What is meant by ‘DDC’?

Within the health professions many people are believed to be “double duty caregivers” (DDCs) – those individuals who provide care both at home and at work. In keeping with the notion that informal can look very differently depending on the population (i.e. childcare, care for friends and neighbors), the focus of our studies is to investigate the health of effects of nurses’ providing informal care for elderly relatives.

How prevalent is DDC?

Although the prevalence of double duty caregiving (DDC) is currently unknown, research has shown that approximately 30-50% of the working population provides care to older relatives, with most care being provided by female family members. Additionally, research suggests that approximately one half of health professionals provide care to an older relative(s).

How does DDC impact me as a nurse?

Although there is some evidence to suggest that employed family caregivers of elderly adults experience a number of adverse health effects, we know very little about the impact of combining personal and professional caregiving. However, by separating professional caregiving from personal caregiving and assuming differences between the two, there is a lack of awareness of the blurring of boundaries between paid and unpaid care. This blurring of boundaries may lead to potential health effects amongst double duty caregivers.

Are there health effects of DDC?

Our previous qualitative study suggested that a dramatic blurring or erosion of boundaries between personal and professional caregiving amongst female health professionals resulted in negative health effects such as feelings of isolation, and mental and physical exhaustion. Thus, in response to these findings and an expressed need by health professional organizations to determine the extent and impact of DDC we developed and pilot tested the DDC Scale, which measures Expectations, Supports, Setting Limits, Making Connections and Caregiving Interface. In this pilot study of female nurses, we found that Caregiving Interface negatively correlated with caregiver well-being and with health outcomes, suggesting the need for further research on the potential health effects of DDC among health professionals.

Why is DDC important to understand?

Developing a more comprehensive understanding of DDC is particularly urgent in a time of health care reform and shortages of registered nurses (RNs) and other health care providers. Additionally, as our population continues to grow older and the average age of a nurse increases, the phenomenon of DDC is predicted to become even more pronounced. If nurses are double duty caregivers it may affect their job, their family, their older relative and their health. It is important to know what potential supports and resources exist to support double duty caregivers, such as workplace or community supports.

What are the implications of Double-Duty Caregiving?

DDC does not just affect the health of the nurse and their older relative, but rather DDC has tremendous health care implications. For instance, some nurses who care for their older relatives without sufficient supports feel obligated to look for other “options” such as taking a leave of absence without pay, or using their sick or vacation time in order to provide care ’at home’. Others may even scale down to part time or leave the workplace to care for their older relative and in a time of nursing shortages, the health care system risks losing a nurse.

How could DDC affect my work?

Our preliminary findings have suggested that being a DDC has both positive and negative effects on nursing work. For example, some of the positive health effects identified by nurses are that some nurses felt that being a DDC has enhanced their understanding of some of the challenges family caregivers experience when navigating the health care system. Other nurses have related to the experience of providing care to older adults in their work environment. Some of the negative health effects identified are that some nurses experienced tremendous stress when trying to balance their professional and personal caregiving duties. Also, many expressed feeling unsupported in their professional workplace due to inflexible work schedules and strict policies related to absenteeism.

How could being a nurse affect the care that I provide to my older relative?

Our preliminary findings suggests that some nurses perceive their professional role as an asset for providing quality care ‘at home’, with specialized knowledge and professional connections many described their nursing background as a resource. Consequently, some nurses described the expectations affiliated with their professional role, indicating that there is additional responsibility to provide care. These nurses can feel conflicted when the expectations to provide care outweigh the supports to assist them with the provision of care.

Are their professional nursing standards that address DDC?

Many nurses are unaware of the professional standards related to the practice of providing ‘professional’ care ‘at home’. These standards vary across provinces.

In British Columbia, practice standards state that at times nurses may have to care for family or friends, but when possible care should be transferred to an appropriate care provider. Care of family members requires caution, discussion of boundaries and careful consideration about the impact of the dual role.

More information may be found at: http://www.crnbc.ca/downloads/432.pdf.

In Ontario, practice standards require recognition of the boundary between the nurse’s professional and personal role and disclosure of this to the client. In caring for a family or friend a care plan must be developed and followed, as well as confidentiality maintained. When the nurse is not able to meet personal needs outside of the relationship, alternative caring arrangements must be found.

More information may be found at: http://www.cno.org/docs/prac/41033_Therapeutic.pdf.

In Nova Scotia, practice standards recognize the difficulty of avoiding family caregiving in small communities. Caring for family or friends is discouraged but when unavoidable, all effort should be made to separate the professional role from the personal role. When boundaries are blurred, it is recommended that another nurse step in to provide care.

More information may be found at: http://www.crnns.ca/documents/standards2004.pdf.