to see different patients, and still have the same experience again and again.