Ron Wright

What of the religion and spirituality of today's healthcare professionals? As part of our work for a book on religion and care for the dying, we interviewed physicians, nurses, chaplains, and social workers who practice in diverse healthcare settings in Indiana. Our biopsy of this nonrandom sample revealed their views of religion and the spirituality of their workplaces.

Traditional Religion
All of the professionals we interviewed describe themselves as religious or spiritual. Some are evangelical Christians whose piety is highly biblical, and who believe in adult conversion or acts of faith. For them, life after death is the heavenly reward for a faithful and righteous life. Another group is religious but more mainline in orientation. They worship in Methodist, or Presbyterian, or Catholic churches; the Bible is somewhat decentered, and revelation is understood less literally. Traditional religion is clearly part of these people's lives, but it is challenged by work experiences, and does not so clearly function as an authority. A third group is best described as spiritual. While they may occasionally worship in a communal setting, their piety is eclectic and idiosyncratic. Membership in an established community is not central to their identities, and their religious engagements have clearly been shaped by personal need or insight. The self defines religion rather than religion defining the self.

We found few respondents who describe themselves as completely nonreligious, who say that religion as they understand it plays no part in their lives. Although nearly all respondents offer trenchant criticisms of religion in the clinical setting, it is interesting that few self-consciously define themselves as completely outside the religious circle.

Our respondents take comfort in their religious beliefs, but to varying degrees and in differing ways. The evangelical professionals live within a structure of belief that clearly sustains them. They have a strong sense of reassurance about their own destiny and that of their patients. In particular they rejoice in belief in a life after death and resurrection to a life in heaven. Religion gives them a system of beliefs to interpret what happens to people at the end of life.

The more mainline Christians, despite ongoing involvements in a church, find their religious commitment more fluid on the ideological or dogmatic level. For them, religion may relate more closely to a set of attitudes toward other people and the world. Thus when we asked whether religion "provides them with help" in coping with death and dying, the crisp answer that the evangelicals can give is not available to the mainline believers.

The spiritual professionals we interviewed have worked out a way of finding meaning in life that is tailored to their own needs. Thus it would be very strange if their spirituality did not help our respondents, or if it were seriously challenged by events at the bedside. For some, the spiritual may involve walking, hiking, or intense recreation; for others it may include spending time with others who see the world in similar ways.

We found it striking that religious institutions and clergy are seldom looked to for comfort or teaching by the either evangelicals or the mainline professionals. In fact, the closest thing to an exception to this rule in our sample is a spiritual nurse who found great help in a somewhat unconventional church. We discovered at least one Christian support or prayer group among the evangelicals in the work setting, but it is clearly separated from regular congregational worship. To be sure, the fact that our respondents didn't say they find comfort in regular worship doesn't prove they don't. But if this connection were vital, one would expect some evidence to appear in the interviews.

Respondents may have concluded that the clergy are rigid, inexperienced, or insecure, or they may not believe that a member of the clergy has anything to bring to their situation. Chaplains get better marks, largely because they show up and they have learned to listen and avoid superficial platitudes. Chaplains with too strong an agenda are quickly written off not only by physicians and nurses but by the other chaplains.

One chaplain clearly defined his role as support for nurses who were, he thought, the primary ministers in health care. He had not stopped ministering to patients, but he acknowledged the limited amount and quality of patient contact he could have. Good stewardship meant investing his time in a way that would have the most significant impact on patients, and that meant providing pastoral support for nurses. We found this insight very suggestive not only for chaplains, but for religious congregations of all sorts.

Professional Spirituality
The notion of medicine as a calling is significant in the lives of many physicians and determinative for some. However, it is very clear that for many physicians medicine is just a job. A surprising number in our sample felt a need to "get a life" outside the professional realm, and all of our respondents have distinctive sets of interests and strong family commitments.

More striking spiritually was the physicians' individualism. They are self-directed. They may choose to go to church; they may find spiritual support in some nontraditional activity. But they are going to make up their own minds about it, and they are not going to be influenced by general social expectations. Doctors, we surmise, must rely on individual perception and judgment in diagnosis and prescription. Judgment calls are made many times a day, if not hourly. Physicians develop the habit of making up their own minds on the basis of their own experience and observation, and then of having others take their judgments seriously.

We found nurses' identities to be more complex and social than those of physicians. Interpersonal and social skills are stressed much more strongly. As Daniel Chambliss and others have noted, nurses serve many masters: patients, hospitals, physicians. Many people who train as nurses do not continue to practice nursing through their working lives. This phenomenon may well suggest disappointment or frustration with the profession. Today, because of healthcare financing and scheduling trends, many nurses are unable to provide the kind of personal care they would like to. Twelve-hour nursing shifts three days a week are great for nurses' family lives, but not so good for patients looking for continuity of care. And nurse-patient ratios vary hugely among the units in which our respondents work.

In short, our biopsy revealed professionals who are reflective and who struggle to make sense of their lives because of their training, the daily demands of their professional work, the complex politics of their workplaces, and the human tragedy they see daily. They think of religion as a possible source of meaning or support, but their likelihood of seeking that support among clergy or congregations is not great. There is a great need for thoughtful and imaginative ministry with and among healthcare professionals.