For effect or otherwise, nurses always have been characterized as angels of mercy. Some, though, like Judith Skillin, RN, are closer to heaven than others.

Skillin, 63, is parish nurse at North Run Baptist Church in Richmond, Va., and more than once, she said, parishioners have told her she is the answer to their prayers after trying for two years to establish a church nursing program.

For 30 years, Skillin had been part of the 600-member church. But it wasn't until after she retired, finishing her career with the state of Virginia, that she could dedicate herself to the postgraduate parish nurse program at Union Theological Seminary and Presbyterian School of Christian Education in Richmond, and begin a ministry to the church's 200 active members and the surrounding community.

"The church has always had a long history of social support. A new role for the church is going to be managing health care for parishioners," Skillin said, reflecting the message of a conference she attended by Duke University's Harold Koenig, MD, titled "The Role of Religion in Health Care."

Americans' increasing reliance on HMOs, a ballooning population of uninsured and a tradition of turning to churches in times of need all affirm Skillin's belief that her volunteer position, with office hours on Wednesday mornings, could grow into a full-time, paid position, as it is at some larger churches.

The needs of the congregation guide Skillin's practice. "We're small, so you kind of know what's going on in the congregation," she said. For instance, she initiated a grief program covering losses by death and divorce because that's what church members were dealing with.

And when, in a short time, there were four diagnoses of multiple sclerosis among the flock, Skillin pulled together disease information for the families and connected them with community resources to help cope with it.

Parish nurses are consultants, teachers and facilitators who often work in confidence on the periphery of a familylike congregation, Skillin said. "We do assessments, we do a lot of referrals."

In one particularly memorable and lifesaving case, a visitor to the home of an elderly couple turned to Skillin to seek emergency hospitalization for an elderly man who had fallen critically ill while caring alone for his homebound wife. Skillin quietly arranged nursing home care for the woman. Other than the pastor, she said, "Not many people knew what was going on."

Besides weekly blood pressure screenings, in which she has referred parishioners for treatment of hypertension and then monitored their ongoing care, Skillin said she tries for at least one educational program a month. "I like to get experts, like a pharmacist, to talk about diabetes medication or a psychologist to talk about grief. I have physicians who come in to talk about health issues or a certain disease," she said.

Skillin draws resources from the breadth of a long nursing career. She began as a med/surg nurse, practiced in infection control and rose to assistant director of nursing in 25 years at Children's Hospital in Richmond, where she handled quality assurance and risk management. She finished her salaried career as a surveyor at the Virginia Department of Health, investigating complaints against nursing homes and home health agencies, as well as doing Medicare and Medicaid fraud surveys.

"I said, 'It's time to retire and play,' " Skillin said. "God said, 'No, no, no.' "

The church program is beginning its third year, and when she needs guidance or resources, Skillin calls on other parish nurses or the seminary. She said she shares a lot with a nurse at another Baptist church nearby and "I have another friend who is a parish nurse at a Lutheran church. We call each other and pick each other's brains."

Broadly, Skillin's program is broken down into four service groups.

"I've spent more time with the elderly and elderly issues," she said, because they are the ones struggling with chronic conditions and end-of-life issues. After that, it's youths who almost daily confront the temptation of drug and alcohol abuse, as well as premarital sex and the threat of sexually transmitted diseases.

Third is men, Skillin said. "Men, you know, they don't go to doctors. I focus on health programs and preventive issues for them." It's much the same for women, the fourth group for whom she also arranges cancer screenings and experts in women's health issues.

With each group, Skillin said, "They already have a spiritual base and what you're trying to do is build on that, give them hope, increase their well-being and give them optimism. You can talk to people and pray with them and have such camaraderie with them that you just can't have if you're working in another specialty.

"I'm a parish nurse minister and this is a ministry of the church," Skillin said. "What I do is try to help them in their body and their mind and their spirit."

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