Hearing the voices of healthcare chaplains

Dr. Wendy Cadge, Assistant Professor of Sociology, Brandeis University in Waltham, Massachusetts, spent some time with hospital chaplains doing their ministry. She found that hospital chaplains are involved in almost everything that happens at a hospital. Chaplains are present for births and deaths and listen to patients and their families in times of crisis and decision. Chaplains take part in committees which can range in scope from ethics committees, to hospice teams, to employee wellness committees. Chaplains train nurses and medical students. But for all their good work, Cadge says that they have little voice when it comes to public conversations about religion and medicine in this country.

She writes in Religious Dispatches:

I interviewed chaplains across the country who, in addition to caring for patients and families around end of life issues, respond to all trauma pages, preside at bedside weddings and baptisms, sit on ethics committees, work with organ donations, and help to train medical and nursing students.

Despite this work, healthcare chaplains have not made consistent contributions to broader public conversations about religion, spirituality, health and medicine in the contemporary United States. This results, in part, from their small numbers. Researchers estimate that there are 10,000 healthcare chaplains across the country. Colleagues and I found that between 1980 and 2003, 54% to 64% of hospitals had chaplaincy services, with no systematic trend over the period. In 1993 and 2003, smaller hospitals and those in rural areas were less likely to have chaplaincy services while church operated hospitals were much more likely to have chaplains. Little is known about how many chaplains these hospitals had, from what spiritual and religious backgrounds, and with what responsibilities.


Cadge, along with her fellow researchers, published their findings in the Southern Medical Journal. They found:

Over the past 25 years, the Joint Commission for the Accreditation of Healthcare Organizations has changed its guidelines regarding religious/spiritual care of hospitalized patients to increase attention concerning this aspect of hospital-based care. Little empirical evidence assesses the extent to which hospitals relied on hospital chaplains as care providers during these years. This study investigates (1) the extent of chaplaincy service availability in US hospitals between 1980 and 2003; (2) the predictors of having chaplaincy services in 1993 and 2003; and (3) the change in the magnitude of these predictors between years. This study examines the presence or absence of chaplaincy or pastoral care services in hospitals using the American Hospital Association Annual Survey of Hospitals (ranging from 4,946-6,353 hospitals) in 1980-1985, 1992-1993, and 2002-2003. Between 54% and 64% of hospitals had chaplaincy services between 1980 and 2003, with no systematic trend over this period. In 1993 and 2003, hospital size, location, and church affiliation were central factors influencing the presence of chaplaincy services. Smaller hospitals and those in rural areas were less likely to have chaplaincy services. Church-operated hospitals were much more likely to have chaplaincy services; but between 1993 and 2003, church-operated hospitals were more likely to drop chaplaincy services than to add them. Not-for-profit hospitals were more likely than investor-owned hospitals to add chaplaincy services. Changes to Joint Commission for the Accreditation of Healthcare Organizations policies about the religious/spiritual care of hospitalized patients between 1980 and 2003 seem to have had no discernible effect on the fraction of US hospitals that had chaplaincy services. Rather, characteristics of hospitals, their surroundings, and their religious affiliations influenced whether they provided chaplaincy services to patients.

Key Points

* Between 54% and 64% of hospitals had chaplaincy services between 1980 and 2003, with no systematic trend over this period.

* Smaller hospitals and those in rural areas were less likely to have chaplaincy services.

* Church-operated hospitals were much more likely to have chaplaincy services.

* Between 1993 and 2003, church-operated hospitals were more likely to drop chaplaincy services than to add them.

* Not-for-profit hospitals were more likely than investor-owned hospitals to add chaplaincy services.

The Hastings Center issues a special issue describing chaplaincy. They describe the Professional Chaplaincy and Health Care Quality Improvement project which was developed in response to a dilemma that professional chaplaincy has long faced:

If chaplains wish to be recognized as a health care profession, they need to be able to describe, to themselves and to others, what constitutes “quality” in their area of patient care. Like other health care professionals, they need to specify how their profession and their day-to-day work in the hospital contribute to the ongoing task of quality improvement in health care.

Cadge concludes:

After listening to many chaplains in Orlando and across the country, I am convinced that to fully understand who chaplains are and what they bring to patient and family care, we need to think more about their broader contexts. I support the development of standards of practice for chaplains and research on what effect they have on patients and families. In this process, though, I don’t want to lose their stories and the witness they bear to the stories of sick and dying people and their families.

I think of the senior chaplain who told me that he has witnessed the deaths of 3000 children during his career—often encouraging parents, when they are ready to leave the hospital after a child dies, to leave the child in his arms.

Modern medicine needs more of these stories—of death, of blessing healthcare workers’ hands, and of caring for someone through an emergency. Chaplains should not neglect to tell them.

Listen to this chaplain describe her work on StoryCorps.

Southern Medical Journal: The Provision of Hospital Chaplaincy in the United States: A National Overview

Read the November/December issue of the Hastings Center Journal. There are six articles on chaplaincy. Membership required to read three of them.

Read all of Wendy Cadges piece on Religion Dispatches: Bearing Witness: The Work of Hospital Chaplains

Follow the blog of The Rev. Marshall Scott (a Board Certified Chaplain as well as a regular Daily Episcopalian contributor) on his blog An Episcopal Chaplain at the Bedside.

The Assembly of Episcopal Healthcare Chaplains serves the hundreds of Episcopal chaplains and other pastoral ministers who represent the Church in its ministry to those who suffer in mind, body or spirit. Learn more about them here.

Category : The Lead

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One Comment
  1. As a chaplain, and certainly as a contibutor to the Cafe, I appreciate being pointed to Dr. Cadge’s article. As a Past President of the Assembly of Episcopal Healthcare Chaplains, I also want to affirm our desire to be resources within the Episcopal Church. Episcopal chaplains are happy to work with congregations and dioceses to offer conversations and education on pastoral care, ethics, working with the health care system, and other issues. I often say that we are the fingertips of the Church’s ministry in healthcare institutions. We are the Episcopalians in healthcare ministries, and the chaplains in the Episcopal Church; and we are happy to offer ourselves on both capacities.

    Marshall Scott

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