3 Great Benefits of Outcome Oriented Chaplaincy

Whenever I teach a session on Outcome Oriented Chaplaincy, there are the incredulous who think that this takes the ‘heart’ out of hospice care. Nothing could be farther from the truth. What’s at the heart of Outcome Oriented Chaplaincy is spiritual care that is both insightful and high quality. The following are three great benefits of Outcome Oriented Chaplaincy: 1. OOC provides a Spiritual Plan of Care that identifies the spiritual concern(s) of the patient AND family/caregiver. At Cornerstone Hospice, a very progressive and highly successful organization, the Spiritual Plan of Care is OOC. The Chaplains identify the spiritual concern, and then discuss the outcome or resolution that the patient is seeking. The Chaplain uses his/her professional experience to select the proper interventions to use that will assist the patient to meet resolve the spiritual concern as much as possible. Likewise with the family/caregiver. Cornerstone is the only hospice I am aware of that has this dual focus on providing a Spiritual Plan of Care for patient and family/caregiver. The electronic record has the Chaplain complete the Care Plan for the patient in one section and the family/caregiver in a completely separate section of the Assessment. 2. OOC wins the approval of the IDT. In any IDT or in some cases, the IDG, is composed of highly trained participants: a physician (some certified in hospice and palliative care); a social worker (some are licensed, some are also counselors); volunteer specialists, bereavement counselors (some with a Master’s degree, others with a PhD); nurses (some with advanced degrees and now all must be certified in hospice and palliative care); and, CNA’s. The Chaplains at Cornerstone Hospice are required to have a Master’s degree in an appropriate field of theology and 3 units of Clinical Pastoral Education. As I understand the trending of requirements, at some point hospice chaplains will need to become Board Certified like our hospital counterparts. I say all of this to indicate that OOC promotes highly educated and skilled spiritual clinicians. Further, a hospice committed to OOC will have didactics to re-enforce the concepts that make OOC such an effective philosophy of care. 3. OOC develops skilled clinicians. Long gone are the days when a pastor would volunteer his/her time visiting the sick of a hospice. Hospice Chaplaincy is a recognized field of spiritual care by a number of cognate groups that have a specialty certification in Hospice and Palliative Care. If the goal is to assist patients to have a ‘good’ death, then it is fundamental to consider that the Chaplain must have the skills to identify and resolve spiritual/existential issues as much as possible prior to the patient’s death. The same applies to resolving the family/caregiver’s spiritual concerns. You can find more information about OOC in “Professional Spiritual & Pastoral Care” edited by Rabbi Stephen B. Roberts. This book is a classic for chaplaincy and is a collection of outstanding contributions by recognized leaders in chaplaincy service. Bless you, Chaplain Friends, as you make full proof of your ministry.

7 Essential Skills Every Hospice Chaplain Needs to Develop

Recently I taught as class for Spiritual Care Volunteers. As sessions normally proceed questions arise about the hospice Chaplain. One question was: “What is the difference between a parish pastor and hospice Chaplain?” Without taking much time from the main presentation I replied, “A hospice Chaplain is much like a medical specialist. Chaplains are specially trained in end-of-life spiritual care. The parish pastor is a generalist who knows a lot about many issues, but will refer to specialists who are more able to counsel people in marriage crisis, or financial crisis or in end-of-life crisis. When I had knee surgery I went to a specialist, an orthopedist, who knew what the problem was and how to fix it.” My plan for this article is list 8 essential skills a hospice Chaplain excels in to provide effective spiritual care. The list is not in order of priority. Skill One: Empathetic Presence. We looked at the topic of empathetic listening in the August 12, 2014, post. Endlink Resource for End of Life Care Education suggests that empathetic presence involves the following: “Active listening; Relaxed yet engaged body posture; Eye contact (when culturally appropriate); Reassuring touch (when culturally appropriate); Listening beyond or beneath the literal words said by a person to the deeper emotions, meaning, and needs; Empathetic presence may also involve a metaphorical “holding someone’s pain” as you are open-hearted but do not become overwhelmed emotionally; It may also ask you to laugh, be joyous, and not focus on illness, pain, or dying; In the face of comments such as “why is God making me suffer so?” or “I just wish this were over, I can’t stand it anymore” empathetic presence might include: Acknowledging their suffering; Saying you are sorry you don’t have the answer or solution; Providing reassurance of your (or the team’s) ongoing care.” Skill Two: Assist patients and families to adjust to their “new normal”. Regardless of the disease process, at end-of-life patients and families experience internal chaos of confused emotions, anticipatory grief, and spiritual pain. The hospice Chaplain can greatly assist through affirming that their experience is normal and expected. Further, the Chaplain can offer reassurance that the entire hospice care team will be there for them. Their “new normal” is a familiar experience to the care team and all that can be done to be supportive will be done. Skill Three: Dignity therapy. Max Chochinov developed this approach to providing a life review for patients. The We Honor Veterans program has a similar life review called the Veteran’s History Project. Both of these formal venues can place in the hands of the family and caregivers a powerful life review of their loved one. A life review can also be done in a more informal manner through a pastoral encounter. Whatever method the Chaplain uses to guide the patient through the life review the key is that the patient can express the highs and lows of life and any expression of regret or satisfaction with life. Skill Three: Meaning making. One of the vital issues patients at end-of-life work through is meaning making. What gave my life meaning when I was healthy? What gives my life meaning, now? These are powerful questions the scream for answers. You will be amazed at what a patient will say to these questions. Some answers will bring the Chaplain to tears. Skill Four: Hope/strength/comfort. These three values I placed together because they play off of one another. When a patient thinks through what gives hopes to their lives, they often receive new strength for their suffering and thus, comfort. There may be others who have entered their lives at some point in the past who made such a profound impact on them that a call, an email, or a letter will provide great strength and comfort. As a Chaplain, I looked for ways I could bolster hope in the lives of those I served. By contacting a university’s sports program, I was able to assist a patient who held the sport’s team and coach in high regard. In another case, a patient received a fishing trip which he talked about during the weeks preceding his death. We must have hope to live when healthy. We need hope to live when we are facing death. Skill Five: Helping the patient see things in a new light. This is a brief definition of reframing. Suffering brings about its own emotional trauma. The skilled hospice Chaplain can greatly benefit the patient by reframing the circumstances. For instance, a patient in an initial visit may be very shocked that his physician has told him that there is nothing else that can be done and hospice is the only option left. A sensitive Chaplain may reply to this by saying, “Your doctor may have told you there is nothing left to do for your illness, but we will do everything we can to bring meaning and hope to your life.” Compassion and common sense are keys to reframing. I read a passage in Mark Twain’s, Tom Sawyer, which makes me both smile and laugh at Tom’s brilliance at reframing a punishment he had rightly earned. He was given the task to whitewash 30 yards of fence on a Saturday while his friends all went to the local swimming hole. Tom’s friend, Ben, began to taunt him with his having to work. Tom’s reply is classic reframing. “What do you call work?” “Why, ain’t that work?” Tom resumed his whitewashing and answered carelessly: “Well, maybe it is, and maybe it ain’t. All I know is, it suits Tom Sawyer.” “Oh come, now, you don’t mean to let on that you like it?” “Like it? Well, I don’t see why I oughtn’t to like it. Does a boy get a chance to whitewash a fence every day? That put the things in a new light…” (Twain, 1970, [1876], p. 18) Skill Six: Perpetuating religious rituals. Most hospice patients have been out of their churches, synagogues, temples, or other place of worship for quite some time. Their souls long for ritual. The hospice Chaplain recognizes that and makes provision to either meet the ritual needs herself or will call upon a local Pastor, Rabbi, Priest, Monk, Imam, or other spiritual leader to assist. Skill Seven: Communicating with patients with a dementia. This is a topic dear to my heart as I have developed a means to do just that. John Zeisel wrote, “I’m Still Here: A New Philosophy of Alzheimer’s Care”. Having done my research and application of theory, I can attest that the patient’s being is still there. My perspective is simple, if the patient is still there, it’s our moral duty to go and find them by learning techniques to reach them. Each of the above skills has to be sharpened and practiced. These skills do set the hospice Chaplain apart from the parish pastor or even other types of Chaplains. These skills characterize the work of the hospice Chaplain affirming the unique contributions they make to healthcare. Bless you, Chaplains, as you provide comfort and care to those you serve.

When theology meets suffering …

When theology meets suffering … The late Yandall Woodfin, Emeritus Professor at Southwestern Baptist Theological Seminary, stated: “You have not done Christian Theology until you have dealt with suffering and death.” As I understand his statement, the application can be taken at least in a two-fold manner… personally and professionally. Personally, I get the idea the idea of how my faith and belief system, my theology, if you will grows in a formative manner through suffering and death. When I was 10 years old, my father died. That was hard for a 10 year old whose surviving family members were two sisters and a Mom. There was suffering involved with the process of life after his death. We were plunged into immediate poverty. My Mother had to find a job and in that day and time, the Beaver Cleaver days when Dad worked and Mom raised the kids, jobs for women were scarce. As it turned out, I lost my Dad to death, and my Mom to the work world. I went from the ready-made breakfasts and lunches, to a get-it-yourself way of living. We did without a lot in those days. Suffering wasn’t limited to my childhood years; it seemed to follow into adulthood. The seminary lifestyle was harsh and hard. I worked two jobs, my wife worked one. It still only hardly made ends meet. The parish pastorate had its good and bad. The good was really good and the bad were really bad. In my 25 years of the parish pastorate I met some of the most godly, God-fearing, God-serving, God-loving people. I also met some of the most horrid people who ever walked on the earth. The latter defined suffering and often were agents of suffering. When I entered into hospice chaplaincy, I discovered a new facet of suffering. Every day I went to work, I discovered suffering from new perspective. Men suffered, women suffered, children suffered … the pangs of life-limiting illness, the sense of loss of nearly everything they worked for or lived for, the reality that their lives would be cut short. With this suffering, there was the suffering of the families and caregivers… the suffering of loss. The suffering of children stricken with diseases that have such monikers as Hurler’s Disease and Epidermolysis bullosa can take the wind out of the Chaplain’s theological sails. How does a Chaplain make it work theologically? So as to not lecture those with strong theological education and come across offensive and arrogant, I will simply offer my own understanding of how I process suffering from my theological formation (which is unapologetically Christian): 1. I look at the beginning of suffering from Genesis. 2. I look at the resolution of suffering from Revelation. 3. I seek understanding of God’s view of justice. 4. I attempt to understand God’s providence. 5. I look to the Cross. If this provides you with an addition framework for your theology of suffering, then this post will have been successful. Dig deep in your soul as your process suffering and theology. Bless you, Chaplains, as you work with Common Man who suffers.

7 Winsome Personality Traits of Hospice Chaplains

7 Winsome Personality Traits of Hospice Chaplains I read in the Positive Attitude Café blog this tremendous description of a winsome personality: “Winsome personalities are the ones that definitely ‘win’ more. Unfortunately, we don’t hear this trait mention very often anymore. Yet, it is a refreshing word description of someone whose life exhibits tangible positive and energetic qualities. People want to be around these individuals. Don’t you? Absolutely!” The hospice Chaplain relies upon his/her personality to begin a healthy, pastoral relationship with both patients and their families/caregivers. There is nothing that takes the edge off of a new relationship than a smile, a kind work, something encouraging, perhaps a bit of appropriate humor, and the attitude of “I like being here with you.” To get you thinking about winsome personality traits, I will list them and provide a brief comment about each. 1. Integrity—Integrity frees up the Chaplain to have all of his mental/emotional faculties about her/him. No energy is drained trying to cover anything up like cheating on a mileage report or length of visit time or writing Clinical Notes for patients not seen. Integrity goes a long way to define the Chaplain. In a pastoral care relationship trust is THE key component. Everything else is built upon trust. 2. Responsibility—Pastors, be they parish pastors or hospice pastors, have a flock that needs care. The hospice Chaplain is responsible for providing that care. When I first started with hospice my assignment was a facility of all dementia patients. I was lost in attempting to provide care. I was in need of instruction. Responsibility lead me to discover new and successful ways to provide spiritual support. It is our responsibility to discover how to provide care for our patients. 3. Flexibility and adaptability are fundamental. One thing I have learned in hospice work is everything is set in jello. Change, as the wind upon the wave in the middle of a hurricane, is the norm in hospice care. The Chaplain has to be flexible and adaptable. This has everything to do with attitude. When it comes to change some bristle and complain. The winsome Chaplain accepts change as the norm and keeps her/his spirit sweet. 4. Compassion—Need this trait have any comment? 5. Courage—Advocating for a patient in an unfamiliar setting is a challenge that requires courage. For instance, I was visiting a patient in a hospital and noticed he was in pain. He had already spoken to the nurse stating he was in pain and was told his next dose of pain medicine was not until 2 hours. I excused myself from his room and spoke to his nurse to request that she look at his chart to see is he had a PRN medication for such a time as this. The orders were clearly written that he did have a PRN medication listed. She then got him the medication and thankfully his pain began to subside. Another example of the necessity of courage has to do with the Chaplain providing an ethical statement in an IDT meeting. I have done this on several occasions. While the hierarchy within the IDT is theoretically flat, there still is a pecking order of sorts. It takes courage for a Chaplain to give an ethical voice to a patient need. 6. Patience—The hospice Chaplain must exhibit patience. In any organization, there will be glitches in technology, problems of various sorts, and issues that defy quick resolution. In providing pastoral care, there will be those who question the use of medication, question what a Chaplain does, and question the benefit of Chaplains. In the world of ministry, there will be parish pastors who think the hospice Chaplain is less than in the value of ministry. This requires great patience. Patience keeps the circumstances calm. Patience keeps the spirit kind and sweet. 7. Conscientious—The hospice Chaplain exhibits a conscientious demeanor whenever a pastoral care visit takes place. The Chaplain exudes this through attentive and interactive listening, through body language, through gentle and insightful dialogue, to name but a few. The Chaplain exhibits conscientiousness by keeping all patient visits in compliance and by providing excellent documentation. The Chaplain recognizes that he/she is part of a Team effort and embraces the IDT with a sense of loyalty to all and to the mission of hospice. Those are 7 I believe are on the top of the list for a Chaplain to have as part of his/her life. Time and space prevents me from discussing these additional winsome traits: Dependable, Discreet, Fair, Observant, Optimistic, Intelligent, Persistent, Capable, Charming, Confident, Encouraging, Reliable, Helpful, Humble, and Imaginative. I will leave that up to you to think on those traits. They are equally important. Bless you, Chaplains, for your great work.

3 Major Warning Signs of Pastoral Caregiver Fatigue

3 Major Warning Signs of Pastoral Caregiver Fatigue You wake up one morning and you don’t feel like going to work as a hospice chaplain. You’re tired, feel overwhelmed, and feel you can’t make it another day. What is the problem? You might wonder if you’re coming down with the flu, wonder if you’re depressed, but conclude you’re just emotionally fatigued. In this post, I want to suggest that there is an early warning system built in to our emotions. However, ministers are the worst at listening to that early warning system. We are so overly committed to our work that we fail to listen to one doing the work … ourselves! Early Warning System Alert #1: Forgetfulness—Forgetting the car keys or a pen or something minor happens from time to time. Forgetting a patient visit and then another is something in a different category. Have you done this lately? The reality is you have your visits on your Scheduler and still miss them. Heed Alert #1. Early Warning System Alert #2: Irritability—Ok, so you got up in a bad mood. We all to that sometimes don’t we? We work out of it by mid-morning and enjoy the rest of our day. After all, we can’t act irritable toward our colleagues, right? Well, Alert #2 suggests that we are irritable toward those colleagues and our family. Nothing satisfies us. We’re in what seems like a permanent bad mood. It seems we’re mad at the world. Heed Alert #2. Early Warning System Alert #3: Decline in productivity—Your caseload has grown and you’re having trouble managing it. You just dread making phone calls anymore. You’re good at it, but not now! You’ve gotten lost in the caseload. Your productivity has declined markedly. Heed Alert #3. If you heed the Alerts mentioned above, then here are the steps you need to take: 1. Speak with your Spiritual Care Manager. Do not wait until you are so far out of compliance that it will take weeks to catch up. That is endangering the company and your position. Nip it in the bud. Keep in mind that self-awareness was a fundamental of CPE. Your SCM will understand and assign a PRN Chaplain to assist. 2. By all means, take some PTO. When you experience this type of fatigue, your body, mind, and soul is crying out for rest. 3. Review recent events in your life. For how long a period of time has this been building? Are you burning the candle at both ends? Are you trying to do too much with your time? Some Chaplains are also bi-vocational pastors. The sheer magnitude of psychic energy expended in both positions can be very draining. Even Elijah needed to rest and eat good food. 4. What are you doing for self-care? Are you getting enough sleep? What about your diet? Are you eating a healthy diet or are you eating on the run and high carb lunches at that? What about exercise? What are you doing to work your body into some short of healthy condition? When was your last physical? 5. If life has you weighed down and you sense you are depressed, get the EAP number from your office. Contact the EAP people, set the appointment, and go. There is no shame in this. We all need help from time to time. 6. Keep your manager informed. Communication is vital at this stage. Spiritual caregiving is not a walk in the park. That you are fatigued confirms this. Get rest, get well, stimulate your spiritual disciplines, do what you need to do for you. Bless you, Chaplains, for who you are and what you do.

What type of Pastor were you before you came into hospice?

What type of Pastor were you before you came into hospice? That is a stunning question. It is a question that forces a sense of self-awareness. 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 forgave 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. Steve Maraboli in his book "Unapologetically You: Reflections on Life and the Human Experience" reminds us, “When you're too religious, you tend to point your finger to judge instead of extending your hand to help.” These qualities, both positive and negative, 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.

5 Rules of Thumb for New Hospice Chaplains

If you are new to hospice chaplaincy, welcome aboard! Getting a firm footing is essential to your long-term success. You will find it a wonderful career. There is never a dull moment as you will soon discover. Having mentored CPE students and Chaplains who came to hospice from the pastorate and other chaplaincy venues, I have distilled to 5 the rules of thumb that will hold you in good stead as you gain your experience. 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, 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. Serving as a hospice Chaplain is a great calling. Getting off to a good start will make your work extremely enjoyable. Blessings upon you, new hospice Chaplain!