Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 5

• Review your ministry as a Parish Pastor.  What type of Pastor were you?  The answer to that will definitely have an effect upon your work as a hospice Chaplain.
  There are 4 key questions that will help you as you explore the answer.  Looking back over a ministry career in the parish pastorate can bring about feelings of nostalgia.  Nostalgia has a way of fogging one’s memory, it must be warned.  So let’s take a walk back over your parish ministry career and do some kicking around.

1.  Key Question #1:  Do you have any unfinished business?  We hospice Chaplains are fairly well known for exploring with our patients any of their unfinished business.  Do we have any?  Unfinished business drains the soul of energy, creativity, and inner peace.  Is there someone you have yet to forgive?  Beware the quick and thoughtless, “Oh, I forgive him long ago.”  Did you really or is it easier just to say that instead of acknowledging your pain and getting before God in prayer for healing that you may, indeed, forgive?  Spiritual pain in ministry is real and lasting.  Perhaps a church member wounded one of your children.  How are you coping with that, particularly if the damage was so bad that that child (now an adult) will have nothing to do with church?  What about your spouse?  Thom Rainer, President and CEO of Lifeway Christian Resources, has a powerful blog site (http://thomrainer.com/blog/).  He posted a few articles about the pastor’s wife (I apologize to those Chaplains who are female. Perhaps you can add to this discussion through the Comments section to share your perspective).  Did she find any of these to be true when it came to her relationship with the church?  In the January 2014 edition of the blog, Rainer suggests “11 Things I Learned from Pastors’ Wives”: 1.The number one challenge for pastors’ wives is loneliness. 2. These ladies need to know they have the love and support of their husbands.  3. A pastor’s wife does not want a church member to tell her what her “job” at the church is.          4. She would like church members to understand that neither she nor her family is perfect.  5. The pastor’s wife does not want to field complaints from church members about her husband.  6. The pastors’ wives who entered ministry with no forewarning about the issues they would face were the ones who stressed the most.  7. She does not want to be told she needs to work to support her husband and family. 8. While most pastors’ wives affirm their identity as a wife in ministry, they do not want that to be their only identity.  9. Many pastors’ wives believe they need training for their roles.  10. These ladies want to be reminded again and again to keep their focus on Christ.  11. Many pastors’ wives want a means where they can support one another.
   Unfinished business does involve emotional responses to what happened in our past.  For most pastors it has to do with being lied to or lied about; mean and nasty words spoken to or about; a forced termination with the accompanying blood bath business meeting; unending stress; imposed and accepted false guilt about taking a day off, going away for a weekend, buying a nice car or nice clothes or nice anything, being openly criticized at a business meeting, being harassed by the church critic, never feeling accepted into the fellowship, being gossiped about in the community, and the list can go on.  Is there any unfinished business?  Believe it or not, the emotional drain will follow you into hospice ministry.  Changing vocational ministry settings will not erase all of that pain.  Hospice service will give you a wonderful change of pace, affirmation, acceptance, a place at the table, respect, encouragement, and many more great emotional strokes.  But, if you are carrying a refrigerator filled with rotting emotions, you won’t be able to enjoy the positive aspects of the work.
    
2.  Key Question #2:  How did you manage your time?  In the parish pastorate you are master of your own time.  What was your schedule?  Did you have set office hours?  Did you have a starting time and a quitting time or was your day open-ended?  Since you were on-call 24/7, what did you do for self-care?  Have you noticed that there are many out-of-shape Pastors?  When you went to a convention or conference, did you notice how many pastors were obese, on all sorts of medication, nervous, anxious, and unable to focus for more than a few minutes?  I observe these kinds of things with a profound sense of sorrow.  What has church ministry done to these men, many of whom are friends of mine?  I spent twenty five years in the local parish pastorate.  I get it.  I know what it is like to work and work hard to get the resistant to come to church, to give to the church, to reach the lost (SBC language for those who need God’s salvation through Christ), to baptize more this year than the previous year, to increase missions giving, to build bigger budgets, to build bigger buildings, to have more and exciting programs to draw children, teenager, young adults, middle aged adult and senior adults, to hire new staff, to have a day care center, to manage the program efficiently, and on and on it goes.  It’s a pressure cooker.  Does a pastor need time for himself or herself?  You better believe it.  Someone used a play on words when commenting on the manner of Jesus… “He came apart from his disciples to pray”… The play on words is this:  either we come apart to pray or we come apart.  How true is that?  What was your pattern for prayer and getting centered spiritually when you were in the parish pastorate?  What is it now?  In the hospice chaplaincy, you have to build a schedule.  In fact, at Cornerstone Hospice you are required to have your schedule posted for the next 2 weeks. You have to visit your patients every 30 days.  That is a Medicare requirement.  You have meetings to attend.  The bottom line is this; you have to manage your time efficiently.  You have a starting time, 8 AM.  You have an ending time, 4:30 PM. 
3. Key Question #3:  What was your reputation as a parish pastor?  What strengths did your congregation recognize in you?  Were you seen as a man of God with a pastor’s heart? A great administrator? A leader? A successful communicator? A good listener?  All of these will hold you in good stead as a hospice chaplain.  Wouldn’t it be nice if were in our success zone all of the time?  Since we’re human, that means we make mistakes and earn the “stink eye” from time to time.  Here are some qualities that a hospice chaplain definitely does not want to be known for: being a KIA (know it all); sanctimonious; stingy; critical; careless with language; careless with jokes (dealing with race, women, morality, to name a few); argumentative; given to moodiness.  These are not exhaustive in number and description.  Perhaps you have more.  Our readers would profit from your observations.
4. Key Question #4:  What preparation have you made for hospice chaplaincy?  Each hospice organization has different requirements for hiring chaplains.  My observation has been that if the requirements are minimal, so is everything else about that organization.  Stay away from that.  The higher the qualifications, then the higher the standards of the agency. It could also follow that the pay and benefits are higher as well.  When I speak of preparation, my own opinions leak out like a fire hose!  When I was younger and impressionable, I was told in reference to the pastorate to prepare fully for the task.  My response to that was to earn a BA, an MDiv. and a DMin.  I’m not sure all that benefited me financially, but it enable me to function in the pastorate in a prepared manner.  When I transitioned to the hospice environment, I was blessed by two hospice agencies which encouraged and permitted me to take 4 units of Clinical Pastoral Education.  Did they pay for my Units?  No, but in a sense they did as they allowed me to take work time for my studies.  While it was not required, I earned Board Certification as a Chaplain and then certification as a Clinical Fellow in Hospice and Palliative Care.  Did any of this earn me a huge raise in salary? No, not a bit.  But, it gave me inner knowledge that I prepared as best as I could for the task I am charged with.  In the coming days, it is my opinion that in the new healthcare climate, Chaplains in the healthcare field will all have to be board certified.  I believe that will be a Medicare requirement.  For the longest time, hospice chaplains were parish pastors who were good people who cared deeply for the sick and dying.  It’s a different day in 2014 than in 1984 when hospice started.  We have gone from a ‘movement’ to an ‘industry’.  That carries with it a different set of requirements.  Hospice Chaplains, be aware of this and do your best to move forward toward board certification.  If you have questions about how to achieve this, please ask.  I’ll provide you with information.  Bless you, Chaplains, in your work.  

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 4

• Embrace the “we” messages of hospice chaplaincy.  The “we” messages must be embraced as much as the “I” messages must be jettisoned.  Here are several:
  • “We are a Team”—It is not up you, Hospice Chaplain, to make the final decisions about anything.  You serve with a Team and must be a Team player.
  • “We work together”—As a team player you function as a critical cog in the workings of the Team. No, there is no spotlight on you as there was in the church setting.  You are one of many team members.  Shine in  your discipline.
  • “We serve”—Our work is servant based ministry.  What we do has a primary focus on the patients and their needs.  We do what do to serve their needs, not our own.
  • “We plan”—At each IDT meeting we participate in a process of quality improvement as we update and edit our Spiritual Plan of Care along with the rest of the Team.
  • “We are accountable”—There is not a lot of accountability in the parish pastorate.  Perhaps there should be.  There are goals to be met, Care Plans to write, visit requirements to meet.  Each of these is deadline based.  You are accountable.  Also, if you defy accountability you won’t last long as you will cause the hospice organization to be in violation of CMS rules and may cause the organization to be fined severely.
    Here are practical tips on how to make the transition and embrace “we” messages:

1. Major on relationships.  You will be in many meetings with your IDT.  Get to know each by name and develop enduring relationships with them.  You will be visiting the same patients and may need to negotiate times and days when you will be visiting so you don’t bump into one another on the same day and time.  One responsibility you have is to provide spiritual and emotional support to your team.  You may be asked to officiate at the funeral of an IDT member’s loved one or officiate at an IDT member’s wedding or provide brief pastoral counseling sessions.  The relationships you build can last for the entirety of your hospice career.  Embrace your team and allow the relationships to build along a natural path.
2.  Win over your Team Manager and your nurses.  I am talking about skill in this rule of thumb.  Your Team Manager and nurses need to know that you are informed and skilled at what you do.  They do not expect you to know everything about medical jargon and disease processes, but it helps if you have a basic understanding of the process of dying.  Keep your nurses informed if you notice severe and quick decline in your patients.  They appreciate your phone call.  Be supportive of your nurses.  Complement them.  Encourage them.  One day you might happen upon them cleaning up a bloody death scene when the patient’s aneurism burst and claimed that person’s life while you are bringing comfort to the family.  You might happen upon a nurse whose visit took extra-long as they were cleaning the patient whose bowels let loose or the patient was in need of care after vomiting.   Their work is hard.  They need to know the Chaplain notices and extends appreciation their way.  All that you do in a positive manner finds its way back to the Team Manager.  When you speak in an IDT meeting, be brief, be detailed, and be informed in your comments.
3.  Participate in the IDT meeting.  The IDT meeting is not a time when you catch up on your computer work.  It is a time for focus and contribution.  You will be called upon to give a short spiritual care synopsis.  Make it count.  Remember, in every meeting you are building credibility.  Be prepared to explain how your actions are achieving the Goals/Expected Outcomes of your Spiritual Plan of Care.
4.  Excel with your patients and families.  I won’t be naïve to think that every patient and family caregiver will get along perfectly with you.  There will be those challenging patient and/or family caregivers that will give you heartburn.  Just keep in mind that these people are at the end-of-life, they have lost control over just about everything, and they are just trying to live another day.  With that said, excel in your spiritual care giving.  Always remember, we do not bring an agenda with us.  The patient sets the agenda.  We are there to serve. 
5.  Complete your computer work.  A Chaplain in the healthcare environment is going to do computer work of some kind.  The documentation at Cornerstone Hospice (my hospice) uses Allscripts.  Among all the matters that need to be addressed, the Clinical Note, pain score, decline observation are among the top matters that need to be addressed with clarity and excellence. 

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 3

• The transitioning parish pastor should be able to identify the pitfalls of the pastorate and seek to diminish their impact on his person and work as a hospice Chaplain.  Some of the more obvious pitfalls include these syndromes:
  • “Out of my way, I’m in charge”
  • “I’m the leader, I have all the answers”
  • “I’m the one responsible here”
  • “I’m the one who makes it happen here”
  • “I’m the final authority on faith and doctrine”
  • These are all “I” messages.  Unfortunately, in this era of the church it is common for the parish pastor to feel he is the sole leader of the church.  This has led to an epidemic of forced terminations of thousands of parish pastors.  Denominational affiliation has little to nothing to do with this trend.  Many pastors are fleeing the parish pastorate for hospice.  While that is complementary to the field of hospice chaplaincy, without cleaning out the closet of the above syndromes, little will change.  Yes, I have come upon hospital and hospice chaplains who missed the unit on self-awareness and are filled to overflowing with the “I” messages.  The above won’t work in hospice any better than they worked in the pastorate, however.

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 2

• A hospice Chaplain must have completed at least 3 units of Clinical Pastoral Education.  Why 3 units?  It is just the minimum acceptable here at Cornerstone Hospice.  I wish hospices were in the financial shape to require Board Certification, but that is not the case.  However, it is required that a hospice Chaplain have at least one unit of Level Two CPE.  In recent years the term self-awareness has given way to a newer term, Emotional Intelligence. 
  Emotional Intelligence is a newer term that has absolutely grabbed hold of the human resources world and business world.  And, it makes sense as EI or EQ whichever you prefer has a good bit to do with how an employee perceives him/herself as well as others.  It is built upon the concept of self-awareness.  You, as a Chaplain, ought to be very familiar with the concept of self-awareness since having up to 1,200 or 1,600 hours of supervised clinical training through Clinical Pastoral Education.  A lot of CPE is based on self-awareness.  Self-discipline and discernment are also key elements of EI.  A fun EI test to discover your level of emotional intelligence is found at this site:  http://www.queendom.com/tests/access_page/index.htm?idRegTest=3037.  I completed it and found that while I had a high level of EI, there was much I could do to grow.  This ‘test’ would make a good discussion starter in Chaplain meetings.  There are three benefits a Chaplain will gain from improving EI:
  1.         Emotional Intelligence helps us to “read a room”.  How many times have you been in a patient’s hospital, facility, or other room with family and friends in it and the dynamics were both subtle and obvious.  What were you learning about those persons surrounding the patient?  What did you think was happening with the dynamics?  Did this information assist you in relating in a more effective manner with the family?  The hospice Chaplain must be keen in this skill.
  2.         Emotional Intelligence helps the Chaplain to be aware of his or her own emotions and not let them ruin a visit.  There will be those times when it would be very easy for the Chaplain to get caught up in an emotional situation and lose effectiveness.  As I interviewed a candidate for a position, I noticed that in discussing the loss of his father, he broke down and wept.  It was clear his mourning was not complete.  This really could get in the way of his work with family members who were in the process of losing their father to death.  A Chaplain must be aware of his emotions or risk losing his ability to serve.  Now, I am not saying that a Chaplain cannot weep with those who weep.  I am saying that transference and projection are not acceptable for the Chaplain.
  3.         Emotional Intelligence helps the Chaplain understand the emotions of the patient and family/caregiver(s).  People need to feel understood.  People, at times, exhibit strange emotions.  People at end-of-life are allowed to exhibit challenging emotions.  If the Chaplain cannot understand the patient or the family caregiver, then an opportunity to assist these folks is lost and their inner peace is at risk.  The hospice Chaplain has a lot riding on her connection with the patient or family member.  When the Chaplain connects and conveys understanding and shows it with appropriate body language, the patient feels able to unburden a potentially deeply burdened soul.

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 1

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy

 

It is not an easy transition from the parish pastorate to hospice chaplaincy.  In the early days of hospice parish pastors took care of hospice patients and their spiritual needs.  As hospice began to develop and became more of an industry than a movement, professional Chaplaincy became the standard.  Making the transition is not easy by any means. 

 

There are at least six guideposts that will assist you with your transition.  Yes, this is a lengthy document, but hopefully in applying these guideposts your transition will not be lengthy.

 

• A hospice Chaplain must have a well-developed Pastoral Care Theology.  It is assumed that a parish pastor will have this.  Unfortunately, in many cases this is not true.  In hospice chaplaincy it is an absolute necessity. Here is my statement:
  My theology of ministry has its roots in the Person and Work of the Holy Spirit.  Three words come to mind in my theology of ministry:  Comfort, Counsel, and Companioning.  These three components of my theology seem so necessary in hospice chaplaincy.  My patients and their family members need comfort; at times they need counsel; and, always, need my companionship on their hospice journey.  Do I dare to think that my Person and Work has the same authority as that of the Holy Spirit?  I would be foolish to think so.  Yet, I feel equipped to provide these aspects of spiritual care as a mature and seasoned Chaplain.  Because I am settled and secure in my own faith journey, I am able to provide spiritual support to those of other faith groups.  I do not compromise my belief system in order to do my work.  Therefore, I am able to provide spiritual care to Christians, Jews, Muslims, Buddhists, Hindus, atheists, agnostics, followers of Eastern religious systems, Wiccans, and those who have other belief systems that are more secular. 
  In reading Professional Spiritual & Pastoral Care, edited by Rabbi Stephen B. Roberts, Skylight Paths Publishing: Woodstock, Vermont, 2013, I came upon an illuminating article by Rev. Dr. Martha R. Jacobs.  Her article is titled “Creating a Personal Theology to do Spiritual/Pastoral Care”.  She states, “My theology has to be large enough to accept the theology of those whom I serve, whether they are Christian, Buddhist, Jewish, Muslim, Sikh, Catholic, Humanist, or Atheist. If I cannot support a patient (or family member or staff person) in his or her theology, then I cannot serve as a multifaith chaplain, I need to be secure in my own belief system.  I also need to be able to be open to understanding and interpreting [my patients’ theology] or that of family members, or staff persons with whom I come into contact.  I have to be open to other people’s theology and help them through using their belief system, not my own.”
  Have you put to pen and ink your theology of pastoral care?  Those of us who have gone through the rigors of Board Certification can reflect upon the hours of work spent thinking through and reflecting upon this subject and then putting those thoughts and reflections on paper.  I urge you to take the time for this project.  You and those you serve will benefit greatly from it.

A Deeper Dive into the Interventions, Facilitating Communication

A Deeper Dive into the Interventions, Facilitating Communication

 

Sometimes it is difficult for patients to discuss their situation.  They don’t want to be seen a complainers, or they are so overwhelmed they can’t put words to their inner suffering.  Of course, there are other barriers to communication, but these two are thought starters for you. 

 

“Facilitate open expression of feelings” and “Use open-ended questions to elicit feelings” are interventions to assist with communication.  Never should communication be something that is forced.  Facilitating and using open-ended questions should be a smooth process for the experienced clinical Chaplain and not something is stilted and awkward.  The Chaplain needs a clear focus on why he/she is using either of these interventions.  When I review Spiritual Plans of Care, I don’t expect to see either of these interventions in the Initial Spiritual Assessment.  It seems to me that the Chaplain will need a few visits before these are added to Plan of Care.  By the third visit it should become clear to the Chaplain that the patient might have spiritual or existential issues that need to be discussed.  Certainly, not on the first visit.  The Chaplain has just met the patient and has no idea the inner pain the patient is experiencing.  What follows are several gentle open-ended questions/statements that could be used in your work:

 

• "Tell me how things are going for you."
• "Can you tell me about your understanding of about your illness?"
• "What is the most difficult part of this illness for you?"
• "As you think about what lies ahead, what concerns you the most?"
• "As you look ahead, what do you hope for?"
• "Tell me more about that."
• "Sounds like you're really worried about..."
• "What do you mean by '__' ('futile,' 'vegetable,' 'hopeless,' 'giving up,' 'everything')?"
   
  The above places the patient as the driver of the conversation.  The Chaplain then engages in inter-active listening.  As we know, just getting ‘stuff’ out brings a measure of inner healing in itself and a bond of trust will develop which is essential for quality spiritual care.
   
  Your feedback on this vital issue of Chaplain/Patient communication is welcome.
   
   

A Deeper Dive into the Interventions: The Ministry of Reconciliation

A Deeper Dive into the Interventions: The Ministry of Reconciliation

 

Facilitate positive relationship with clergyperson(s)/family members/institutions/others; and, Identify conflict with clergyperson(s)/family members/institutions/ others are the two main interventions for the purpose of reconciling estranged parties.  Identifying the problem is the first step, facilitating the process is the second step.  Facilitating is always on a permission basis because it takes work to do so.  Some patients are unwilling or unable to put forth the effort to forgive.  For those who might question the energy involved in the act of forgiveness, read on. 

 

The Chaplain is the one to provide the emotional and spiritual support to the patient when there is the devastating, back-handed answer of “No” to a humble request of “I know what I did was wrong, please forgive me.”  That answer leaves the patient and in other cases, the caregiver all discombobulated… emotionally and spiritually. 

What is the Chaplain’s response to the brokenness of the patient?  Let’s review the circumstances… First, what does it take to bring a hospice patient or, for that matter, any person to the point of seeking forgiveness?  I think I can speak to this because, like you, I have had to ask for forgiveness from those I have wounded.  It is a personal epiphany of the extent of failure, the awakening that what was done was so wrong that it damaged people I love, and that humbling oneself was far secondary to seeking to right the wrong.  Has any of you been denied what you requested?  I have.  If you can recall the pain of having been told, “No, I won’t forgive you”, then you can compassionately identify as you provide support to the patient reeling from that denial.  Brokenness responds to brokenness.  How have you worked through your denied request for forgiveness?  Counter-transference is not a healthy thing.  C.S. Lewis helps us out when he wrote: “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time, waking and sleeping.  It doesn’t change God.  It changes me.”  How does this statement inform your life?  “It changes me.”  Hearing those words drains the infection from the wound allowing me to heal.  It is never a pleasant experience to come to the place of deep humility, bare your soul and in that position of vulnerability seek a rightness where there was only wrongness and have it all pushed aside and denied.  We all pray because we are helpless.  Working through this type of pain is something only God can do.  Out of the richness then of your experience with God are you able to provide a balm to the deeply troubled soul of your patient.  God has a lot of experience with people who have said, “No”, to him.  I hope you have noticed that I did not provide a simple formulary of “The Three Steps to Helping Your Patient Overcome the Pain From Being Denied Forgiveness.”  I don’t think there is such a thing.  Life does get messy.  The above is part of the “identifying” process.  Moving forward to seek forgiveness carries a risk.  If the damage done to a loved one or friend or other person is so traumatic it may be a person to person meeting might cause more damage.  If so, could a letter be more effective?  There is much to consider in this matter of reconciliation.  May you wisdom and to guide you in your work.