Staff Care in the Emergency Department

In the middle of the Emergency Department at Indiana University Health Methodist Hospital, there is an “island” of work stations. A five-foot-tall glass wall separates the north and south sides of the island. Two department secretaries sit on the south side of the island and face multiple computer screens, phones, and overhead microphones. The critical care charge nurse sits at a computer on the east end. Every morning, the ED chaplain sits at a workstation that is diagonal from the charge nurse. April 2020 was the beginning of the first surge of COVID-19 patients. On one morning that month, a veteran charge nurse looked up at the chaplain and said, “You need to pray for us every day.” In response, the ED chaplain now prays every day in the middle of the unit where he is visible to the staff.

“You need to pray for us every day.”

What is the role of a chaplain in caring for team members in an Emergency Department during a traumatic event? The answer to this question is closely tied to the evolving role of the ED chaplain. Chaplains have been working in the Emergency Department at IU Methodist since the 1960s. They have always responded to the most serious Level I events such as traumas, strokes, code blues, and heart attacks. Every chaplain at Methodist does some work in the ED while on duty. The most recent development came in early 2017 when the nursing leadership of the ED requested that a staff chaplain be assigned to the ED as “a chaplain for the ED staff.” A former chaplain resident and recent seminary graduate was hired for this role.

Over the past four years, the role of the chaplain in caring for the ED team members has developed in two ways. First, spiritual care during traumas has become more structured. Second, the daily care of ED team members has become more intentional and consistent.

The chaplain works in parallel to the patient experience

While the technology of trauma care has changed, the process of trauma assessment and care follows an established model. Primary assessment and care is followed by a secondary assessment with vitals, medical history, and a head-to-toe exam. In late 2017, the newly hired ED chaplain developed a written process entitled “Spiritual Care Response for Level I Events in EMTC.” The process outlines what is happening to the patient at each step of assessment and care, what the medical team members are doing, and what the chaplain is doing. While it does not prescribe specific interventions, the process places the chaplain’s work in parallel to the patient’s experience and the work of the medical team members. This process was reviewed by ED physicians and nurses and every new chaplain is trained in it.

How does this written process contribute to the care of ED team members during traumatic events? Most critically, chaplains are embedded with the medical team during traumatic events. The chaplains are with them as they are experiencing difficult moments. Chaplains participate in those moments and can reflect upon how larger issues such as race, culture, community, and gender have played a role in the situation. When team members have been impacted by caring for a patient, the chaplain cares for them as someone who knows the situation firsthand.

“You are our chaplain, too.”

The day-to day-care of the ED team members takes multiple forms. First, the ED chaplain spends time in the ED when there is not an active trauma response. The medical team knows when and where they can find the chaplain if they have a need of their own. Second, the chaplain provides brief didactics on the role of the chaplain in the ED. New medical team members are often surprised and pleased when they understand that “You are our chaplain, too.” When time allows, the chaplain will engage them with the question “How did you decide to become a nurse (or physician, respiratory therapist)?” to learn their motivations and hopes. Third, the chaplain holds brief conversations with team members who have participated in a traumatic event. These conversations can be initiated by the chaplain, sought by the medical team, or requested by the ED managers. The focus of these conversations is having providers describe their experience of the event, normalizing their reactions, making suggestions for healthy coping, and receiving permission to follow up. Finally, the ED chaplain provides blessings to people and places. With their permission, the chaplain blesses new team members during their orientation, departing colleagues on their last day, and any team member who is at a major life transition. Every new room or newly renovated ED room is blessed. Medical team members can request that a room be blessed. [Suggested text for this is available here.]

In summary, the steady, active, and predictable presence of a chaplain in the ED creates the opportunities to care for team members during and in response to traumatic events and to care for the ED as a community of practice.