On January 12, 2011, little seven pound, 10 ounce, 20.5 inches long Carson joined the Samantis family after a fairly easy pregnancy and uncomplicated delivery. Until Carson was born, both his mother, Kristen, an interventional cardiology nurse at Massachusetts General Hospital in Boston, and father, C.J., worked full time. Until four days before Carson was born, Samantis, now 31 years old, was working.
In the 1980s and 1990s, over 80% of women ages 25–34 years old were working, according to the U.S. Bureau of Labor Statistics. Before the Family and Medical Leave Act (FMLA) passed in 1990, around one-third of women never worked while they were pregnant, one-third quit their jobs, and only one-third took a maternity leave that often lasted under a week.1 For employers and employees, today's culture of working mothers elevates work-family relationships to a high priority. The FMLA allows employees who have worked at least 1,250 hours to leave their jobs for 12 work weeks in a 12-month period, without pay, to give birth and care for a newborn child.
But nurses face particular stressors when they return from maternity or paternity leave, and the Massachusetts Nurses Association and other unions say these benefits could be better. While all working mothers (and fathers) have a difficult time reacclimating to work, nurses generally face grueling 12-hour shifts, so they are away from home for longer periods of time and may feel especially drained by the nature of the work they do caring for patients.
Samantis decided to start a family only after carefully considering the economy and her job. She waited to have Carson until she had earned enough time off to take the full 12 weeks of paid maternity leave. While she has worked at MGH as a nurse for over two years, she has worked at MGH for a total of nine years, with a previous position in health education.
The days when every mom was a stay-at-home mom are a distant memory. New mothers are returning to work in large numbers, and nurses are actually more likely than other moms to return to work full time. According to the U.S. Department of Labor, 20% of nurses work part time, and most of those women are married with young children. At Massachusetts General Hospital, where Samantis works, nurses represent 15% of the hospital's overall maternity and paternity leave, but most of the new parents return to the full-time 36- to 40-hour workweek, according to the hospital's human resources department.
"This is where the recent economy has had a larger impact on nurses and this trend [of working mothers]," says Steve Taranto, Director of Human Resources at the Knight Nursing Center for Clinical & Professional Development and the Yvonne L. Munn Center for Nursing Research at Massachusetts General Hospital. "Especially in today's economy where fewer people have jobs and more nurses are supporting unemployed spouses, this is the career that the marriage or family will turn to as the reliable source of benefits," he said.
After Carson was born, the Samantis family decided they didn't want to put the baby in daycare, so they agreed that Kristen would work part-time. How that reduction in income from her career would affect their new family's lifestyle troubled her.
"I was a nervous wreck when I had to go back to work," says Samantis. "I kept thinking about it as each week of maternity leave passed by."
While hospital administrations have streamlined adjusting schedules when nurses take paternity or maternity leave and return, nurses find returning to work particularly stressful because of their own schedules. Nurses often work nights on already minimal sleep as new parents, and they are balancing a baby's sleeping patterns with long hours and/or night shifts at the hospital.
"Since I was going back to work mostly nights, I was sad that I wouldn't be the one putting him to bed each night," Samantis says. C.J., her husband, was handling nightshifts with the baby on his own, and little Carson wasn't sleeping through the night. C.J. would stay up all night with the baby, then return to work in the morning, and Kristen would work nights, then stay awake most of the day taking care of Carson.
According to research published in Health Affairs in 2011 by Project Hope: The People to People Health Foundation, job burnout or dissatisfaction among nurses is a big problem in hospitals because of risks to patients, work disputes, and turnover.1 The research found much higher levels of burnout with nurses working in hospitals and nursing homes, where lower patient satisfaction levels correlated with more dissatisfied or overworked nurses.
"There are fewer jobs out there, so the nurses, even if they have just had a baby, have more of an incentive to pick up more hours as they adjust back into work, where their career is often a large source of income for their family," says Taranto.
While Samantis originally thought she would sleep when the baby took naps during the day, she discovered that Carson napped less as he got older, which didn't allow her to sleep like she planned. "That makes for a cranky baby and mom!" she says. Immediately after returning from maternity leave, Samantis worked 36 hours a week, but she has since dropped that number to 28. "We are not superheroes!" she says.
The nature of nurses' schedules when taking maternity leave, versus other roles in a hospital, may actually be advantageous. Nurse managers have more freedom and flexibility to adjust schedules to meet a new parent's needs by offering more hours to part-time workers and per diem nurses.
Before and during her leave, Samantis closely communicated with her supervisor and still does. When she needed to cut back her hours after Carson was born, her supervisor was supportive and checked in periodically to see how things were going. Her manager recently gave Samantis the option to cut back to 24 hours a week, which the new mom is considering now that Carson is five months old and sleeping less while she is at home with him during the day.
Although cutting back working hours is a big decision, as fewer hours means less income, Samantis would only need to be at work two days a week instead of three, a schedule worth considering for a family not using daycare.
According to the Human Resources department where Samantis works, most nurses return from maternity leave at the 36- to 40-hour workweek level, while only a few come back at the 20- to 24-hour workweek level. They attribute this trend to the economic stresses of the past three years. Like Samantis, nurses who are new parents are working on limited sleep and would prefer to be home more often with their babies, but taking cuts in their hours means cuts in their paychecks.
"Mass General's flexibility with nursing schedules is what leads to the greatest success with regards to retaining nurses post-maternity leave," Taranto says. The hospital was named a "Working Mom Institution" in 2005 by Working Mother, scoring particularly high in child care options, parenting and child care workshops, and benefit policies that allow mothers flexibility around part- or full-time employment. MGH has a job vacancy rate of 1% and a turnover rate of 3.1%, which represents return for education, nurses becoming stay-at-home moms, or family situation changes. Communication between supervisors and nurses about schedules is key to keeping MGH working mothers happy, Taranto says.
According to the Mayo Foundation for Medical Education and Research, returning to work at the end of the week or on a weekend eases new parents back into the work routine. Nurses have the flexibility as well to not schedule themselves two days in a row at first, so they only need to get through one day of work before they can return to their babies.
Of course, returning to work also presents an emotional challenge for new parents. For moms in particular, postpartum hormones are still fluctuating 12 weeks after giving birth, so being back at work may be that much more stressful.
"You haven't had a chance to wrap your head around taking care of a baby yet," says Samantis, who says she felt "out of sorts" when she returned to work after her maternity leave. According to the Mayo Foundation, for all new parents, nurses or otherwise, calling to check in with your baby and whoever is taking care of him or her is important for your peace of mind and to stay connected with a shift in your life that is still so new.
Leaving your baby in someone else's care is one of the most important decision new parents can make. Finding reliable childcare is also one of the most challenging aspects of being a working parent. While MGH provides childcare for their workers 10 minutes away from the hospital, as well as onsite daycare centers for emergencies, the Samantis family decided they didn't want their baby in daycare but had no one to call to stay at home with him. Working their careers around alternating days and nights at home was the best decision for her family, Samantis says. In this way, her schedule options allowed her family to work through this.
Breastfeeding can also complicate the return to work. Some babies have trouble latching, and it takes time to develop a routine. Once moms are back at work, sticking with this schedule becomes even harder.
According to the World Alliance for Breastfeeding Action, for the first six months back at work, employed women should receive support from their workplace to provide private breastfeeding options. Hospitals today have lactation rooms set aside for their working moms, but the commitment presents daily challenges. Finding time during your shift to sit in a lactation room is one thing; you then need coworkers to care for your patients while you're pumping. But many still make it work.
At MGH, Human Resources and the Employee Assistance Program have been monitoring and keeping track of numbers in the hospital's lactation rooms, which have been adjusted and their numbers increased based on their volume of use.
"Pumping while back at work is a huge commitment," says Samantis, who shifted to baby formula for Carson when they returned from the hospital, even though she originally planned to breastfeed until she went back to work. "With that being said, many of the moms I work with do it and are successful!"
Maintaining regular bed times, cleaning out unnecessary commitments, and maintaining a positive attitude are all keys to balancing your work and home life.
The Samantis family has found good routine now, and Kristen says Carson "is sleeping like a champ through the night." She still doesn't work two days in a row unless it's the weekend, so she says her lack of sleep at home doesn't affect her work too much. She is thankful she can be home with Carson to watch him play and grow while still maintaining her career.
"I'm just now feeling like I can balance everything—home, life, relationships, work. It's still hard being a working mom, but everyday I feel like it's getting a little easier!"