• What is the ministry of parish nursing practice?
• How often are Presbyterian congregations actively involved in providing a parish nurse ministry?
• How do parish nursing and care team ministries work together?
• What are the different organizing frameworks for the ministry of parish nursing practice?
• How does one begin the development of a parish nurse ministry?
• How long does it take to establish a parish nurse ministry?
• Why is attendance at a basic preparation course using the standardized core curriculum in parish nursing recommended?
• How much does the ministry of parish nursing cost?
• What about liability insurance?
• What can I do to prepare to have a parish nurse ministry as part of the congregation I serve?
• How many parish nurse ministries are there in the United States?

The health ministry of a parish nurse program in a local congregation can definitely be enhanced by the additional support of care teams. Often the parish nurse will identify needs for supportive care for families and individuals. The parish nurse assessment of the family or individual's situation would be vital information for the formation of effective care team outreach. Both ministries can be an integral part of the congregation's comprehensive strategy to care for persons with a wide range of holistic health care needs in any size congregation.

Here are just a few of the important collaborations of the parish nurse
and a care team:

1. The parish nurse would serve as one part of a congregation's professional ministry staff team assessing and coordinating care for the congregational health needs. Professional nursing skills in assessment, case management, and referral would help identify persons needing care team assistance, ease the process of completing an assessment of the care partner's situation, and provide an ongoing professional nurse consultant to the care team and care partner. It is important to remember that the parish nurse does not provide direct hands-on nursing care to care partners such as wound care, medication administration, or baths. Parish nurses make referrals to community health nursing agencies and other services for direct nursing and health care services.
2. The parish nurse would assist the care partner in developing a long term care plan for receiving complete assistance with changing holistic health care needs. Additional community health services could be added to the situation as desired. This might help the care team avoid situations where needs and services become unmanageable or beyond the scope of the supportive secondary care of any care team.
3. The parish nurse would be a potential holistic health educator for the care team meetings and for individual members of the care team. For example, a parish nurse could provide educational topic discussions and support for grief and loss, a variety of new disease conditions in the life of a care partner, self care support for care team members, or information on community resources available.
4. A parish nurse could be one of the spiritual growth supports for the care team and care partner. Along with other professional pastoral support, the parish nurse could pray for the team, meet with care team members with spiritual questions as they care for others, and support the spiritual journey of the care partner.
5. The parish nurse could be an additional confidential communication link for care team, care partner, professional pastoral care staff, and the congregation, when appropriate. There are already meetings of parish nurse and other staff pastors for communicating ongoing care needs in the congregation. Care team reports could be added to the agenda of these ongoing meetings so that all remain informed of the important team ministry of all caring together in Christ's love!

There are four basic organizing frameworks for the ministry of parish nursing practice. There are derivations of these frameworks that have developed over time. The four organizing frameworks are:

Institutional/paid—The nurse is paid in the parish nurse position. The pay for the position may be generated from the institution of the congregation. In some instances the nurse may be an employee of the institution and the congregation will contract with the institution for a specific nurses services. There is a contract or covenant between the congregation and institution that specifies the roles, responsibilities and contributions of each party. The institution may be a health care system, school of nursing, community coalition, home care agency, long term care facility, diocese or other incorporated entity.

Institutional/unpaid—The nurse is not paid for the services provided in the parish nurse position. However, there is a covenant or agreement between the congregation and institution regarding the theological reflection and continuing education of the nurse as well as consultation on the documentation of services rendered and maintenance of health records in the congregation.

Congregational/paid—The nurse is paid and there is no relationship with an institution. This will require the nurse and/or congregation to develop written guidelines that describe the nature of the ministry and how continuing education and opportunities for ongoing spiritual formation are provided for the nurse.

Congregational/unpaid—The nurse is not paid or compensated for the time given in this ministry. This requires the nurse and/or congregation to develop written guidelines that describe the nature of the ministry and how continuing education and ongoing spiritual formation is provided for the nurse.

Education on the ministry of parish nursing practice is ongoing, but essential for initiating the work. Often the best way to learn about parish nursing is to locate a working parish nurse and spend time "shadowing." Informational resources which go beyond this very sketchy description should be read and considered before making a final determination about beginning a program. Important early in the work is the philosophical considerations of parish nursing. Persons who focus on developing a parish nurse program should gain an appropriate mindset of the congregation as a health place in the community, health as being whole person oriented and more than physical, and the nurse as being other than the provider of medication, dressing changes and other physical care.

Attending the Annual Westberg Symposium is an excellent source to learn about parish nursing and network with others nationally and internationally involved in parish nursing. Identification of local resources is also important. It is equally important to contact denominational offices to see what resource they may have available to assist in this work. Some denominations may have a designated parish nurse consultant for their denomination. Once the education has begun it is helpful to establish a task force that can do some of the basic work while keeping the congregation informed of progress. Review of the "Protocol for Working with Congregation" under the "Information for Parish Nurse Coordinators/Managers" may be helpful. The suggested text for basic education on parish nursing is "Parish Nursing: Promoting Whole Person Health within Faith Communities" The publisher is Sage Publications.

Often times those interested in developing a parish nurse ministry perceive it as a simple endeavor requiring little time effort and resources. Like any other ministry being introduced into the congregation, if it is to sustain over time, careful planning and implementation need to be provided. Often the early work of mindset development and education can be time consuming. It must be considered that the work group will meet probably once a month for two hours. This reflects the voluntary nature of the work and the importance of developing a sound foundation for the ministry to sustain. It can take as long as twelve to twenty-four months to establish the parish nurse ministry. However, in taking that time and expending the effort it is more likely that the ministry will be integrated successfully into the life of the congregation.

One standardized core curriculum has been developed through The International Parish Nurse Resource Center. The curriculum has been endorsed by 35 parish nurse experts from across the United States. This provides for a basic preparation of the nurse with content that over sixty educational institutions across the country are providing. This curriculum includes content on the theology of health as well as prayer and worship.

Parish nurse courses and in some cases curricular emphases have been developed by a number of university throughout the United States.

The financial perspectives of the development and integration of the ministry of parish nursing practice depend largely on the organizational framework that is chosen, the size and resources of the congregation, the support of the pastor and the philosophy of the denomination. If the nurse is going to be paid then a salary range must be determined. Are there going to be any benefits included such as sick and vacation time? What supplies, material, equipment will be needed by the nurse? What kind of programming will the parish nurse be providing? What resources are available for that? Who will be paying for basic preparation of the nurse, liability insurance, and ongoing continuing education? Cost is an issue that is important to be dealt with early in the development of the ministry. Networking with others within your denomination or community may help in answering some of the financial questions early in the development of the ministry.

Liability insurance is a must for both the parish nurse and the congregation. Seabury and Smith Insurance Company (Previously Maginnis and Associates) has a particular policy for parish nurses. They also have a policy where an extra fee can be paid and both the parish nurse and congregation are included in the coverage.

Read the available literature on parish nursing. Re-look at Scripture from the perspective of health and healing. Perhaps enroll in a seminary course on health and healing and the congregation. This may provide a new perspective in which to preach to the members of the congregation where they are given the opportunity to begin to see how their congregation is really serving as a health place in the community. It is so important for clergy to be able to see the possibilities in revitalizing the mission of health and healing. The parish nurse ministry then becomes a concrete way in which to live out the call to preach, teach and heal.

There is no answer to this question. It is known that over 4,000 nurses have been prepared using the standardized core curriculum in parish nursing. However, there are many more nurses who are using this title and have not had any preparation for the role. At the last Westberg Symposium for parish nurses every state was represented except five with an attendance of over 900. The clear message is that it is growing. More people in more congregations are able to access a parish nurse to assist them in integrating their faith in addressing their health.