No Days Off: The Emotional Toll of Caregiving at Work and at Home, What Grandparents Go Through Every Shift
By K. David Swagler, MHA, BS, BSN, RN, CCRN, TNCC
I often think about the nurse whose shift never truly ends.
She finishes 12 hours in the emergency department emotionally and physically spent from caring for patients and supporting families through some of their most difficult moments. Then she goes home, changes out of her scrubs, and begins another shift – making dinner, helping with homework, transporting grandchildren to activities, and preparing for another busy day ahead.
For many nurses, particularly grandmothers who provide regular care for their grandchildren, this is not an occasional occurrence. It is their daily reality. In my Emergency Department alone, I have eight grandmothers who balance caring for patients three days a week and caring for their grandchildren the other four.
Caregiving has always been at the heart of nursing. It is what draws many of us to the profession and what gives our work meaning. Yet for some nurses, the role of caregiver extends far beyond the walls of the hospital. Due to rising childcare costs, changing family structures, and the need for multigenerational support, many grandmothers have become essential caregiving support for their grandchildren. Some provide occasional assistance, while others function as full-time caregivers outside of work1.
While these responsibilities can bring tremendous joy and purpose, they can also create a unique and often invisible burden – no time or space for personal recovery. Nurses provide many specific functions, but the essential service they deliver is themselves and if they are not functioning at their best selves, that service falls short2.
The challenge is not simply that these nurses are busy. It is that they rarely have the opportunity to recover.
Recovery time is essential in healthcare. We ask nurses to provide empathy, exercise sound clinical judgment, communicate effectively, and remain emotionally present for patients and families. All these responsibilities require energy and emotional reserves. However, when a nurse leaves work and immediately steps into another caregiving role, there is often little time left for rest, exercise, hobbies, friendships, or even uninterrupted sleep. I see this at morning huddle, when they are running to get their grandchildren to the bus on time or when the schedule is being made and they are trying to plan caregiving dates and are feeling anxious about conflicts and managing their time.
Over time, the absence of meaningful downtime can have significant consequences3.
Many of these nurses experience chronic fatigue and emotional exhaustion. They may feel pulled in multiple directions, carrying concerns about their patients while simultaneously worrying about their families and grandchildren1. They may struggle with guilt, feeling that they are never fully able to give enough to any one role despite giving everything they have.
This constant state of caring and expressing empathy can contribute to compassion fatigue.
Compassion fatigue is often described as the emotional and physical exhaustion that comes from prolonged exposure to the needs and suffering of others3. It is a well-recognized challenge in healthcare, but it can be amplified when caregiving responsibilities continue long after the workday ends.
Compassion fatigue can lead to impaired ability to concentrate, difficulty making simple decisions, and persistent feelings of being overwhelmed – the same symptoms seen in those with PTSD3.
The signs can be subtle at first. A nurse who was once endlessly patient may become more irritable. Someone who was highly engaged may seem emotionally withdrawn or detached. Concentration may become more difficult. Small stressors may feel overwhelming. Eventually, the emotional reserves that allow nurses to connect deeply with patients and colleagues begin to diminish.
This matters because nurses’ well-being and patient care are inseparable.
When nurses are exhausted, emotionally depleted, and unable to recover, it affects not only their personal health but also their professional practice. Compassion fatigue can contribute to decreased job satisfaction, increased absenteeism, burnout, and even turnover. It can also affect communication, teamwork, and the ability to provide the level of compassionate care that patients deserve. These are just the professional implications related to fatigue; there are also the personal effects to consider as they care for their families and grandchildren. You can see this in higher Family and Medical Leave Act (FMLA) and sick leave utilization, decreased charting, and poor patient feedback scores. These are tangible warning signs and should not be ignored.
As leaders, we have a responsibility to recognize that some of our team members are carrying burdens that may not be immediately visible.
Not every caregiver is caring for an aging parent or a young child. Some are grandmothers who have taken on significant caregiving responsibilities for their grandchildren. They may not even identify themselves as caregivers because what they are doing simply feels like helping family. Yet the physical and emotional demands are very real. So are the very real socioeconomic implications of caring for grandchildren, especially if the situation is larger than just childcare needs. Many of my team members contribute financially and find the balance of being home and picking up shifts an impossible task.
They may not even identify themselves as caregivers,
but that is exactly what they are.
Supporting these nurses does not mean lowering expectations. It means understanding the realities that influence their well-being and performance. It means creating environments where people feel comfortable discussing the challenges they face outside of work. It means considering flexibility whenever possible, encouraging nurses to use their earned time off, promoting employee assistance resources, and normalizing conversations about fatigue and self-care. We allow team members to pick up partial shifts without penalty and have programs, such as a weekender role, that allows for time at home during the week but doesn’t cut benefits or supports down.
Most importantly, it means recognizing that caring for our caregivers is not a luxury – it is a necessity!
For nurses who are also grandmothers and caregivers, self-care can feel impossible. There is always another responsibility, another task, another person who needs something. But rest is not selfish. Recovery is not weakness. Time spent restoring one's own physical and emotional health is an investment in the ability to continue caring for others.
Recovery is not weakness.
The nursing profession is built on compassion, but compassion is not an unlimited resource.
As healthcare leaders, colleagues, and organizations, we must become more intentional about identifying and supporting those who spend their lives caring for everyone around them. The grandmother helping with homework after a 12-hour shift, the nurse driving grandchildren to appointments on her days off, and the caregiver who never seems to have a moment to herself all deserve the same compassion they so freely extend to others.
Perhaps the most important question we can ask is not, "How much more can our nurses do?" Rather, it is this: “How can we better care for the people who spend their lives caring for everyone else?”
K. David Swagler, MHA, BS, BSN, RN, CCRN, TNCC
Secretary, Greater Cleveland Organization For Nursing Leadership (GCONL)
Nurse Manager, MetroHealth Emergency Services
Footnotes
1. Bert Hayslip, Christine A Fruhauf, Megan L Dolbin-MacNab, Grandparents Raising Grandchildren: What Have We Learned Over the Past Decade?, The Gerontologist, Volume 59, Issue 3, June 2019, Pages e152–e163, https://doi.org/10.1093/geront/gnx106
2. Nolte AGW, Downing C, Temane A, Hastings-Tolsma M. Compassion fatigue in nurses: A metasynthesis. J Clin Nurs. 2017; 26: 4364–4378. https://doi.org/10.1111/jocn.13766
3. Austin, W., Goble, E., Leier, B., & Byrne, P. (2009). Compassion Fatigue: The Experience of Nurses. Ethics and Social Welfare, 3(2), 195–214. https://doi.org/10.1080/17496530902951988
4. Yeşil, A., Polat, Ş. Investigation of psychological factors related to compassion fatigue, burnout, and compassion satisfaction among nurses. BMC Nurs 22, 12 (2023). https://doi.org/10.1186/s12912-023-01174-3
