Chaplain Edward Williamson on an acceptable weekly workload

Census 25 Proposal

I am currently a hospital chaplain, but I am also a PRN hospice chaplain. Hospice chaplaincy is a vocation that engenders respect in some quarters and a rolling of the eyes in others. When I did hospice chaplain work full-time in Colorado, some hospital chaplains wanted to know what I wanted to do when I grew up!

Hospice chaplains are some of the most dedicated ministers in service today! Who else would suffer to be on call 24/7, rain or shine, and expect to give quality ministry at 1:30 AM and receive no pager pay for their efforts? I have renewed wedding vows on the fly at 2 AM and performed family funerals in the wilds of the Sangre de Cristo Mountains. I have seen more death in five years than most ministers experience in their entire career.

I believe it is time to take a hard look at the workload of most hospice chaplains and bring them in line with more traditional ministries. I have no hard empirical evidence when I make this next statement but I believe that no hospice chaplain should have to minister to more than 25 terminally ill patients at a time!

I believe this because most hospice chaplains do more than visit patients. Many of them are also the volunteer coordinator or the bereavement counselor. When I would come to work on a typical Monday at 8 AM I would first sit down and plan my day. I would make phone calls to my patients and schedule visits. I would do phone assessments with new patients. I was usually ready to visit my first patient by 9 AM.

The whole day would race quickly by. I was fortunate if I could grab a sandwich for lunch. Then I would come back to hospice and try to get a computer terminal to chart my visits. My computer illiterate case manager demanded that we keep paper charts so I had to print out what I had charted so it would be available for audit. Then I had volunteer responsibilities to contend with. My CEO would nudge me out the door every evening when our census was above 30 (and I was not ready to go home).

At the time I was too “dedicated” to admit my stress levels were high and I was burning out. It didn’t help that my hospice had a “hire them fast and fire them when they are finished” philosophy when it came to chaplains in their employ. When I was fired it was a great relief. I had no problem proving wrongful termination in order to collect unemployment benefits.

Looking back over that debacle and speaking to my fellow hospice chaplains, I came to the conclusion that most hospices hire one chaplain in order to meet the government requirement and then they will hire no more chaplains. When they burn them out they replace them.

Many chaplains use imaginative tactics to cope with an impossible workload. One hospice chaplain would visit his patients in nursing homes by having the staff gather them in the cafeteria after the breakfast meal and have “mini-church” with them. He would minister to 10 – 15 patients in a one-hour period and leave. He charted the same entry for all those patients and would go on to the next nursing home to repeat the same procedure. His patient load was 75 (which he bragged was no problem) but it would be difficult to say that spiritual care actually occurred. Another would phone his patients all at once and chart them as physical visits, using great imagination to fill in the blanks and visit only patients that were truly end stage. Other chaplains visited patient bi-weekly or once a month depending on their census.

I believe this foolishness needs to end! I know there is a movement to board certify or hire only board certifiable chaplains for hospice ministries. I think this is a worthy idea but along with this learned and experienced chaplains should meet and determine what a standard, acceptable weekly workload is for a hospice chaplain. My vote would be no more than 25 active patients per week per chaplain. This would give chaplains a goal of five patients a day with time to chart the visits at the end of the day.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.