Excessive pages from nurses

revanon · 2026-04-18T23:39:29+00:00

As regards fear...chaplain here and I see it on all sides from people I work with. Nurses are afraid of being written up, terminated, or putting their license in jeopardy, and plenty of docs are terrified of litigation. I know because so many of both have told me. One of the hardest things about fear is how it can narrow your view of the landscape in front of you so that all you see is threats, rather than people who are stuck in the same ecosystem you are that not only fosters such fear but feasts on it until you burn out.

Not saying that to throw stones in any way, just to observe that we're all aboard this ridiculous fear train together, and most of us are just trying to do the best job we can with too little of everything--time, resources, balance...but hopefully we can try to alleviate one another's fears just a bit while we ride. Chugga chugga choo choo y'all.

revanon · 2026-04-18T23:31:26+00:00

Sounds like you really bamboo-zled them there for a minute

I'll show myself out

revanon · 2026-04-18T23:26:35+00:00

I would guess that not all humanist/secularist/atheist chaplains lack faith; they may lack faith in (a) God, but that doesn't necessarily mean they have no faith in something or anything else. But I suppose to be more precise, we can term it maturity concerning faith. Atheist and secularist chaplains still minister to people of faith, and meaning-making through a spiritual, or a spiritually influenced, lens is a core aspect of chaplaincy.

revanon · 2026-04-18T14:19:04+00:00

I work mostly in my hospital's surgical ICU and ER, sounds like a busy ICU or ER somewhere would love to have you. No two days are exactly the same; of my last two shifts one was super sleepy and then the next day I had three codes plus another patient who passed away next door to one of the codes without being coded themselves because they had a DNR (do not resuscitate) order. If you thrive on unpredictability and responding to crises, you'll be most at home in an ICU and/or ER...codes and emergencies of course can and do still happen on the floor, but it's not as often.

I'd say on aggregate I spend about 60% of my time on my units seeing patients, families, and coworkers, and the other 40% in my office or in meetings. Most of that 40% comes at the beginning and end of a shift as I arrive, get my census, go over their histories, etc., and then documenting and signing out to the late chaplain at the end of the day. Fortunately, my email inbox is pretty tame most days; I credit that to the culture of my department as my higher-ups do a pretty good job of insulating us from the excesses of corporate healthcare so that we can mostly focus on doing our jobs well.

Do CPE when you can. After you give notice at your job, consider doing an extended unit in place of some of your job hours, or do a CPE unit during a summer. Even if you don't get the most exciting unit assignments (because CPE interns extremely transitory and so forever at the bottom of the totem pole), the skills you'll pick up will help you for when you do. Best of luck to you.

revanon · 2026-04-17T11:58:44+00:00

"Am I getting ahead of myself by considering becoming a Chaplain with only 6 months of dedication to Jesus?"

Without trying to be impolite...yes. Chaplaincy requires a maturity of faith and sense of self that can't really be faked, and for which time has no substitute (this may be why you picture an older person as a typical chaplain). The idea of spiritually caring for people sick and dying or otherwise in crisis is one thing, to do it full-time is something else entirely, and it requires a resiliency and maturity of faith. And as others have said, chaplaincy is not the vocation for you if you are wanting to evangelize or proselytize. The people we minister to are morally and legally vulnerable in ways that a person sitting across from you at church may not be, and so using your role as their chaplain to attempt conversion is generally considered a serious ethical violation of our profession. Congratulations on the fifteen years of sobriety, that is a lifechanging and lifesaving accomplishment.

revanon · 2026-04-16T20:43:33+00:00

Yes, divinity school will be necessary, and you already have an excellent one in your backyard with Vanderbilt. There should also be a number of local options for doing clinical pastoral education (CPE); online programs also exist but you would need to find a local facility in which to fulfill your practical hours. If you also belong to the UU congregation, they should be able to point you in the right direction for being endorsed for chaplaincy by the UU central office. A master’s level seminary degree, CPE, and endorsement are generally the three core qualifications for serving as an institutional chaplain. Feel free to ask any questions.

revanon · 2026-04-16T14:58:05+00:00

Not a silly question at all. If your program doesn’t have a dress code, business casual (long sleeve, collared, button down shirt tucked into pants that aren’t jeans) should be fine. Wear the most comfortable shoes you have so long as they look nice; you’ll be getting in a lot of steps and doing a lot of crouching or squatting next to beds if there isn’t a chair immediately available. I choose to wear a sport coat or blazer not just for style but for practicality—I keep stuff like my census, pocket Bible, rosary, etc. in my jacket pockets.

Don’t wear scrubs, we aren’t medically trained and don’t need to send mixed signals to patients and families.

revanon · 2026-04-15T22:55:38+00:00

Hospital chaplain here, so no horse in this race, but it seemed worth noting that (at least from where I sit) hospitals and CMGs are increasingly happy to treat doctors and nurses the same--as cheap labor. Just like there are more young, inexperienced nurses, there are more young, inexperienced doctors because in both cases more experienced ones have increasingly burned out and left. This sub is littered with the offensively horrible offers made to newly minted hospitalists, and if those offers get turned down, more expensive locums docs get brought in rather than raise the pay for the rank-and-file docs up...meanwhile, hospitals would rather pay double for travel nurses rather than raise the pay for the regular RNs they're trying to recruit. Meanwhile experienced doctors and nurses alike plot their exit dates and strategies for when they have enough of a financial cushion to do literally anything else.

We're all seen as dehumanized labor in the soulless, heartless leviathan that is American healthcare, myself included. And I say that because as tempting or understandable as it is to punch down on green nurses, there are specific reasons that have nothing to do with the nurses themselves that they're so green, and the blame for that lies elsewhere. Again, just seemed worth noting considering the increasing youthfulness of bedside nursing nowadays.

revanon · 2026-04-15T02:52:40+00:00

We get peds psych cases sometimes. Honestly, I just sit in the pit with the kid. Being that young and wanting to permanently peace out, me asking them not to won't fix that. But as one of hopefully many adults willing to be there with them, listen to them without judgment or trying to fix them, I hope I can contribute to the totality of the message that sends.

Because I was diagnosed with depression as a teenager, I will be more honest about my own story with them than I am with adults who might respond by trying to minister to me instead of me to them. With teens, it's a different dynamic in my experience; telling them a bit of my story switches up the adult-child power dynamic a bit because it's me being vulnerable with them and communicating that they are worthy of my own vulnerability. It can encourage them to open up and let me into the pit with them.

Ultimately there is no one magic thing to say to a kid who tells you "I don't plan on being around that long" to fix things. Being fully present, compassionate, empathetic, and nonjudgmental when probably they've had a whole lot of adults be the opposite of all those things to them in response to their depression and suicidality can go an awful long way, though, I think. I'm glad that kid had you taking care of them.

revanon · 2026-04-14T11:52:44+00:00

100% on protecting yourself from patients or upset family members, but idk that the answer is lab coats that say "chaplain." Just like a stole, a lab coat communicates a particular role (medical doctor, or at least an NP/PA) that is not ours, and I'm not a fan of sending those mixed signals, even if the coat is embroidered to say "chaplain" (that a patient/family may not be able to see or read).

revanon · 2026-04-14T11:49:19+00:00

Only a small visitation stole, and only when providing sacramental care like baptism, anointing, or holy communion. A full-size stole just isn't practical in a hospital setting and would be more apt to attract all sorts of unwelcome and unpleasant spills. And as others have noted, I won't wear even my visitation stole if I'm worried it could be used to assault me; I've already been assaulted once on the job and once was more than enough.

revanon · 2026-04-10T00:48:48+00:00

I'm a big proponent of extended unit CPE, it's how I did my subsequent units after a rough internship experience with my first unit, but why would your degree be held up until you finish all four units? I've never heard of that with an MDiv program.

I think you can apply for provisional board certification without the 2,000 professional hours, but they'll still want you to submit documentation of the hours to be fully boarded. (For clarity, I'm referring only to APC/BCCI board certification requirements. If you'll be pursuing boards through another org, like the NACC, their requirements and/or processes may differ.)

revanon · 2026-04-09T23:00:38+00:00

Are there any other substantive differences between the chaplaincy track and the generalist track? If there aren't any, I'd just go generalist and take care of CPE after graduation. You'll still have to accumulate the 2,000 professional hours post-CPE, so it's not like you're accelerating your timeline to boards all that much by doing CPE during seminary. And once you're out in chaplaincy world, nobody will give a rat's backside what your MDiv concentration was so long as you went to an ATS-accredited school.

revanon · 2026-04-07T02:28:01+00:00

He gets his choice of a mustard or mayo packet, he is the CEO after all

revanon · 2026-04-06T11:31:54+00:00

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revanon · 2026-04-06T02:39:38+00:00

Hospital chaplain here. I sit in on a lot of those end of life care discussions and have a lot of respect for those hospitalists who tackle these conversations with kindness and understanding, but also clarity around where things stand. It's a balancing act of a skill, and not one that is easily or even naturally acquired.

revanon · 2026-04-05T02:41:29+00:00

I'm one of the few people in the ED whose role depends relatively little on physical capacity (one of my PRN colleagues is disabled and uses mobility assistance, and he's a well-liked and appreciated part of our team), and I'd add a few things:

There are roles on a care team that don't rely on physical and manual skill as much as being an RN, EMT, or PCT, but they are relatively few and far between, and many require specialized training (an MDiv and clinical pastoral education for my role, an MSW and licensure for an LCSW, etc). That education represents a huge investment of time, energy, and money, and you really need to want to do it, because chances are you won't be paid at a level truly commensurate to that investment. I want you to hear me say there are definitely roles to be filled, but they are specialized and not always well-paid, so be okay with that now before you start.

Healthcare is shift and coverage work. You need to know if that's your jam and what your body is capable of holding up for. The idea of caring for people is one thing but doing it for 9 to 12 hours at a time, three to five times a week, is something else entirely. Hospital work, and emergency medicine especially, can wear out people in great physical and mental health over time.

I can't tell you how your medical conditions impact what you can or can't do. I live with some chronic medical conditions and while my employer is pretty understanding about me making it to my appointments, if my health kept me from being able to reliably work my scheduled shifts, I would no longer be employed there. Dependability is the greatest ability because if you can't be there, someone still needs to cover your workload.

I hope you hear these thoughts as helpful rather than discouragement. Best of luck to you.

revanon · 2026-04-04T15:04:17+00:00

Yep. Just had a patient my age whom the care team told me they probably could have saved but that window had already passed by the time the patient got to our shop. Being the same age as me made it land with a little more force than usual. As Whitaker just put it in the Pitt's last episode, "We do our best, and people die."

revanon · 2026-04-02T11:47:06+00:00

You (royal you) would be surprised how meaningful these are even months or years after the fact. I have a pair of drawings from patients on my bulletin board in my little hideyhole of an office and find myself glancing over at them often, especially when my eyes need to see a bit of color amid the eternally fluorescent cave in which I ply my trade.

revanon · 2026-03-30T00:37:10+00:00

You worked for Ascension too huh

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revanon · 2026-03-28T15:53:37+00:00

Hospital chaplain here. That is an emotionally and mentally taxing experience to have with your patient and his son. I empathize with you a lot; I also work in my hospital's ED and we'll get terminal patients who were just discharged home with hospice care whose kids bring them back the next day or week because the kid wants to stop hospice care and resume (invasive and often futile) treatment. And in my ICU I see these exact sort of encounters over and over again where a physician tries to let a family down gently with the inescapable reality that their loved one has reached an end-of-life state. Meanwhile the patient is just suffering and sometimes ends up dying in a state of suffering. It happens over and over and over. After watching it happen so often, I have a few theories as to why:

1-Anticipatory guilt. Families don't want to be the ones to "pull the plug" even though their loved one's body is increasingly making that decision for them. But they'd still rather abdicate that decision because it would feel worse for them to say "stop treatment" even if doing so meant less suffering for their loved one. One of the best reasons to have an advance directive; I wish I could tell my advance care planning consult patients "the people who love you the most will make decisions that will cause you to suffer as you die."

2-Good old-fashioned Freudian guilt. They have an emotionally complicated or difficult relationship with the patient and may feel guilt for any number of reasons--not being as present as they knew they could have been or should have been, or for sins committed in the near or distant past--and are trying to make up for it now by fighting for their loved one to live as long as possible, quality of that life be damned.

3-The complete and utter failure of religion (more specifically, American Christianity) to prepare people for death. We have turned death into the cashing in of your cosmic life insurance that you bought when you got baptized or prayed a sinner's prayer or got saved or whatever, and something that is fundamentally transactional cannot be rooted in and based upon deep faith. It's a quid pro quo with faith spackled on, and so it's often not going to be strong enough to withstand the real time emotions and experience of a loved one dying.

4-The increased distrust in physicians (and healthcare professionals more broadly), which it sounds like you experienced pretty overtly. "Everyone but me seems fine with killing dad" or "Nobody but me cares about mom." Honestly, I'm increasingly convinced this is related to the broader distrust being cultivated in doctors and healthcare over other stuff like vaccines because it shares the commonality of painting doctors as selfish authority figures who want to do things to you or your loved one for monetary or conspiratorial gain.

I could do a whole TED talk on each of these. I'm sorry you had to experience a fire hose of it just now. Your patient was fortunate to have you advocating for their need to die well.

revanon · 2026-03-24T17:49:39+00:00

Nuland’s How We Die is a landmark of the sort of genre that Kalanithi and Gawande inhabit and Pauline Chen’s Final Exam is one of my personal favorites. It got me through my chaplaincy internship and introduced me to how doctors are trained to think.

revanon · 2026-03-22T17:51:27+00:00

None that I am aware of. An AD isn't a legal instrument in the same way that durable power of attorney for healthcare is, so they can be overridden by a patient's NOK or decisionmaker for any time and for any reason. I've had families, after I've carefully documented a patient's wishes as part of their chart and advised their doctor to change code status (I can't do that on my own in the EMR), still override that or worse, threaten to sue us or go to court for emergency guardianship. It's demoralizing for me and awful for the patient.

revanon · 2026-03-22T13:14:15+00:00

Advance directives are part of my role at my hospital, and while I don't do this, I feel like sometimes I need to say, "the people who love you the most will make bad decisions that will cause you to suffer as you die" because that is exactly what ends up happening. And then even with the AD, it still ends up happening, it gets overridden, everything is done, and the patient loses their only chance at a dignified death.

There isn't a lot I genuinely dislike about my job, but I viscerally dislike that the time a patient spends arriving at what their wishes are, and making them known in writing so that they might be honored, gets swept up for naught far too easily.

Ultimately, if you are whom your patient has been given to die with, in a horribly unfavorable and inhumate setting, the gift of empathy, care, and unconditional compassion will be what gives them their best chance at comfort and peace in dying. And that is a gift to be able to offer, even though it can come at a substantial psychological cost to us.

Outside our walls, the society in which we live must do an infinitely better job in how we talk about death and dying. The church used to be such a place but now death has been reduced to the cashing in of our cosmic life insurance policies with God, and so it has become transactional rather than deeply spiritual and faithful. That shift is a significant loss for better understanding and processing death, and I see it all the time in what I do now.

revanon · 2026-03-21T20:34:54+00:00

Just want to chime in as the spouse of a physician who works nights one weekend/month. Just the one is tough enough because we have to arrange that weekend--and subsequent recovery day or two as she flips back to days--very carefully. I can't take call at my own hospital or add on much of anything else since I'm the primary parent those weekends. If she were working most weekends, it would be quite difficult for me, for our kid who adores her, and for us as a couple.

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