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.