From Spirituality to Strategies:

A Chaplain’s Guide to Improve

Employee Satisfaction
and Workplace Positivity
Reverend Aidan Lacy

N ursing leaders often struggle to cultivate

reliable methods for identifying and solv-
ing problems of staff morale, self-morale, and overall
employee satisfaction. Pastoral care leadership and the
services provided by a strong chaplain group have been
overlooked as a viable integral discipline with value-
laden strategies to assist nursing leadership in this
endeavor. The services provided by pastoral care are
often isolated to the benefits related to patient and
family spiritualism. This article explores the insights
and contributions of one pastoral care chaplain and his
methodologies for positively impacting employee
morale, including his own teams at a major, level one
trauma center in South Florida.

www.nurseleader.com Nurse Leader 173

BACKGROUND
A search of the literature revealed a gap in knowledge related
to the use of pastoral care services as an adjunct to effective
nurse leadership and positive work culture development. The
criticality of this relationship is overlooked and under-
researched. The timeliness of this article and the wisdom it
imparts is essential in this chaotic milieu of health care.
Caring has never been a more important dimension of nurs-
ing leadership. Roach identified a climate of caring as being
therapeutic, “not only for patients and families but also for
caregivers themselves.”1(p.95) The Institute for Healthcare
Improvement offers what is now the quadruple aim as a
roadmap for nurse leaders to innovate new ideas and solu-
tions to; improve population health, improve the patient
experience, decrease health care costs, and improve employee
satisfaction.2,3 This article offers techniques and methodolo-
gies developed from 12 years of practical experience, self-
reflection, and formal education of the director of mission
(DM) of a 460-plus-bed trauma center. His quest, to provide
supportive effective guidance to nurse leaders as an adjunct to
required standards and policies, is shared below.
UNDERSTANDING THE SPIRITUALITY OF WORK
Recognizing that we live in a pluralistic society with people
of diverse faith or no faith traditions creates the need to
examine how pastoral care could create a beneficial universal
connection with staff. This connection is not a contrived or
forced adoption of religious beliefs. It is not created instanta-
neously. It is the recognition that the DM, as catalyst, seam-
lessly creates a positive work environment, one individual at a
time, from which caring cultures take root. The DM has
identified and named several necessary tools as adjuncts to
developing the universal caring connection. They are sacred
space, loitering with intent, the inverse naughty spot, food
that remembers, and golden forgiveness. These are offered for
reflection and adoptability by nurse leaders when considering
the beneficence of pastoral care’s contribution.
SACRED SPACE
The necessity of daily reminders of our life’s journey and
how we come to be in this moment in time is essential. So
often, leadership self-reflection is limited to the positives and
negatives of communication. Although this may be a sign of
emotional intelligence,4 it does not provide a deep enough
dive into our personal history. This is necessary to gain a
perspective of why I work, and how I work. The answers to
these questions affect how we relate to others: the core foun-
dation of positive work environments.
Nurse leaders build relationships one individual at a time.
Interesting objects that are kept on person or in offices may
be kindling for starting conversations. Examples may include
sentimental objects such as photographs of friends and family.
One may find a bowl of dog treats or special candies to
remind them of loving pets or grandfathers that adored
chocolates. Staff members are encouraged to individualize
their sacred space. Some staff may wear a locket or affix a
photo to their stethoscope. A joint effort may be in decorat-
174 Nurse Leader
ing the unit for the seasons. The objects should be changed to
reflect the changing seasons of our lives. More exacting,
changes can occur on important anniversaries. This individu-
ality invites conversations from which understanding and
acceptance flourish. The realization of our human connec-
tion, the “collective we.”
A SACRED SPACE STORY
A colleague tells the story of how a constantly ringing work
phone helped create a sacred space. She placed a huge grin
on her face with every intrusive ring. This purposeful expres-
sion reminded her of Clarence’s statement from the movie,
It’s a Wonderful Life.5 Every time a bell (phone) rang, she
imagined an angel getting its wings. That memory made her
smile all day. She made a conscious decision to practice spiri-
tuality of work, creating a universal connection with the
recipients of her friendly demeanor.
LOITER WITH INTENT
The DM is perceived as someone to call when a patient is in
crisis, or a family has tough decisions to make. This narrow
view limits the DM’s potential to positively impact patients
and families and, even more importantly, employee morale.
Instead of waiting to be called to care, the DM recognized
that by being present, familiar, and available, families would
begin to open up, and eventually the basis of a relationship
formed. So too with the staff. Upon arrival to the unit, the
DM would hear, “I was just about to call you.” Realizing that
best intentions may not come to fruition within a busy day,
but happy to help, the concept of “loiter with intent” was
born. The DM with no formal agenda rounded on units and
began to connect with staff. Slowly, the realization of DM
dependability took hold and a “bridge of trust,” was formed.
They would share the ups and downs of their days, be it
personal or professional.
This is different than rounding with purpose described by
Studer6 and further developed in the literature.7 This
methodology teaches the utilization of a script from which to
elicit important responses to daily work challenges. The prob-
lem with this methodology is the adeptness of staff to recog-
nize the sameness of questions leading to a perception of a
contrived sense of caring.
When the DM loitered with intent, staff would often offer
really good solutions to the logistical nursing problems and
challenges they were facing. This time together afforded all a
deeper richer experience. Some staff quickly caught on to
the purpose, and the term “loiter with intent” is attributed to
their astuteness. Instead of a negative, contrived rounding
experience, the staff responded with anticipation to a visit
from the DM. This was evidenced repeatedly by comments
such as, “we missed you yesterday,” “where have you been,”
and “I need to tell you what happened.”
Loiter with intent is a few precious nonjudgmental
moments in an otherwise busy day. It is in essence a sacred
space where negativity could be released and positive solu-
tions created. The DM would share the issues with the nurse
executive or administrative director to create a transparent
June 2018
understanding of real-time, real-life staff challenges.
Outcomes of these encounters included a dismantling of the
“we versus them,” “staff versus administration” mentality.
Loiter with intent is not an intentionally religious interven-
tion. It is instead a beautiful, nondisruptive spirituality that
celebrates supportive loyalty.
INVERSE NAUGHTY SPACE
A few precious moments in an otherwise busy day in which
to release negativity and positively reflect help create a
healthy work environment. The ability to find this time and
use its mutual potential may need to be coached. As children,
we are often placed in “time-out,” isolated punishment forc-
ing reflection on our latest transgression. As mature profes-
sionals, we come to recognize that private space and time to
reflect are important to learning and leadership.
A current assessment of nursing units may include message
boards festooned with management notices, nurse of the
month winners, and social event calendars. Our break rooms
are replete with the often-negative energy of gossip. The DM
and pastoral care group are both impetus and resource for
developing the “inverse naughty space.” They assist in creating
a message board filled with positive thoughts, not just from
philosophers, theologians, and poets, but from the contribu-
tions of staff and notes from patients and families. Simple
guidelines avoid it from becoming a place where a particular
religion is pushed or proselytized. Board messages are meant
to both challenge and comfort the reader, depending on their
spiritual need that day.
This “time-out” is no longer a period of negative isola-
tion, but rather one of a positive place for quiet reflection.
In order for the inverse naughty spot to work, there are 2
important guidelines. The first is that anyone standing in
front of it gets 5 minutes alone before being dragged back
into the chaotic choppy waters of the day. The second is
that as a sacred space, the inverse naughty spot needs to be
updated with fresh messages.
The inverse naughty spot allows for affirmative respect of
colleagues and staff. The nurse leader recognizes that time to
collect thoughts and draw on the wisdom of others, provides
refreshment and renewal, all necessary to provide compas-
sionate care to patients and families. The nurse leader can
exercise the inverse naughty spot along with the staff. Doing
so shows vulnerability and may inspire others to become the
answer to challenges and barriers.
FOOD THAT REMEMBERS
The DM’s perspective affords the leader opportunities to
view the ordinary as extraordinary. Imagine food becoming
the cornerstone of a leadership moment filled with spiritual
generosity and learning. The nurse executive can influence
the ordinary to become extraordinary.
Consider if you will the following. When you work in a
hospital, you never go hungry. Potluck lunches, doughnuts
from sales representatives, and the latest candy bar drives
abound. However, in moments of crisis, when colleagues
experience the loss of a dream, or the loss of a loved one,
www.nurseleader.com
what role does food play? In times of helplessness, energies
are expounded on cooking. Trays of baked ziti, lasagna, pies,
and cookies mysteriously multiply. Imagine if these wonder-
ful gestures were made more meaningful by representing the
individual’s favorite foods.
A Food That Remembers Story
When we lost one of our own team members, we had to face
and engage the spiritual darkness. On one of the worst days
of our lives, medical professionals, usual pillars of strength,
courage and compassion, displayed their human vulnerabili-
ties. A team member subtly hinted that to truly honor the
person we prepare their favorite foods. With the sharing of
these specific foods came an outpouring of memories: how
our friend made us laugh, lessons they taught us, and the
legacy they left us. It was a powerful experience that helped
the team remember where we came from, our mission in life,
and how we feed each other and nourish each other in our
daily work space.
Food that remembers is a powerful expression of the spiri-
tual maxim “love is stronger than death.” The nurse leader
may not know every individual staff member to the fullest.
That’s okay. The leadership lesson is to avail yourself of time
to be among your staff on a more personal level. This is an
opportunity to participate, listen, and learn.
GOLDEN FORGIVENESS
The news has been replete with issues surrounding ethics
violations and billing fraud.8,9 The Joint Commission, which
accredits health care facilities, released its 2017, quarter 2, list
of the 10 most-reported sentinel events: those incidents that
cause patient harm. Sixteen were related to criminal events.10
When conducting root-cause analyses, it becomes evident
that good men and women—health care professionals with
knowledge of the event—remain silent, giving credence to
the saying, “It’s not the crime, it is the cover-up.” The impact
of these moral and ethical concerns are substantial and
require the nurse leader to develop an action plan to assist in
recognition and prevention.
The DM is positioned to help in the creation of a safe
space, where speaking up with forthright honesty becomes
the norm. The following technique is offered for use the next
time a disruptive incident requires inquiry, or proactively as a
teambuilding exercise.
Murky Waters: an Exercise in Golden Forgiveness
This technique is attributed to Stewart.11 The visual effect it
produces has led to some very therapeutic conversations.
Assemble a bowl of clean water, and several different colors
of food dye. Assign each color with an emotion, for example,
red is anger, blue is sadness, yellow is fear, and green is envy.
As the group begins to discuss the event, the DM adds the
appropriate food coloring represented by the emotion
expressed. Over time, the water in the bowl becomes murky
until it is a dark black. The DM begins asking questions of
the group, i.e., “what needs to change,” and “what was the
right thing to do,” and “what could have been done differ-
Nurse Leader 175
ently?” As honest reflection occurs, the DM begins pouring 11. Stewart G. Simple Science Sermons for Big and Little Kids. Lima, OH: CCS
Publishing; 1998.
“water,” from another container into the original bowl. The
scientific secret is that the water being added is in actuality Reverend Aidan Lacy is pastor of St. Patrick’s Church in Palm
bleach. The water takes on a golden tone. This fact does not Beach Gardens, Florida. He can be reached at
minimize but contributes to the power of illumination. fraidan@stpatrickchurch.org.
When the group, including the leader, freely admits what
was done well, and what could have been done better, there
is movement away from the “cover-up,” and toward coura- Note: The author declares no conflict of interest.
geous change. Golden forgiveness leads to the creation of
positive healthy work environments. 1541-4612/2018/ $ See front matter
Crown Copyright © 2018 Published by Elsevier Inc.
All rights reserved.
CONCLUSION http://dx.doi.org/10.1016/j.mnl.2018.03.005
The aforementioned tools are the culmination of 12 years’
experience as a hospital DM, directly responsible for a 5-per-
son chaplaincy program including a modest volunteer pro-
gram. Some ideas have been scrapped and on occasion
re-tooled; however, even in those moments, there have been
learning moments of grace. I consider my hospital career to
have been a time of deepened spirituality. Unlike other reli-
gious, in this role, I was not afforded the opportunity to
attend spiritual retreats where time for prayer, meditation, and
self-reflection were part of the curricula. Instead, I have
developed a spirituality that can travel from the boardroom to
the patient’s bedside, to the breakroom, the chapel, and on
occasion, the morgue. The nurse leader can use these tools as
well, even if a DM or chaplaincy program does not exist in
the facility. The tools, sacred space, loiter with intent, inverse
naughty spot, food that remembers, and golden forgiveness,
are effective. Implementation of these strategies takes a con-
scious commitment of time and energy. However, these tech-
niques will help the nurse leader chart a new course towards
a positive work environment.
Be confident enough to teach, humble enough to learn
and so: “I arise today with the strength of Heaven” (“The
Breastplate” of St. Patrick), and that is sufficient spirituality
for the work of my day. NL

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health-charged-for-medicaid-fraud.html. Accessed November 8, 2017.
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176 Nurse Leader June 2018