In 1998, a brief, informal
and non-scientific survey
of twenty-four health care institutions tallied the number of
supervisors of clinical pastoral education and the number of
supervisors-in-training serving at these institutions. The clinical
pastoral education programs at these institutions were considered to be
large, that is, recording 40 or more student units trained each year.
Additionally, the number of program units and number of student units
were recorded. From the responses received to that survey, an average of
3.1 supervisors of clinical pastoral education and 2.7
supervisors-in-training were on staff in the queried settings. Eight
program units per year, on average, were offered and 52.1 average
student units per year were revealed. This means that roughly 17
(rounded up from the calculated 16.8) student units were supervised on
average per supervisor.
We wanted to query
supervisors of clinical pastoral education currently in practice to
compare their responses to similar questions regarding their
responsibilities and additional aspects of time allocation. We felt,
based on anecdotal evidence, that the job of the supervisor of clinical
pastoral education (CPE) has been accruing duties as the health care
environment changes and we were curious about which duties as well as
the time allocated to each were presently pursued by the average working
professional in our survey group.
Although we
created the survey, titled above, to gather data from a sample of
currently practicing CPE supervisors about core duties and time
allocated to them, an important, secondary portion of the survey was
devoted to CPE supervisors’ perception of the amount of time to be spent
going forward on these duties and related tasks in their setting. This
introspective look seems to have invoked some concerns related to
self-care of individuals in practice as the workload was analyzed. These
concerns may suggest follow-on questions for a future survey as well as
a re-visitation by respondents and other readers of the personal and
professional mission goals involved in CPE supervisory practice. If
readers and respondents can use the survey findings to assist them in
improving their effectiveness and/or efficiency of their practice,
suggest collective changes needed within professional governance, or
support human resource management proposals, remedies, and recruitment,
among other effects, then an ongoing benchmark of this type of data,
regularly collected, may be demonstrated to have value. We would
appreciate any feedback readers and participants would share for the
betterment of presentation of this survey and future surveys and
suggestions for topic areas.
One-third each of the respondents represented the northern
and southern regions of the United States. Twice as many eastern vs.
western institutions were represented among the remaining third and
about one-fourth of all respondents’ regional locations were not
recorded. The most frequently reported title among respondents (one
third of respondents) was Director/ Manager of CPE. The second most
numerous was those with varied titles but which included indications of
administrative standing such as coordinator or chief (29%). The
remaining responses were equally divided among those reporting Director
or Associate Director of the Pastoral Care Department and Staff CPE
Supervisor titles (12.5% each). It appears that the job
descriptions of those with varied titles, as well as those with the
standard titles above, can be very different among institutions leading
to the probable conclusion that job titles could be a poor indicator of
the job duties engaged by respondents. In future surveys, respondents
may be better categorized by operational definitions applied during the
survey process as to the primary, secondary, and tertiary priority tasks
within their work schedules.
Prior positions
held by respondents logically followed an upwardly mobile progression
from positions described as “assistant” or “associate” and even
“interim”. However, several supervisors-in-training apparently
immediately took on administrator roles in an institution after
graduation. Most of the respondents had been in their current position
four years; the highest number of years experience was 12 and the lowest
several had been in position only a few months
Five broad aspects of supervisors’ duties were
targeted for questions and a set of final questions were used. These
areas were: (1) staffing levels and CPE supervision-specific duties, (2)
other CPE related duties, (3) other duties within the respondent’s
facility, (4) EAP, facility committee, and continuing education duties,
(5) duties in the community at large, and (6) retrospective questions
and expectations for the future.
An average of
two CPE supervisors were identified with each respondent’s institution.
However, one institution reported as many as five CPE supervisors.
Coupled with the data on titles of respondents, these findings tend to
indicate a generally flat or horizontal management hierarchy in the
field (that is, fewer levels of “middle managers” between the chaplains
or students and the top management of a given pastoral care department).
Where there are pastoral care departments with CPE programs, the pastor
care department may almost always be managed by a CPE supervisor.
Between this
average of two CPE supervisors at each institution, one CPE candidate
was supervised. Each respondent, on average, signed for eleven student
units. These data tend to suggest that fewer numbers of supervisors were
supervising fewer SIT’s and signing for less hours, about 35% less, than
the average 17 hours just five years ago. One possible reason for this
finding is that the 1998 survey represented responses from only large
(40 or greater student units trained per year) programs whereas the
present study surveyed supervisors without regard to size of program.
Additionally, we suspect that some respondents had SIT’s in their
program but did not personally supervise them, thereby undercounting the
units. Finally, the results suggest that the amount of time spent in
directly supervising SIT’s varies significantly from perhaps a minimum
of 4 hours to a maximum of about 21 hours per month per SIT. The group
vs. individual time during which an SIT was supervised was not readily
discerned based on the survey question used. This important section of
data should be re-addressed in a future survey using questions designed
to clarify these issues and more directly compare trends over time.
Reasons for the
reduction in average supervisors per institution may be due to on-going
staff reductions throughout health-care institutions that affect
staffing levels for CPE departments and programs. The corresponding
decrease in the average number of hours signed by supervisors may
indicate the greater burden of content and/or regulatory education
available or required in programs up to 2003. These causative factors
may need to be probed in a future survey of supervisors.
What specific
types of tasks occupy the average CPE supervisor in CPE duties? About
40% of this time is group supervision activities. Twenty percent appears
to be in individual supervision, with close to twenty percent in all
other direct supervision. About 10% is reserved for didactics. The
smallest component of CPE duties, around 5%, is devoted to direct
supervision of the SIT. Over all, direct supervision of students
occupies, on average, about 35% of the supervisor’s time each month.
A recent
article, entitled “Critical Issues in the Training and Certification of
Supervisors” (ACPE News, Jan/Feb 2003, page 6) by Paul D. Steinke, ACPE
Supervisor for the New York University Medical Center, asked the
question: “What’s happening to the Certification Commission?”. The
problem cited was that fewer candidates for Associate Supervisor of CPE,
only 3 of 12 specifically in the article or 1-in-4 if projected to the
population, earned certification. The article put forth the suggestion
that part-time supervision of candidates has become the norm, forced on
the profession by cost-benefit analysis that Supervisory CPE programs
don’t return as much to institutions and by poorly paying stipends that
leave candidates little choice but to maintain incomes with full time
employment. The result, in the author’s perception, was that part-time
Supervisory CPE slows down the formation process and may under prepare
candidates meeting certification committees as if they were full time.
The
findings of our survey support the position that less supervision is the
trend. Therefore, if extrapolated, this trend may indicate that the
profession may be bound for a significant shortage of trained CPE
supervisors in the future leading to less CPE and fewer chaplains and
supervisors to replace retiring professionals and consequently fewer
professionals to meet anticipated future demand for services.
Among other CPE-related
duties beyond specific CPE supervision, slightly more than a third each
of time allocated to these is used for curriculum development and
general administration of the CPE program. The remainder of this time is
consumed by development of the individual as a CPE supervisor. These CPE-related,
but non-supervisory duties comprise 18% of the CPE supervisor’s time
monthly, on average. Given the free-form comments collected in the
last section of the survey regarding desire for self-care comparisons
among CPE supervisors trying to cope with perceived levels of workload
that have increased, this area warrants further study and potential
action plans on the part of individuals, regions, and the ACPE.
Additionally,
among other CPE-related duties, preparation for various cycles of
accreditation is particularly time-consuming. First-time accreditation
efforts accounted for 12% of the time devoted to accreditation. Another
20% was used to prepare for the Five Year accreditation. Not
surprisingly, 68% of the time devoted to accreditation activities was
spent on annual program accreditation activities. The latter activity
actually consumed an average of one hour monthly for a three-month
period, indicating a lesser burden than, say, Five or Ten year
accreditations which took about 5 and 10 hours, respectively, over 10
and 29 months, on average, respectively. Notably, a first accreditation
process seems to take about 9 hours monthly over a little more than two
years. Do these data indicate an onerous process of accreditation?
Or do they reflect a justified expenditure of time and effort to
maintain the highest standards in the profession? These questions await
future studies but would be well worth the effort to learn the truth
given both the necessity to maintain a high level of professionalism and
the possible need to stem a tide of early retirement or other exit by
current practitioners from the field due to perceived workplace stress.
The issue also requires consideration of third parties such as the U.S.
Department of Education and its standard of recognizing and relying on
ACPE accreditation. It is our understanding that the current trend in
accreditation is to move from a “compliance” (auditing) type of approach
to more of a “consultation” style of visit. Perhaps these data suggest
this is indeed what is needed.
About 9% of the
average CPE supervisor’s time was spent monthly engaged in specific
pastoral care duties to patients. Specific pastoral care to staff
averaged 3%. Conducting support groups consumed an average of less than
one percent of the supervisors’ time per month. As could be expected,
those respondents with the greatest number of hours recorded for
specific pastoral care duties held titles indicating direct supervision
of CPE or pastoral care; the hours diminished for those holding titles
of Director, indicating more hours devoted to administrative tasks.
Service on special response teams likewise took less than 1% of the
average supervisor’s time each month. All other departmental
administrative tasks took an average of 11% of the supervisors’ monthly
hours.
Forty percent
of CPE supervisors carried the on-call pager for their institution,
however of those who did, they carried it for only an average of 6% of
their time per month. Twenty percent of CPE supervisors carried the
pager as back-up chaplain. During this on-call period, the CPE
supervisor had about a 50-50 chance of actually being paged on average.
Most of the CPE
supervisors responding to the survey (82%) were not involved in the
Employee Assistance Programs (EAP) at their institutions. Of those
involved in EAP at their institution, this duty required about 3% of
their total working hours monthly on average.
Continuing
education demands accounted for an average of 4% and service on
facility-wide committees accounted for an average of 2.5% of the
supervisors’ monthly schedule.
Specific
involvement by CPE supervisors in activities outside the walls of their
respective institutions averaged 2% of the available time. Of responding
supervisors, annual service on ACPE committees took 5% of their time.
Attending ACPE meetings annually required a reported 3% of their time.
Most of the respondents participated in ACPE meetings or served on ACPE
committees and roughly half of respondents also participated in national
meetings of other groups. These activities took about 1% of the
respondents’ time per year.
Denominational,
synagogue, and mosque committee activities were engaged in by 60% of CPE
supervisors, taking 5% of their time monthly on average. About 68% of
supervisors’ institutions provided some measure of time off for the
supervisor to engage in these outside activities.
The final aspect
of CPE supervision queried in the survey involves CPE supervisors’
perceptions of their workload in selected areas over the past five years
and a question asking them about their expectations for workloads over
the next two years.
The baseline
measure between these past and future calculations is the surveyed
average number of hours worked by the respondents each month, 201 hours.
The highest number of hours worked per month was 270 and the lowest was
150. Using a 40 hour work week (160 hours) as a standard for comparison,
the average CPE supervisor worked one-fourth longer hours. Forty-four
percent of those responding to this question claimed to work in excess
of 200 hours per month on average, meaning essentially working nearly
every weekend or late into several weeknights or a combination. A future
survey may explore the distribution of these hours during a monthly
cycle; for example, do the hours accrue because a supervisor works an
overnight shift or are the workdays routinely long. Additionally, are
the hours counted inclusive of hours “on call” but not specifically
engaged in handling cases? The contingency aspect of these hours must be
accounted for but what weight should they have if not full hours of
work?
In any event,
the perception of CPE supervisors is that their current workload is
significantly more demanding and the average number of hours worked each
month significantly increased over the past five years. Sixty-four
percent of supervisors stated their job has become more demanding, 14%
believe it is less demanding, and 23% felt their job was about as
demanding today as it was five years ago. Similarly, 62% said they are
working more hours overall on average. Some reasons cited for the
increase in workload over the past five years include expansion of
programs, promotions, facility expansion or acquisition, involvement in
certification, and greater acceptance by other staff and administration
of the benefits of clinical pastoral care and supervision. Could
respondents also be working more hours in the effort to show the value
of their services to their institutions or to allay fears and anxiety
that their programs could be eliminated in the present budget
environment?
The majority of
those expecting workload to decrease appear to be moving actively toward
retirement, intentionally reducing workload against a current of greater
demands.
At the same
time, the supervisors’ perception of hours of work devoted to CPE and
pastoral care has significantly changed. Sixty-eight percent of
supervisors reported doing more hours of CPE supervision (9% were doing
less and 23% were doing about the same) but only 20% were doing more
pastoral care hours (65% were doing less and 15% were doing about the
same). Some supplanting of time designated for pastoral care by hours of
CPE would be expected as respondents have advanced from lower levels of
administrative responsibility to greater levels in the course of their
collective advancement in titles and ripening careers over a five-year
period.
However, despite
the reported hours of workload at present by CPE supervisors, fifty-two
percent of supervisors believe their workload will increase over the
next two years. Only one respondent felt workload would be decreasing
and the remaining 43% felt workload would remain about the same.
Given the
current average number of work hours per month already recorded by
supervisors, how will this additional workload be absorbed? Many more
hours devoted to the practice will not be a viable option. The
supervisor may have to work smarter and more efficiently. Maybe greater
use of SIT’s in direct supervision of students is one solution if it
does not risk loss of an interpersonal pastoral relationship. Perhaps
technology will play a role in communications across time or distance,
i.e. videoconferences and computer infrastructure, to support a more
technology-enabled supervisor workload. Future surveys should explore
the use of communications, computer, and other technology by
supervisors. Additionally, the previously mentioned consideration of
revision of professional organization review may play a role in opening
up the time available during a supervisor’s workweek. Conversely, it may
be that increasing levels of effort to improve professional ethics,
certification, competence, and oversight are partially responsible for
expectations of increased workloads.
In
summary, our respondents appear to have provided a perspective from the
field regarding the current practice of CPE supervision. We have
highlighted a number of areas that may serve as useful “talking points”,
drawn as conclusions from this survey, when negotiations related to
productivity and time and resource management for CPE are engaged in the
work place. Finally, we have earmarked several questions and issues for
further study. We appreciate the time and effort given to preparation of
responses by each member of our panel of supervisors and their
dedication to the higher calling in this profession.
