Prevent staff misuse of chaplains’ services
Line between friend and counselor easily blurred
For years, Jane, a hospice nurse, had watched Jonathan, a hospice chaplain, comfort patients and their families struggling to make sense of the diseases that rob them of quality time with their loved ones and eventually their lives. Her admiration of his work helped foster a friendship much like the ones she had developed with other members of her interdisciplinary team.
When Jane’s husband suffered a stroke a few months ago, she was thrust into the same situation as many of the families she cared for. She was the sole caregiver, which meant she was responsible for the day-to-day care of her husband, with the added responsibility of being the sole breadwinner.
With the responsibilities of home and work applying equal and opposite forces, her distress was becoming evident to co-workers, whose concern was for her personal-well being as well as for her professional performance. Jonathan was the first to ask Jane if she needed to talk with someone. She expressed a reluctance to seek counseling elsewhere, instead choosing to open up to Jonathan, a colleague and a friend.
As part of the interdisciplinary team, it’s easy and appropriate for chaplains and other team members to develop close collegial relationships. The above fictional example is only one situation in which the line between counselor and friend can be blurred. While hospice chaplains are well aware of the thin line between acting as a colleague/friend and acting as a counselor, that same line can get blurred in the give and take of everyday interpersonal relationships.
Watch for warning signs
"Boundary issues must be constantly monitored," says Thomas Welk, MA, DMin, director of education and pastoral care for Harry Hynes Memorial Hospice in Wichita, KS, formerly Hospice, Inc. "It’s not the responsibility of the chaplain to be an employee’s pastoral caregiver."
The following are warning signs that chaplains and employees may be crossing over into counseling territory:
- A chaplain finds himself or herself counseling a worker on an ongoing basis.
- Workers without a support system continually seek the chaplain’s counsel.
- A chaplain notices that he or she is spending more time with one team member than others, perhaps diminishing the chaplain’s availability to other staff.
The relationship between chaplains and their team members is unique. In times of personal or professional crisis, the hospice chaplain is often the first person other hospice workers turn to for emotional or spiritual guidance. That is especially true if the employee doesn’t have his or her own support system or does not belong to a church.
A chaplain’s first response is often that of a friend, says Thomas Davis, MDiv, chaplain with Harry Hynes Memorial Hospice, but the chaplain’s empathetic response could be easily construed as an opening for counseling.
Because chaplains have a predisposition to reach out and help, it’s easy for workers to seek their counsel. In some cases, such as when the loss of a patient triggers strong feelings of grief, ministering to employees is acceptable to a point. But personal problems also pose a danger.
Welk says one way for chaplains and workers to stay within their boundaries is for the chaplain to address the grief issues of all the hospice workers as a group. This can include memorials and nondenominational services. Chaplains also can refer individuals who feel they need additional care to a hospice’s employee assistance program or the employee’s own church for spiritual care.
Experts warn that hospices should evaluate chaplain-employee relationships to ensure the chaplain is not overburdened and workers don’t cross ethical boundaries that could compromise the team approach to hospice care.
This is not to say that chaplains should not minister to their co-workers or that hospice administrators should measure the amount of time their chaplains spend helping co-workers. In fact, chaplains play a key role in ensuring their co-workers’ spiritual and emotional needs are met.
Provide encouragement
It is common for hospice workers to feel a sense of loss or grief when a patient dies. Sometimes that grief is heightened when a patient or a patient’s situation reminds workers of their own personal experiences. For example, the experience of caring for an Alzheimer’s patient in the final weeks of life may trigger a worker’s memories of her own parent’s death from the same disease.
These feelings of grief, while strong, usually are not enough to prompt the worker to seek counseling through the hospice employee assistance program. An observant chaplain will likely notice the signs of grief the worker is experiencing, or the worker will ask the chaplain for help.
Employee ministry allows for discussion between the worker and chaplain to assess the worker’s problem. It’s at this point where ethical lines are at risk of being crossed.
Does this mean hospices shouldn’t allow workers to discuss their problems with a chaplain? No, but the chaplain shouldn’t be the primary counselor. Instead, experts say chaplains should feel free to help the worker identify the underlying issues that are at the root of their problems, but they also should encourage that staff member to seek counseling outside the hospice.
This is especially true in situations where the problem lies outside work but is affecting performance at work, such as marital problems, caring for a chronically ill relative, or parenting issues. While this may seem like straightforward advice, chaplains are often trapped by their most valued assets — their compassion and their desire to help others.
Acting as a resource for workers in need is an excellent way to minister to employees. In cases where co-workers have questions about their own spirituality, for example, chaplains should encourage workers to seek the guidance of their own minister, priest, or rabbi.
Use team approach
While individual cases need to be handled delicately to preserve professional relationships between chaplains and the interdisciplinary team members, ministering to employees is still part of a chaplain’s responsibilities.
For example, chaplains should recognize their responsibility to foster a team atmosphere through their ministry and to act as an advocate for the team to help make sure interdisciplinary team needs are met.
Experts recommend that chaplains play leadership roles in developing team-building activities. More importantly, the team atmosphere that a chaplain fosters can also aid in employee ministry.
Chaplains can use team meetings to discuss feelings of grief or distress that arise from the loss of a patient or other situations that may affect morale. For instance, if the death of a patient has had a significant impact on staff, this situation could be addressed during a team meeting in which each staff member is allowed to light a candle in memory of the patient and reflect aloud on memories each person has about the deceased patient.
Chaplains can also minister to their co-workers’ spiritual needs by conducting educational inservice meetings on religious issues, such as the features of different types of faiths. Chaplains can use this opportunity to encourage workers to reflect on their own spirituality by talking about how their spiritual beliefs interact with those of a patient or a patient’s family.
The bottom line is that when hospice staff misuse a chaplain’s services, the chaplain’s effectiveness with patients and their families can be diminished because of overwork or burnout. Chaplains must be able to exercise professional judgment when it comes to employee ministering, yet still encourage co-workers to seek their assistance when necessary.
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