Hospice chaplains often have little recourse for upward mobility along their career ladders. This can make recruitment and retention difficult among the next generation of the spiritual care workforce.

More professionals from a wider range of interfaith groups are entering the field, according to Shana Sullivan, bereavement coordinator of Texas-based Heart to Heart Hospice. Sullivan is also an end-of-life doula and chaplain.

Understanding the priorities of an evolving chaplain workforce will be key to providing quality end-of-life experiences for patients and families amid rising demand, Sullivan indicated.

“When we look at the next generation, we see that the face of chaplaincy is changing, it’s no longer the pastor who retired from leading a church congregation providing spiritual care,” Sullivan told Hospice News. “There’s an uptake and big rise in agnostic chaplains and a growing group of atheists in chaplaincy. You’re starting to see a lot younger people from all walks of multicultural and interfaith. We’re seeing a lot more interfaith chaplains, and that means more education in understanding other people’s beliefs.”

Seeking out next generation

The next generation of hospice chaplains can be found in various communities, according to Victor Couzens, lead pastor at Inspirational Bible Church. Couzens most recently served as hospice executive director of Hartford Healthcare at Home, part of The Pennant Group (Nasdaq: PNTG). He has also held hospice chaplain roles at St. Elizabeth Healthcare and Trustbridge prior to its affiliation with Empath Health.

“Chaplains are not just those individuals in their 20s or those changing careers, they are people wanting to provide spiritual support who align with the hospice mission,” Couzens said. “They are absolutely everywhere, in every walk of life and every demographic. That’s the approach we’re going to have to take to be successful, to be willing to look everywhere. Some are in college or trade schools, some are coming back from the military or are entrepreneurs, some have families with hospice experience … Identifying people with that mission is one of the most critical and valuable pieces of retention.”

Today’s chaplain workforce needs a firm grasp of the multifaceted cultural and interfaith belief systems that exist among hospice patients and their families, according to Couzens. Hospices in their recruitment efforts should emphasize the misconception that spiritual care is not religiously centered, he added. Spirituality can look very different across underserved populations compared to others, Couzens said. Having spiritual care providers well-trained in multicultural beliefs is key, he indicated.

The ability to recruit and retain chaplains is being impacted by a general lack of organized career structures for spiritual care providers, according to Couzens.

Creating more career development opportunities could go a long way toward attracting and keeping a quality, trained chaplain workforce during a time of significant need among underserved populations with diverse beliefs and values, he said.

Very few hospices offer spiritually-specific leadership positions, which can limit the ability for chaplain staff to sustain and advance in their careers, Couzens indicated.

“From a retention standpoint, many times a spiritual care provider’s direct supervisor is a nurse, a social worker or someone other than another spiritual care provider,” Couzens told Hospice News. “Sometimes they struggle because they do not have the opportunity to report to someone who is part of their discipline. There are very few agencies that have directors of spiritual care, and that speaks to whether or not they’re actually prepared to provide the highest focus there. The opportunity to ascend into a leadership position is a big factor when it comes to retention.”

Without stronger advancement opportunities hospices could be at a disadvantage when it comes to providing inclusive, quality spiritual care experiences, Couzens stated. Lagging career development opportunities for chaplains can pose challenges around developing innovative and evidence-based best practices in spiritual care delivery, he said.

Building spiritual care career ladders

Hospices have taken varied approaches to chaplain recruitment and retention amid a shrinking pool of spiritual care professionals. Providing more educational opportunities for chaplains has been among the keys to minimizing turnover, but these initiatives have taken on various forms across the country.

Providing ongoing avenues for clinical pastoral education is a large part of ensuring workforce sustainability, said Sarah Byrne-Martelli, staff chaplain at Massachusetts General Hospital’s Department of Spiritual Care. Byrne-Martelli also serves as chair of the palliative care and hospice advanced certification commission at the Association of Professional Chaplains.

Hospices nationwide have varying requirements for chaplain staff, which can complicate these professionals’ ability to provide quality care, according to Byrne-Martelli. Chaplains need a more standardized training path in order to help combat burnout, she said.

A big part of clinical pastoral education and theological training involves studying interfaith components and gaining exposure to multiple cultural beliefs while identifying your own personal biases, Byrne-Martelli said.

“There really aren’t clear standards about who can be hired as a chaplain,” Byrne-Martelli told Hospice News. “When you’re trained in clinical pastoral education, you learn more about health care and about navigating your own boundaries. Some of those important professional skills might be missed without that education to help someone stay and grow in their role sustainably. We need chaplains trained in hospice and palliative care philosophy who know tons about medical ethics, goals of care and complex bereavement. It’s hard to be motivated if there isn’t a way to utilize and advance those skills.”

Hospices seeking to strengthen their workforce could offer assistance for professionals to achieve their board certification in chaplaincy, she stated. Chaplains gain invaluable insight during clinical pastoral training on how to provide ethical, goal concordant care, according to Byrne-Martelli.