Being a primary caregiver for a family member who lives in a different city
or state can feel like a full-time job, complete with its own set of stressors and related emotions.
“I think caregivers can be disappointed at times,” said Vicki Williford, a
chronic care nurse in Greensboro, North Carolina. “The home health nurse comes
and goes, and [the caregiver] still has another 23 hours to go.”
That’s 23 more hours to make sure the care recipient has taken medication,
avoided falls, eaten healthy meals, and made it to the bathroom in time — all
of which have to be supervised remotely by long-distance caregivers.
The need for non-clinical family members to provide care to aging loved ones
will likely continue to rise, due to a growing population of seniors and the shortage of health care providers in America. The
burden of caregiving may be further complicated by distance; a 2015 study
from the National Alliance for Caregiving found roughly 25% of caregivers live 20 minutes or more from the
recipient’s home (PDF, 1.8 MB).
What unique challenges do long-distance caregivers face, and how can a relationship with a health care team help overcome these challenges?
The Challenges of Caring from Afar
Nearly 44 million Americans provide unpaid care for a family
member. Of these Americans, between 5 million and 7 million are doing so from a distance
of one hour or more, according to a report from the Journal of
Gerontological Social Work.
All caregivers, regardless of
geographic proximity, are met with tasks that challenge emotions and
resilience, as they work to provide the best possible quality of life for a
loved one in need of support. They may have difficulty accessing clinical
training, balancing caregiving with a full-time job and personal life, and
managing the length and scope of caregiving.
Those supporting a family member
from a distance may experience added stress from coordinating logistics
remotely, without the affirmations of face-to-face interactions from a health
care team and their loved one.
Challenges unique to long-distance
- Traveling to and from the care recipient’s home
- Using technology to stay in touch
- Limited in-person communication with the care recipient
- Building provider relationships from afar
- Coordinating legal and financial concerns remotely
- Planning visits for other family members
- Keeping all parties up-to-date
- Wavering confidence about choices made for the care recipient
Digital Tools for Long-Distance Caregivers
Some caregivers may find help through digital tools that
make it easier to check in on a care recipient, which can include:
Mobile Apps – For face-to-face communication
Smart Devices — to adjust home temperature or door locks
Wearable Devices — to transmit vitals or call 911 in case of an emergency
Home Cameras — to monitor activity and visitors; for keeping track of medication schedules and deliveries; providing alerts of home break-ins
Keep in mind, not all technology seems user-friendly at first, so it’s important to check in with all parties — including a health care provider — about the level of comfort using new tools.
Being Part of the Health Care Team
Many care recipients have a team of providers, such as nurses, managing
multiple aspects of their treatment. Caregivers can certainly be a part of that
team, even from a distance. That team can also offer support for the caregiver.
“All the research suggests that we do better with adversity by having people
who are in our corner,” said Dr. Barry J. Jacobs, clinical psychologist, family
therapist, and author of The
Emotional Survival Guide for Caregivers.
“We don’t take over people’s lives,” he said of caregivers. “We work with them to provide support to enhance their lives to be more functional and help them live more the way they want to live.” Both the caregiver and provider need to understand the strains that each party is experiencing, which comes from clear and consistent communication. There are several ways family members can demonstrate to providers they want to be an active participant in a loved one’s care.
Building a Relationship with a Provider Remotely
- Identify a member of the family who has the capacity and availability to be granted power of attorney for medical decision-making and communication with the primary provider.
- Establish the need for regular check-ins and preferred modes of communication.
- Attend appointments when possible. If it’s not possible to be there in-person, try dialing in, or follow up with a phone call to the provider and care recipient.
- Conduct background checks of aides who are providing in-person care.
- Keep notes of changes in health or questions about the care recipient’s needs.
- Make a list of medications and other treatments in order to support medication adherence and monitor changes in therapies.
- Understand that a treatment plan will evolve as the care recipient’s condition changes, and be open to that change.
Williford said it’s common for
families to lack consensus on a treatment plan for a patient with an unexpected
hospitalization, which can make a provider’s job much more difficult.
“Families come in from all these
different states, out of town, and then they’re now faced with: ‘What do we do
with Mom?’” she said. “They’re trying to decide, and yet the mom’s saying to
me, ‘No one asked me what I wanted.’”
Having these conversations as a group can help the care recipient feel that they have agency over their treatment plan and keep everyone on the same page — regardless of what time zone they’re in.
A Taste of One’s Own Medicine
Supporting a loved one from afar involves complicated responsibilities and
constant communication that can prove taxing. It’s common for long-distance
caregivers — especially those with less support — to feel emotionally burned out or exhausted. Being far away from
the care recipient can increase anxiety about a loved one’s wellbeing, and may
be compounded by stress of periodic traveling or lack of sleep for providing
care across different time zones.
Without proper self-care, caregivers may experience caregiver strain, or a feeling of burnout that leaves
individuals unable to perform daily tasks or cope with feelings of anxiety.
“You know you’re experiencing burnout as a caregiver if you’re waking up in the morning with a sense of dread,” said Jacobs.
How to Manage Burnout as a Long-Distance Caregiver
- Set a cadence for phone calls.
- Make time to self-reflect each day.
- Take an inventory of your emotions.
- Accept help when it’s offered; ask for help when it’s not.
- Utilize a care team on the ground to perform in-person tasks.
- Take notes during visits so there’s less to memorize.
Drawing boundaries is one thing;
adhering to them is another. Caregivers have to carve out time to care for
themselves and get the help they need as well. Jacobs said he uses a marathon
as a metaphor for caregiving.
People “need to see this as a long, arduous course for which they need to really take care of themselves along the way,” he said.
“They run past a water station at
mile five and people are waving water bottles at them,” Jacobs said. “That kind
of self-replenishment on a regular basis develops some sort of emotional
Even when distance is not a factor, caregivers are still at high risk of being overwhelmed. In fact, boundaries can be extremely difficult for spousal caregivers in particular, who feel a heightened sense of obligation for their loved one’s well-being. Spousal caregivers are at increased risk for burnout. Many of them — almost one in five — are outlived by their husband or wife, according to a 2018 study published in the journal Alzheimer’s & Dementia. Accepting an offer of assistance, even when it doesn’t seem crucial at the time, can help caretakers sustain the energy and will needed to provide the best quality care, while still finding time to rest and enjoy life with their loved ones.
Resources for Long-Distance Caregivers
Refer to the organizations below for
further reading and resources on how to provide high-quality care for a loved
one, from afar.
Citation for this content: [email protected], the online DNP program from the Simmons School of Nursing
We’ve been profiling various nursing specialties so that you can get more information about what the job entails and what education you would need if you’d like to consider that specialty. Next up—Family Nurse Practitioner (FNP).
According to Miranda “Mandy” Wiggins, CRNP, an FNP with
Main Street Family Care in Alabama, FNPs are responsible for patients from
birth to geriatrics as well as all aspects of that care. They provide
comprehensive treatment and see patients for yearly wellness visits, write
prescriptions for them, order any necessary testing, and follow up to review
results of testing.
In addition, Wiggins says, “We are there for them for acute
illness and management of chronic medical issues.”
She admits that one of the biggest challenges in being an FNP is educating patients. Often, patients don’t understand that FNPs can provide many more services than an RN. They think that nurses and FNPs are the same position.
But there are so many more rewards to this job. “I chose
to be a family practitioner so that I could impact as many demographics as
possible in my practice. I enjoy providing care to patients of all ages and
presentations,” says Wiggins. “I enjoy the interaction with the patients and
the involvement of family members to ensure they are being given the best care
in and out of the office. They will remember that you took time to give them
resources and helped plan for their future needs.”
“The greatest reward is most definitely the continuity of
care we are able to provide from our listening and diagnostic skills to
providing follow-up care and establishing a trusting relationship with those
patients. It’s very rewarding to see them improve in their plan of care and to
be able to care for them over a period of years,” she says.
If you’re thinking of becoming an FNP, Wiggins says that the NP program usually takes two years to complete after earning a bachelor’s degree—if the student attends full-time. This timeframe includes a residency program and leadership/professional practice courses. Certification is also a must.
“If you love your patients and have a desire to serve, go for it!” says Wiggins.
The term “midwife” literally means “with woman.” Although nurse-midwives are best known for their work during pregnancy and specifically labor and delivery, nurse midwives care for women’s health in a comprehensive way. Certified nurse midwives (CNM) are advanced practice nurses specializing in prenatal care, labor and delivery, postpartum care, gynecology, well women’s health care, and family planning. They work anywhere other advanced practitioners do: in the hospital, at the clinic, and at home.
In the past, many people thought of midwives as only assisting women in home births, water births, and labor without anesthesia. Although some women may choose to deliver their babies in this way, midwives actually oversee all types of births, including those that are more conventional in the hospital. Nurse midwives have the credentials and authority to empower patients, so the kind of care given is according to their preferences and in their best interest.
Despite common misunderstandings, nurse midwives are qualified
to care for women during various stages of life. Furthermore, as prescribers
and independent providers, they are able to manage all types of pregnancies,
whether straightforward or complicated. Like other advanced practice nurses,
many midwives have years of experiences as registered nurses in labor and
delivery and other areas of women’s health. Many contend that the unique
experience of working as a registered nurse before advancing is what sets nurse
practitioners, including midwives, apart from their physician counterparts.
Within midwifery, there are stratified scopes of practice and levels of education; this is both location and training-dependent. Just like other advanced practice nurses, midwives work with varying degrees of independence from physician oversight in an ever-changing climate of advanced practice patient care. The majority of midwives hold a master’s or doctorate nursing degree (CNM); there are also certified midwives (CM) who have passed their advanced practice boards while maintaining a bachelor-level degree of education. For those who don’t have a bachelor’s, master’s, or doctorate degree can qualify to be a certified professional midwife (CPM). They are either trained through apprenticeship and/or formal education, and their scope of practice is narrower than CNMs.
As standards of health care providers evolve, the accreditation process for nurse midwives has increasing standards. The good news is that nurse midwives are learning through rigorous training and experience to provide high-quality patient care independently. Nurse midwives are more than the overseers of alternative birthing methods. They are fully licensed and independent women’s health providers.
For more information on this career path, visit DailyNurse.com/nurse-midwife.
Nursing is a vocation rife with occupational hazards. On a daily basis, nurses come into contact with sick patients, infectious agents, teratogenic chemicals, and radiation, to name a few environmental risks. Additionally, nurses are constantly on their feet, walking several thousand steps per shift. They are expected to help lift, move, and transfer patients several times per day, and face many potential musculoskeletal injuries from strenuous physical labor.
It is not surprising, then, that many nurses worry about the risks inherent in their daily job descriptions once they are expecting. Many nurses are women of childbearing age, and a pregnant nurse has to take certain precautions to keep herself and her growing baby safe. Below are some of the hazards pregnant nurses may face and suggestions for mitigating those risks.
Infection. Perhaps one of the most obvious risks to a pregnant woman and her fetus is infection. A nurse in the emergency department (ED), for example, may encounter patients sick with potential pathogens, from strep throat to tuberculosis to the flu. A pregnant nurse should follow standard precautions with all patients, and may also wish to wear a surgical mask around patients with a fever or suspected respiratory illness. A pregnant ED nurse may also wish to limit exposure to pathogens by reducing time spent in triage, if possible. Pregnant nurses may wish to avoid taking care of patients with active shingles or varicella zoster infections, as well as patients on airborne precautions.
Pregnant nurses should be immunized against influenza; the vaccine is safe for women in all stages of pregnancy. The live attenuated flu vaccine is unsafe for pregnant women. As an added benefit, flu antibodies are also passed to the fetus. If a pregnant nurse cares for a patient with influenza and later suspects she may have contracted the flu, she should speak with occupational health at her hospital to possibly receive a prescription for Tamiflu. Tamiflu works best when taken within 48 hours of symptom onset.
Drugs and chemotherapeutic agents. Because several drugs and pharmaceutical agents have known fetotoxicity, great care should be taken by the pregnant nurse when administering those and any medications to patients. Medication preparation is risky, and pregnant nurses may be exposed to hazardous drugs through skin absorption, inhalation, accidental contact, or needle-stick injuries. Sometimes while drawing up medication, the liquid can splash or make contact with the skin. Nurses should at the very least wear gloves while drawing up any medications or handling drugs, and at the most, should avoid handling known chemotherapeutic agents such as methotrexate.
Nurses should also weigh the risks and benefits of continuing their particular field of nursing while pregnant. Cancer treatment drugs, for example, have known effects of infertility, miscarriage, birth defects, and low birth weights.
Ionizing radiation. Radiation for diagnostic imaging is common in nearly all hospital departments, and nurses are at risk not just of background radiation but also of direct ionizing radiation. Nuclear medicine departments in particular are of high risk to a pregnant woman. Effects of radiation on a fetus depend in part on the dosage of radiation and on the baby’s gestational age. The thresholds of safe exposures are not well investigated, but research has demonstrated an “all or none” effect; that is, significant exposures cause either no effect or a fetal loss. Although dosimeters are used in areas where high radiation exposure is expected, other areas of high ionizing radiation (e.g., the emergency department) are rarely monitored. Expectant nurses should be very aware of their surroundings.
Stress, physical labor, and shift work. It may be necessary for nurses later in pregnancy to modify their shift schedule or behaviors to help accommodate their needs. Nursing is already a physically rigorous vocation, but add in the fatigue of pregnancy and it can be extremely physiologically demanding. In the first trimester, many women experience morning sickness, which to the pregnant nurse can be debilitating. Later in pregnancy, back pain and sciatica can also interfere with nurses’ ability to continue working until their baby is full term. Additionally, the 12-hour shifts typical for most hospital nurses become more taxing later in pregnancy, and it may be necessary for the pregnant nurse to request a modification to shorter shifts or part-time hours. The best solutions for pregnant nurses are to enlist colleagues for help when possible, to always use safe-lift equipment when available, and to speak up when requiring assistance.
If you are pregnant and struggling to perform your duties, certain pregnancy complications are covered by the Pregnancy Discrimination Act. Pregnant nurses should also be familiar with their state and employer’s Family Medical Leave Act policies and eligibility requirements.
For more information about the hazards to pregnant health care workers, you can browse the National Institute for Occupational Safety and Health’s website about the effects of workplace hazards on female reproductive health.
The Clemson University School of Nursing recently received a $5,000 scholarship from the CVS Health Foundation to assist students in their studies to become family nurse practitioners. CVS’s grant is part of the new Advance Practice Nurse and Physician Assistant Scholarship program which launched this year.
The program is aimed at reducing the nationwide shortage of family nurse practitioners and physician assistants by supporting these promising future health care professionals. Scholarships will be provided to accredited academic institutions around the nation to be distributed to family nurse practitioner and physician assistant students for covering costs of tuition, books, and other academic fees.
Clemson is thankful for the scholarship funds which will go towards helping deserving students become excellent family nurse practitioners. Eileen Howard Boone, president of the CVS Health Foundation, credits the scholarship as one of many steps that the foundation is taking to increase the number of qualified healthcare professionals in South Carolina and around the nation. Boone tells The Newsstand at Clemson.edu,
“We know how important having a strong pipeline of family nurse practitioners and physician assistants is to making high-quality, convenient and affordable health care services more accessible. We’re proud to support schools like the Clemson University School of Nursing who are providing quality education to students pursuing a career as a family nurse practitioner.”
The scholarship will be awarded to students in good academic standing who are pursuing advanced practice nursing master’s degrees, doctorate family nurse practitioner degrees, or master’s degrees as a physician’s assistant. Scholarship recipients are also required to intern or volunteer with an organization supporting underserved populations, and at least 25 percent of the scholarship funds will be awarded to bilingual students.