We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place.

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We hope that this will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

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Case #19 (See responses below)

I was recently hired as a hospice chaplain. My supervisor commented that I needed to obtain a "clinical jacket" that would readily identify me as a employee of this specific hospice. These jackets are the same as those worn by the clinical staff. I am appalled at the idea of wearing clinical garb for pastoral visits. I objected, noting that although the roles of clinician and chaplain might at times overlap, the focus of their work is quite different, and that pastoral care may be compromised by a uniform. (I also know the bereavement counselor and volunteer coordinator do not wear clinic jackets.) My supervisor spoke to the Human Resource Director, who backed down; although it was reported she was not happy about my refusal. Of course, I have no objection to ID badges or distributing information with the agency name on it. I am also specifically not referring to the collar/no collar conversation.

My feeling is that this issue is about "branding" the agency, not about security or role authority. There is tremendous competition among hospices – non-profit and for-profit – for visibility and clients.

Have others encountered this issue and have the same take on it?

Has anyone encountered real pressure to conform to an agency uniform code?

What other trends are in the "marketplace" that are likely to affect agency chaplains?

Case #19 Responses

What came to mind while reading of the insistance that the chaplain wear a "uniform": If the Hospice is dogmatic about its uniforms, is it also dogmatic about the kind of care it provides?
Rabbi Cary Kozberg
Columbus, Ohio

I have never been asked to wear a particular uniform in my work with Hospice and was surprised to hear of the request.
Jonathan Scott
Putnam, CT

Why not have uniforms that have disciplines noted on the front? It would clarify the roles to have differing uniforms.
Rev. Amy Jo Jones, BM, MM, MDiv., BCC
Chaplain/Grief Support Center Coordinator
Big Sky Hospice
Billings, MT

My question has to do with why this chaplain is "appalled" at the request that he/she wear a clinical jacket. Healthcare chaplaincy is a clinical discipline, as well as a pastoral one. I am aware that many hospice organizations do not require any CPE (and some not even Master's level theological education) for chaplains they hire. That this chaplain is "appalled" by such a request may indicate that he/she may not have any or much CPE or be aware of the clinical nature of what chaplains do. It's hardly unheard of for chaplains in hospitals to wear clinical jackets, especially in "on call" situations in which visibility is important.

I'd also ask the clinical/theological question about why this is a "cross" on which this chaplain is willing to "crawl up and die." The choice, for good or ill, has already been made by this chaplain in this organization. It hardly seems central enough to whether this chaplain can function "pastorally" to be worth the issue he/she made of it.

Jon Altman
APC Associate Chaplain
Petal, MS

I suspect that the wide range of responses indicates the breadth of experiences in the field. Today, the agencies offering hospice services run the gamut from small, local community non-profits to Fortune 500 "agra-businesses" that are looking to "horizontally integrate their services" with a continuum of care that takes grandma from discharge home care with her first wrist or hip fracture to assisted living to skilled nursing care and finally hospice as a way of maximizing the client interface.

I, too, work for a very large for-profit hospice that requires chaplains to wear a "uniform" as a matter of branding, not as a matter of presenting oneself as a qualified professional.

Chaplains were only exempted from the requirement of wearing "scrubs" when confronted with the argument that to do so would simply raise the facility's expectation that we ought be giving personal care, when of course we are unable to do that.

Perhaps the writer's strong feelings about being made to wear a uniform had more to do with the total ethos of his or her agency and the motivation behind being reduced to another generic representative of the monolithic service provider.

I doubt that it reflects his professional qualifications--as a rule of thumb, the big three for profits still prefer seminary trained, ordained M.Divs with CPE to less formally educated or uncredentialed religious, not because of the superior service they may or may not provide but because they tend to reduce the possibility of exposure to CHAPS violations by evangelizing or not being well equipped to deal with diversity.

If you are a chaplain for whom this all sounds strangely "corporate", be glad. It is a growing reality among the increasingly dominant major players whose first concern is to project competency rather than supply it and whose "high view" of the chaplain's contribution is to assure frequency compliance for Medicare billing.

Charlotte Ellison
Battle Creek, MI

It has become abundantly clear that some of the best ministry that we have to offer is delivered in our work with the clinical team and our preparation of the other team ministers to be spiritually sensitive to patients and to offer appropriate spiritual attention to patients. When we do that part of our ministry well, patients receive quality spiritual care, and their overall satisfaction with their clinical experience increases. I believe it actually enhances our pastoral care to look more like the rest of the clinical team, and it lets the patient know that the institution takes seriously their spiritual needs at the time of hospitalization. Furthermore, it is a very clear way to distinguish the Pastoral Care team from clergy who are “outside the entity” for HIPAA disclosure purposes.

Stan Jones
Chaplain Coordinator
Methodist Hospital
Clarian Health Partners
Indianapolis, IN

As an active duty military chaplain, most of my work is done in a uniform. While that may be the exception in the civilian world, I do not see how this would compromise the standing of a chaplain as part of a multi-disciplinary health care team. Each member of that team brings to the table his or her specific skills. To me, this does not seem to be an ethical issue for which one should go "to the mat."

Rabbi Maurice S. Kaprow, BCC
Command Chaplain
PCU GEORGE H W BUSH (CVN 77)

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