Hi, I wanted to address some of the questions you present, if I may... the parish nurse works within the organizational constructs of the parish with which she is affiliated/employed. Most of the time, she is not given a "carte blanche" to do whatever she feels necessary as the "specialist"... but is accountable to the pastor or equivalent. My own experience as a Parish Nurse in a Cathedral setting was to start a "health and wellness" ministry... since at that time it was not felt expedient to actually hire another staff member (since then a "mental health nurse" was hired--as I had correctly assessed at the time was needed). Change within a fixed and rigid system (as in a huge intercity parish like this) often comes very slowly... I was well aware of that the whole time. Another academic nurse who was "head" of this committee after me (I had to stop because I was involved in a devastating MVA--and needed serial surgeries) tried all too hard to make change much too fast. She didn't last long. I do have friends from my certification class that, indeed, were hired as the lone or one of two parish nurses in other churches... their experiences are much different, of course.
Of course, nursing dx (especially in light that it is only nursing in the medical field that acknowledges spirituality and spiritual deficits)... are part and parcel of our assessments: often made on the spiritual health of the whole congregation... as well as the issues surrounding the whole health picture of individual members and the community to which the parish is committed in service. Our interventions are sometimes misunderstood--and sometimes we can even be mis-judged or held in contempt... by some, anyway. But an understanding of spirituality and what is entailed in being "change agents" offsets these kinds of responses... leading to our increased strength and ability to deepen our faith walks as well as the faith walks of others... and their health needs as a whole. I have since understood that others (including physicians) simply cannot do what a Parish Nurse can. My mistake was trying to integrate a "multi-specialty" approach to Parish Nursing... I thought at the time to utilize people who would be better accepted by the hierarchical structure, as well as having other viewpoints... and talents. It was not successful as a whole. "Too many cooks spoil the broth." So, I'd say before starting out--know your parish very well--and work to being an independent practitioner... for the sake of order and the successful integration of all a Parish Nurse is! That way the pastor and staff will have some kind of idea as to the purpose and usefulness of the unique talents and education of the Certified Parish Nurse. There simply are times when physicians cannot do what nurses can.
Another reason for being an independent practitioner is because of relationship issues/envy/and other human foibles involved in the kind of "committee" that I had attempted to set up. Non-medical religious ministers can often "intervene" not knowing what they are doing--causing such chaos... and disruption that there is no healing for anyone. The uniquely-broad education of the Parish Nurse puts her in a position of being able to assess much of which someone only trained in ministry/theology cannot--as well as bring to healing when allowed. Sometimes this, too, takes awhile to "sink in". The measurement of "outcome" also sometimes takes quite awhile to realize; being done in retrospect--sometimes a long time down the road. In Parish Nursing there are usually not "quick responses" to interventions. The love of the good parishioners goes a long way to making all this "worthwhile" however... and is the consolation of nurses, anyway, isnt' it?