The spirit of Congregational Nurse Program at Memorial Hospital has remained essentially the same since the original learning history was written. However, there have been a few changes in the last two years. Both the financial and programmatic elements of the program have been modified to meet the changing needs of the churches and the nurses.

The original financial arrangement between the church and Memorial has been altered to assist churches with the salary expense of having a nurse on staff. In the past, Memorial would decrease its financial participation on an incremental basis (20%) starting after the first year and by the fifth year Memorial was no longer paying any of the salary (only benefits). This has changed considerably as a result of the financial burden put on the churches, causing several to leave the program. Memorial now pays 100% of the salary the first year, 80% the second year, 60% the third year, and by the fourth year they are paying 50% of the nurses salary. Memorial will remain at 50% thus alleviating the difficulty churches had in paying 100% of the nurse’s salary. This has greatly helped the retention rate among churches. Memorial continues to pay the benefits for each nurse enrolled in the program. Other financial changes include a small cut back in nurse continuing education dollars and the churches pay the nurses travel expenses in full.

There has been a great deal of positive feedback as a result of these financial changes. There are more churches interested in participating in the program and few dropping out as a result of financial issues. Memorial has also determined what the nurses raises will be on a yearly basis, another change in the financial structure of the program. According to Sara Hake, Congregational Nursing Program Manager, "This change helps us stay competitive with other nurses salaries in a highly competitive market and helps us retain the nurses. This level on continuity is important in this program in particular."

The Congregational Nurse Program is in its sixth year of operation. There have been twenty-four (24) churches and twenty-two (22) nurses involved in the Congregational Nurse Program since its inception. Currently, there are sixteen (16) churches and fifteen (15) congregational nurses participating in the program. (One nurse ministers to two churches.) Most of the turn-over of churches happened during the first three years of the program when many of the financial issues had an impact; or as a result of ministers leaving the church. There is a direct correlation between the departure of a minister and the discontinuance of association with the Congregational Nurse Program. Sara Hake recounts, "When a minister leaves a church, the program is most vulnerable. Especially if he or she is asked to leave. We have found that when new ministers come in they want to start fresh with a new staff. Unfortunately, this means the congregational nurse is asked to leave as well." There have been instances when church "politics" impose a stumbling block for congregational nurses. The nurses have learned to try to remain impartial, but this is hard to do because they are considered administrative staff, and are directly related to the leadership clergy.

Some of the programmatic changes have greatly enhanced the present Congregational Nurse Program. The training program component was downsized to sixteen (16) hours a week for four (4) weeks due to the fact that most of the nurses were experienced and had already received some of the training. Program leadership found that the "mentoring" component of the training was much more effective and useful in teaching nurses about this type of work. According to Sara Hake, "The mentoring program is easier to tap into. Great information is shared by those who have done this for years. It’s a wonderful opportunity to teach nurses about the things that work and those that don’t."

Some of the nurses have begun to use computers to perform their charting duties. They also use NIC, NOC, and NANDA coding (American Nursing Association standardization) to do their notes. This has proven to be an effective and efficient way in which to track and classify their work. Many of the churches, when the program started, did not even have computers. Now nurses have access to computers through their church and at the Congregational Nurse Program office.

Another important transformation in the Congregational Nurse Program has been the introduction of "quality indicators." Every church and nurse develops their own quality indicators through a quantitative mechanism. The results are reported on a quarterly basis to the program manager, Sara Hake. She recounts, "The quality indicators are hard to do because the groups often change. This makes it hard to track information and maintain quantitative integrity. However, they do help us to see how the nurses have made a difference."

A lot more networking among nurses and clergy have helped to strengthen the program in recent years. The nurses meet on a monthly basis, alternating churches each month, to share information and network with each other. They have structured the meetings to include both a formal and informal component.

They often start the meeting with, what they call, "devotions," a time to worship together and reflect on their commonalities. This sometimes includes music or songs performed by some of the talented nurses. It is considered a "renewal" time for many of the nurses. All of the nurses and all of the clergy meet together once a year and all the ministers meet alone once a year. These meetings are designed to help clergy network amongst themselves, to share information, ideas and support one another, both during the actual meeting and one-on-one when needed throughout the year.

The Congregational Nursing Program added another part-time staff person in addition to Sara Hake, the Congregational Nursing program manager. In 1998, Ann Seckinger joined the program as Chaplin Coordinator. Her primary function is to provide spiritual guidance to the nurses and help them become more attuned to the spiritual aspects of their role in the church. According to Sara, "Ann and I make a good team; because I am a nurse myself, I can provide the nurses with professional assistance and supervision, and Ann can help the nurses in their spiritual direction." This is a unique and very successful staff configuration among congregational nurse programs.

Sara Hake, Program Manager, believes that there are a few things that stand out as lessons learned, "First, we now know that the Health Cabinet, the church congregation body that assists, coordinates and evaluates the congregational nurse, must be formed and supportive of the program before they can even hire a nurse. This is critical to the health of the program and the nurses. Secondly, the Health Cabinet must have the first year plan on paper before the nurse will begin. We know that it is important to have the roles of the nurse, Memorial and the church, spelled out, plainly, before the nurse can start." The plan is a critical component because it sets out expectations of both the church and hospital. The nurse is considered a part-time employee of the church, however, in their 20 hours each week they must spend several hours performing administrative duties at Memorial Hospital. They attend a monthly nurses meeting, they meet with a program supervisor, perform quality indicators and charting duties, all of which takes time away from the church. This understanding is made clear, up-front, to avoid any potential issues after the nurse has begun working at the church.

It is obvious from both the quality indicators and participation levels that the Congregational Nursing Program is having an impact on the people it affects. The changes that have occurred in the last few years have all helped to enhance an already successful program. As the Congregational Nurse Program continues to evolve and change we will continue to keep you updated.