Hospital chaplains are involved in almost everything that happens at a hospital. They are there for births and deaths; they talk to patients, their families; they sit on committees; they train nurses and medical students. But they have little voice when it comes to public conversations about religion and medicine in this country.
This February I spent several days at the Spiritual Care Collaborative Summit, a historic meeting of health care chaplains and pastoral care providers in Orlando, Florida. Between plenary addresses and visits to the Disney theme parks, participants talked about their work as chaplains in hospitals, hospices, and other health care organizations. They held meetings to designate new board-certified chaplains and spoke about the future of their profession.
As I listened, I remembered one of the first mornings I had shadowed Karen, a hospital chaplain, as part of an ongoing research project. On that day, I arrived at the hospital promptly at nine only to learn that her day had started almost three hours earlier, with visits to patients waiting for same-day surgeries. By nine, we were on our way to a meeting of the palliative care team—which was followed by patient visits, conversations with families, and support for social workers who were taking the family members of a recently deceased patient to view his body before it was taken to the funeral home.
I interviewed chaplains across the country who, in addition to caring for patients and families around end of life issues, respond to all trauma pages, preside at bedside weddings and baptisms, sit on ethics committees, work with organ donations, and help to train medical and nursing students.
Despite this work, health care chaplains have not made consistent contributions to broader public conversations about religion, spirituality, health, and medicine in the contemporary United States. This results, in part, from their small numbers. Researchers estimate that there are 10,000 health care chaplains across the country. Colleagues and I found that between 1980 and 2003, 54% to 64% of hospitals had chaplaincy services, with no systematic trend over the period. In 1993 and 2003, smaller hospitals and those in rural areas were less likely to have chaplaincy services while church operated hospitals were much more likely to have chaplains. Little is known about how many chaplains these hospitals had, from what spiritual and religious backgrounds, and with what responsibilities. (More on this here.)
Part of chaplains’ relative silence also stems from their lack of medical training, and corresponding low status in the medical profession. Many of the country’s leading voices around religion, spirituality, health, and medicine are physicians.
Part of it also stems from their status as a developing profession. At present, hospital chaplains are encouraged to become “board-certified” which requires a graduate level theological degree, the endorsement of a faith tradition, and evidence of four units of clinical pastoral education (1600 hours of training).
However, this certification is not a license that is required before a chaplain can be hired by a hospital. In fact, hospitals are not required to have chaplains. The Joint Commission, which sets guidelines for hospitals, currently states that “Each patient has the right to have his or her cultural, psychosocial, spiritual, and personal values, beliefs and preferences respected.” They say little about how hospitals should do this.
At the Spiritual Care Collaborative and beyond, chaplains are thinking about their roles and responsibilities in health care. The Healthcare Chaplaincy in New York is conducting research about hospital chaplains, working to develop an evidence base for chaplains’ work. The Hastings Center also recently published a report featuring six essays on hospital chaplaincy. These essays encourage chaplains to develop standards of practice—which they are doing—and to work together to identify and teach their best practices. Given a chaplain’s traditional role in end of life situations, some authors encourage chaplains to focus first on working with palliative care teams to clarify and improve their care for dying people and their families. As members of a profession that is both religious/spiritual and medical, and that includes a wide range of people doing a wide range of tasks in their institutions, the challenges are complex.
After listening to many chaplains in Orlando and across the country, I am convinced that to fully understand who chaplains are and what they bring to patient and family care, we need to think more about their broader contexts. I support the development of standards of practice for chaplains and research on what effect they have on patients and families. In this process, though, I don’t want to lose their stories and the witness they bear to the stories of sick and dying people and their families.
I think of the senior chaplain who told me that he has witnessed the deaths of 3000 children during his career—often encouraging parents, when they are ready to leave the hospital after a child dies, to leave the child in his arms.
Modern medicine needs more of these stories—of death, of blessing health care workers’ hands, and of caring for someone through an emergency. Chaplains should not neglect to tell them.
