As more people are being sent home “quicker and sicker”, family members are taking on more frequent and complex caregiving responsibilities than in the past.  In 2002, more than 1.4 million Canadians 45 years of age and over combined paid employment and care to older adults, and most caregivers worked full time. As the average age of registered nurses (RNs- 44.3 years) continues to rise, there is an increasing likelihood that more Canadian RNs will be caring for elderly, disabled relatives. However, little is known about the extent to which this major group of health professionals cares for their elderly relatives or how the blurring of professional and personal caregiving boundaries affects their health because there is a tendency to treat professional and personal caregiving as separate domains.

History of Double Duty Caregiving Studies

Previous Studies

Study 1  1999-2001
An Analysis of Health Professionals’ Work and Family Lives
[ link to abstract and reference]

Study 2  2000-2002
Health Professionals as Family Caregivers: Practice and Policy Implications
[ link to abstract and reference]

Study 3  2004-2006  
Double Duty Caregiving: Development and Validation of the DDC Scale
[ link to abstract and reference]


Double-Duty Caregiving at a glance…

Health professionals who assume elder family caregiving responsibilities are located at the juncture of the public and private domains of caregiving,
where they constantly negotiate the boundaries between professional and personal caring work.

This conceptual model depicts the experience of double-duty caregiving. Study1 illuminated four inextricably linked components of double duty caregiving:
1) familial care expectations, 2) level of support, 3) negotiating strategies, 4) caregiving interface.



Familial Care Expectations

The expectations to care for aging relatives are especially strong for DDCs, the duality of the gendered expectations of women and family care combined with a professional background positions DDCs at the forefront of care. Expectations of self and others have a profound influence on the types of caregiving responsibilities and the care work assumed by DDCs.

Level of Support

Double Duty Caregivers receive varying degrees of emotional, informational, and instrumental support from family, colleagues, and community resources. For example, spouse and siblings/adult children play a critical role to help manage the care of an elderly relative. In addition to or in lieu of family supports some DDCs rely on colleagues to provide necessary support. For example, some co-workers ‘cover’ for short-term absences, or alter their schedules to help accommodate the double-duty caregiving demands. The presence or absences of suitable supports have a significant impact on how DDCs appraise their caregiving situations.

Negotiating Strategies

A number of interrelated negotiating strategies, such as setting limits, using connections and delegating care, are used by DDCs either to limit the caregiving demands on them or to expand supports in order to manage increasing demands. For the most part, setting limits is often used by DDCs to help contain the expectations of family and professionals. Using connections is another strategy that DDCs employ to ensure that their family member receives quality care. In some situations, DDCs use their knowledge of the system and their professional status to acquire certain types of supports, such as home care services or consultations with specialists. A third strategy used by some DDCs is delegating care to paid professionals and/or family members. Recognizing that DDCs cannot provide all the care all the time, some ask others to take on some of ‘their’ caregiving responsibilities.

Although these strategies were somewhat effective in limiting demands while increasing supports, especially in the form of instrumental help, it is apparent that the source of the demands, the types of caring work involved and the resulting blurring boundaries of care, involved multiple factors, both paid and unpaid. The context of caregiving needs to be considered when assessing how nurses’ access strategies.

Caregiving Interface

The caregiving interface (connection between professional lives and personal lives of caregiving) varies for each person, depending on the degree of expectations of familial care and on the level of support available to manage multiple caregiving demands.



What else do we know about Double Duty Caregiving?


Findings from Study 1 (see Double-Duty Caregiving: Women in the Health Professions, 2005) suggest that there are three distinct, yet interconnected types of double duty caregiving experiences:

Making it work…

The expectations tend to be low for these caregivers, partly because the care needs of the elderly relatives are not excessive. Requests for assistance are usually periodic, fall within the DDC’s domain of professional practice and require a small amount of time. DDCs who are experiencing ‘making it work’ are generally able to contain growing expectations and solicit any needed assistance, which usually results in a minimal blurring of boundaries.

Working to Manage

The expectations tend to be moderately demanding, and for some gradually increase over time. Often these DDCs need to acquire more health information outside their area of expertise. In addition, families and other health care providers often expect them to assume more and more care and strategies for limiting care may not as effective.

Living on the Edge


The level of familial expectations to provide complex, daily care can be exceedingly high. If family and workplace supports were previously present, they have weakened considerably. In addition to caring for their elderly relative, many DDCs provide emotional and instrumental support to other family members who lack health professional skills and knowledge. Boundaries between personal and professional caregiving become almost completely eroded. Many DDCs experience exhaustion and loss of self while they are ‘living on the edge’.



Study 4

Health Care Professionals Caring for Elderly Relatives: Investigating the Health Effects of DDC (2008-present)


The purpose of the study is to test the model of double duty caregiving (DDC) and to determine if and to what degree DDC impacts the health of professional caregivers.

Study Goals

By using both quantitative and qualitative approaches, we are making visible what has been “invisible”- caregiving at the juncture of professional and personal caregiving domains. We hope that study findings will inform health professional policies (e.g. Best Practice Guidelines (BPGs)) related to the blurring of professional and personal boundaries among male and female RNs in Canada.  In keeping with the theoretical framework of the study and with past practices of the investigative team, researchers work with health providers, professional organizations and policy makers to promote the uptake of the study findings, work to inform the development of policies and/or develop new policies, and plan future research to evaluate the proposed policy recommendationsUltimately, study findings will promote an evidenced-base partnership approach that will address the potential health effects of double duty caregiving.

Phase IQuantitative (survey)

We used a cross-sectional survey design to validate the measurement scales employed in the proposed DDC model, and to test the following hypotheses:

  1. Expectations have a positive effect on Caregiving Interface;
  2. Supports have a negative effect on Caregiving Interface;
  3. Making Connections and Setting Limits have a negative effect on Caregiving Interface
  4. Caregiving Interface has a negative effect on Health.

 3700 male and female RNs in British Columbia, Ontario, and Nova Scotia were invited to complete a mailed or online survey, with the aim to test the DDC Measurement Model.

Structural Equation Modeling techniques are being used to conduct these tests. Furthermore, comparison of DDC scores by gender with respect to health status, well-being, and burnout are also being conducted. 

 Phase II – Qualitative (interview)

A grounded theory approach was used to further explore the three proposed prototypes of DDC (making it work, working to manage and living on the edge).  Using a purposive sample of DDCs selected from Phase I who fall within these prototypes, we explored how male and female DDCs mediate the caregiving interface and resulting health effects. Through the use of repeat interviews (Time 1 and Time 2), theoretical sampling helped to enhance our understanding of the possible caregiver oscillation within these three DDC prototypes found in our initial qualitative work of DDC.  Participants were also asked to describe the impact of policies (or lack of) on their health as DDCs and to recommend any changes that could address their issues/concerns.

Concurrent with data collection, data are being analyzed using the constant comparison methods of constructivist grounded theory, modifying the emerging theory such that it fits both the new data and the relevant constructs within the prototypes of DDC.

We expect to share findings within the next couple of months.