On Volunteers Once Again

I mentioned in my last post this article on PlainViews from Chaplain D. W. Donovan. I’m happy to see further response to my original article on volunteers in chaplaincy. As I have said, I think we’ve expressed opinions on whether to have them, but haven’t really articulated professional reasons beyond “If administrators believe a volunteer can do what I do, my position is at risk.” I appreciate that he is approaching this question from a perspective of bringing together the needs of patients and families with the training and capacities of the clinically trained chaplain.

There are a number of his statements with which I agree in part, but differ with him about application or implication. For example, he states, “The functions he describes, such as passing ice water and distributing literature, are not truly nursing functions;” and goes on to say, “Today’s nurse is a true medical professional, charged with assessing the medical needs of the patient (this is not just a role for doctors) and helping to coordinate their overall care.” First, I would suggest that nurses would assert that they assess nursing needs rather than medical needs. Nursing as a profession has indeed worked hard to express it’s own distinct purview and body of knowledge (and some nurses of my acquaintance would be offended at the word "medical" in this context, as it smacks of still being the "handmaids of the physician"). Within that I would suggest, second, that historically these were functions of nurses of generations past, and while they are not now commonly done by RN’s or LPN’s, it is because those professionals have delegated those tasks, not because they have excluded them from their professional purview. Those functions are supervised and delegated by professional nurses, and so are within the sphere of the profession of nursing. (We can find an interesting perspective of a parallel professional debate among nurses on the web log “Nurse Ratched’s Place.”)

I would certainly agree with Chaplain Donovan that we are “an integral part of the health care team.” At the same time, we are part of the health care team to bring ministry. To be more clear, we are part of the team as spiritual providers, and not as medical, much less generic “health care” providers. We are there precisely because we are not physicians and not nurses, and so on; and that spiritual competence is our distinct purview and body of knowledge. We have noted recently physicians interested in being more spiritually informed (and nurses for a longer period), in much the same way – perhaps in exactly the same way – that they seek to be culturally competent. In general, despite the anxiety we sometimes feel, the result is physicians who are more interested in working with us and not somehow thinking they can do our job.

I can further appreciate the definition of the role of the Chaplain in Chaplain Donovan's department: “to assess the degree to which the patient's emotional and spiritual equilibrium has been disturbed by the healthcare event and to determine what interventions would be appropriate to help the patient restore his or her equilibrium and when such interventions should be employed.” It is remarkably parallel to his understanding of the role of the nurse: “charged with assessing the medical needs of the patient (this is not just a role for doctors) and helping to coordinate their overall care.” Nurses coordinate nursing care that they delegate rather than necessarily providing themselves. By the same token, Chaplain Donovan’s definition of the role of the chaplain speaks to assessing spiritual needs and determining interventions. That does not foreclose the delegation of some of those interventions to properly supervised students or to properly trained volunteers.

Let me make a specific example. In my center volunteer Extraordinary Ministers from a Roman Catholic parish come to the hospital to offer communion to Roman Catholic patients and to some staff members. While they may be from the local parish, they are there under my supervision. They are specifically there under an agreement with the local archdiocese. They are trained for their ministry by a chaplain Board Certified by NACC. Their training includes information about patient privacy and the requirements of HIPAA. They have their access to patients under my purview and through my coordination. At the same time, if there is a problem with one of them, I am the person the hospital holds responsible to address and resolve the problem. They offer a ministry that I can’t: sacramental care that I as an Episcopal Priest can’t authentically offer. Their care may come from the local parish, but they see patients from many parishes; and those patients see this first and foremost as a ministry of the hospital. This is not an intrusion of the church into the hospital; nor have I decided that rites and rituals for patients are not part of my responsibility. Instead, I meet this responsibility through a collaboration with the church. It is, I think, comparable to a physician specialist referring to a subspecialist.

As Chaplain Donovan notes, administrators certainly want those who “cook the best vegetables.” To follow that metaphor, we need to be clear that we are trained as chefs. And to helps us feed more people, it may well be poor use of our professional time to mop the floors when we need to be at the fresh market. This is not to say that the mopping is not important for health and safety, or that it is not our responsibility to see that it is done and done right. The importance of our clinical training, on which Chaplain Donovan and I agree, is that capacity for development and implementation of a broader vision of spiritual care for the patient, family members, and staff. To find ways to incorporate the ministries of people with gifts but less training, for those specific ministries for which they are or can be trained, expands our ministries, rather than diluting or diminishing them.

I continue to assert that providing caring presence and information about the availability of a clinical chaplain are within our professional purview, even though they don’t require our highest expertise. To delegate those functions does not make them less the responsibility of the chaplain, and does not make us less chaplains; but it may well mean more patients are aware of and have access to compassion and spiritual care.