Far More Than Burnout and Burden: Gerontological Nurses and Care Partners

Nurse burnout. Caregiver burden. The corrosive experiences of burnout and burden are everywhere today, threatening to blot out the very purposes of nursing and caregiving. Nurses and care partners support us all at various points in our lives and especially so in later life.

The terms burnout and burden have become shorthand characterisations of the contemporary state of our roles. Nurses are burned out; caregivers are overburdened. The words are draining, connoting a sense of hollow actions and brittle responses lacking both purpose and relationship. Yet, the work that nurses and care partners do separately and together is vital to any society.

Defining vital social roles like those held by nurses and care partners in the negative is detrimental. Our roles—many of us are both nurses in our professional lives and care partners in our personal lives—are fundamentally relational and reciprocal. Relationships within these roles and the rewards we find within them sustain nurses and care partners alike. Relationships central to the scope of these roles anchor our responsibilities with a sense of meaning and feelings of fulfilment. Examination of problems and dissatisfaction without consideration of other elements entailed in these roles quickly erodes the understanding of purposes, key features and benefits. We all know that feeling dissatisfied in any role rapidly dissolves into feelings of being trapped or wanting to simply leave. Departure from nursing and caregiving roles, where possible, may offer some relief to that person but can provide no substantive means to redress the causes. Gestures offered by institutions that espouse self-care and resilience skirt the underlying causes of burnout and burden, risking a sense of tokenism among their nursing workforces as well as care partners who receive healthcare there. Thus, these reactions are not solutions and instead further damage both the identities and purposiveness of nursing and caregiving.

In every context, the language we use represents our beliefs and perceptions. For example, the term caregiving and its companion label of caregiver specifically underscore a naïve impression that roles like ours are about giving to others without reward. The use of these words misrepresents relationships where one person needs specific care from another and reciprocates to them in other ways. Indeed, the word caregiver sufficiently frustrates people in that role that there is now a movement to replace the word caregiver with the more accurate and inclusive phrase care partner. While care partners are working towards a better understanding of their role, I am concerned that we in nursing are not doing the same.

With abundant references to burnout and burden, those looking on from outside our world of gerontological nursing or at nursing more broadly might be forgiven for thinking that our role is ultimately thankless. Around the world, nurses are researching burnout and, when we consider care partners, burden is the word that tops many of our research agendas. But burnout and burden too easily become caricatures of caring social roles. Certainly, burnout and burden are consequential phenomena. They often emerge when work is devalued and when support and resources are inadequate. Thus, these phenomena deserve careful study in collaboration with both nurses and care partners to pursue sustainable structural and systemic solutions. Conversely, near-exclusive focus on them can distort the social roles of nurse and care partner, even thwarting the means to redress burnout and burden. Research that seeks to only describe burnout or burden fails to grasp the reality that burnout and burden exist for many reasons that sometimes require different solutions.

Effectively understanding and mitigating burnout and burden as phenomena in nursing and caregiving requires balance. That equilibrium comes with understanding the identities of nurses and care partners, the scope of their roles and the larger social purposes achieved through their work. Broadly, professional nurses understand health, function and well-being as capacities to be promoted in partnership with the people in their care while considering the environments in which those individuals, families and communities live, work and play. Nurses' care leverages sophisticated knowledge and skills that span the biological to the spiritual. Conversely, care partners give varied forms of direct physical and emotional care along with instrumental care to people with whom they have some personal relationship. The roles of nurse and care partner are thus inherently complementary in the purposes they fulfil and in the identities that emerge from addressing the respective purposes.

Working with the identities of nurse and care partner, grasping the scope of these roles helps delimit the authority held within them and defines consequent power that benefits health and society. Today, understandings and interpretations of the identity, scope and authority of nurses and caregivers commonly lack substance. Going forward, we must correct this trend. Amplifying the strength of our research requires a clear shift. Overemphasising the phenomena of burnout and burden puts essential care at risk by obscuring the purposes for which nursing and caregiving exist. We need to better address the what, why, how and when through which gerontological nursing and caregiving contribute to positive change in health, function and well-being for individuals, families and communities across our societies. Only then can we advocate for structural and systemic changes from education and practice development through institutional and health policy.

Nursing and caregiving are fundamentally relational and reciprocal in nature. These roles do not exist without relationships. There is no nurse without patient, no care partner without care recipient. But these roles are reciprocal in other ways, too. Caregiving is part of vast numbers of people's lives. Many people who are in the patient role on one day are care partners the next. Likewise, those of us who are nurses are always patients at some point and are frequently care partners in our personal lives. Too often, healthcare practices and policies force our separation as nurses from care partners despite a natural alliance. We would do well to recoil at this separation. As patients and care partners ourselves, we are commonly frustrated with our healthcare experiences. Finding both nurses and nursing advocacy missing in many healthcare contexts, we become the patients and the care partners doing our own advocacy, coordinating and integrating health care for ourselves and especially for those people in our lives with whom we are care partners. Our personal patient and care partner experiences, both those that are uplifting and those that are disappointing, can drive our research towards better ways to ensure that the former is commonplace and the latter incidental.

Going forward, we at the International Journal of Older People Nursing (IJOPN) hope to read many more of your manuscripts reporting research shaped by these key directions. We want to read findings from studies of how nurse and care partner identities influence health, well-being and healthcare experiences for older people. Concomitantly, we want to receive manuscripts that report investigation of scope and authority including trials to promote nurses practising at the top of their registration or licence. Similarly, we want to receive research reports of studies that examined how to foster care partner engagement and what results from it. In keeping with our activist age-friendly, climate-friendly stance and commitments, we expect consistent use of inclusive language and careful consideration of effects on the planet and sustainability in everything submitted for publication. The use of the phrases older people, older person and older adult must now be matched by the term care partner, which now replaces the word caregiver in this journal.

While the studies we imagine you designing will take time to develop and conduct, we know that many members of our IJOPN community are already carrying out quality improvement projects, culture change initiatives and other creative means to improve health and well-being in their health and social care agencies as well as in their communities. Here at IJOPN, we only publish research, commentaries and reviews. Nonetheless, we would love to read about your projects and initiatives in our social media streams. You can find us on Facebook at https://www.facebook.com/IJOPN/ and on X/Twitter with the handle @IntJnlOPN (https://twitter.com/intjnlopn?lang=en). We invite you to use our hashtag #GeroNurses when you post about what makes nursing and caregiving rewarding and how to support these roles which are vital to health, function and well-being for older people and those who care for and about them in our communities around the world.

The author declares no conflicts of interest.