Eleanor Colston, RN, has been a nurse for 40 years, so when her sister was diagnosed with cancer, the family assumed that Colston would take care of her. Even though she had just accepted a new job, for seven months Colston traveled 60 miles every weekend to care for her gravely ill sister. The experience left her emotionally and physically exhausted.

Colston isn’t alone. More and more nurses are feeling pressure to care for ailing or elderly family members–from their families and from themselves.

"You feel that because you’re the nurse, you ought to be able to do this," said Marilyn Rantz, Ph.D., RN, a professor at Sinclair School of Nursing at the University of Missouri, who recently placed her mother in long-term care. "Your family thinks you should be able to do this."

"There has been extra pressure," said Carolyn Markey, RN, president and CEO of the Visiting Nurse Associations of America in Boston, who cares for an ailing parent. "You want to care for her, and you still have your other responsibilities, and your family thinks you are the expert."

That is true regardless of a nurse’s area of expertise, said Jean Ellis, RN, who also works at VNA. "Maybe you’ve been in pediatrics all your life, but all of a sudden you’re a geriatric expert."

Family members provide 60 percent to 80 percent of long-term care for the elderly. The average caregiver is a daughter or daughter-in-law, aged 46, with a high school education or some college, married, with a 40 percent likelihood of having a child under 18–a profile remarkably similar to that of the average nurse, according to Ronald Toseland, Ph.D., professor and director of the Ringel Institute of Gerontology at the State University of New York at Albany.

About 64 percent of the group works, and the other one-third worked at some point while caregiving. Most spend 20 hours per week on home caregiving.

The job of caring for an elderly parent can last as long as 18 years, Markey said, and for many women, this comes after 17 years of caring for children. "It is very much a woman’s issue, a sandwich generation issue and a nursing issue."

It also is an issue that isn’t about to go away. The number of elderly people in the United States has almost doubled since 1960, with an estimated population of 51.1 million by 2020. Those who need care will be increasingly older, which means many will be less independent and in poorer health.

Nursing 24-7
While caregiving has its rewards–rewards that attracted many nurses to the field in the first place–doing it around the clock can be stressful.

Interrupted sleep equals chronic fatigue, which equals physical and psychological problems.

Caregivers have no privacy and little control over their time. They seldom get out and see their friends.

Relationships with family members may deteriorate. To watch a loved one decline is difficult. For nurses, the effects are magnified, Rantz said, "because we do this all day long, then go home and do it some more."

Caregiving can be expensive, too, and to make matters worse, the caregiver’s work situation almost always suffers.

A national survey of working caregivers found that 20 percent had reduced their work hours, 29 percent rearranged their schedules and 19 percent took time off without pay, Toseland said.

Some eventually leave the workforce and lose the earnings, benefits and personal satisfaction a job brings.

Ironically, it may be best for nurses to quit work.

"For nurses to try and do both takes its toll," said Patty Watson-Wood, RN, senior health and caregiver support coordinator for Southern California’s Senior Care Network. "You cannot have your sleep disturbed more than once a night or you need to get help. You can’t get up and go to work."

"Care of the caregiver is crucial," said Colston, now a public health consultant with the New Jersey Department of Health and Senior Services. "You have to find a way to have a break in order to be able to take care of someone. Ask for help. Hire someone. Get some rest."

Time is critical
Unfortunately, nurses are not always good at following this kind of advice, said Ellis, who has been caring for her elderly parents for the past two years while working full time. She is a widowed mother of three. Her siblings live out of state.

"Time is a critical need. One of the more difficult things is juggling time off work for medical appointments and still being there for my children."

She has used vacation time for her parents’ medical appointments, because she believes it is important to interact with the physician and serve as an advocate for her parents.

Here, at least, being a nurse is a huge advantage. "The average person doesn’t know the questions to ask and the information to get. If you don’t know where the system is leading, you can get so lost."

Nurses also are more likely to know what resources are available, or at least how to find out.

Caregivers need those resources, too, said Bonnie Lawrence, manager of communications at California’s Family Caregiver Alliance, an agency that directs caregiver resource centers statewide.

"Nurses talk about being able to detach emotionally from patients at work but have a harder time doing that when they are providing care at home. One way to get relief is to join a support group," Lawrence said.

"Tap into community support before you need it," Ellis said. "Be aware of different situations and when it is appropriate to bring resources in. Know what is reimbursed and exactly what type of services are we talking about. Call these organizations and do a reality check: Is the service delivered what you really need? Tap into discharge planning departments and social services. Ask about not just skilled care, but volunteer groups who can help."

She often turns to the Internet for information.

Tough assignment
Caring for a family member may be a nurse’s most difficult assignment.

"In some ways it was harder, because of what I knew," Rantz said. "You want to do everything exactly right." But it also may ultimately be the most rewarding.

"When my sister died, I did not feel one minute of guilt," Colston said. "I wouldn’t change what I did."