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A Christian nurse suspended for offering to pray has sparked health care and religion debate

The case of a community nurse suspended at the end of last year for offering to pray for a patient has sparked fresh debate on the relationship between health care and religion. Helen Mooney finds out what nurses think about the issue

At the end of last year North Somerset PCT decided to suspend one of its nurses, Caroline Petrie, for offering to pray for a patient. Ms Petrie was later reinstated to her post but the case unsurprisingly attracted widespread coverage when it came to media attention earlier this month.

Last week Nursing Times carried out a survey to gauge the views of the profession on issues surrounding the case, which attracted more than 2,500 replies in only three days – nursingtimes.net also has received more comments and views on this particular story than any other.

The survey results show that the overwhelming majority of nurses think that the PCT went too far, with 91% saying that Ms Petrie should not have been suspended for offering to pray for a patient.

One respondent described it as a ‘ridiculous overreaction’ while another said ‘nurses are accused of far worse and do not get suspended’.

‘I don’t know all the facts but as long as she wasn’t trying to instil her beliefs onto the patient I can’t see any harm,’ was one reply, which perhaps characterised best many of the comments.

However, there were those who backed the trust’s move. One respondent said: ‘If the patient initiates the request then there is no problem but until that happens there should be a clear division between personal belief and work. If the nurse is unable to abide by that then the only alternative should be suspension.’

Ms Petrie, a community nurse and a Baptist from Weston-super-Mare, offered to pray for a 79-year-old patient on a home visit. The patient reported the incident to another healthcare worker, saying she had been ‘taken aback’ but not offended.

Ms Petrie has said in the press that praying is her way of saying ‘get well soon’ and even said that she would do it again.

She was accused by her PCT of breaching the NMC code of conduct by using her professional status to ‘promote causes that are not related to health’ and by failing to ‘demonstrate a personal and professional commitment to equality and diversity’.

According to the trust, it was ‘not acceptable’ within the NMC’s code of conduct ‘to project personal beliefs unless invited to do so by patients and families’.

A PCT spokesperson told Nursing Times that although the organisation would not say it was wrong to pray for patients, the issue was ‘more complex’.

The trust said it understood that for ‘some people of faith, prayer is seen as an integral part of health care and the healing process’ and that it was ‘acceptable to offer spiritual support as part of care when the patient asks for it’. But it warned that ‘for nurses, whose principal role is giving nursing care, the initiative lies with the patient and not with the nurse’.

The PCT, as stated, made much mention of the NMC in its reasons for the suspension. However, the council has not commented on the individual case and whether the PCT was correct in its interpretation of the code of conduct, which does not offer specific guidance on religion or prayer in the NHS. An NMC spokesperson told Nursing Times that the council did not feel it needed to be more specific on religion or spirituality. ‘It is up to nurses to interpret the code of conduct – it does not need to be more explicit, if they need more guidance or advice on the issue they should come to us, we can give that advice on an individual basis,’ she said.

Likewise an RCN spokesperson said the college currently had no guidance that dealt specifically with the issue of faith, although religion will feature in part under new guidance on equality, along with race and gender, later in the year, she said.

With the possible exception of that which may be given out by individual trusts, seemingly the only guidance available on religion at the moment is the Department of Health’s new policy document Religion or belief: A practical guide for the NHS, which was published last month.

It devotes an entire section to warning NHS staff against ‘proselytising’ – or preaching and trying to convert people to a religion. But this seems an odd fit with the case of Ms Petrie.

‘Members of some religions, including Mormons, Jehovah’s Witnesses, evangelical Christians and Muslims, are expected to preach and try to convert other people,’ the guidance states.

‘To avoid misunderstandings and complaints on this issue, it should be made clear to everyone from the first day of training or employment, and regularly restated, that such behaviour, notwithstanding religious beliefs, could be construed as harassment under the disciplinary and grievance procedures,’ it adds.

However, it does not state anywhere that a nurse or any other healthcare professional cannot offer to pray for a patient.

The Nursing Times survey clearly shows that there remains a great deal of confusion within the profession surrounding religion in the workplace, and specifically this issue of praying for patients (see box).

Should nursing practice automatically include a spiritual element?

‘Spiritual support is an integral part of holistic practice’

‘You do not have to be religious to be a caring individual’

‘It should be included in our initial assessment. If the patient has no need or desire for spiritual help it does not have to be an ongoing consideration, although nurses should remember that even the most unbelieving often look for God at times of great stress and crisis’

‘Spirituality is distinct from faith or religion and can be anything from a photograph album to a sunset, a Beethoven sonata – or indeed a hymn of praise to a Creator. We are all spiritual beings’

‘The role of the nurse is to support those patients in doing what they cannot do for themselves, and we should be mindful of their own spiritual needs rather than our own while at work’

Of those who responded to the survey, 85% felt there was insufficient guidance for nurses on praying for patients. More than 40% said they had been asked by a patient to pray with them and an overwhelming 91% said it could be appropriate for a nurse to pray with or for a patient.

Additionally, three-quarters thought that there was not enough advice on dealing with religion at work in general and a further 75% said that nursing was not adequately prepared to deal with the religious needs of different cultures.

All of which suggests that the DH and others need to try harder in making it clear to health professionals what they can and cannot do regarding religion and the NHS workplace.

The government, however, told Nursing Times that it thought its guidance was sufficient and disagreed that it had failed to debate widely enough in its development.

Is there sufficient guidance for nurses on dealing with religion at work in general?

‘No one wants to talk about religion and only God knows why’

‘In my work place we received information on all religions except Christianity. A sign of our times?’

‘Religion and belief guidelines are still to vague, superficial and open to diverse interpretation’

‘More information on different faiths in education would be helpful. As would being able to discuss the topic without fear of suspension’

‘The NMC Code of Conduct talks about not using your professional status to promote interests outside of nursing but this is a very broad statement and open to many interpretations, and misinterpretations’

A DH spokesperson said its new guidance aimed to ‘raise awareness of the key issues that may face patients and staff from the diverse range of religions and beliefs that are now common within the UK’.

‘It encourages consultation and assessment of the needs of those served. Prior to its publication the guide was widely consulted on with patients, staff and interest groups,’ the spokesperson added.

But those who stand on the bridge between religion and health care disagree. According to Anne Aldridge, president of the College of Healthcare Chaplains and a hospital chaplain at Addenbrookes hospital in Cambridge, there needs to be clearer guidance, which includes information on where nurses can go for help and training.

Ms Aldridge was critical of the ‘lack of uniformity’ in religion and spiritual training for nurses across the NHS. ‘The help and training nurses are getting on this is different across the UK. I am not against nurses praying with patients but patients can be very vulnerable, so nurses have to be careful. There is a very fine line,’ she said.

Ms Aldridge said that at the hospital where she worked, the chaplains ran an education and introduction programme when nursing staff had their induction.

‘We explain about the spiritual needs of the patients and how praying is very much often a part of that. We talk to nurses about how they can get involved in spiritual care and if they feel anything is beyond their expertise while working how they can call on the help of a hospital chaplain as part of the NHS team,’ she said.

Has a patient ever asked you to pray for them?

‘Some patients are hopeless and they need hope. And as a believer we know prayer brings hope’

‘Provided the patient gives uncoerced consent, what’s wrong with prayer? As far as I know the basic rule is do no harm. I do not think prayer harms anyone’

‘I do it all the time, however I do not offer it directly. Providing the initiative comes from the patient, personally I can’t see the reason why I should refuse’

‘We offer paracetamol, one could offer prayer – the patient always has the right to say no. The patient can always say no, what’s wrong with an offer?’

Steven Fouch, general secretary of the Christian Nurses and Midwives Association, agreed. Perhaps unsurprisingly he said he felt that in the case of Ms Petrie the PCT had overreacted. But he added: ‘The NHS does not have very good guidelines on spirituality and care.’

He described the new DH guidelines as ‘vague’. There needed to be ‘much more of a debate about how people are trained to give appropriate spiritual care’ and the DH did not consult widely enough before issuing its guidance, he said.

‘There needs to be a dialogue between all the vested parties including the DH, the professional bodies, NHS Employers, all the faith communities and even the British Humanist Association,’ he added.

For now, it definitely appears that there is a need for greater clarity on the role of nurses in dealing with issues of religion and spirituality.

As one survey respondent said: ‘Nurses need to be supported and criteria laid down to avoid unnecessary emotional and political angst.’

Readers' comments (17)

  • YES WHEN PATIENTS ARE WILLING TO RECEIVE ONE. AND I HAVE TIME TO DO IT, I AGREE WITH THAT.

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  • Thank you for this survey. In my opinion it shows clearly where we ended up with excessive care for political correctness rather than for genuine and true dialogue. Political correctness is a cheap cookbook that comes with unpredictable outcomes that are unable to satisfy anyone involved. Dialogue and individualisation of care is always a better option. PATIENT and THEIR individual needs FIRST please!

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  • Nurses should be allowed to pray for their clients.Especially when there is no Clergy man available in sight.Wholistic approach as well as common sense should override political correctness.We should remember that this nation was founded on and still makes use of Christian values.

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  • I wonder how employers respond to nurses suggesting acupuncture or homeopathy to their patients, treatments which (especially homeopathy) have no clinical evidence basis and which have spiritual roots? I work with someone who suggests homeopathic remedies to our patients and I feel I need to confront this issue. Offering to pray, which may also not have an evidence base (or does it?) for someone is less imposing as it's not advising the patient to take a course of action but offering to do something on their behalf, which most would agree is not going to do any harm.

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  • Yet another example of rampant political correctness! The PCT has obviously never heard of holistic care and are living in the dark ages. Had this nurse offered aroma therapy or some other intervention lacking a researched evidence base the PCT no doubt would have accepted that even if the patient had complained.

    Quality of life is increasingly being recognised as important and a component of that is the spiritual dimension to care. This nurse should be applauded not castigated for recognised that dimension. Time the PCT came out of the dinosaur age!

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  • I believe in God, and i'm happy with that. However, many people do NOT believe in God and are happy with that AND are pretty anti-God - the last thing they want to hear when ill and vulnerable is about relying on something they don't like, don't agree with and find pretty offensive to help them. I'm a nurse, and i would never suggest to a patient i'd pray for them - who am i to do that? - where's my consideration and respect for that patient's possible views? - they could easily be someone who's anti-God and finds the idea of my praying for them offensive. It's not about what i want - i can pray for them all day every day if i want - it's about what the patient wants, and the last thing they may want is God. Come on, wake up and smell the coffee, it's an offensive offer to many people and i'm not being a good nurse if i don't consider and respect that

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  • I do not believe in a supreme being - the laws of probability are against it.

    However, I do believe in an informed consent and this requires certain uncomfortable questions to be asked of the patient if a holistic approach to patient care is to be undertaken.

    As a nurse who takes the more scientific view, I would not actually pray for the patient myself but I would facilitate that service if it was required.

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  • I see no reason why one cannot offer prayer for the patient provided is not forced upon the individual concern after all is part of rendering care to the person in question.All things work well for good.

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  • "Anonymous" says that the PCT is living in the Dark Ages. While the PCT may have overreacted, [though this nurse was previously warned about mixing religion with work], I believe that the PCT is trying to bring staff into the 21st century.

    Current EU legislation advocating freedom of religious belief has led to vastly excessive pandering to any organisation or individual claiming to act from religious conviction. Balance must urgently be restored.

    Faiths include [though are not limited to] anglicans, animists, bahaais, baptists, branch davidians, buddhists, catholics, druids, goreans, hindus, jains, jedi, jehovah's witnesses, jews, methodists, mormons, muslims, ndokis, pagans, parsees, pastafarians, quakers, rastafarians, satanists, scientologists, shintoists, sikhs, taoists, voodooists, and wiccans. What are the clinical indications for applying the rites or rituals of any of these "schools"? What robust evidence for the efficacy of these procedures? What guidelines as to how they should be applied: e.g. facing which point of the compass or during which phase of the moon?

    Health professionals should stick to healthcare. That is what we are paid for. Patients wishing complementary treatments should seek these elsewhere: not risk having their faith in healthcare compromised by unauthorised and unprescribed treatments, and other whacky ideas.

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  • I see a tendency in this discussion to equate prayer with complementary therapy.

    For example, John Hunt (01 March) writes, "Patients wishing complementary treatments should seek these elsewhere". 'Anonymous' of Northampton (26 February) writes, "Had this nurse offered aroma therapy or some other intervention ..." Roger Nuttall, (26 Feb) writes, "I wonder how employers respond to nurses suggesting acupuncture or homeopathy to their patients ... "

    These responses suggest that we think that to pray with or for a patient or client is to 'offer a treatment', particularly an alternative or unconventional treatment.

    But prayer isn't treatment. It's the act of speaking up for a person before God. It's advocacy in its best form - taking a person's needs to the appropriate forum for an appropriate response.

    Advocacy naturally requires the consent of the patient. Caroline Petrie asked for that consent. The patient didn't give it. So Caroline went no further with her offer of advocacy. That's good advocacy in practice.

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  • Religion should stay out of nursing. It is our duty as a nurse to keep a professional boundary.

    If I was a patient, I would be offended if someone offered to pray for me. If I knew a nurse was deeply religious when caring for me, I would feel that they may judge my lifestyle choices. If I didn't know their own personal opinion, it would not have any effect on me.

    We have to maintain a professional boundary, it is our duty. This includes not divulging many aspects of our personal life, it doesn't just stop at religion. We are there for the patient, to meet their requests whenever possible. Not to share our personal values and beliefs with them.

    Offering prayer and saying it it part of holistic care is wrong. The correct approach would be do discuss a patients spiritual need with them, if appropriate, and then trying to fulfill that need with an appropriate person or set up - eg calling in a priest or vicar or providing privacy for personal prayer, support cleansing etc.

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  • On admission to hospital I informed the nurse that I was an atheist. However, I was asked three times before going into surgery, for removal of a brain tumour, if I wanted to see the chaplain. I found this offensive as the implication to me was that I didn't know my own mind (or they thought I was going to die).
    On the second occasion that I was admitted they sent the chaplain to pray over me even after I told them that I was an atheist.
    I also found offensive the notion that if I was an atheist that I was a 'Christian atheist'. I was not asked if I wanted to speak with an Iman or a faith healer for example so this was not about providing 'spiritual' support.
    As a nurse and an atheist I try to be respectful of the beliefs of others (and to listen to what they tell me) and when requested I always ensure that individuals get the support they require. I have also sat with people (who asked me to) whilst they prayed and I have never questioned a patient's religious beliefs.
    How offensive would it be to a Christian if I brought along a Wiccan priestess to pray over them or implied that their beliefs were so unimportant that I just ignored them.
    Most people know what they think prior to being admitted to hospital. If a person discloses that they have religious belief then that is the point at which support should be offered.

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  • I think it depends on case to case basis. If we get the consent of the patients/or relatives, and do it in discreet, I don't see it is a problem. The management doesn't need to "suspend" the nurse for such act. So ridiculous. They need to apologize to her.

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  • Geez. If you don't want her, send her down this way. I would have loved to have someone who offered to pray for me.

    When I was in the ER, Most of the nurses and doctors assigned to me seemed like mechanical robots with inhumane ice-cold hands.

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  • Religious beliefs and professional practice should be kept separate at all times.

    There's a distinct possibility that the recipient of your care doesn't share the same religious beliefs as you in the many multi-faith societies in which we find ourselves these days. Whilst some patients would take offence at being offered a prayer, others might simply decline and not give it another thought, but some will question the professionalism of the person making the offer, especially, perhaps, those who are aware of the scientific experiments that have failed to show any effect whatsovever of praying for ill people.

    Gary Porter-Jones

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  • I will say that it offends me if someone tries to instill their views upon and they are unwanted but I think for this nurse to offer prayer with her best intentions does not violate profession standards and that to offer it before it is asked for is by a sick patient is like offering a glass of water. If the patient doesn't want it they can refuse and no big deal. I do think on a somewhat different angle that companies and corporations actually use spirituality in a negative way to patronize and manipulate nurses as little angels and that they should all be sweet and kind promoters of corporation healthcare. This is certainly not done with doctors who contract in general and are not employees of these entities who by the way are more concerned over legal issues usually than right or wrong. The patient herself said she was not offended. Was this some sort of political instigation? Probably!

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  • I wonder if prayers would be useful directed towards saving the NHS at the moment?!

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