What is the role of chaplains in the larger process, in relating with staff? How do short, unplanned conversations contribute to staff care? These were questions that arose in the wake of the code blue I wrote about in the previous post. I explored them further in my Verbatim:
Two days later, during my normal clinical hours in CCS, I was charting near a nurse whom I had met during my first unit, summer 2019, and had a conversation with. I had run into her once before this unit, and it was clear to me she did not remember me, and I also did not have a chance to remind her of our previous connection.
This nurse was talking with another nurse about getting called into management’s office due to low handwashing percentages, but she was saying that it was a problem with the sensor, since there was no way she was not protecting herself on the COVID units. [All of us wear a sensor, which tracks whether we foam in and out of patients' rooms, and how often we wash our hands.]
At first, I was just overhearing their conversation, but at this point, got pulled in:
Nurse A: And the problem is, when you’re all gowned up, when you come out, you have to disrobe and take the gloves off first, and then by the time you’re washing your hands, the sensor doesn’t remember.
Nurse B: I mean, if this was 2015, and they were harping about handwashing, fine. But we’re in the middle of a pandemic, and this is what they choose to focus on?
Nurse A: (Turns to me). You know, this pandemic has shown a lot of problems that already existed. Like racism, poor management, and all of that. This hospital was already being managed poorly before, but now, I don’t think they’ll be able to handle all this. I think they are going to get bought out by another system, or they’ll fold.
Chaplain: Yes, for sure. Those problems were there already, but this just made it more obvious. I can see how being a part of a larger health system would help streamline some of the organizational issues. That’s got to be so stressful (chaplain tries to show empathy through body language as well, shaking head, sighing…)
Nurse A: You can say that again. This is not what I went to college for. Not to decide who gets to receive care, who lives or dies. We were taught to treat everybody.
Chaplain: (nods, holds space to see if she wants to say more). That is so tough. When resources are stretched so thin.
Nurse A: You know they call us frontline heroes, but then we are also the first to get blamed, when they need a scapegoat. But you can’t be heroes and villains at the same time, you know? You’re either batman, or you’re not! (She starts to laugh, and chaplain joins in.) I’ll be back. (Nurse goes into nutrition room. Chaplain continues to chart.)
NurseA comes back out, and tells me that the ice cream sandwiches from the hospital cafeteria are better than those she found in grocery stores. Apparently, the ice cream portion is thicker. Another nurse had brought a bunch of ice cream sandwiches in earlier, for the unit.
Chaplain: I guess that’s one tiny perk of working here? (nurse nods, with her mouth full. Chaplain says, as if on her behalf:) Hey, I’ll take it?!
(Nurse B comes by to grab something. Respiratory Therapist [RCP] also walks onto the unit.)
RCP: Hey (greets 2RN). How’s it going up here? I’m coming from the ED. (She seems very friendly, and as if coming up to the CCs makes her feel more relaxed, compared to being in the ED).
Nurse B: I want something more to do. It’s so quiet in here. You leave the COVID units and you’re like, wait, is this how it used to be all the time?
RCP: I know, you’re like, huh?
Chaplain: (starts replaying the code blue in her head, but and thinks, without saying aloud) It’s like a different universe on the COVID units.
(Nurse B leaves to go attend to a patient.)
Nurse A: Dang, you know that patient in CCR 15, or was it 14? The 34 year old, didn’t make it. That was New Year’s Eve, or something?
Chaplain: (Nods.) Yeah, Thursday. I was here for that.
Nurse A: That patient was afraid of everything. Needles, tubes, He was so sweet.
Chaplain: Aw.. (nods, makes eye contact with both RN and RCP thinks):I am learning more about this patient, whom I never knew)
RCP: Oh yeah, I had him in the beginning too. I cried for an hour at his bed.
Chaplain: (Looks at RCP and gives eye contact/active listening body language, wondering): What exactly does she mean by that? Is she going to share more?
Patient: Hey!
RCP: I mean, down in the ER it’s like deaths all the time, but this one we knew, and I was with him from his first day.
Nurse A: Yeah, I was there in the beginning too.
Patient: Hey!
1RN9: Man, what does he want again? (She had just turned him earlier, with the help of 2RN)
Chaplain: (to Nurse A) I can go in and talk to him. I’ve spoken with his wife about visiting, so I know a bit about what he might like to talk about and his personality.
RCP: He seems anxious, but at least he’s not the one (motions to another room on CCS) over there who kicked me in the head the other day.
Chaplain: Oh yes, that patient—I just got off the phone with his wife. She told me he’s had dementia for a few years now and often thinks he’s fighting in the war.
RCP: I don’t blame them. They must be so confused about where they are.
Patient: Are you coming?
Chaplain: (puts on face shield): I’m coming.
***
Further reflections:
· The Care Receiver
I assessed that the RN mostly needed more support from management. She was upset at being faulted over handwashing, when there were larger concerns (such as staffing) at play. She felt like management personnel were “taking out” their stress on employees. She also seemed aware of larger systemic issues in society, which the pandemic has made worse. It also seemed that “actions speak louder than words” was very much at play, in her feeling like she was receiving support. I felt that, for her, words were cheap if action was not there.
· The Chaplain
As the on-call chaplain, my role when on-call to respond to code blues and be available for staff and family, as needed. Although I did touch base with the nurse about my availability, I did not proactively follow up with the family after the patient’s death, as it was near the end of the day. Often after code blue deaths, the social worker or nurse will inform me that the family needs time to process what happened, and to make arrangements.
While charting on the critical care unit 2 days later, I had processed my own experience of the code blue, and was open to being an empathetic presence for staff, while also not “fishing” for conversations, given how busy and overloaded they are. I usually respect that they are working, and may not have the mental or emotional capacity to talk about their feelings, or really share about their experiences. However, the way this conversation flowed, I was included quite naturally.
· The Spiritual Care Encounter
I encountered the conversation “randomly”—and it was a “follow-up” about a patient, but not necessarily with the staff who were at the code blue. However, there was continuity in the story, since this patient was in Critical Care for quite a while and clearly made an impression on the staff. I tried to respond in a “pastoral manner” by mostly holding space and was an active listener for this conversation, and I felt she felt safe sharing her honest feelings with me. My identity as a chaplain was expressed by accompanying others in their process and bearing witness to others’ suffering and distress. I learned from this encounter more of the sentiments of nurses about administration and the discrepancy between how society views them (frontline heroes) and how management treats them (villains, scapegoats). Given my thoughts, from the nurse’s words earlier, about her preference for care to be “shown” rather than “said,” rather than staying in the conversation about the patient who expired, I offered to go talk to the patient, to give this nurse a break and a chance to catch up further with her colleagues. Had I not gotten up to go see the patient, I would have wanted to verbally affirm the role of the Nurse and RCP.
Theological/Philosophical Reflection
One of the themes I heard from the nurse was frustration in the discrepancy between how she was perceived—she knew she was important and indispensable, and yet she did not feel like she was treated according to her value. I was very aware of my own helplessness in fixing the larger systemic situation. This experience further brought to my awareness that my theme of Intention is multi-faceted and can equip me to discern more quickly how I “ought” to “be” in a given scenario.
Peer/Educators Consultation
My educator gave me permission to do one verbatim that involved interactions with medical staff. My main questions are: “should” I have “done” more during the code blue, or with so much going on, was it “enough” to simply be present, give empathetic eye contact, and be available as needed?
For the conversation in critical care two days later, I did not feel prepared to “go deeper” with the nursing staff, as they were still on the clock and constantly prepared to attend to patients. I felt that it meant more for me to show that I was on their team, that I was doing my part to care for patients, at bedside.
As the pandemic continues to heavily impact our hospital, I anticipate future situations similar to what I have described above. Therefore, I wanted to bring it before my peers and educator to get perspective on how to navigate the balance between seeing patients and being present to staff.
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