Oh my gosh, I only read the first sentence so far because I am now arriving at the zoo, but I am going to have so many thoughts and feelings about eliminating chaplains. Especially in a world in which physician's schedules don't allow being spiritually present.
Oh my gosh, I forgot about my craziest experience with a volunteer chaplain. Back when I was moonlighting as a chaplain, had a chaplain convince a family that their loved one wasn't dead.
I meant back when I was a resident, moonlighting at another hospital as their ER physician, but will include a more in depth version in my upcoming writing :)
This is such an important and necessary post. Even though the majority of people would say that holistic care of the individual is essential, health care, mental care, and even spiritual care have a price to pay and that price is the bottom line. I feel your frustration and I’m sorry because the care and selflessness you give to your work does not translate to a tangible profit. Just a thought, but what is becoming more evident in our society is the lack of self awareness and the importance of that. I pray and hope that our individual emphasis on isolationism doesn’t doom us all. I know it’s difficult but society needs people like you Christine to save us from ourselves. You’re not alone, you’re seen and being held in love and prayer, friend.
Thanks Steve! I knew you'd get it! Your point on isolation is a great one, as well as the lack of self-awareness. Not sure how we fix those yet, but grateful for so many smart, thoughtful, spiritual people like yourself to help us think through it!
OK, finally got a chance to read the whole thing. And apologies, I have so much to say, so maybe grab your coffee first ;)
1. My small rural hospital went from an on call, but paid chaplain to a volunteer chaplain probably about 8-10 years ago. It's tough because you don't have a relationship with the person and don't know the skill set they bring. This is at a small rural hospital that transfers out the vast majority of the sickest patients not one of the largest, most prestigious, most specialized hospitals IN THE WORLD.
2. You are 100% right that the presence of a chaplain allows us (physicians) to do the part of the job that only we can do and then go to the next patient to do the job only we can do. Not only are you allowing us to see more patients sooner, but chaplain prevent moral injury. I can tell you that leaving a grieving family alone without a support person because you have to go, but there is no one else coming feels fucking awful. Also, in general, we physicians are emotionally stunted. We just don't have the skills to be useful to a grieving family.
3. What is happening in healthcare workers right now goes so far beyond burnout, I don't even have words for it. We are burned out, morally injured, and traumatized, and our leadership keeps prescribing "self-care" as if a meditation app is going to fix that I have had a 12 year old in my ER for two days waiting for a hospital bed. I have never had the experience of chaplains checking in on my wellbeing, but there is research that shows that the follow up that chaplains do reduces the risk of a traumatic event becoming PTSD.
4. So many of the factors that increase the likelihood of PTSD are about system factors like workload and feeling abandoned by leadership. This really exemplifies that leadership just absolutely don't care about that.
5. This is just such an incredible self-own on the hospital's part. Like there is just no way this is good care for humans unless you believe that you can boil a person down to their blood pressure, their hemoglobin A1c, and their brain MRI.
Hmm, perhaps it's time for me to write a sassy editorial in a Boston newspaper even if I don't really have standing.
This is the perfect sassy editorial! Send it in! Seriously, I cannot wait to read more from you via your own post, which you've already managed to outline above. It is so crucial for chaplains to have champions for our existence, especially the physicians! Here's my attempt to respond to your excellent points:
1. Yup, this is the model in so many hospitals - definitely ones that are more rural or community-based. I worked at a hospital a few years after they fired the whole department and then tried to get the local clergy to volunteer. It backfired because the clergy were upset by the actions that they refused to volunteer! And we were slowly trying to build it back up.
2. This sounds like the perfect study - find hospitals that don't have a chaplain present for death notifications and find ones that do - and measure the doctors'
moral distress/injury in both.
3. Yes! Absolutely. We might need to invent a new word. Also you had me chuckling with "meditation app"
4. We did a study back BC (before Covid) that the number one factor for nurses to avoid compassion fatigue was feeling as though their leadership had authenticity.
5. Yup. Since we are not a billable service and part of the operating budget, we are often first on the chopping block. Some chaplains are advocating for us to become reimbursable, but the field is divided on this.
It would be an interesting study, but I suspect there are more leadership factors at play that would confound the study because people who cut chaplaincy are probably less supportive leaders in a lot of regards.
I also think billing for chaplaincy services could be a big risk. 1. If people have to pay for it I suspect many/most people wouldn't elect to. 2. The number of people who don't see the value in chaplaincy because they are religiously unaffiliated is ever increasing so they wouldn't independently value it. I honestly think it could be the end of chaplaincy, though it may be with or without billing. I can relate, global health also runs into the challenge of being considered valueless because we don't generate revenue.
It is interesting for sure. I am much more in your camp, although hospices have been able to see a lot more hiring of chaplains with it being a mandated service.
That’s good, I think chaplaincy certainly is an essential service in hospice. The healthcare and political environment being what they are, I’d be shocked if it could be mandated more broadly.
Christine! Thank you for bringing awareness to this short-sided and misguided decision by Mass general. I'm shocked. When the research from many angles supports that caring for the whole person is not only good for humans but also the bottom line, this seems like quite a blind decision.
We know from the research at this point that persistent pain is not singularly physical but also social and emotional and in order for full resolution of the pain, all domains must be addressed. Whenever I bring this up I also include spiritual although it's the one domain of pain that we don't have the research on yet. But I know it's true. A move to diminish caring for the needs of the whole person in the hospital setting makes me quite sad and angry.
Thank you for the work that you and so many other chaplains do. You are essential 💜
I am so grateful for your views and your understanding of what we do! I think chaplains need more interdisciplinary relationships and buy-in. Your writings on pain have helped shape my own, especially the interconnectedness between the domains. I know you are educating others too. And more research to do on the spiritual domain!
I served as a hospital chaplain in Rhode Island and then for Hope Hospice. I'm shocked. Yet not surprised, well, I am surprised, saddened maybe a better word for the disregard of such powerful and desperately needed work, as anyone who has stood bedside knows. My heart aches for the families who will have to go through their darkest hour alone and for the staff that depended on us. And for those who made this decision, may they never be in need of a chaplain's shoulder.
Carol, lovely to meet you here. Your comments remind me- I almost included a section on the differences with the mandating of hospice chaplains and how that has really made them essential in different ways.
Lifting up the essential (and often unrecognized) skills of a chaplain who walks besides others 'navigating the human condition'. I am indebted to Rev. Christine Vaughan Davies and the Spiritual Care Team at RWJUH who taught me these life-changing skills while I served as a resident chaplain.
Aw, thank you Mary Beth, we are so proud to count you among our alum! I thought of you the other day when handing someone the on-call phone (we finally upgraded from a pager) and the "Mary Beth blessing" that your peers liked to joke about!
Wow. I served as a chaplain at Mass General 20 years ago as part of their CPE program. It was transformative, and I’m terribly sad to hear about this decision. It is a loss for everyone involved
Such a short-sighted decision — even just a semester-long CPE unit helped me recognize how vital chaplains are. The things I witnessed, even as an intern, were so difficult and holy. (Side note, watching The Pitt with my mom, who’s a retired nursing professor, and I keep saying, “Where is the chaplain? The chaplain should be here right now! This is a trauma center!”) Thank you for this. ❤️
Christina - thanks for the solidarity! Difficult and holy is an excellent description of this work. And that is interesting to hear about The Pitt, I haven't watched it yet, but a few of my medical colleagues have watched it and talked about how realistic it is and healing for them to watch. There was recently a chaplain on Grey's Anatomy which I was excited about (finally, after over 20 seasons!) but he was mainly a love interest for one of the residents and then left the show!
Hi Christine! Thank you for your advocacy. Chaplains and Clinical Pastoral Educators have been soaking up the same distress that other healthcare providers do, and for just as long. It is an insult to our profession(s) to be so carelessly caste aside. I refuse to buy into the fear but I am also a realist and working in an academic healthcare setting is unsettling right now. Clinically trained chaplains are more than worth the small salaries that we are paid. I recently asked a psychologist friend of mine where all the psychologists in inpatient mental health went, and she replied with the same SMH response that cutting spiritual care from the budget engenders. Who is left to humanize healthcare anymore? To do the deep listening? To accompany those who are suffering? Here’s to us and the heavy lifting that we do!
Mary, thanks for reading and I'm glad we are in this together. I am trying not to be alarmist, but some worrisome dynamics are going on. I am crossing my fingers that it will not take root further.
That's interesting re: the inpatient mental health provider issue as well. It is problematic all around.
I could not agree more with your thesis here Christine. Any time I have a patient who is dying or someone with an unfortunate diagnosis, I consult chaplains, not just because they help the patient, but they help entire families. It's so easy to feel alone in the hospital, where you're separated from your friends and normal life and there are uniformed people coming in/out of your room but chaplains always provide a calming presence and know how to connect with people. I'm surprised that one of the most prominent hospitals in the country is making these moves. Also, how maddening to get calls to be a "chaplain for a day" !!
Thank you for your advocacy! It is so gratifying when physicians understand the depth and importance of our work. And yes to the isolation in the hospital, even if it's routine and short-term. So often I find that being alone brings up distress for patients.
As a fellow chaplain, a resounding YES to all of this! Thank you for the passion and effort into this post, and so many others. May these words reach and educate more!!
Oh my gosh, I only read the first sentence so far because I am now arriving at the zoo, but I am going to have so many thoughts and feelings about eliminating chaplains. Especially in a world in which physician's schedules don't allow being spiritually present.
Hope you said hi to the giraffes for me - they are my favorite! I like to think they are proof that God has a sense of humor!
No giraffes at our zoo. Minneapolis is not a great climate for giraffes most of the year. The Amur leopard was busy being awesome though.
I am so excited to have you as an advocate for chaplaincy!
Oh my gosh, I forgot about my craziest experience with a volunteer chaplain. Back when I was moonlighting as a chaplain, had a chaplain convince a family that their loved one wasn't dead.
WHAT?!!? @#$6 - I have to hear that story more fully!
I meant back when I was a resident, moonlighting at another hospital as their ER physician, but will include a more in depth version in my upcoming writing :)
This is such an important and necessary post. Even though the majority of people would say that holistic care of the individual is essential, health care, mental care, and even spiritual care have a price to pay and that price is the bottom line. I feel your frustration and I’m sorry because the care and selflessness you give to your work does not translate to a tangible profit. Just a thought, but what is becoming more evident in our society is the lack of self awareness and the importance of that. I pray and hope that our individual emphasis on isolationism doesn’t doom us all. I know it’s difficult but society needs people like you Christine to save us from ourselves. You’re not alone, you’re seen and being held in love and prayer, friend.
Thanks Steve! I knew you'd get it! Your point on isolation is a great one, as well as the lack of self-awareness. Not sure how we fix those yet, but grateful for so many smart, thoughtful, spiritual people like yourself to help us think through it!
Probably the most Jesus thing I can do is to love others and maybe we can then move closer to loving others first instead of next.
Amen!
OK, finally got a chance to read the whole thing. And apologies, I have so much to say, so maybe grab your coffee first ;)
1. My small rural hospital went from an on call, but paid chaplain to a volunteer chaplain probably about 8-10 years ago. It's tough because you don't have a relationship with the person and don't know the skill set they bring. This is at a small rural hospital that transfers out the vast majority of the sickest patients not one of the largest, most prestigious, most specialized hospitals IN THE WORLD.
2. You are 100% right that the presence of a chaplain allows us (physicians) to do the part of the job that only we can do and then go to the next patient to do the job only we can do. Not only are you allowing us to see more patients sooner, but chaplain prevent moral injury. I can tell you that leaving a grieving family alone without a support person because you have to go, but there is no one else coming feels fucking awful. Also, in general, we physicians are emotionally stunted. We just don't have the skills to be useful to a grieving family.
3. What is happening in healthcare workers right now goes so far beyond burnout, I don't even have words for it. We are burned out, morally injured, and traumatized, and our leadership keeps prescribing "self-care" as if a meditation app is going to fix that I have had a 12 year old in my ER for two days waiting for a hospital bed. I have never had the experience of chaplains checking in on my wellbeing, but there is research that shows that the follow up that chaplains do reduces the risk of a traumatic event becoming PTSD.
4. So many of the factors that increase the likelihood of PTSD are about system factors like workload and feeling abandoned by leadership. This really exemplifies that leadership just absolutely don't care about that.
5. This is just such an incredible self-own on the hospital's part. Like there is just no way this is good care for humans unless you believe that you can boil a person down to their blood pressure, their hemoglobin A1c, and their brain MRI.
Hmm, perhaps it's time for me to write a sassy editorial in a Boston newspaper even if I don't really have standing.
This is the perfect sassy editorial! Send it in! Seriously, I cannot wait to read more from you via your own post, which you've already managed to outline above. It is so crucial for chaplains to have champions for our existence, especially the physicians! Here's my attempt to respond to your excellent points:
1. Yup, this is the model in so many hospitals - definitely ones that are more rural or community-based. I worked at a hospital a few years after they fired the whole department and then tried to get the local clergy to volunteer. It backfired because the clergy were upset by the actions that they refused to volunteer! And we were slowly trying to build it back up.
2. This sounds like the perfect study - find hospitals that don't have a chaplain present for death notifications and find ones that do - and measure the doctors'
moral distress/injury in both.
3. Yes! Absolutely. We might need to invent a new word. Also you had me chuckling with "meditation app"
4. We did a study back BC (before Covid) that the number one factor for nurses to avoid compassion fatigue was feeling as though their leadership had authenticity.
5. Yup. Since we are not a billable service and part of the operating budget, we are often first on the chopping block. Some chaplains are advocating for us to become reimbursable, but the field is divided on this.
Also, do you have that compassion fatigue study. I’d love to read it and possibly incorporate it.
Nope, it never got written up or disseminated because the healthcare worker who was the Lead PI got laid off.
UUUUUGGGGGGGHHHHH!!!
It would be an interesting study, but I suspect there are more leadership factors at play that would confound the study because people who cut chaplaincy are probably less supportive leaders in a lot of regards.
I also think billing for chaplaincy services could be a big risk. 1. If people have to pay for it I suspect many/most people wouldn't elect to. 2. The number of people who don't see the value in chaplaincy because they are religiously unaffiliated is ever increasing so they wouldn't independently value it. I honestly think it could be the end of chaplaincy, though it may be with or without billing. I can relate, global health also runs into the challenge of being considered valueless because we don't generate revenue.
It is interesting for sure. I am much more in your camp, although hospices have been able to see a lot more hiring of chaplains with it being a mandated service.
That’s good, I think chaplaincy certainly is an essential service in hospice. The healthcare and political environment being what they are, I’d be shocked if it could be mandated more broadly.
Christine! Thank you for bringing awareness to this short-sided and misguided decision by Mass general. I'm shocked. When the research from many angles supports that caring for the whole person is not only good for humans but also the bottom line, this seems like quite a blind decision.
We know from the research at this point that persistent pain is not singularly physical but also social and emotional and in order for full resolution of the pain, all domains must be addressed. Whenever I bring this up I also include spiritual although it's the one domain of pain that we don't have the research on yet. But I know it's true. A move to diminish caring for the needs of the whole person in the hospital setting makes me quite sad and angry.
Thank you for the work that you and so many other chaplains do. You are essential 💜
I am so grateful for your views and your understanding of what we do! I think chaplains need more interdisciplinary relationships and buy-in. Your writings on pain have helped shape my own, especially the interconnectedness between the domains. I know you are educating others too. And more research to do on the spiritual domain!
I served as a hospital chaplain in Rhode Island and then for Hope Hospice. I'm shocked. Yet not surprised, well, I am surprised, saddened maybe a better word for the disregard of such powerful and desperately needed work, as anyone who has stood bedside knows. My heart aches for the families who will have to go through their darkest hour alone and for the staff that depended on us. And for those who made this decision, may they never be in need of a chaplain's shoulder.
Carol, lovely to meet you here. Your comments remind me- I almost included a section on the differences with the mandating of hospice chaplains and how that has really made them essential in different ways.
Lifting up the essential (and often unrecognized) skills of a chaplain who walks besides others 'navigating the human condition'. I am indebted to Rev. Christine Vaughan Davies and the Spiritual Care Team at RWJUH who taught me these life-changing skills while I served as a resident chaplain.
Aw, thank you Mary Beth, we are so proud to count you among our alum! I thought of you the other day when handing someone the on-call phone (we finally upgraded from a pager) and the "Mary Beth blessing" that your peers liked to joke about!
Wow. I served as a chaplain at Mass General 20 years ago as part of their CPE program. It was transformative, and I’m terribly sad to hear about this decision. It is a loss for everyone involved
It is a big loss. I recently heard that the CPE program where I trained (another large academic medical center) is also closing.
Thank you for this post. The work you and your fellow chaplains do is so important and vital. 🙏
Thanks Chris, your support is so meaningful to me!
Such a short-sighted decision — even just a semester-long CPE unit helped me recognize how vital chaplains are. The things I witnessed, even as an intern, were so difficult and holy. (Side note, watching The Pitt with my mom, who’s a retired nursing professor, and I keep saying, “Where is the chaplain? The chaplain should be here right now! This is a trauma center!”) Thank you for this. ❤️
Christina - thanks for the solidarity! Difficult and holy is an excellent description of this work. And that is interesting to hear about The Pitt, I haven't watched it yet, but a few of my medical colleagues have watched it and talked about how realistic it is and healing for them to watch. There was recently a chaplain on Grey's Anatomy which I was excited about (finally, after over 20 seasons!) but he was mainly a love interest for one of the residents and then left the show!
Your work is so important. Thank you for sharing this piece.
Thank you! I'm glad to find your writing and looking forward to reading more.
Hi Christine! Thank you for your advocacy. Chaplains and Clinical Pastoral Educators have been soaking up the same distress that other healthcare providers do, and for just as long. It is an insult to our profession(s) to be so carelessly caste aside. I refuse to buy into the fear but I am also a realist and working in an academic healthcare setting is unsettling right now. Clinically trained chaplains are more than worth the small salaries that we are paid. I recently asked a psychologist friend of mine where all the psychologists in inpatient mental health went, and she replied with the same SMH response that cutting spiritual care from the budget engenders. Who is left to humanize healthcare anymore? To do the deep listening? To accompany those who are suffering? Here’s to us and the heavy lifting that we do!
Mary, thanks for reading and I'm glad we are in this together. I am trying not to be alarmist, but some worrisome dynamics are going on. I am crossing my fingers that it will not take root further.
That's interesting re: the inpatient mental health provider issue as well. It is problematic all around.
Agreed in so many ways. Former hospital chaplain here. Here's a short piece that just appeared in Faith Facts, which invited chaplains of all stripes (I'm Zen Buddhist) to describe the life of a chaplain: https://faithfacts.com/articles/former-chaplain-at-lowell-general-hospital/
I also put the article in the Notes of Substack, here: https://substack.com/profile/24272765-charles-huschle/note/c-109715817?utm_source=notes-share-action&r=eg8zh
Glad to connect with other spiritual care providers!
Lovely to meet you. I look forward to reading your piece, thanks for sharing it here!
I could not agree more with your thesis here Christine. Any time I have a patient who is dying or someone with an unfortunate diagnosis, I consult chaplains, not just because they help the patient, but they help entire families. It's so easy to feel alone in the hospital, where you're separated from your friends and normal life and there are uniformed people coming in/out of your room but chaplains always provide a calming presence and know how to connect with people. I'm surprised that one of the most prominent hospitals in the country is making these moves. Also, how maddening to get calls to be a "chaplain for a day" !!
Thank you for your advocacy! It is so gratifying when physicians understand the depth and importance of our work. And yes to the isolation in the hospital, even if it's routine and short-term. So often I find that being alone brings up distress for patients.
As a fellow chaplain, a resounding YES to all of this! Thank you for the passion and effort into this post, and so many others. May these words reach and educate more!!
Alyssa, lovely to meet you! I look forward to reading your work. Yay for chaplains on substack!
This is so important, Christine!! Thank you, thank you!
Thanks for reading! I know you get it!
Thank you for saying so! ❤️