Quenstedt-Moe is presenting a new dimension to the parish nurse role that could benefit many parishioners, especially the elderly in rural areas. She also describes a unique situation with Sam and Carolyn, in which she did what most parish nurses probably would have done. However, combining the role of parish nurse with that of a home health nurse raises three major issues: a) legal implications and risk to the church and to her own license, b) the priorities of parish nurse ministry and c) incongruence with the Scope and Standards of Practice of Parish Nursing.1
Combining the role will put the church at risk for liability. A parish nurse practicing as a home health nurse violates the defined role of the parish nurse and may go beyond the independent functions of nursing allowed by state licensure. The Scope and Standards for Parish Nursing clearly states the boundaries of practice.
Though a valid point, the individual nurse's "skills, interests and knowledge" are not what the parish nurse role is about. Parish nursing is clearly defined as noninvasive. If the congregation hires the nurse as a "parish nurse" and that nurse proceeds to practice beyond the scope of the role, the congregation's liability is at risk and may not be covered for those actions, thus placing them at risk. Such actions may also put the nurse's licensure at risk. Many policies clearly state that within the role of a parish nurse, coverage will be provided as long as the parish nurse is performing the duties and services within the scope of one's license and state practice act. Not all nurses are prepared as home health nurses.
The parish nurse ministry and priority should clearly be on the needs of the congregation as client. Appropriate referrals should be made so that the parish nurse becomes a catalyst for transformation and change to the entire congregation, as well as individuals. If all of the time is spent on "home health care," who is caring for the congregation's needs?
On the other hand, if a parish nurse is employed by a hospital or health care agency rather than a congregation, the job description may be different and the nurse is accountable to the institution, thus allowing the nurse to do "home care." However, that isn't the situation described in this article. In most states, one's license allows a nurse to change dressings and to perform a host of other treatments. Parish nurses (paid or unpaid) are held accountable to a higher level of care than volunteers and could be sued for omission of that standard of care. The question for the parish nurse must be: "Why am I making this visit?" In the role of parish nurse, a needs assessment should be made and that may include a head-to-toe, but then the role switches to that of referral agent/advocate, not caregiver.
Perhaps the role of the parish nurse does need to be broadened, and home health may be an area to consider. However, because home health care is available in most areas of the country, this change would need to be carefully evaluated. The major consideration is that most parish nurses are unpaid volunteers. Would the expanded role be appropriate for them? Furthermore, if the role is expanded, liability for nursing malpractice may remain an unresolved issue for many churches and nurses. Thus, the church/congregation may then decide not to have a parish nurse at all. Ultimately, we must ask how such an expanded role may benefit or hinder the congregation with a parish nurse, a specialty designed to focus on wholeness and wellness, not illness.