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Body and Soul

In cities across the country, nurses are responding to a higher calling, one that enables them to wed their avocation with a vocation: meeting the health and spiritual needs of their patients by serving as parish nurses. The parish nurse movement today presents unique opportunities for the minority registered nurse who hears the call to serve both God and minority community members.

By David Chasey

While there is nothing simple about parish nursing, it does have some simple concepts at its core: Church-based health care that is guided by spiritual and holistic principles that emphasize prevention and education and that integrate the healing and health-sustaining power of spirituality within the context of contemporary health care delivery.

The Rev. Granger Westberg, a hospital chaplain and medical school professor working in the Chicago area, is someone who wished to integrate the healing power of religious ministries with those of the medical health system. He developed the original parish nursing model. Chicago’s Lutheran General Hospital implemented Westberg’s vision in 1984, cooperating with a network of six ecumenically based churches (three Lutheran, one Methodist and two Roman Catholic).

The first parish nurse network allowed nurses to be paid for their work, serving as employees of the hospital contracted out to the churches. The churches reimbursed the institution for the salary of the nurse, who served not to treat, but to evaluate, provide spiritual counsel, educate, recruit and train volunteers and organize spiritually based preventative health care programs. Essentially, the parish nurse acted as a liaison between the individual parishioner and the medical system.

Updating the Past Model

The parish nurse movement has grown dramatically since Westberg’s model was realized 15 years ago. It has been and remains a burgeoning grass roots movement. Outreach programs to economically disadvantaged minority communities are a vitally important part of this movement. The parish nurse—and the spiritual commitment he or she embodies—is the very heart and soul of this dynamic and evolving trend in health care.

“When I started as a parish nurse in 1986 in Iowa, I wondered whether churches would come to value their parish nurses and be able to both want and continue financing the program,” remarks Carol J. Smucker, R.N., Ph.D., currently the parish nurse program coordinator for Baptist Hospital of East Tennessee in Knoxville. “The answer seems to be that they can, as demonstrated by the thousands of parish nurses and programs established across the country.”

Despite the dramatic growth of the parish nurse movement at large, present employment opportunities for parish nurses appear to be, at best, problematic. The Rev. Fr. Richard Gilbert, executive director of the World Pastoral Care Center in Valparaiso, Ind., states, “Most parish nurses are unpaid, or otherwise underpaid, but have become an integral part of the parish ministry.”

Many also perform their services part time. Additionally, the availability of paid parish nurse positions is contingent upon a variety of highly variable and uncertain factors, including the regional presence of parish nursing programs and the supply of grant money.

What remains constant is that parish nursing today is a recognized, certified subspecialty within the registered nurse profession. Says Smucker: “Parish nursing standards have been published by the American Nurses Association. There are educational programs available, annual conferences attended by 800 nurses at a time and the Health Ministry Association, which represents parish nurses.”

The Call of the Spirit

One example of a successful parish nurse network is the Queen of Angels-Hollywood Presbyterian Medical Center in Los Angeles, which maintains a network of 18 local churches and an estimated 35,000 congregation members. All the congregations are Christian, but there are indications of a wider inclusion for the future: Jewish and Muslim groups have reportedly expressed interest in the program. The parish network has five full-time parish nurses serving a population that is ethnically diverse and poor, including many seniors and homeless people. Seventy-five percent of the served population has no health insurance. For these reasons, hands-on tasks such as flu-shots and child immunizations have a prominent place in the program.

Across the country in Charlotte, N.C., Gloria Griffin, MTS, R.N., was hired by Presbyterian Healthcare in 1990 to be a paid parish nurse at the Episcopal Outreach Mission in the Chapel of Christ the King, located in a mostly black inner-city neighborhood. After receiving her R.N. degree in 1984, Griffin found her way into psychiatric nursing where she began to hear “the nudging of my spirit.” She empathized with the spiritual needs of patients but also felt restricted by the tight guidelines of the secular psychiatric institution. Griffin expressed the resolve she experienced with this conflict: “I simply went about my nursing tasks in a manner that I felt was pleasing to Christ.” Through many experiences, Griffin continued to follow the inner summons and eventually decided on a parish nurse position in the inner-city neighborhood of Charlotte.

It turns out that the neighborhood of the Episcopal Outreach Mission was the same neighborhood where Griffin grew up. Griffin, who is Caucasian, describes her experiences at the mission: “I’ve held the hand of a 14-year-old in the delivery room as she gave birth to her first son, frightened and alone. I’ve sat at the hospital on Christmas night beside the bed of a 24-year-old dying of sarcoidosis, and at her request read a Luke II passage to her as her fears were calmed and she then went to be with the Lord. As a parish nurse, I’ve been in crack houses as well as in Christian homes struggling to make ends meet. I’ve advocated for my patients in schools, in doctors’ offices, in courts and in a number of unique settings. I’ve said many times that they give to me more than I can ever give to them.”

Emma Penson, R.N., a parish nurse at Mount Olive Baptist Church in Knoxville, works 20 hours a week serving the mainly African-American congregation there. Penson, who is also African American, has served as a parish nurse at Mount Olive for four years. Previously, she had been a parish nurse at New Providence Presbyterian Church, (which maintains a congregation that is 98% white), where she created the community’s first parish nurse position.

Fifteen years ago, Penson was a registered nurse living in Knoxville with her two-year-old son and caring for her mother who was afflicted with Alzheimer’s disease. “God had a lot to do with this,” Penson states. “It sounds as though this was all my brilliant idea. It had a lot to do with my own mother’s illness and her death, and taking care of her. I discovered that I couldn’t find anybody to give her what I thought she needed, not just to feed and change her—that wasn’t enough.”

Penson developed this deeply personal experience into the parish nursing program that eventually gained acceptance and was funded by New Providence Presbyterian Church. She methodically and persistently pursued her ideas and their realization. It took her four years to develop her program and find the church that would fund and implement it. During that time, Penson was also preparing herself. She went back to school to study human behavior. “I thought that that was so critical, to understand behavioral things,” she notes. “Then I got a part-time job at a behavioral hospital. That gave me some more experience and I realized that was the way I wanted to go.”

Of critical importance, Emma networked. She was on three different organizational boards in the Knoxville area. She has always maintained involvement in civic activities as well as volunteer work. She found that her networking helped her to overcome the biggest stumbling block encountered by her fledgling parish nursing program: money. She couldn’t carry through with the program without earning income for herself.

Penson remarks, “Everywhere I’d go I would tell people what I had and how I wanted to present it. Then one night at a meeting, one of the ladies who knew the program I wanted to have [learned that] a minister had donated money and he wanted it to go toward something that helped older adults.”

The woman informed the minister about Penson’s plan. New Providence Presbyterian Church listened and eventually accepted it, developing it into a program with the capacity to care for ten seniors. Penson brought to the church community setting her spiritual enthusiasm and her well-studied program of readings, songs, games, human interaction and spiritual ministry that she had developed over the previous four years.

“They allowed me to come in with a color scheme,” she explains. “They decorated the rooms for me. We had all kinds of games and activities. I started out with a prayer. We did a lot of spiritual singing, a lot of contemporary singing. For meals it was like a festival, with very bright, stimulating colors. It was very positive and upbeat.”

Earning and Learning

Penson’s case illustrates how parish nursing—though a spiritual calling—still requires funding to achieve its goals and remain feasible as a career. Although parish nursing is primarily a ministry, opportunities do exist within parish nursing models for nurses to pursue the field professionally. By working part-time as a parish nurse within her own program, Penson secured herself a modest paycheck.

Other models of organization and payment have evolved significantly since the concept of parish nursing was realized in 1984. The success of the first parish nursing network spawned a dynamic and divergent grass roots movement that has continually built upon the basic concept to fit the specific needs and aspirations of the various congregations and communities involved.

“Anytime you have a grass roots movement everyone wants [their variation] to be distinct and separate. But when you come right down to it there is a lot more commonality than people would like to acknowledge,” says Ann Solari-Twadell, R.N., BSN, MSN, MPA, director of the International Parish Nurse Resource Center, an often-cited nexus of parish nurse information and educational resources.

Solari-Twadell believes that all of the national parish nurse programs can be classified within either four basic models or derivations of these basic models. Essentially, she explains, the parish nurse is either paid or volunteer, and works with or without institutional support. When a facility such as a hospital, nursing school, long-term care facility or church is involved, it provides networking opportunities, continuing education, supervision and theological reflection. Payment may derive from the institution or directly from members of the congregation, according to Solari-Twadell.

A sampling of parish nurse networks nationwide reveals variations on these models. Headquartered in Park Ridge, Ill., Advocate Health Care is the organizational descendent of the original parish nurse program inspired by Westberg. Today, Advocate Health Care’s program has 24 paid parish nurses working both part time and full time at 30 congregations. The congregations represent an ecumenical, denominational mix of churches covering the greater Chicago area.

Toward the opposite end of the scale of paid/volunteer parish nurse representation is the Center for Congregational Health Ministry, based in Wichita, Kan. Supported by the Via Christi Health System, CCHM helps to organize parish nurse programs and once organized, provides support to them. The CCHM network is free and open to all faiths, providing resources to, but not directing, the congregations it serves.

“Through the Center for Congregational Health Ministry, I am currently working with more than 80 churches in Kansas and northern Oklahoma,” says CCHM Manager Jo Veta Wescott. “Most of the nurses are in volunteer positions and seem quite satisfied with that arrangement. However, there are several in paid positions and we have two in part-time positions.”

Wescott notes that one of the part-time nurses serves in a network of four small Methodist churches, work that is funded by a three-year grant; other churches in the network are seeking grant funding for paid parish nurses. Wescott adds: “At some point, I want to see the health care institution that employs me hire parish nurses who are assigned to a particular congregation. I truly believe parish nursing is the future of health care in our country—either paid or volunteer.”

Some parish nursing networks take an eclectic approach, using a combination of paid nurses and volunteers that reaches across several congregations. Northwest Parish Nurse Ministries, an interfaith network affiliated with Legacy Emmanuel Hospital and Health Center and headquartered in Portland, Ore., states that its aim is “to initiate, develop and support parish nursing/health ministries within congregation/faith groups throughout the Pacific Northwest.” NPNM employs more than 25 hospital parish nurse coordinators, 19 of whom are paid, working either part-time or full-time building up the parish nurse network among the churches around their hospital. Annette Stixrud, the NPNM program director, states, “We hope that the places with the paid nurses will pave the way for the rest.”

In Knoxville, Smucker oversees nine part-time paid positions. She reflects, “Paid positions are a reality in many parts of the country, although the positions usually start out part-time. Our nurses work 20 hours a week and are employees of the hospital. Receiving benefits as a hospital employee adds to the attractiveness of the position. The part-time aspect, however, does keep some nurses from applying.”

Means of Support

In Los Angeles, the Greater Hollywood Health Partnership has linked up with the Health and Faith Coalition of Los Angeles County. This wider coalition also includes the Southern Area Clergy Council and the Los Angeles County Department of Health Services. The Health and Faith Coalition has received a three-year, $2 million grant from the Robert Wood Johnson Foundation and the Irvine Foundation. This funding has enabled Los Angeles County to set up health ministries at ho
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j {´Írsing networks have relied on grants to fulfill their missions. Yet even with outside funding, creative and resourceful systems of payment are typical of the intricate, financial nuts-and-bolts that allow a network to not only survive, but prosper. While Griffin was a paid parish nurse at the Chapel of Christ the King, for example, she worked 20 hours a week for the first two years and moved to full time thereafter. Griffin performed multiple duties and maintained a high level of involvement in the community—which is surprising given two striking facts about Griffin’s assignment: The church is located in an economically disadvantaged neighborhood and has only 50 congregation members. How does an inner-city congregation with a mere 50 members manage to support a full-time, highly proactive parish nurse?

Griffin was hired by Presbyterian Healthcare Chaplaincy Services and placed as the parish nurse for the Chapel of Christ the King. Using funding from a Duke University endowment, the hospital is responsible for paying Griffin, although the payment schedule is designed to gradually ease the church into paying her salary. The Duke endowment “funded the original start-up positions of the first four positions” of the parish network, Griffin explains. “This was done in increments in which the church gradually assumed more and more of the salary amounts until it would assume all of the salary after the fourth year.”

However, because the church could not afford to meet the normal payment schedule for Griffin’s parish nursing position, Presbyterian employed another mechanism of financial accommodation. Griffin explains: “In my case, I received funding from a different and more affluent church which paid the money directly to the hospital. The mission church did pay a small percentage of the money [as much as it could afford] to the hospital to be distributed.”

The payment arrangements adjusted over time. “The second phase of the Duke money, along with some from the hospital, continued to support my position. In my third year I became full time with the support of the other church funding half of my salary and the other half from the Duke endowment, along with some from the hospital as the endowment monies ran out.”

Another creative adaptation to scarce resources relies on the parish nurse as facilitator, organizing volunteers within the congregation. Griffin says, “The nurse begins to train those in the community to help with health promotion and other things such as immunization drives, elderly visitation, transportation to and from physician appointments and other places.”

“The nurse builds a database over time of both needs and volunteers and matches the two together,” she continues. “More and more can be accomplished if there are volunteers who are willing to help.”

Setting It in Motion

For the minority nurse attracted to this subspecialty, parish nursing is primarily a ministry. Yet there are secular attractions to becoming a parish nurse. “Parish nursing by itself is very attractive to many nurses in these days of down-sizing R.N. staffs,” says Baptist Hospital’s Smucker. “Nurses interested in community health, health education, health promotion and including spiritual care in their practice are the ones most interested in parish nursing.”

Embarking on the ministerial career of a parish nurse requires a proactive and engaged approach. Smucker concludes, “I would say parish nursing is a viable career goal but is dependent on the availability of programs in different parts of the country. Nurses may have to start their own programs in churches or interest a health care institution in their community in investing in a program.”

David Chasey is a freelance writer based in Pittsburgh, Pa.

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