Here is a not-so-nice secret: Some nurses sometimes prevent chaplains from doing their work well. Given the support chaplains can provide to the interdisciplinary healthcare team—to patients and their families, and to clinicians—let's expose this secret.
Recently, I completed a survey of 266 chaplains in the United States (Taylor & Li, 2020; Taylor & Trippon, 2020). What many communicated was that, though they generally have great admiration for nurses, they also have frustrations while working with them. I asked a provocative question, and admittedly one that may have biased their responses: How often do you sense nurses creating resistance (or “gate-keeping”) to your work? I asked because I had heard this anecdotally for years. Although nearly half (49%) reported never or rarely, nearly as many (47%) responded that it occurred occasionally or sometimes.
In what ways do nurses prevent chaplains from fully functioning? What are our barriers to working with chaplains? What can we do to enhance collaboration? Allow me to briefly share some of what these chaplains taught me.
HOW DO NURSES PREVENT CHAPLAINS FROM THEIR FULL FUNCTION?
Trained chaplains provide support across the continuum of care for patients, their family members, and clinicians when they experience emotional, spiritual, religious, and ethical challenges. They provide this support to all, regardless of others' religiosity or lack thereof. Thus, nurses who only make referrals when a patient is about to die or only for religious patients or only for patients who desire a ritual fail to allow the chaplain to function fully. “[I] [h]ave a low threshold for calling the chaplain,” one respondent wrote. Chaplains ask that they be called when a nurse or a patient's family member is distressed. Call before the crisis point, if possible, to allow the chaplain to establish rapport or avert spiritual disintegration. Allow opportunity for chaplains to practice to the full extent of their ability.
WHAT ARE NURSING BARRIERS TO WORKING WITH CHAPLAINS?
Scant evidence documents nurse perspectives about collaborating with chaplains. This, along with what chaplains conjectured, inform my list of potential barriers. These barriers include lack of information about the role, training, and skill set of chaplains; fear that chaplains will interfere with patient care (e.g., “be in the way” or unwittingly create emotional upheaval for a patient); a previous experience that led to concluding that all chaplains are incompetent and all patients must be protected from them; and professional territoriality. This last barrier may specifically apply to nurses who believe they are spiritual care experts. It is also possible that nurses may be territorial about their religion and resist making a referral to a chaplain of another religion.
HOW CAN WE ENHANCE COLLABORATION?
The most vital component of nurse–chaplain collaboration is communication. Talk with your chaplain. Learn about your chaplain's training, certification, and expertise. Some chaplains may be untrained volunteers with limited skills, whereas others may be board certified and extremely competent. Learn when, for what, and how they would like to receive referrals. For example, some chaplains prefer a nurse to not ask a patient's permission to make a chaplain referral because often patients say no; this prevents a chaplain from the opportunity to gain rapport, break a stereotype the patient may have, and to offer care. Thus, ask your chaplain (and consult referral policy that may exist) regarding how nurses are to initiate chaplain referrals.
A nurse can improve patient care by providing chaplains with pertinent background information prior to a visit; this may enhance the chaplain's ability to be therapeutic. A potential irritant for both nurses and chaplains is when experiencing the presence of the other at the bedside as interference (e.g., “the nurse interrupted”). Thus, nurses can negotiate time and space for patient care with chaplains. They can also encourage the chaplain to give report after patient visits. Indeed, communicate!
Nurses are spiritual care generalists. Professional, trained chaplains are the experts. Let's work together to provide spiritual care.
Taylor E. J., Li A. H. (2020). Healthcare chaplains' perspectives on nurse-chaplain collaboration: An online survey. Journal of Religion and Health
, 59(2), 625–638. https://doi.org/10.1007/s10943-019-00974-9
Taylor E. J., Trippon M. (2020). What chaplains wish nurses knew: Findings from an online survey. Holistic Nursing Practice
, 34(5), 266–273. doi: 10.1097/HNP.0000000000000401