Tuesday, November 3, 2009

From Kansas to Oz...

I've decided that switching from one hospital system to another as a chaplain is sort of how I imagine it would be like if I moved to England from the U.S. Many similarities, but also many differences. Same language, but different dialects/nuances. Similar, but different, cultures.

At the end of August, my CPE residency year ended and I immediately began a job as a PRN (as-needed; very part-time) chaplain at another local hospital system. I'm on-call one night a week (usually Fridays) from 9pm to 10:30am and occasionally (maybe once or twice a month) get called in to work a regular shift if one of the regular staff is away for vacation or illness. There are four of us PRN chaplains and we're actually shared by two hospitals in the same system, about nine miles apart from each other.

While I love chaplaincy and really like my supervisor and the other staff members, it's been a fairly major transition for me, and I didn't expect that. Sure, the actual work is pretty much the same; offering spiritual and practical support to patients and families. However, BSHR has different policies and procedures than RRMC did, even in the pastoral care role. Actually, we're called "Spiritual Care" at BSHR while RRMC was "Pastoral Care."

A few more differences:
-Loads more documentation is required. At RRMC, I filled out a "stat sheet" once a week, detailing how many patient, family, and staff visits I made, as well as how many deaths I attended, how many Advance Directives I helped with, etc. When I was on-call, I entered each page I received in a log book, with a brief description of the incident including the time and location. At BSHR? We have a computer-based system, and I make a detailed assessment for each patient/family interaction and then print out a chart note at the nurses station. On average, it takes me 10 minutes to document each patient/family interaction, sometimes more. I also need to document the time I spend with patients and charting. I see the benefits of it, but it's been a learning curve.

-Some of the terminology is different. For example, I have twice gotten paged for something called a "Rapid Response" or "Stemi Code." Apparently it's an early intervention method to prevent a "Code Blue" (cardiac arrest) from occurring. I'm sure this happened at RRMC, but I was never paged for it, so I had NO CLUE when I first heard about it.

-Different priorities. RRMC was a secular hospital, and BSHR is Catholic. We have prayers over the PA system twice a day, there is a VP of Mission, and at orientation they spent 15 minutes explaining what it means to be a Catholic hospital, informed by the teachings of Jesus, emphasizing vocation, even encouraging us to pray with patients. That's nice, since sometimes I felt pastoral/spiritual care was not a priority of the administration at RRMC. However, at RRMC we made a conscious effort to offer prayer to every pre-surgical patient and there is no such effort at BSHR.

-Different facilities and accomodations. At RRMC (which is a Level 2 trauma center), the ER has a very nice, large, "meditation room" for families and loved ones to gather during traumas/emergencies/deaths. It was off the beaten path and allowed the medical staff to have a private place to speak with families (for good news and bad news) and allowed families a quiet place to gather/wait/grieve. At one of the BSHR hospitals, there is a very small consult room that is right in the thick of things. At the other BSHR hospital I work at, there is no such room. Ironically, this is the ER that has recently been renovated.

There's more...but my tired brain can't think of them right now. Maybe more tomorrow?

I'm feeling better today...I even made it out of the house to do a few errands, cleaned up the kitchen, and did two loads of laundry. Harry is feeling better, too, but he's still staying home from work tomorrow.

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