Remember the past with gratitude. Pope John Paul II (2001, para. 2)
Many healthcare organizations owe their underpinnings to religious identification. Christian, Jewish, and Muslim faithful called to care and serve were the first known nonfamily direct caregivers of the sick. Today, healthcare secularization trends, starting in the 20th century, have muted the religious emphasis in many organizations. One group retaining religious identity while continuing to evolve with the times is Catholic healthcare. Religious sisters were the center of Catholic healthcare development in the United States. The number of religious sisters has slowly and steadily declined for more than 30 years. The authors wondered about the impact this has had on the continuation of Catholic identity within Roman Catholic-sponsored healthcare.
A glimpse to the past provides a lens to view the future with hope. Religious Sisters in Health Care: The Conspicuous Love of Jesus is a project to aid in understanding the impact that Roman Catholic religious sisters have had on healthcare in the United States. The impetus for this work was the realization that it was rare to see a religious sister at work in a Catholic hospital. From the beginning of a full career until nearly retirement, it was clear the physical presence of sisters in hospitals was subconsciously understood to identify Catholic healthcare. Without the sisters in this role, the sense of Catholic mission as defining practice suddenly seemed less obvious.
The authors had worked with many sisters who accomplished great things. These religious women were, almost without exception, forward thinking. Religious Sisters in Health Care: The Conspicuous Love of Jesus project attempted to bring two things to practicing nurses: an appreciation of how sisters have laid a solid foundation for ongoing ministry and how Christian nurses can purposefully keep their own healing ministry alive for every person under their care, whether or not the nurse identifies with the Roman Catholic faith or works within a Catholic healthcare organization. The project uses the words of religious sisters to remember and reaffirm commitment to the essence of Catholic healthcare: the healing presence of Jesus, particularly to the thousands of nurses, therapists, and technicians who deliver direct care to patients.
WHAT IS CATHOLIC HEALTHCARE?
For context, a brief summary of the legacy of Catholic sisters interviewed is significant. Religious sisters in the Roman Catholic faith did not set out to build hospitals in the United States. Each order responded to calls for ministry: calls to care for the poor and underserved and those who society turned away. Catholic healthcare in the United States began quietly. In the 19th century, in Toledo, Ohio, the Grey Nuns of Montreal answered a priest's call to care for those affected by a typhus epidemic (Fitts, 1971). “We are meant for work such as this,” Reverend Mother Marie Julie Descamps replied. “The sick, the poor and orphans are our raison d'être” (reason or justification; Ockuly, 1995, p. 3). Sisters of Mercy answered the call to care for young girls living on the streets. In the late 1800s, it would have been hard to find a less desirable role for a girl than to be without shelter and protection. No one wanted to associate with people who obviously lacked Christian morals. The sisters provided love, safety, and a chance to learn a work skill while preserving the reputations of these vulnerable women (Sullivan, 1995). The Sisters of Notre Dame came to Cleveland, Ohio, and worked with the enormous immigrant population to establish schools and orphanages (Vincentia, 1955). Humility of Mary, founded in France, answered the call in 1864 to provide education, healthcare, and community service to those in the Cleveland and eastern Ohio regions (Grabowski, 2022).
From the beginning, religious sisters didn't need to be told about social determinants of healthcare. They attacked them head-on. Attention to the social and economic realities affecting overall health is a hallmark of the caring and compassionate difference found in Catholic identity. The sisters' work changed and grew with the times. Catholic healthcare grew throughout the 20th century in size and scope, yet the number of sisters who discerned the call to the work declined.
To learn what it was like to be part of the largest growth in U.S. Catholic healthcare, the project sought stories from sisters who have directly influenced Catholic healthcare from the last half of the 20th century until today. Their stories tell how to sustain focus on what defines our best selves. Most specifically, the sisters had advice to those who do the direct care work of Catholic patient care, as well as administrators and nondirect patient care staff.
A convenience sample through known contacts was asked to participate. The target population was women from religious orders whose charism, which is a special gift bestowed by the Holy Spirit, specifically identifies healthcare as part of their mission or whose individual work takes place within Catholic healthcare. Each sister had extensive experience in the ministry of Catholic healthcare. Their roles ranged from nurses to chaplains to administrators. For further details, see SDC: Biographical Information at https://links.lww.com/NCF-JCN/A95. A short questionnaire was developed and face-to-face interviews were conducted. All interviews were audio-recorded in their entirety and are archived at the U.S. Catholic Special Collection in the libraries of the University of Dayton, Dayton, Ohio; see Web Resources for the link.
LIFE AS A SISTER IN CATHOLIC HEALTHCARE
When describing the most significant changes during her professed life, each sister immediately recognized the importance of Vatican II. Called to order by Pope John XXIII, Vatican II or The Second Ecumenical Council of the Vatican was a coming together from 1962 to 1965 of Catholic clergy and other leaders to examine the church's relations with the modern world. The meeting had far-reaching outcomes and transformed the way the Catholic Church responds to lay leadership and directly meeting the needs of the people (Alexander, n.d.). Supporting lay leadership, recognizing the value of education for sisters, and opening the church to new ideas profoundly affected each sister interviewed. Sr. Marjorie Bosse said, “Vatican II allowed us to be more able to reach people. Sisters of Mercy go where the people are. Today in the greater Cincinnati area we have five hospitals but more than 100 different outreach centers.”
Vatican II also opened up the church ministry for laity in both Catholic education and healthcare. According to Kauffman (1995), the Second Vatican Council represented a shift to new religious consciousness in accord with the roots and distinctive character of religious life. In the following decade, the number of religious sisters involved in healthcare declined from 13,618 to 8,980, mainly due to the increase in women leaving the religious life and fewer women discerning a religious vocation.
Those sisters who remained in healthcare were particularly ready to embrace change. They were better educated, more professionally competent, and had a higher consciousness of the meaning of religious life. The Sister Formation movement preceded Vatican II by approximately 15 years and recognized that religious communities of women needed to change (Kauffman, 1995). Previously, orders were perpetuating immaturity. With the Sister Formation Conference, internal community changes brought greater professionalization, cooperation, and collaboration among congregations. Sr. Doris Gottemoeller explained,
For example, six months after entering religious community with only a high school education, sisters in formation were often teaching school. It was acknowledged this was unjust and impossible to sustain so it was changed. Sisters would have college preparation, ideally a bachelor's degree, before going into education ministry.
Congregations post-Vatican II embodied dialogue and discernment. Sr. Doris recalled that in the 1960s, change was in the air internally and externally. For the sisters, these changes included moving from blind obedience to thoughtful discernment. Sr. Doris went on, “I outgrew blind obedience. I had the benefit of every bit of this. My community was very generous to me.” Sr. Doris remembered life pre-Vatican II: “I was in charge of a multi-million-dollar organizational budget but wasn't allowed to drive or leave my house alone after dark. Attending evening board meetings required some careful coordination and scheduling because neither was I allowed to go alone.” Post-Vatican II, each congregation had periods of experimentation to craft new constitutions and customs. Change was directed by the communities. “That changed everything. We could travel, go to evening meetings, participate in decisions, and drive.”
The Sisters of Mercy traditionally received new assignments every August. Sr. Rita Mary Wasserman's first assignment was to teach 54 first graders. She enjoyed teaching and was prepared to continue. The next year her assignment slip told her that nurses were needed and directed her to Mercy Hospital School of Nursing. She became a registered nurse. Sr. Rita Mary said, “We were told whether we would be nurses or teachers or go elsewhere there was a need. We were told where to serve and we obeyed.” Even today, nearly 60 years post-Vatican II, religious sisters continue to take a vow of obedience and accept ministries assigned by the order. Obedience calls the sister to imitate the obedience of Jesus Christ, understand God's will for her, and obey lawful superiors in her order and within the Roman Catholic hierarchy (Strain, 2011).
One exception was Sr. Dorothy Thum. Influenced by working with her father in a bakery, her love of science and “the miracle of the human body,” she was studying dietetics at the University of Dayton. When she discerned her call to the religious life, she discovered that the Sisters of Mercy had a healthcare ministry. Sr. Dorothy sent a letter expressing her interest, joined the order, and completed her studies at Edgecliff College. She served initially as the Assistant Dietary Director and then Dietary Director at Our Lady of Mercy Hospital in Cincinnati.
Almost without exception, the sisters went directly into leadership positions in Catholic healthcare after college graduation. For example, Srs. Marie Hartmann and Marjorie were assigned as operating room nursing supervisors; Sr. Mary Thill was the administrator at Rosary Hall, a care facility for Franciscan sisters. Sr. Rita Mary sums up her transition and that of many others, “One day I was a student nurse and the next a supervisor at Mercy Hospital in Toledo.” Career trajectories included board positions around the country and sometimes globally. Positions as CEOs were common. Leadership positions within their congregation crossed over to leadership within a healthcare system. Sr. Doris is an example of a sister who was not assigned to healthcare until later in her career. In 2000, nearly 50 years after taking her first vows, Sister Doris was assigned to be Senior Vice President for Mission Integration at Mercy Health. Prior to this, she had served as a teacher and a member and officer on various other boards, committees, and task forces. Sr. Doris also served as Provincial Superior or head officer of the geographical area known as the Cincinnati Sister of Mercy Province.
IMPACTS OF CHANGE
The sisters strongly felt that bringing individual Catholic hospitals together as systems, which began in Ohio in the early 1980s, was a significant movement that impacted Catholic identity in healthcare. It was also an outgrowth of the Sisters Formation Conference recommending increased cooperation and of Vatican II calling for new roles for laity. Hospitals and religious congregations needed to work together and not compete. The continual focus on the mission and commonalities strengthened Catholic identity in the communities that were served.
As systems were created, they were very intentional in investing in mission activities. Sponsorship involved annual written reports to Rome along with updates to the bishops. Adherence to Ethical and Religious Directives for Catholic Health Care Services also strengthened identity. These directives are decreed by the United States Conference of Catholic Bishops and govern ethical decisions made within Catholic health facilities (Penan & Chen, 2019).
Sr. Dorothy saw how the world expanded and opened up. She credits lay leadership alongside sisters in growing the influence of Catholic healthcare.
This expansion for Catholic healthcare has been guided by the religious and lay leadership of the Catholic Health Association. The impact of technology on healthcare cannot be overstated, particularly as one looks back from the early days of the Sisters of Mercy and Venerable Catherine McAuley in Ireland to today's health care.
As Sr. Maxine Young has observed, Catholic identity in healthcare faces serious challenges. Health insurance companies' control of healthcare access, a focus on specialization rather than the whole person, and profit margins emphasized over the individual have to be integrated into the Catholic business model. Catholic identity has been challenged to bring balance to these very real forces in the industry today.
Fr. Joseph Cardone, Chief Mission Officer, Bon Secours Mercy Health, summarized it well.
What sisters did historically they did not do alone, they always worked with others, particularly lay people. They came to care for the sick. They did not come to build hospitals. There is a shortage of women religious today. But the future of Catholic healthcare does not depend on women religious. The sisters have been very shrewd and very smart. They recognized that they would not always be around and planned for others, especially laity, to be trained to take their place.
Father Cardone was referring specifically to a unique structure envisioned by the Grey Nuns of Montreal, the Public Juridic Person (PJP), an organization that operates within the church structure to oversee ministry and maintain Catholic identity. The PJP replaces the congregation as the religious sponsor while holding fast to the charism of their founders. Remaining true to Vatican II, Catholic healthcare has promoted lay leadership in a multifaith environment. It is clear that healthcare is a business and lay leaders bring the business component. Hard business decisions have to be made with compassion and adherence to the ministry. Sr. June Ketterer, Grey Nuns of Montreal, said about St. Vincent Mercy Medical Center, “Our ministry is not rooted in the Grey Nuns but in Jesus.”
The continual evolution of roles is important. Sr. Dorothy recalls, “Sisters may have started it, but they were not alone.” In 1843, Sisters of Mercy came to the United States from Ireland and opened the first American Mercy Hospital in Pittsburgh, Pennsylvania. Today, in her role as Senior Vice President, Mission and Values Integration, Mercy Health, Toledo Market, Sr. Dorothy works to protect children from neglect and abuse by advocating for Mercy Health-Children's Hospital. The message came through clearly in each Project interview: Sisters go where they are needed. They have developed Catholic healthcare to adhere to a high standard. Now they are moving on to meet new needs. Sr. Doris said,
The presence of sisters was indispensable in bringing us to the present point (in Catholic healthcare) but they are not necessary in moving forward. A solid foundation in healthcare has been laid and we are not needed to lead forever. Our numbers have dwindled, and attention needs to be paid to other ministries.
SUSTAINING CATHOLIC IDENTITY
Sr. Maxine, in her work with the elderly in need, constantly calls on her faith, asking, “What would Jesus do?” This prayer helps in daily decision-making and she believes it is a powerful tool for staff in all levels of Catholic healthcare. The sisters' view of the future of Catholic healthcare identity was strong and positive. Sr. Marjorie said, “Catholic identity is strengthened because we work within the organization. People feel their work is a sacred trust and they will continue to carry it out. Patients feel that in the care they receive. I don't worry.” Sr. Doris answered,
Since we don't take Catholic identity for granted but are very deliberate in our commitment, it is stronger than ever. Do you think there is anyone in Cincinnati who does not know that Mercy Health is Catholic? What accounts for that? It is not any one thing, but it is the visible art, signage, chapel, prayer in the workplace, general excellence, charity.
Sr. Dorothy reflected that compassionate care is Catholic identity made visible. She thought that lay people may own the mission even more strongly when sisters are not present, actualizing an understanding that sisters cannot be the only ones responsible for the mission.
Sr. Rita Mary cited several tangibles, like a prominent display of the Stations of the Cross at St. Charles Mercy's new behavioral care unit, the Blessing of Hands done annually during Nurses Week, and allowing patients to take the room crucifix home if they ask. These ideas were not spearheaded by the sisters, but by lay leaders.
Sr. Marjorie said simply, “Caring comes through.” She gave a great example.
One of the biggest mistakes we made was years back when we built our room size based on payment we received. This was wrong. We did what the insurance company told us to do because we were concerned about the bills patients received. Now we give all patients private rooms because we care for the person. Dignity is worth something. It is the person. We have corrected that mistake.
Sr. Doris stressed the need for advocacy, particularly advocacy that brings attention to the social determinants of health. The sisters have always recognized that health does not exist in a vacuum. Advocacy is a core work of mission addressing healthcare policy, food access, education, neighborhood safety, and mental health service availability. To this she added that Catholic healthcare advocacy means fair and equitable employment opportunities for direct care providers, including working with unions.
Sr. Mary Thill is introspective about the role laity will play in the future of Catholic healthcare as sisters have moved from being a labor force to being present as elders. She believes the sisters have a stronger contemplative life than most laity. The laity must be given “tools and skills to develop a stronger spirituality.” Regular attention to spiritual development is essential for every person who cares for others in Catholic healthcare. She wholeheartedly supports the use of mandatory spiritual time off in the form of retreats and other forms of time away from the bedside.
ADVICE TO PRESENT AND FUTURE LAY LEADERS
Despite the wealth of experience of these sisters, they were reluctant to give advice. This reluctance may be threaded by the knowledge of how complex healthcare is and how difficult the job. It also reflects the genuine humility of these women who are not easily given to presumptive behaviors. Yet some advice was forthcoming.
Sr. Doris said,
Sustaining Catholic identity begins with hiring. These hires should value the ministry that is identified Catholic, not necessarily that they are Catholic themselves. You can use the system and Catholic Health Association resources as tools for the healing ministry of Jesus.
Hiring the right person for the job no matter their faith is long-standing in Catholic healthcare. In the late 18th century, when recruiting Dr. William Worrall Mayo to St. Mary's Hospital in Rochester, Minnesota, which eventually became the famed Mayo Clinic, Mother Alfred Moes, Sister of St. Francis of Our Lady of Lourdes, told Dr. Mayo when he asked if his being Episcopalian would be a problem, “The cause of suffering humanity knows no religion or sex; the charity of the Sisters of St. Francis is as broad as their religion” (Kauffman, 1995, p. 132).
Looking forward, Sr. Marie Hartmann said, “As laity you are the ministry, and you carry responsibility and privilege of the healing ministry of Jesus into the future.” Sr. Dorothy said explicitly that lay leaders “must own the mission statement in heart and spirit. Say it and do it.” Once again Sr. Maxine asks, “What would Jesus do? The keys to this question are love, justice, peace, and respect. As Jesus said, ‘When I was sick, you comforted me’” (Matthew 25:36, paraphrased).
Sr. Rita Mary reflected that when the Grey Nuns left St. Vincent, it was hard for them. They left the spirit of their foundress St. Marguerite d'Youville and the Sisters of Mercy will leave the spirit of Venerable Catherine McAuley when they leave Mercy. Sr. Dorothy drew parallels between these two remarkable foundresses who both made the best of their situations. “Women with commitment and dedication have influenced the world. Go to the needs of the people. We are to do the same. Meet the needs of people with Jesus's love.”
Sr. Mary Thill concluded,
Sisters will not be a physical presence here forever. I have no idea what religious life will be like in the future. That's God's job. But people who work here are aware of the dignity of other people and of our ministry. All of us who work here need to be reminded of that truth often. We need to go away and renew. Retreats and other programs give staff an opportunity to explore the spirituality of the workplace away from the workplace and are essential for every person working with patients in Catholic healthcare.
When asked how every single direct caregiver could be budgeted for time off to renew their commitment to Catholic healthcare, she replied, “Put it in the budget. It's essential.”
All Christian nurses, whether associated with Catholic healthcare or not, can learn much from these religious sisters. Sisters love openly and conspicuously as Jesus loves. They hope and trust in grace with every breath. Nurses do well to remember their example of love whether at the bedside or in the boardroom. Caring and healing have always been part of Catholic healthcare identity and professional nursing practice.
Nurses can also learn from the sisters' example of drawing their strength by soaking up Jesus' love. The work of nurses is the work of giving strength: strength to heal and hope, strength to respect the individual and family regardless of gender, religion, health status, or lifestyle. The sisters who were interviewed understood that rejuvenating opportunities must be offered regularly to recharge and remind nurses from where caring strength comes. Continually obedient to God's Word, they ask us to follow Jesus' example, “Come with me by yourselves to a quiet place and get some rest” (Mark 6:31, NIV).
Catholic healthcare does not depend on the physical presence of the sisters but on the healing presence of Jesus. The sisters' foundational ministry put Jesus as the center of Catholic healthcare. Whereas Christians acknowledge Jesus is present in all healthcare settings, for those working in Catholic healthcare, Jesus's presence is part of their identity. The defining marker of Catholic healthcare is the healing presence of Jesus owned by the nurses and all other staff who care for the sick and underserved.
- Well-Being Resources of the Catholic Health Association
- Religious Sisters in Health Care: The Conspicuous Love of Jesus (all oral histories cited in this article and additional interviews with other sisters and Catholic health workers)