2 pages
Britney Foster
SpiritualCaregivingChapter2.pdf
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The State of the Current Healthcare System
The demands on caregivers to keep up with breakthroughs and
setbacks, with economic forecasts and paperwork requirements, with
“code blues” and needlestick precautions, with fast-moving gurneys
and insurer limits are colossal.And I’m afraid that the things that
imbue our patients’ lives with meaning—the values, fears, and
sources of solace that immediately come to mind when one’s health
is threatened—frequently get disregarded in this whirlwind
of change.
—Dr. Herbert Benson, Timeless Healing
Our healthcare system is in crisis. Many would identify it as an eco- nomic crisis, with the focus on profit making as a detriment to care, and indeed this focus is a major issue. But the crisis is broader and deeper than the for-profit model of healthcare would suggest. It is a true iden- tity crisis and may ultimately be a spiritual one.
In the midst of trying to balance the competing demands that swirl
C o p y r i g h t 2 0 0 4 . T e m p l e t o n P r e s s .
A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .
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around healthcare providers, some may lose sight of their ministry and their call to be healers.They may pull away from patients and insulate themselves against the pain that calls out to them from patients and fam- ilies.This interpersonal distance only increases the healthcare providers’ sense of discontent and intensifies their own pain.They may wonder, Is this all there is? I didn’t become a doctor, nurse, social worker, or ther- apist to deal with insurance companies that want to limit care. I didn’t enter this field to feel like I was on a treadmill every day just trying to do the basic minimum for my patients.
These are questions of meaning and purpose:What is the meaning of my life? What is the meaning of my profession? And, do I make a dif- ference? Sometimes these questions lead to such profound disillusion- ment that the healthcare provider chooses either to walk away, as nurses have done in droves, or to push feelings of discontent out of awareness and settle for providing care that is less than satisfactory.1
There is an epidemic of low staff morale and burnout in medicine and nursing, making it difficult to hire and retain staff and affecting the quality of patient care.2 Staff turnover is as high as percent per year in some hospitals. Malpractice insurance rates are rising out of sight because of increasing litigation, due at least in part to poor doctor- patient relationships and patient dissatisfaction with the limited biotech- nological care that they are receiving.3
What is missing in the doctor-patient relationship? Lack of trust, we think, is one factor. A trusting relationship exists between doctor and patient when the doctor respects the patient as a unique individual and addresses the patient as a whole person—including body, mind, social relationships, and spirit. When that is the case, litigation almost never occurs. Even if mistakes are made, the patient is usually willing to for- give the physician to preserve the relationship. Physicians, too, get more out of their job as providers when they deliver care in this way.
One reason that whole-person care is becoming less and less com- mon today is the loss of a sense of ministry or spiritual “calling” among health professionals.There is evidence that having a sense of calling may influence staff morale, productivity, sick days, and burnout rates among healthcare workers.4 Consequently, addressing the spiritual needs of
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hospital staff may need to become a priority.5 Training health profes- sionals to integrate spirituality into patient care may help them recog- nize, develop, and value their own spirituality, their sense of calling, and the satisfaction they experience with their work.
In our interviews, we asked participants questions about the health- care system. First, we wanted to know if participants believed that the current healthcare system had an impact on their own spirituality. Second, we asked whether or not the healthcare workplace had the potential to be a spiritual environment.Third, we inquired about ways that participants contribute to the spiritual environment of the health- care workplace. Fourth, we asked whether participants believed that an intangible such as a spiritual environment affects employee retention. Fifth and last, we provided a list of concepts that are identified in the lit- erature as necessary for a spiritual work environment and asked each participant to prioritize these concepts and comment on the top three.
Although many of our participants asserted that the current health- care system has a negative impact on their personal spirituality, there were a few individuals who believed that the healthcare system actually strengthened their own spirituality, and one nurse stated that the health- care system had no impact on her spirituality. Those who identified a negative impact focused on insurance restrictions, lack of or inadequate healthcare coverage for some patients, the burden of navigating a maze of bureaucratic requirements, an overly litigious society prone to legal suits, the deterioration of the relationship between patients and health- care providers, and a culture that depersonalizes patients.Those who said the healthcare system actually strengthened their spirituality identified the same problems but concluded that these problems made them more dependent on prayer and a vital relationship to God.There were also a few participants who were neutral in their responses.
Negative impact. Physician Jack Hasson declares, “Negative factors such as lack of funding for healthcare and medications for patients and the amount of ‘red tape’ in medical practice are barriers to the mission
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of caring for our patients.This requires us to spend time on issues that lessen the time we would like to spend on spiritual issues with patients, staff, and others.” Retired oncologist Alton Lightsey finds that “the increased demand for justification and documentation compete for time and energy to care for patients, families, and colleagues.” In a similar vein, Joanne Smith, a nursing administrator, adds,“The healthcare system challenges my spirituality every day as I struggle with what needs to be done for a patient and what insurance and various regulations say I can do.The patient does not always come out a winner in this struggle.”
Mitroff and Denton identify the importance of shared values of ser- vice as a foundation for creating a spiritual work environment.6 Com- menting on the importance of values from a nursing perspective, Nancy Hines notes:
The current healthcare system often challenges my spirituality. For instance, I am challenged to make sure I care for people as valued individuals and not as a way to make money. I have to look for ways to build caring into every interaction. Clearly the work environment can either promote caring or destroy it through the values that are explicit as well as implicit in the culture of the workplace. I con- tribute by challenging values, by asking tough questions, and by following through on issues, problems, and ideas. Sometimes I feel as though I am a lone voice argu- ing for a more caring and spiritual approach to problems. I get especially concerned when I see an attitude of “planned neglect” color the care provided to the debil- itated elderly. It seems as if the conclusion that “This is Mr. Smith’s time to die” is arrived at much too easily, with little respect or caring directed toward that indi- vidual. It’s almost as if we are throwing people away.
Nancy is not alone in her disdain for the ever-present focus on the bottom line.Vicki Germer, a psychiatric nurse, complains,“I am so frus- trated by the current healthcare system; everything seems to be about money, and there is so much more that we should think about, like doing our best to help patients and families dealing with psychiatric problems.”
Mohrmann contends that the practice of medicine has as its central metaphor the image of the healthcare provider as a minister: “We who
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minister to those who suffer are called to love them, and this means that we are to give ourselves—our knowledge, our time, our passion, our strength—without stint.”7 Increasingly, this image is challenged by a sys- tem that demands more from its practitioners and allows far less time for patients.
Dr. Bernita Taylor poignantly laments the change in the doctor- patient relationship:“The doctor-patient relationship used to be almost sacred—it was on a higher plane. Now it is more a business relationship. The doctor is a merchant and the patient is a consumer. In the process, we have lost something very precious.” Dr.Tom Grace, also focusing on the doctor-patient relationship, says, “As medicine becomes more of a business, it is absolutely essential that ‘good’ people stay in medicine.The personal relationship is critical, and we need to take the extra step to make sure that it happens.”
Of course, other healthcare professionals feel the challenges to a healing relationship as well. Harriet Coeling, a nurse faculty member, describes the work environment of nurses as one that diminishes who they are and what they can contribute to the nurse- patient relationship.
I think the main reasons nurses leave a job situation or leave nursing completely are lack of respect from those they work for and with whom they interact, a lack of appreciation for what they do, and the unreasonable work conditions they face. I think these factors come from a desire to enhance prof- its and/or a desire to make oneself appear better than others (nurses). So I think that if more people in the organization could see the image of God in each worker and treat each person with the dignity and respect due to God himself (in a more spiritual environment), we could indeed prevent so many nurses from leaving nursing.
Dr. Sandra Jamison, a retired nursing professor, finds the state of the healthcare system very discouraging because it is so market driven. She decries the depersonalization of patients and caregivers alike:“The heart
The practice of
medicine has as its
central metaphor the
image of the
healthcare provider
as a minister: “We
who minister to
those who suffer are
called to love them,
and this means that
we are to give
ourselves—our
knowledge, our time,
our passion, our
strength—without
stint.”
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of nursing is the person, and today the person is viewed as just another market commodity.” On a similar note, Dr. Sagrid Eleanor Edman, retired nursing dean of Bethel College, observes, “The current health- care system makes me angry. I am frustrated because I am sure that so many patients are not getting their needs met. Currently I am working with parish nurses, and I really emphasize the advocacy role of the parish nurse—someone needs to speak up for the patient and make sure that needs are met!”
Even hospital chaplains feel the constraints of less time available for developing a healing relationship. Jeffrey Flowers observes, “We are asked to be more global, experts in all religious expressions to ensure that all people have their needs met.We are also asked to do more with less, to build faster relationships, which, of course, will be less meaning- ful. People move through the system so quickly it is hard to know them.”
Another nurse, Miriam Jacik, provides a scathing evaluation of the current healthcare system:
Presently our healthcare system endorses healthcare delivery that is fast paced, impersonal, and by all means cost saving.The patient is very often lost in the process. In the name of efficiency, we have sacrificed personhood. In the name of progress, we have tread upon ethical and moral values. To remain involved in healthcare, as we presently know it, requires that the care provider have a spiri- tuality and set of personal religious values that are strong enough to meet the challenges of the times.The recipients of our care need to find caregivers who are persons of integrity with moral values and principles that direct their lives. I believe that spirituality must be alive and ever deepening in my life and in the lives of all dedicated healthcare providers.
Sometimes the rules that govern “professional” practice get in the way of spirituality. Charity Johansson elaborates:“The constraints of the healthcare system make it more challenging to work as a whole being, honoring the spiritual in ourselves and our patients. For example, if a dying patient asks me to pray with her, I will. But then to be ethical, do I track the minutes of prayer and subtract them from the physical ther- apy time? I sometimes feel a little shaky stepping outside traditional
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practice. There’s such a move for evidence-based practice, but the assumptions underlying evidence-based practice don’t allow much role for spirit. It’s so man-made.”
Positive impact. Eileen Altenhofer, a parish nurse, agrees that the cur- rent healthcare system is very hard for everyone to cope with—it is complicated, expensive, and often inaccessible. However, she says, “It influences my spirituality by making me feel I need to pray more to have patience and perseverance.” Reflecting a similar position, Genie Ford adds,“The healthcare system makes me pray.There are many issues for concern, such as the lack of healthcare for everyone and the nursing shortage.These issues are so overwhelming, but the one thing that I can consistently do is to pray.”
Harriet Coeling concurs:
The stresses of the current system make me more aware of my need to maintain my relationship with God and to draw upon him for the strength and guidance I need to get through each day. Healthcare today is so complex that I find I need a personal focus to guide my decisions and to make wise ones. I see the whole world as a spiritual environment, a place that draws me into deeper relationship with God. I think both peaceful and stressful places can draw me closer to God, although they do so in different ways.
From the perspective of an occupational therapist, Jay Brashear explains the impact of the healthcare system on his spirituality.
When I felt initially called to be an occupational therapist, I believed that I would be a really good OT. Now I recognize that I am probably an average clinician. But I can see that the reason God wants me in this profession is for what I con- tribute spiritually. God has given me the ability to think outside of the box, to call a spade a spade, and an overwhelming desire, despite today’s inadequate healthcare system, to make patients feel unique and loved and not just another case. I believe that the current healthcare system does not offer people reasonable options for getting well.As a system it is failing.As a clinician, I hope that my prayers for a patient plus my call to be with them will give them something that they really need, and that is full healing.
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Neutral impact. Diane Molitor, a nurse, explains her perspective:“The current healthcare system does not influence my spirituality; my spiri- tuality influences how I react in the current healthcare system. My spir- ituality makes me more aware of the importance of being honest and sincere with others and exercising the Golden Rule—that is, treating others as I would like to be treated. I recognize how important it is to be compassionate and caring not only to patients and their families but to co-workers as well.”
Dee Brooks, another nurse, responds:
I am not sure if the system influences my spirituality. I think we should be more aware of and provide for a patient and family’s spiritual needs, and that I just may have been called to see that this happens as part of my total care for these people. A hospital workplace is a place where you see people’s vulnerabilities in a time of stress—this can include co-workers as well as patients and families. When you allow the peace of Christ to shine through via calmness, quiet, lis- tening, doing caring acts, and touching, this is often felt by those around you, and it spreads.
Most who work with me know my religious convictions and appreciate who I am because of them. I am not shy about asking a person’s religious practice and if I can help in any way to see their needs are met while in the hospital. If asked to pray, I am there. Hopefully, through my actions those around me who are not as comfortable with these issues or had not considered the workplace a spiritual environment can learn from me how to incorporate spirituality in their work and be comfortable with it.
* In what ways does the current healthcare system have an impact on your own spirituality?
* In what ways does the culture of the healthcare system affect your ability to act as a ministering person?
* Think about a recent interaction with a patient, family, or colleague, from which you walked away feeling good about what occurred. How did your spirituality influence that interaction?
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* Think about a recent interaction with a patient, family, or colleague from which you walked away feeling dissatisfied with how you han- dled that interaction. Describe what you would have liked the out come to be. In what ways would your spirituality have brought about the desired outcome?
:
We asked in what ways the healthcare workplace is a spiritual envi- ronment. Most of our respondents talked about the power of individual example to shape, influence, and create such an environment. Some identified the importance of externals, such as a pleasing décor and the availability of quiet, private spaces within the healthcare facility. Others discussed the influence of leadership in the creation of a spiritual cul- ture. One nurse, Margie Schmier, told us that the only workplace that she believed was spiritual was that of hospice, with its focus on end-of- life spiritual issues.
Let’s listen to the voices of the participants. According to nurse Genie Ford, the core activity of caring makes
the healthcare system a spiritual workplace:“If you look at life as a spir- itual journey, then your workplace will naturally be a place where spir- ituality can be practiced. Caring for people is a spiritual endeavor.”
Chaplain Jeffrey Flowers also comments on the significance of car- ing relationships in healthcare: “So much time is spent in a workplace with important relationships being nurtured, it seems impossible that it would not be a spiritual environment. Of course, it can also be a nega- tive spiritual environment if people feel threatened or suppressed in their workplace. In order to be productive, it seems that one must find the ability to be at ease with one’s spirit, to find meaning and purpose in what one does.”
Dr. Sagrid Eleanor Edman believes that the commitment of individ- uals to integration of faith into everything makes the workplace a spir- itual environment.
Dr. Jack Hasson recognizes “that the workplace is shaped by those
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that enter it—many have different and often foreign approaches to spirituality. We need to lead by our personal examples of spiritual approaches to what we do, but be open to others and their approaches, which work for them—this is especially true for patients when they are ill and stressed.”
In discussing the influence of the external factors, Eileen Altenhofer points out, “A workplace can be spiritual by making the environment more peaceful, quieter, pleasant to view, and perhaps most importantly, by the smiles on the faces of the staff.”Adding to this, Charity Johansson suggests,“I think any workplace that provides some quiet private space begins to provide a spiritual environment. I still need some privacy for my prayer, and I need to be in environments that are beautiful—visual- ly, auditorally, and tactilely. Such environments feed my soul and help sustain my spirit. In the same way, allowing for enjoyable experiences promotes spiritual being.”
Dr. Karen Soeken comments that in order for the workplace to be a spiritual environment, it must be a place of growth, encouragement, and development of talents and abilities with a “peaceful yet energetic ambience.”
Mitroff and Denton contend that the leadership of an organization plays a critical role in creating a spiritual environment:“No organization can survive for long without spirituality and soul.l.l.l. We need to integrate spirituality into management. We must find ways of managing spirituality without separating it from other elements of management.”8
Nancy Shoemaker, a psychiatric nurse, makes sim- ilar observations:“All workplaces have an atmosphere or culture. When the leadership staff recognize the importance of spirituality and demonstrate spiritual values—respect for patients and staff alike, honesty, integrity, hope—not only do staff feel valued, but there is ongoing hope for patients to improve.”
Working in the home environment gives Jay Bra- shear a slightly different perspective:“If the workplace is the patient’s home, then it is absolutely a spiritual
The State of the Current Healthcare System
“No organization
can survive for long
without spirituality
and soul.l.l.l.We
need to integrate
spirituality into
management.We
must examine ways
of managing
spirituality without
separating it from
the other elements
of management.”
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environment.This is where the patient has been accustomed to practic- ing very personal activities such as getting cleaned and dressed, which are things that most people are able to do in their own home. When someone is unable to do something that everyone else can do in their own homes, then the home becomes the ground on which they want to be healed—physically and spiritually.”
Miriam Jacik provides a summary of what is essential for the work- place to be a spiritual environment:
It is necessary for the supervisory staff as well as the care providers within the envi- ronment to be persons of integrity with high moral standards and values and have lives that are directed by spiritual principles. Such an environment will be graced by the personal gifts of each caregiver. Collectively they will create an atmosphere of love, caring, goodness, and peace that can’t help but emanate from them and touch the lives of all the patients who enter that environment.When a spirit of ministry, as opposed to mere job performance, exists, persons with needs of any kind who enter that environment will have their needs more adequately met.
However, a work environment that is contaminated by standards of greed, cor- ruption, dishonesty, and power-seeking that filter down from the level of upper management is hard pressed to have spirituality develop and flourish to any real degree. Evil and a pervading lack of morality can corrupt a whole organization, making it very difficult for goodness, justice, and other spiritual values to exist. Persons of faith, morals, and spiritual practice can individually and collectively affect their work environment, rendering it a spiritual environment. It takes the personal conviction that the way one lives one’s life can affect in a positive way those around oneself.
I believe this and trust that my spirituality and religious convictions do make a difference in my work environment and in the lives of those I serve in ministry. Being true to what I believe and having it be reflected in my choices and actions contribute to the environment in which I work. Finding myself in an environ- ment that is not life-giving and perhaps corrupt challenges me to endeavor to be a change agent in some way. If I find that efforts at bringing goodness, rightness, truth, and integrity to an environment are futile, this is an indication to me that I must leave the environment.
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* In what ways is your work environment a spiri- tual one?
* What factors support and/or hinder your work environment from being a spiritual one?
* How would you rate the importance of external factors, such as décor and provision of quiet spaces for prayer and contemplation, in the creation of a spiritual work environment? How important are individual internal factors such as commitment to caring and ministry in creating a spiritual environ- ment?
* What is the role of leadership in creating and com- municating a spiritual culture in the workplace?
A common theme of caring and serving others ran through our participants’ responses to the ques- tion,“In what ways are you able to contribute to the spiritual environment of your workplace?”
Dr. Jack Hasson says, “My contribution to the spirituality of the work environment is by reflecting love, caring, and concern for my fel- low workers and patients in a sincere and genuine manner.” Dr. Bernita Taylor takes a similar approach:“I make sure to acknowledge the impor- tance of other workers in our office and how we all depend on one another to get the job done. It is so important to be supportive to co- workers who are experiencing stressful times.”
Harriet Coeling elaborates:
In my organization, I try to represent God’s love to others with the hopes that some might come closer to God through this effort, and I try to help others see my interpretation of how God is active in my life and helps me in so many ways.
The State of the Current Healthcare System
When a spirit of
ministry, as opposed
to mere job perform-
ance, exists, persons
with needs of any
kind who enter that
environment will
have their needs
more adequately
met. Often, however,
a work environment
that is contaminated
by standards of
greed, corruption,
dishonesty, and
power-seeking that
filter down from the
level of upper
management can be
hard pressed to have
spirituality develop
and flourish to any
real degree.
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I share with others in the hope that others might better understand how God wants to be recognized by them as being active in their lives. I try to behave in a loving, patient, joyful manner so that I can contribute to making the workplace a more spiritually healthy place in which to work.
Eileen Altenhofer shares her efforts to make the external environ- ment more spiritual, as well as her volunteer caring efforts that go above and beyond the call to serve others: “In my current parish nurse role, I try to incorporate spiritual components into displays. For example, I prepare a monthly bulletin board highlighting a particular resource theme. There is always a poem, a Bible verse, or an uplifting thought related to the theme that is incorporated into the bulletin board. I also volunteer at Highline Hospital, where I research health topics in the Planetree Library. I prepare information packets for hospital patients at their request, answering questions about their particular illness.”
Patricia Camp, a nurse, laments:
There are things that I see in the hospital environment that detract greatly from it being a spiritual atmosphere.Valuing and respecting others is spiritual and is expressed in many different ways.When I hear caregivers use foul language and or engage in any type of “verbal abuse of patients,” the atmosphere is certainly not a spiritual one. I also believe that the appearance of the healthcare profes- sional also contributes to or takes away from a spiritual environment. Uniforms should always be neat, clean, and professional in appearance.This outward sign is a reflection of how individual practitioners value their profession as well as how they value and respect patients.
Vicki Germer, a psychiatric nurse, identifies the responsibility of the individual for contributing to the spiritual environment: “I engage in positive conversations that focus on the good in people and situations. I also contribute through prayer, sometimes my own silent prayer and at other times shared prayer, through music, and through a positive, caring attitude.”
Dr.Tom Grace also highlights the importance of personal prayer as a contribution to making the work environment a spiritual one:“I pray for my patients before surgery, and many times they ask me to join them
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in prayer, which I always do. Prayer is also important for the staff that I work with, so I also pray for them.”
Dr.Karen Soeken identifies intrinsic qualities that contribute to spir- ituality, such as being a person of integrity, showing respect for others, being a good listener, and being someone who others can come to without feeling judged or demeaned. She also highlights the importance of extrinsic factors such as the atmosphere of her office—the art on the walls and the desk, as well as the music that she has playing. All these factors contribute to a spiritual environment.
Kelly Preston, the former congregational health program coordina- tor for the Ingalls Center for Pastoral Ministries, believes that the pres- ence of a parish nurse program contributes to the spiritual environment of the facility.The fact that a healthcare institution supports such a pro- gram is recognition of the important relationship between faith and health.
A home care nurse, Karen McCauley, believes that the presence of nurture and support to others is foundational to a spiritual workplace.
I think it is important for nurses to get together to discuss their concerns and to support one another. Sometimes meetings like this can be very negative; how- ever, they also have the potential for producing positive ideas and generating support for the team.From a personal perspective, I believe I contribute to a spir- itual environment by helping others in any way that I can. I try to always be opti- mistic; it helps me cope with situations that are beyond my control.Also, I believe that being negative seems to draw forth more negativity from others and really has a detrimental impact on the whole environment.The Prayer of St. Francis is my favorite; I say it every day and make a conscious effort to follow it.
Lord, make me an instrument of Thy peace. Where there is hatred, let me sow love. Where there is injury, pardon. Where there is doubt, faith. Where there is despair, hope. Where there is darkness, light. Where there is sadness, joy.
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O Divine Master, Grant that I may not so much seek to be consoled, as to console;
To be understood, as to understand, To be loved, as to love; For it is in giving that we receive, It is in pardoning that we are pardoned, And it is in dying that we are born to eternal life.
Dr. Christina Puchalski believes that “it is essential that we respect the beliefs of others and that we focus our understanding on the core values rather than the differences of each religion.We would find that we have much more in common than is different. If the workplace is to be spiritual, it is essential that people feel cared for, supported, respect- ed, and loved.”
Her own efforts are directed not just to her work environment at George Washington University School of Medicine but toward system- wide changes. She founded and directs the George Washington Institute for Spirituality and Health, a university-based organization working toward a more compassionate system of healthcare. The institute has proposed the following changes:
:
. Recognize and accept that they are entrusted with the care of: • the physical, • the emotional, • the social, • and the spiritual aspects of their patients in all phases of
patients’ lives; . Support patients in their suffering and in the midst of existential pain; .Address spiritual values and beliefs as part of the routine medical
history; . Form collaborative partnerships with chaplains, clergy, and other spiritual
care providers; and . Recognize that their own spirituality plays a key role in their professional
lives and affects how they interact with their patients and colleagues.
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:
.A field of spirituality and health whereby physicians and other health- care providers can further their academic and professional interests in order to improve the care of patients;
.An increased amount of scholarly research by a variety of disciplines on the roles of spirituality and health;
. Health administrators and healthcare policymakers who recognize the importance of spirituality in healthcare; and
. Healthcare training programs in spirituality and health that span all disciplines.
:
.A recognition of the role of spirituality in healthcare, and particularly in chronic illness and end-of-life care; and
.An increased awareness by and an empowering of the nonmedical public regarding the role of spirituality, particularly in chronic illness and end-of-life care.
—Taken from www.gwish.org/id.htm
* What do you bring to the healthcare workplace that contributes to a positive spirituality?
* How do you live out your spirituality in the workplace? * Consider the problems that you encounter at work—how would
spirituality influence the solutions to these problems?
In a study reported by Trott, spiritual well-being was evaluated among workers at a Fortune engineering-construction organi- zation.9 The sample demonstrated a moderately high level of spiritual well-being as well as significantly positive relationships between spiritu- al well-being and perceptions of organizational openness, general self- efficacy, and normative and affective organizational commitment.
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Additionally, a significant inverse relationship was found between spiri- tual well-being and commitment to staying in the job. Although there are no similar studies that examine the healthcare environment, the responses of our participants seem to indicate that Trott’s findings might be generalizable to the healthcare system. When we asked participants whether an intangible such as spirituality could effect employee reten- tion, we received overwhelming affirmation to this suggestion.
Charity Johansson responded, “I think the degree to which an employer environment acknowledges the value of and promotes the health of the whole person—body, spirit, and soul—including the intel- lect, emotions, and imagination—strongly affects retention. There will always be some turnover, which isn’t necessarily a bad thing. But often people leave because something is moving in or out of balance.”
Surgeon Tom Grace believes that an environment where employees feel supported and valued for their contributions to a culture of care produces high morale and low turnover. Expressing a similar viewpoint, physician Jack Hasson says, “Employee retention is certainly positively impacted by an enjoyable work environment where spiritual matters are experienced as a natural concern.This allows workers to feel at home and to look forward to work every day, knowing they are working for a greater good. In such an environment, even the stressor of increased work and slightly less compensation will not be viewed in such a neg- ative fashion as to lead to employee turnover.”
In total agreement, psychiatric nurse Nancy Shoemaker believes “the supportive culture resulting from a spiritual environment is very instru- mental in employee satisfaction and retention. Staff such as myself will work under adverse conditions with very difficult patients when there is a shared belief system that values each individual as a precious human being.”
Kelly Preston comments that sometimes there is a pull between pay and benefits versus a spiritual culture as factors influencing retention:“I do believe that a spiritual environment influences retention; however, sometimes money can be a driving force for many nurses who may be single parents and will leave a position for another where pay and ben- efits are better.Yet here at Baptist Health System,we have many employ-
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ees who have been here more than thirty years! Employees say that the mission of the hospital to the provision of pastoral care is the reason for their longevity.”
Feeling loved and cared about are not only important for patients but for healthcare providers as well. Eileen Altenhofer says,“I believe staff is more likely to stay because spiritual components in an environment con- tribute to a feeling of calmness and being cared for. Happier patients result in the staff feeling more satisfied with their delivery of care.”
Diane Molitor, a nurse, adds, “In a true spiritual environment, you would see employee retention. People don’t tend to run away from warmth, caring, honesty, or a relaxed environment where they can be themselves.”
Dr. Bernita Taylor also supports the view that employees prefer to remain in a work environment where they are loved and respected.
Miriam Jacik reflects on her nursing experience:
I believe that a spiritual environment is a felt experience for those who work in it and has positive aspects that are perceived by caregivers. A spiritual environ- ment, even though it may be wrought with busyness, stress, or difficult situations, is different and is felt to be different by those working in it.There is a sense of God-given strength, peace, and goodness pervading the whole environment.This allows one to balance the negative factors such as stress and busyness against existing factors that are positive.
This, I believe, draws caregivers to want to be in such an environment, to decrease turnover, and to increase retention. In the thirty years that I have prac- ticed nursing, I have found that a chaotic work environment with no positive aspects like a spiritual environment affords will most likely lead to frequent staff
burnout and a high rate of staff turnover.
Chaplain Jeffrey Flowers’s observations conclude this section: “It is clear that where people are happy, they are more productive, and when they feel that what they do has purpose, they will do it with greater pride.These are spiritual words and concepts.Also, a spiritual communi- ty cares for one another. Employees who feel cared for are more likely to be loyal and to stay.”
The State of the Current Healthcare System
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* Do you believe that a spiritual work environment influences em- ployee retention and turnover? If so, in what ways does this occur?
* Think about employee retention and turnover in your place of work. How is spirituality an influencing factor?
* What factors would make you stay or leave a place of employment? Have you ever left a position because the environment was not spir- itual? What was it like?
We identified fourteen concepts from the literature focusing on spir- ituality in the workplace, and we asked participants to prioritize the top three and comment on why these concepts were most important.The concepts included: () meaningful work; () purposeful activity;10 () affirmation; () interconnectedness and relationships;11 () shared values; () concern for ethical and moral dilemmas; () open communication; () reasonable expectations regarding productivity standards, paperwork requirements, and other responsibilities;12 () support for spiritual care for patients and families;13 () authenticity; () awareness; () con- gruency;14 () a focus on the patient; and () a sense of vocation.15
Table shows the ranking of each of the top three concepts. Meaningful work was ranked as the most important concept by thir-
teen of the participants; interconnectedness and relationships was ranked second in importance by twelve of the participants; and shared values was ranked third in importance by seven of the participants.
Let’s listen to what participants told us regarding the importance of these concepts.
Meaningful Work
Everyone who ranked meaningful work as the most important com- ponent in a spiritual environment had similar comments. Othelia Lee, a social work professor, exclaims,“I feel passionate about what I do!” Dr.
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Michael Parker, a gerontology specialist, espouses a similar view: “A sense of calling provides and fosters contagious passion.” Joyce Kinstlinger, a community resource counselor. agrees: “You’ve got to want to make a difference and put your heart into what you are doing with patients and colleagues.” Cynthia Poort, a nurse involved in men- tal health treatment, asserts, “It is essential that work impacts your life and the lives of others—otherwise why do it?” Sister Karen Pozniak concurs: “Unless work is meaningful, it is hard to do it.When work is meaningful, it is carried out with the heart and not willpower.” Dr. Daniel Ober believes that “work must have meaning to give us a sense of who and what we are.” Nurse Genie Ford adds,“One has to perceive that what one is doing is important to the overall mission of the organ-
. Ranking of Importance of Fourteen Spiritual Concepts
1st-Place 2nd-Place 3rd-Place Total Weighted Spiritual Concept Ranking Ranking Ranking Score‡
Meaningful work 13 5 1 50*
Purposeful activity 3 3 – 15
Affirmation – 3 5 11
Interconnectedness 4 12 5 41**
Shared values 3 2 7 20
Ethical and moral concern 3 4 10
Open communication 2 7 5 25
Focus on patient 11 2 2 39***
Reasonable work expectations 3 6 12
Open support for spiritual care 5 2 2 21
Authenticity 1 2 2 9
Awareness 1 – – 3
Congruency – – – –
Sense of vocation 3 1 – 11
‡ The first place votes were given three points, the second place votes received two points, and the third place votes received one point.A total was obtained for each spiritual concept.
* Most important concept ** Second most important concept *** Third most important concept
The State of the Current Healthcare System
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ization, whether it is being on the janitorial staff or the management team.”
Interconnectedness and Relationships
Many participants commented on the significance of interconnect- edness and relationships with God, with patients, and with colleagues.
Sandra Brown, a nurse practitioner, speaks about the nurse-patient relationship: “It is through relationships that patients find meaning in their circumstances and in their suffering.The nurse-patient relationship is bound by a sacred trust that nurses will always seek to meet their patients’ needs. This requires the nurse to enter the patient’s presence with the intent to connect in a meaningful and spiritual way.”
Carol Story, also commenting on the importance of relationships, believes,“When all is said and done, if people are not connected to one another either by values, dreams, goals, faith, or work, life has little meaning, and a deep sense of loss exists.”
Focus on Patient
The focus on the patient was chosen as the third most important concept.The comments of many of the nurse participants were similar. Karen McCauley states,“My work is the patient and how the patient is treated involves my spirituality.” Diane Molitor emphasizes the impor- tance of a focus on the patient,“The patient is the reason for our work.” Eileen Altenhofer explains,“If we focus on the patient, we become less task oriented.This is a very tall order during the current nursing short- age and short hospital stays of patients. However if we take the extra step of imparting to the patient that we really care how they feel and how they are progressing, it contributes to their healing and ultimately there is a better outcome. And finally, Dr. Gunnar Christiansen states,“A spir- itual environment will not develop unless the patient comes first. In a medical office or a hospital, the purpose in utilizing our God given gifts is to give care for others as persons. Unless we primarily put our focus on our patients, it is likely that we will focus only on their disease.”
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* How would you prioritize the fourteen concepts? * How do you see these concepts operationalized where you work? * How would you like to see these concepts operationalized? Identify
one action that you could take to make this happen.
This chapter has reviewed the spiritual crisis of the healthcare system. We have examined the pressures and demands on healthcare profession- als to do more with less and to meet unreasonable demands for docu- mentation and for regulatory compliance.We have heard the voices of nurses, doctors, therapists, chaplains, social workers, and others describe the impact that the healthcare system has on their own spirituality as well as their conclusions regarding the potential of the healthcare system to be a spiritual environment.They have also shared their own stories of how they continually strive to make the healthcare system what it should be, a healing and ministering environment.We have listened to their voices affirming that an environment lacking in spirituality has difficulty holding onto employees.And last, we hear these same health- care providers telling us that it is ultimately important that their work be meaningful and structured around relationships and interconnected- ness with patients, families, and colleagues and bound together by shared values.
Before continuing with chapter , which takes us to the next step and suggests what the ideal healthcare system might look like, let’s lis- ten to one more voice, that of Chaplain Robb Small: “The healthcare system needs more communication and much less emotional abuse of its employees.There needs to be greater effort to understand the balance between the financial margin and the spiritual mission. Success and financial tails wag the dog. I would like to see some of this turned around. I would like to see the leadership of institutions realize that as long as the focus is upside-down, work will be a painful struggle instead of a joyful service that one can be excited to get up each morning look- ing forward to the day.”
The State of the Current Healthcare System
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