Analysis

Nursing at work, caring at home: advice, tips and your workplace rights

It’s tough coping with loved ones’ needs as well as a demanding job – but flexible working and a supportive workplace can make all the difference
woman helps frail man to take a meal at a kitchen table

Its tough coping with loved ones needs as well as a demanding job but flexible working and a supportive workplace can make all the difference

  • Thousands of nurses quit work every year because of the burden of family responsibilities
  • As a nurse, you may feel imposed on by relatives who assume caring duties come more easily to you
  • Real-life survival tips and flexible working suggestions from nurses who broached the issue at work

Almost one in seven nurses missed work in the past 12 months because of caring commitments at home, a Nursing Standard survey suggests.

1 in 7

Nurses have taken time off to care in the past 12 months

(Source: Nursing Standard well-being at work survey 2019)

And the burden of family caring can be greater for nurses

...

It’s tough coping with loved ones’ needs as well as a demanding job – but flexible working and a supportive workplace can make all the difference

  • Thousands of nurses quit work every year because of the burden of family responsibilities
  • As a nurse, you may feel imposed on by relatives who assume caring duties come more easily to you
  • Real-life survival tips and flexible working suggestions from nurses who broached the issue at work

Picture: iStock

Almost one in seven nurses missed work in the past 12 months because of caring commitments at home, a Nursing Standard survey suggests.

1 in 7

Nurses have taken time off to care in the past 12 months

(Source: Nursing Standard well-being at work survey 2019)

And the burden of family caring can be greater for nurses because relatives may be keen to pass responsibilities on to ‘the nurse in the family’.

We spoke to three front-line nurses about the challenges of juggling work and home life – and steps they and their employers have taken to strike the difficult balance between the roles of nurse and informal carer.

People often fail to recognise their status as informal carers

Of the 2,150 UK nurses who took part in Nursing Standard's well-being at work survey, 14.5% (312) said they have had to take carer's leave in the past year.

‘My relatives leave me to get on with it because I’m the nurse in the family’

Louise, a nurse who cares for her father

But the proportion of nurses who also have caring responsibilities could be higher still because many may not even realise they are informal carers. Indeed, it takes an average of two years for a carer to acknowledge their role, according to NHS England.

Mother, daughter, nurse – all in a day’s work

It is a statistic that rings true for Louise*, who works as a staff nurse in a large teaching hospital in England.

As well as being a mother of two young children, she takes responsibility for caring for her father, who has mobility difficulties.

'At first I saw my caring role as simply doing as any child would do; helping their parent out. Carers were "other people", not me,' she says.

72,000

NHS workers have quit their job in the past two years because of unpaid caring responsibilities 

(Source: Carers UK)

She adds that other family members tend to 'leave her to get on with it' because of her nursing background.

'There's a sense of "well, you're the nurse in the family", she says.

'My grandma was in hospital not long after I started training: my family assumed I would be able to understand her notes and do all the talking to staff. I was 19 years old and hadn't even been on placement.'

Families ‘delegate’ caring duties based on day job

According to NHS England, a carer is anyone who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support.

‘If you need half a day, or a few days to be able to sort out care, then that should be possible’

Emily Holzhausen, director of policy and public affairs, Carers UK

Rebecca Cowley is a carer liaison officer at Chesterfield Royal Hospital NHS Foundation Trust in Derbyshire. She says it can be common for nurses' families to 'delegate' caring responsibilities to them because of their day job.

‘Nurses and NHS staff are kind by nature,’ she says. ‘They are giving and caring, so you do tend hear: “Oh well, I’ll do it. I care, so I will help.”

‘It’s part of their nature or they wouldn’t be doing the job that they do.'


Sometimes siblings may assume that if there is a nurse among them, they can take on caring
responsibilities Picture: iStock

Women more likely than men to give unpaid care, and to give up work 

£77 billion a year

The economic value of unpaid care provided by women in the UK

(Source: Carers UK)

But kindness only goes so far. According to charity Carers UK, 72,000 NHS workers have quit their jobs in the past two years to care for a loved one who is older, has a disability or is seriously ill.

Research backs up what many know from experience – that women are more likely to give unpaid care than men, and in turn are more likely to give up work to care. 

The charity says the NHS is particularly vulnerable to losing staff to family caring duties because a high proportion of its workforce is female – 77%, according to NHS Employers.

The need for carer-friendly employment practices in the NHS


Emily Holzhausen of Carers UK

Carers UK director of policy and public affairs Emily Holzhausen says the NHS must become more carer-friendly to retain staff.

‘The NHS has an incredibly huge range of complex services to deliver and I can understand these things need to be balanced, but we have to recognise the pressures there are on people in their families,' says Ms Holzhausen.

'If you only need half a day to sort out care then that should be possible. Equally, if you need a few days to be able to sort out care or do something very specific to support your relatives, then that should also be possible.

'We need workers to be well and to be able to manage their lives.’

Nurse shortage makes the issue even more pressing

With an estimated shortage of 44,000 nurses in England alone, it is a situation the NHS can ill afford to ignore, according to RCN national officer for employment relations Hannah Reed.


Hannah Reed, RCN national officer
for employment relations

‘While all nurses care for people as part of their job, many care for somebody at home,' she says.

'It is important those who need to care for members of their family are supported in doing this.

‘We need to give those with caring responsibilities the flexible working they need while investing in the entire workforce to ensure we have the right number of nurses in the right place at the right time.’

Legal rights of nurses who are carers

Nurses who have caring responsibilities are offered a number of protections in law, including protection from discrimination and the right to emergency leave.

Employees have the right to request flexible working arrangements to fit around home life, such as part-time working or compressed hours.


Case study: moving to compressed hours made a big difference 


Compressing working hours can be
helpful Picture: iStock

One nurse carer who has benefited from flexible working is ward sister Paula Cooper, who provides daily support not just for her 30-year-old son, who has cerebral palsy, but for her former mother-in-law too.

Ms Cooper, who works at Chesterfield Royal Hospital NHS Foundation Trust, says the turning point for her came in 2018 when she had what she describes as a breakdown.

This led her to rethink her working pattern: she now works longer shifts and has every Friday off.

‘Having Friday off has helped massively,’ she says. 

Early mornings and late nights caring for relatives

Despite the support from her employer, life is still busy. On a typical day, Ms Cooper gets up at 4am so she can visit her former mother-in-law before starting work at 7am.

After finishing work at 7.30pm, she then travels to the home of her son, who uses a wheelchair and needs help with shopping, cooking and cleaning.

Sometimes, Ms Cooper doesn’t return home until ten o'clock at night.   

‘There is a lot of pressure,' she tells Nursing Standard.

Ms Cooper says the hospital's carer liaison officer Rebecca Cowley has been a key source of support.

‘Rebecca has even attended an appointment with my son for me because I was at work. I know she is going to be my first port of call if I need help.’


How England’s largest trust cares for its carers

Barts Health NHS Trust in London set up a network for staff carers in June 2018.

‘We want staff to understand that, unless we meet these colleagues’ needs, we run the risk of losing highly skilled and dedicated individuals,’ says director of people services Liam Slattery.

Sister Faiza Sharif's father has progressive supranuclear palsy, a rare condition that compromises balance, movement, vision, speech and swallowing.

She was finding it difficult to cope with work and caring responsibilities, and was signed off sick for two months because of anxiety.

Her line manager suggested a change in working pattern, and she now works three or four shifts in a row, with three or four days off in between. 

Easing the pressure can help individuals be more productive at work

The result has been transformational for Ms Sharif and her employer. ‘I’ve had zero sickness, zero compassionate leave, zero carer's leave and when they are short of staff, I am the first person who will come and help,' says Ms Sharif.

'If I’m needed to stay behind it’s not a problem because I know when I need to go early I can. It works both ways.'

Ms Sharif adds that her caring role has shaped her relationship with patients' families.

‘When I see that relatives are quite heavily involved in the care I try to advise them to take a step back, take it a bit easy and have a break.

'Their role will come in once the patient is discharged.’

 


Picture: iStock

What is being done to support carers at national level?

The 2019 Interim NHS People Plan sets out how the health service in England will recruit and retain staff.

It pledges to ‘look to include support for those in our own workforce with caring responsibilities at home as part of making the NHS the best place to work,’ but stops short of giving details about exactly what this support might include.

Carers UK runs a forum called Employers for Carers, where organisations can share information and ideas about how to support employees who are unpaid carers. There are five NHS employers in the network. 

Initiatives to support carers seem to be improving across the UK. In 2019, 7% of carers said that unpaid caring negatively affected their work, while in 2013 this figure stood at 10%, according to Carers UK's Juggling Work and Unpaid Care report.

I am an informal carer – what are my rights at work?


Picture: iStock

  • Protection from discrimination If you live in England, Scotland or Wales and look after someone who is older or disabled, the Equality Act 2010 protects you against direct discrimination or harassment as a result of your caring responsibilities. Agency workers are covered by the Act, but their employer is their agency, and not necessarily the organisation in which they are working. Likewise, working carers in Northern Ireland are protected under the Human Rights Act. Those working in the public sector – the NHS, for example – have protection under section 75 of the Northern Ireland Act, which requires public bodies to promote equality of opportunity for staff who are carers. In some cases, carers may have rights under disability and sex discrimination legislation
  • Flexible working All UK employees with more than 26 weeks' service have a right to request flexible working. This can include part-time or term-time working, compressed hours or job sharing
  • Time off in emergencies All employees have the right to take a ‘reasonable’ amount of time off work to deal with an emergency or an unforeseen matter involving the health of a dependant. Carer's leave is unpaid unless your employer gives you paid time off as a contractual right
  • Parental leave If you have 12 months' service and are responsible for a child, you have a legal right to take time off work to look after a child or make arrangements for a child's welfare, with up to 18 weeks’ leave per child. According to Unison guidance, this could include spending more time with your child in their early years, accompanying your child during a stay in hospital or settling your child into new childcare arrangements. This is unpaid unless your employer offers paid parental leave

Adapted from Carers UK factsheet

 

Why NHS managers need to lead by example

Carers UK's Ms Holzhausen says all staff must be treated equally in relation to their needs as carers. ‘Some people who don’t have children, for example, do have caring responsibilities, so where there is flexibility shown for parents, a similar flexibility is also needed for people caring for others.’

She adds that line managers need to set a good example by ‘championing from the top’.

'Leaders who say “actually, I’m trying to support my parents, or I have a disabled child”, that makes a big difference.’

A supportive line manager (and an honest conversation) can work wonders

For Louise, it was a frank conversation with her own line manager last year that helped change things at home as well as at work.

She says: 'It spilled out of me: school runs, medical appointments, admin, family politics. I had a full-time job before I'd even put my uniform on in the morning.'

Louise was granted paid emergency leave, and together she and her manager researched care and funding options for her father. They drew up key points for a family meeting about sharing responsibilities for her father's care.

A flexible working request has been approved, and Louise now works shorter shifts over four days instead of three to manage school drop offs and pick ups, and her father's care.

'Life will always throw a curveball, but knowing there is leeway in my professional life makes a huge difference,' she says.


Picture: Tim George

Are you a line manager? Tips for supporting the carers in your team

  • Know the definition of a carer According to NHS England, a carer is anyone who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support
  • Appreciate that caring roles and responsibilities vary According to NHS England, caring can encompass practical tasks such as helping someone get out of bed or bathing, through to emotional support such as helping someone cope with the symptoms of mental illness
  • Recognise signs a staff member may be struggling This could include changes in mood or behaviour, lateness, more frequent requests for shift changes
  • Proactively offer support and signpost HR policies Have a conversation with the staff member – ask if they are okay, and if there are any changes or challenges at home

(Source: NHS England)

 

*Name has been changed


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