This is the talk I gave at the EMBT UK NAP conference on Friday 18th October.
Good morning, I’m Fi and I‘ve been a haematology-oncology nurse for 24 years. I started work as a newly qualified D grade in September 2000 on the haematology and transplant unit at The Christie in Manchester (my hometown) after falling in love with haem as a student in Liverpool.
In January 2007, after returning from maternity leave when I had my second child, I became a band 6 and I’ve now been a sister for over 17 years – and my baby has just turned 18.
So, I’ve been around a while, I’ve seen a lot of developments, I feel like I have a lot of knowledge and skills, and I’m still completely in love with haem and transplant, and I’m particularly passionate about supporting early career nurses so that they hopefully stick around like I have. It’s so important to have skilled and experienced staff on our units and if we nurture our teams, we’ll hopefully retain those who like me find the most job satisfaction at the bedside.
I’m also a Church of England priest.
I was brought up in a church-going family, which was already a bit weird 30 odd years ago when I was still in school, and like a lot of teenagers I stopped going as I had better things to do and many of the things I perceived as the teachings of the church didn’t sit well with my own values, particularly those around the role of women and the inclusion of the LGBTQ+ community.
But then, compelled by something and newly married, in March 2002 I started attending my local church, which had a woman vicar – one of the first – and I learnt I was allowed to believe in things like evolution and that there’s an incredibly wide breadth of beliefs in the Church of England - so wide that I’m sure there’s a C of E community for anyone who follows the Christian faith. I was incredibly lucky that my local church was, and continues to be, progressive and inclusive.
It became a huge part of my life, I had the kids, and I was feeling compelled again, this time drawn to a more formal leadership role in the church, and it felt like that was a call to the priesthood, which made no sense with my vocation as a nurse – I’m sure many of you feel that nursing is your vocation and you can’t imagine being anything else.
I subsequently learned about something called an MSE or minster in secular employment. MSEs are priests or accredited lay people (lay means someone who isn’t clergy) where it’s recognised that their priestly work or ministry is actually in their place of employment, and I met MSEs who were nurses, solicitors, vets, dentists and even tax officers! I went through a very lengthy selection process (it took about 3 years), started training in September 2013, was ordained in 2016 and priested in 2017.
I’m also now a Chaplain at the Christie.
I’d worked as a staff adviser with the team since 2010, so when I was ordained I took up an honorary chaplaincy role. I have to be very careful and very strict with boundaries, so the honorary contract formalised and authorised the work I was already doing.
In 2019 the opportunity arose for a paid role within the team, I dropped my nursing hours to 30 per week – the biggest career decision I’ve ever made - and I work one day a week as a chaplain - I’m now the deputy lead for the service.
So that’s a whistlestop tour of how I got here, and I guess what I’ve been asked to convey is how the dual role informs each of my jobs, where there’s overlap, where’s there’s clashes and how it can benefit patients and staff in a transplant setting. I’m pretty sure this is an entirely unique combination of roles within the same trust, but I truly believe that each makes me better at the other.
My personal belief is that each one of us has a spiritual life that needs to be fed, what this needs is as different and unique as we are. For some it may be our faith. If like myself you work in a tertiary or regional centre, you’ll know the joy of working in a diverse, multi-faith and multi-cultural environment. Those of us with a religious faith might practice or express that in vastly different ways.
For others our spirituality might be fed by music, literature, nature, poetry, pets, craft, hospitality, baking, meditation – it’s vast, and as a nurse who’s always worked with patients in isolation I’ve always been keenly aware of how our patients can feed and care for their spiritual life whilst isolated from most of the things which nurture and ground them, and what we can do to help.
Spirituality is anything that helps us connect- with ourselves, with others, with our world, and (if we have faith) with God or a Higher Power. Spiritual need, and even distress, kicks in when these connections are compromised or broken.
The role of a chaplain is in essence to walk alongside the patient and assist them in whatever way is right for them to care for their spiritual needs, which keeps a person grounded in who they are at their very core.
They way I explain to people how our chaplaincy service at the Christie works is that we’re the one person who goes to the patient’s bedside with absolutely no agenda, each of us who goes to see a patient in our various healthcare roles has an agenda to meet- an assessment to do, information to obtain, bloods, tests, observations, something to administer, and this is true of the wider MDT as well.
As a chaplain you’re meeting your patient where they are, as who they are as a complete person, not the one aspect of their care I may be concerned with as a healthcare professional but as someone who just wants to check “how are you today, is there anything you want to talk about?”
We’re the privileged witnesses to and holders of people’s stories, the number of times I’ve gone to a bed side and felt the overwhelming honour of someone sharing their story or that of their loved one.
There can be misconceptions of why we’re there due to perceptions of what a chaplain is, we introduce ourselves as being there for spiritual support, and very little of what we do is religious care. Mostly we give pastoral support, and around 1/3 of the patients under our care are not religious.
In 2023 we had a total of 1138 patient contacts, from 10 different faiths or world views, we had 398 new referrals, assessed 127 patients in the last days of life and this was between our 3 paid team members, who between us make up 1 full time equivalent, our Roman Catholic cover 2 days per week and 2 honorary chaplains from minority faiths. This year the numbers are already much higher as our volunteers have finally returned post covid, we try to have a volunteer assigned to each ward and visiting weekly to help build those therapeutic relationships.
So, does being a chaplain make me a better nurse? 100% yes. In chaplaincy you’re journeying alongside someone in a different way to how you do as a nurse, and it changes your perspective. The patients who as a nurse we find the most difficult or frustrating - you know the ones I mean - are often the ones that as chaplains we do the most work with, it helps you to understand their complexities, the origins of those complex, frustrating and obstructive behaviours and therefore how they need us to work with them to achieve the healthcare goals necessary.
I may have known a person for months or years as a nurse, but then the richness of what I learn about them through their significant chaplaincy conversations teaches me things about them I would never have otherwise known and might in some cases transform how we care for them medically.
One of my boundaries is that, unless it’s an emergency I don’t give religious care on the ward I work on, but this is one of the important ways my work as a nurse informs my chaplaincy – by identifying those patients I’ve worked with as a nurse who will benefit from chaplaincy input, and I’m almost always right! Giving that opportunity for someone to open up and release into the world the things they’re holding inside is transformative.
We’ve very carefully chosen the chaplains who do see the patients on the transplant unit. We have Rabbi Lisa (who sadly has just left us to take up a Rabbinical post in Birmingham), who has extensive training in mindfulness and was employed with a specific focus on the teenage and young adult patients on my unit, which alongside our haematology and transplant programme houses the regional TYA oncology unit.
Our volunteer chaplain is Mary, a retired GP who’s a humanist, she focuses on the adult patients and as well as her medical knowledge has the unique perspective of just returning to us after fighting for her life in ICU. It’s had a huge impact on how she empathises with patients.
When we recruit Rabbi Lisa’s replacement our focus will be on the needs of the TYA and non-religious patients, including the many going through transplant under our care.
For my chaplaincy work with the oncology patients in the rest of the hospital my nursing knowledge gives me the ability to quickly assess where a patient is at medically as I often don’t even know their diagnosis. I process what they’re attached to, how they look or the snippets of medical information we’re given about them. All these things I’ll interpret in a much more clinical way than my non-clinical chaplaincy colleagues.
Most of the patients who end up in our care are long stay – at least 3 weeks – and my long experience with long-stay and isolated patients has created the empathy to hopefully understand where they’re at and what they may need.
The other way the roles complement each other is in my passion for staff support, which is part of my focus within chaplaincy and a huge part of my nursing role. I’ve recently completed PNA training, and the skills honed through this seamlessly feed into chaplaincy, where we also offer debrief after complex or traumatic events, and support staff as individuals and as groups.
Since coming into post, I’ve tried to raise our profile amongst staff as another means of support, entirely separate from nursing structures. We’ve supported staff through cancer and other illnesses, through caring for family members, abusive relationships, disciplinary hearings, pregnancy loss, the death of colleagues, racist abuse, financial struggles and many other things. All our staff data is anonymously recorded.
Chaplaincy might not be someone’s first choice through difficult life events and traumatic work experiences, but chaplains work at the cliff face of trauma and grief. And we have a ritual for any occasion! Something deep within us as humans seems to crave ritual, and we can come up with something religious or secular for any purpose. My colleague Andrew developed a secular service for staff to use to say goodbye to patients who’ve died, knowing that with our long-stay patients staff often grieve deeply.
Every November I take part in a day where we invite the families of TYA patients who’ve died to collectively remember their loved ones.
In conclusion, in my experience, my two roles seamlessly inform the other, how could they not if I’m to be an authentic practitioner within each role? I’ve avoided clashes by ensuring my boundaries are firm within each role and by helping raise awareness of what good spiritual care can look like.
