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Cover story

Parish nursing:
Care for the sick, healing for the community


The work of a parish’s health ministry can be likened to peeling an onion, says one leader in the movement. The outer layers of the onion are the statistics of the leading causes of death in the United States -- such as heart disease, cancer, murder. Peel that off, and you find behaviors linked to the causes: smoking, overeating, drug abuse, violence.

“But you don’t stop there,” said Sharon Stanton, president of the Health Ministries Association, “because people do those things to cope. You peel down to the core roots of why people are emotionally, mentally and spiritually sick. You find powerlessness, lack of information, joblessness, economic despair, emotional despair, broken relationships, broken families, disconnected families, lack of forgiveness, a broken relationship with the environment. You’re getting at the root causes and healing people from within -- getting to the heart and helping them grow.

“It’s so much more than just praying for someone after surgery and helping them heal faster,” she said. “It’s about helping communities heal themselves.”

At the forefront of this work are parish nurses, whose numbers have been growing in congregations -- Protestant and Catholic, as well as other faiths -- for almost 20 years.

A specialty practice recognized by the American Nurses Association, parish nursing takes so many forms that it is as layered as an onion itself. Nurses work as volunteers, part-time and full-time at a parish. Someone who volunteers to take blood pressure screenings once a month might be called a parish nurse, but in the ministry’s fullest expression, nurses can be spending their days visiting homes and hospitals in the community, assuring that disadvantaged clients -- whether parishioners or community members -- receive needed services; or they may organize health fairs, seminars and support groups, educating the community about health issues and their connection to faith.

What they do not do is provide clinical services -- hands-on intervention like giving shots or drawing blood. The term that could be applied to all parish nurses is health promoter, focusing on care of the whole person -- physical, psychological, social and spiritual -- with the spiritual dimension considered central.

“As God’s people, we have a responsibility of stewardship of his gift of life,” said Jeanne Nist, a registered nurse and manager of the Holy Cross Parish Nursing Program in Silver Spring, Md. “It’s very empowering for people to understand what they can do ... to be a part of health and wellness, and not just seek crisis intervention.”

The connection between faith and health is not a new one. Catholic orders of nuns founded to care for the sick and the evangelical deaconess movement of the 19th century were forebears of parish nurses. More important, the work of health ministry can be traced to Christianity’s roots.

Paying attention, as Jesus did

“Obviously, Jesus spent a lot of time responding to sick people -- healing them, touching them, paying attention to them,” said Fr. Ed McLaughlin, pastor of the Orland Park, Ill., church of St. Michael, which counts parish nursing among its many ministries. “If we’re going to continue his work, we’re going to have to do that.”

The modern concept of parish nursing gained prominence through the Rev. Granger Westberg, a Lutheran minister who in the mid-1980s worked with Lutheran General HealthSystem in Park Ridge, Ill., to hire six nurses to work with six area congregations, including two Roman Catholic parishes. In 1986, the National Parish Nurse Resource Center (later to be renamed “International”) was formed. The center was affiliated with Lutheran General HealthSystem and, following a merger, Advocate Health Care in Park Ridge, until last fall, when it moved to St. Louis under the auspices of Deaconess Parish Nurse Ministries. The Deaconess organization is affiliated with the United Church of Christ.

In 1997, the American Nurses Association designated parish nursing as a specialty practice and in 1998 published scope and standards in cooperation with Health Ministries Association.

The International Parish Nurse Resource Center estimates that there are about 7,000 parish nurses in the United States, based on the number that have completed the center’s basic preparation class, which is offered by 64 partner institutions around the country. However, noted the center’s director, the Rev. Deborah Patterson, this is not the only preparation program available.

Another problem in estimating the number of parish nurses, the United Church of Christ clergywoman said, is that “parish nursing is so broadly defined. Some people define it as a full-time paid position. But most parish nurses are paid half-time. About 65 percent of all people who consider themselves parish nurses are unpaid. Some are half-time volunteers. There’s no way to measure it. If someone is only doing blood pressure screenings at church once a month, I would argue that she’s a nurse doing something nice for the church, but she’s not a parish nurse -- but she may call herself a parish nurse.”

With scope and standards acknowledged by the American Nurses Association, Nist noted, it is important to impress on people who want to identify themselves as parish nurses that “this is a specialty practice that takes specialized education.” Such education is available through the International Parish Nurse Resource Center and also increasingly at nursing schools.

Under the Holy Cross Parish Nurse Program, which provides mentoring and resources to parish nurses in more than 35 faith communities, most nurses begin as volunteers, said Nist. “As congregations become aware of the value of a staff position parish nurse, they tend to pursue funding one,” she said.

With the help of a health system

Programs such as those at Holy Cross in Silver Spring, Deaconess Parish Nurse Ministries in St. Louis, and St. Joseph’s Center for Health Ministries in Atlanta, represent a common model in which a church’s parish nurse is placed with the assistance of an umbrella organization, usually a health system or hospital that may also provide benefits while the parish pays the nurse’s salary. The organization supplies resources and educational programs for the nurse.

For the organization, it is an opportunity for community outreach, said Nist. “The advantage to the institution is it is an entrée into understanding the needs of the community and how to meet those needs,” she said.

A parish nurse without such an institutional connection is essentially functioning as an independent practitioner, said Stanton, who heads St. Joseph’s health ministries center. A program such as St. Joseph’s offers the parish nurse the chance to call on doctors and ethicists and a legal department if necessary -- which can be critical for a practice that often deals with end-of-life issues.

Even with a volunteer nurse, a full health ministry represents an investment by the congregation. For example, Deaconess Parish Nurse Ministries asks that a congregation stepping into parish nursing provide $2,000 to start up the ministry and budget for $1,000 a year thereafter for books, materials, the nurse’s continuing education and expenses.

Parish nursing is not considered an essential ministry, said McLaughlin, and in less affluent parishes it can get squeezed out by other demands on funding. But in poorer parishes, the need for health care access is greater. “It seems to be almost a luxury ministry that we should not make a luxury ministry,” he said.

St. Michael’s nurse, Kathleen Blanchfield, added, “The Catholic church has made such a commitment to health care and to social justice and the poor. I see it as an opportunity to pull the wisdom of those two systems together.”

Both Stanton and Nist advocate matching affluent congregations with poorer inner-city churches to help them fund health ministry programs.

Rural congregations also have difficulty funding parish nursing, Patterson said, but “the volunteer model is spreading fairly rapidly.”

No matter which denomination it is affiliated with, parish nursing programs usually work with a variety of local congregations to set up health ministries. For instance, St. Joseph’s Center for Health Ministries, affiliated with a Catholic hospital, has an advisory board with representatives from Christian denominations as well as Jewish and Hindu communities.

Furthermore, within Christian congregations, the nurse may not necessarily belong to the same denomination as the church she serves. One might find a Methodist nurse serving an Episcopalian congregation, or a Catholic nurse in a Lutheran church. “Parish nurses don’t get into the doctrinal issues that are divisive in health care,” said Patterson. “Abortion is not a big topic. It’s whether or not someone gets into a nursing home or gets prenatal care.”

Still, differences in such things as prayer and church governance can cause difficulties for a nurse working in an unfamiliar faith tradition. Stanton said she encourages nurses going to work in a congregation belonging to a different denomination from her own to attend its orientation classes to understand its theology and respond appropriately in ministry.

Usually, though, Catholic parishes want Catholic nurses, something Stanton attributes to sacramental considerations.

Too much baggage

Both Patterson and Stanton caution against nurses serving in their own congregations. “There’s too much baggage,” said Patterson. “Other people already know them and may not want to share confidential information. Also, if there’s a problem, it’s hard to fire that parish nurse -- you’re basically firing them from their home congregation.”

Nurses serving in their own congregations are more likely to fall prey to parishioners’ idea that the nurse is on call 24 hours a day, said Stanton. A congregation can “push you to the point where you’ve got to respond to medical emergencies,” she said. “I tell them to teach people to call 911.”

The situation also “opens up whole new areas of vulnerability” in terms of confidentiality, she said. “People think, ‘I’ll go to her and ask how Mrs. So-and-so is doing.’ It’s more difficult in your own congregation.”

Even if they are not members of the congregation, nurses must educate both parishioners and staff about confidentiality obligations. At St. Sylvester’s Parish in Chicago, staff members asked parish nurse Edna Arroyo to provide information on where she goes and who she sees. “I will give them raw numbers, statistics,” she told NCR. “You have to explain that you took an oath that you will keep everything about your client confidential.”

The issue is critical for Arroyo, who often serves undocumented immigrants. “Once you lose credibility with them, you might as well not come to work,” she said.

Advocates of integrating faith and health see parish nursing as ideally only one component of a larger religious commitment to health ministry. Stanton envisions a faith-health partnership in which the congregation “reclaims its role as a healing agent within the broader community” and transforms people’s understanding of health -- “that it’s not primarily medical,” she said.

Today, nurses are the best prepared to coordinate this movement toward integrating faith and health systems, Stanton said, but others can be brought on board. In developing health ministries, she has had contacts with doctors, a psychologist and a social worker.

A nurse’s work can have a ripple effect to bring those people in. Stanton described how a parish nurse and pastoral associate were present as a woman died of cancer, offering spiritual support. Her husband, who had before her illness been considering joining the church, not only joined but worked with the nurse to establish a support group for men going through what he had. “He began to become an integral part of that congregation,” Stanton said. “He took over leading the group of men to grieve, forgive themselves and support each other.”

After the tornado

Another parish nurse brought together 14 local churches to respond when a tornado ripped through the community three years ago. Six hundred people lost their homes or lost property value. The parish nurse “began the process of healing,” Stanton said. Working with the Red Cross and with other congregations in the community, the nurse developed a disaster plan -- none of the 14 local churches had one before the tornado hit. “Nurses don’t often think of a global response” as she did, Stanton said. “It took the gifts of all those congregations to heal the community.”

It is the spiritual aspect of the ministry, not the nursing practice, that is transforming, Stanton said. And it is “not as in-depth as it could be.”

Nurses who are considering parish work but have not had theological preparation, Stanton said, “will say, ‘Oh, this is so wonderful, I can now go pray with someone.’ But prayer is not the only way to share faith with people. You must identify them as brothers and sisters in God.”

Coursework such as the Marquette University “Wisconsin model” can offer that theological groundwork, Stanton said. Marquette’s School of Nursing has trained more than 1,300 parish nurses in the United States.

Stanton requires that the nurse be strong in her own faith. “If they say, ‘I’m still floating around,’ they shouldn’t be in this movement,” she said. “It’s about everything from your relationship with God to the environment, society, community, nonviolence. All of that emanates from a just and loving God.”

Arroyo said that a nurse must be called to do this work. Someone who is not called cannot “make the financial sacrifice or the personal sacrifice that it entails,” she said. She notes that she could be earning “easily double” her current pay. But more than that, “you have to invest a lot of yourself emotionally in this work. You suffer with your clients.”

“I don’t know that this is the kind of thing I would have been very good at when I was 23,” said Margaret Hoarty, nurse at Holy Name Parish in Omaha, Neb. “I used to always think that someday I would have it all figured out. And now I realize that you never figure it out -- that’s the point, you just keep learning and growing.

“When you see people who are ill or in the midst of grief or in very difficult life situations, it brings you back to those spiritual questions. It causes you to rethink your own spirituality and where you are with your own journey. It’s not a place for easy platitudes.”

Stanton, who is a co-journer in the Sisters of St. Francis of Rochester, Minn., noted that even before Granger’s work, women religious “were doing a lot of this stuff in the ’70s.” Stanton herself was working with churches and public health and developed a model in which a nurse would serve four or five churches.

Now, with a broader model of health and faith together, she said, “It’s time for the Catholic church to grab this ministry and move with it. It’s not just about hiring a nurse in a church. It’s about enabling congregations to build truly caring communities. Our whole theology of justice is the center of this ministry.”

Teresa Malcolm is NCR news editor.

National Catholic Reporter, June 7, 2002