Caring for others has health benefits. But the way Americans do it is all wrong

In November, the Centers for Disease Control and Prevention (CDC) launched a campaign to curb burnout among healthcare workers. The program, called Impact Wellbeing, is the first federal campaign of its kind to give hospitals what the CDC refers to as evidence-informed solutions to reduce healthcare worker burnout. The campaign came after another report suggesting the mental health crisis among healthcare is only worsening in the United States. CDC data showed that more recently, health workers reported having more days of poor mental health within the previous month. Additionally, there was a rise in the percentage of healthcare workers who reported feeling burned out “very often.” 

The story goes that the pandemic exacerbated challenges that healthcare workers were facing leading to unprecedented levels of burnout. Even before then, a myriad of factors were accumulating leading to healthcare workers suffering mentally and emotionally. Healthcare workers say the solution, and impact, is more complex than what a federal campaign can offer, although the campaign is a start. In part because it doesn’t address what drew them to be healthcare workers in the first place: to help others.

While previous research shows that caregiving has positive health effects, the narrative around caregiving in America has turned into one about exhaustion, impossibility and rage. What healthcare workers are experiencing is a microcosm of that.

In October, a study published in JAMA found that healthcare workers — nurses, physicians, other healthcare-diagnosing and treating practitioners, health technicians, healthcare support workers and behavioral health workers — are at an increased risk of death by suicide compared to those who worked in non–health care professions. Many nursing practices are centered around Jean Watson’s Theory of Caring, which states “the centrality of human caring and on the caring-to-caring transpersonal relationship and its healing potential for both the one who is caring and the one who is being cared for.”

Caring in this context is a mutually beneficial experience for both the nurse and the patient. Caring can be re-energizing and a catalyst for self-growth. Yet the inability for nurses in particular to do their jobs is causing what many in the profession would prefer to call “moral distress” instead of “burnout.” 

“The basic definition of moral distress is when you know the right thing to do,” Gerard Brogan, RN and director of nursing practice, told Salon. “But constraints outside your control are preventing you from doing that.”

In 2014, a National Opinion Research Center found that 83 percent of nonprofessional caregivers viewed their work as a “positive experience.” It gave them a sense of giving back to someone who had cared for them. Scientific research has shown that caregivers live longer. For example, a study published in the American Journal of Preventive Medicine found that people who volunteered at least 100 hours a year had a reduced risk of dying over a four-year follow-up period compared to those who didn’t volunteer. Another study in 2013 found that volunteering can lower blood pressure.

“Any nurse who's done it for any length of time knows it’s a very rewarding profession,” Jean Ross, a nurse and president of National Nurses United (NNU), told Salon, adding that in her 45-year career she’s seen a massive decline in the industry leading to endemic moral distress. It used to be that nurses were listened to and supported in the workplace, she said. “Now, it’s all designed to comply with some sort of efficiency-expert model, where you don't want to have too many staff on hand or too many supplies on hand, look what happened.”

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Indeed, the way caregiving is undervalued, underappreciated, and overall forced to do in isolation, is part of the problem. Healthcare workers, and the estimated 53 million Americans who are unpaid caregivers for a family member, have very little structural support in America. This inherently makes caregiving more taxing and stressful. Brogan said especially when it comes to nursing, it’s like healthcare workers and management “have different priorities.”

During the pandemic, molecular biologist Steve Cole wanted to simulate how isolation could be affecting antiviral immunity and how caregiving could be an antidote. To find an answer, researchers relocated 21 adult male rhesus macaques from their communities to two weeks in an isolated cage. Sheltering in place for the monkeys was associated with 30 to 50 percent reduction in the circulating immune cell population, which showed up in their blood samples as quickly as 48 hours of isolation and persisted for two weeks. Improved immunity didn’t resolve until four weeks later when they returned to their respective monkey communities.

However, there was an exception: when some of the monkeys were given a chance to care for a younger monkey in isolation, their immune responses were more robust than those who were in complete isolation. Cole said this study showed the potential health benefits of caregiving, how it can give people a sense of purpose and meaning. But the way it’s done in America is “very stressful.” 

“The way we have it arranged in our society now is that you are more or less 24/7 responsible for this person,” he said. “A sustainable version of caregiving is where caregivers do it for some part of their lives, and then they get some rest and regeneration.”

Ross said measures that are meant to curb the crisis among healthcare workers, like adding a “zen room” in hospitals for healthcare workers don’t help. What they need are the tools and support to care for their patients. 

“Those things that they offer to us, they do nothing that is helpful to us,” Ross said. “You're running your butt off, you don't have enough nurses to care for your patients, and we should take a break and go to the zen room?”

Brogan said he became a nurse when he was 19. He was idealistic, and wanted a job where he felt like he had meaning. He’s never seen nurses suffer from so much “moral injury” than he’s seen over the last few years. 

“I speak to nurses all day every day, and I've never ever seen this level of disaffection amongst nurses with their employers,” Brogan said. “Anecdotally, I hear people say ‘I just can't do this anymore.’”