BAN, RN, IBCLC
The U.S. surgeon general recently made the groundbreaking decision to shine a spotlight on parental stress and its wide-reaching impact on the health of families, children, and society as a whole.
“Something has to change… Raising children is sacred work. It should matter to all of us,” Dr. Vivek Murthy stated in the foreword of his August 2024 advisory, “Parents Under Pressure.”
He called for a “fundamental shift” in how mental health and wellbeing of parents is valued and prioritized.
What makes Dr. Murthy’s advisory on parental stress so groundbreaking is that the advisories themselves, by definition, are a big deal. The U.S. Department of Health and Human Services (HHS) states that surgeon general’s advisories exist to “call the American people’s attention to a critical public health issue” and are reserved for “significant public health challenges that require the nation’s immediate awareness and action.”
The U.S. surgeon general’s priorities often are highly relevant to the work and lives of nurses. The most recent advisory is no exception.
Along with other health workers, nurses often provide frontline care to parents, youth, and the general public while juggling their own families and household obligations. Nurses are a prime example of a profession sandwiched between two highly demanding existences. Many American families are struggling, and nurses are in a perfect position to empathize and advocate for positive change.
Dr. Murthy’s advisory functions as a strong, descriptive, and definitive call-to-action. Within mere hours of its release, the topic of parental pressure gained widespread traction in the media and sparked discussion within health-related circles.
It’s not news that raising a family can feel stressful. Caregivers know this feeling viscerally, perhaps even as a daily reality. However, the acknowledgement from the surgeon general is both validating and reassuring to parents.
Dr. Murthy’s 36-page advisory has four focus areas:
It reads as though penned by somebody who knows firsthand the challenges of parenting but with the influence and authority to inspire change.
“Throughout their lifespan, parents and caregivers often face heightened stressors, including financial strain and economic instability, time demands, concerns over children’s health and safety, parental isolation and loneliness, difficulty managing technology and social media, and cultural pressures,” he wrote.
While everybody experiences stress in some capacity, Dr. Murthy stated that parents have been “consistently more likely to report experiencing high levels of stress compared to other adults” over the past decade.
This cumulative stress has consequences, like the increased risk of mental health conditions, and extends beyond the overburdened individual.
“Parental mental health conditions can have far-reaching and profound implications for children, families as a whole, and for society, including increased health care costs and reduced economic productivity,” he wrote.
Inequities also exist in how parental stress impacts various populations. Family or community violence, poverty, racism, and discrimination are among the circumstance that can increase the risk for mental health conditions, according to HHS.
Dr. Murthy’s call to action spans from the top down, including various levels of government, community organizations and schools, health systems, and professionals, researchers, family and friends and — finally — the parents and caregivers themselves.
So, what exactly about parenting is so stressful? Perhaps ask a nurse who is supporting struggling families at work, often while helping raise his or her own children. Time to step inside the shoes of caregivers in the trenches!
A harried parent has been sitting in the emergency room for hours with their teenager on suicide watch. The family didn’t have the resources to drive to the nearest children’s hospital, so here they are — at the bustling urban hospital’s adult ER at 1 a.m.
This single parent is frantically trying to arrange school transportation for her younger children in the morning because the next-door neighbor cannot stay for long. She texts her boss that she’ll be absent from work (again), while simultaneously comforting her teenager and receiving medical instructions.
There is no current children’s mental health bed placement, so they’ll remain in limbo. Nobody has eaten real food for hours. Could this parent lose her job and not be able to pay her bills? How can she help her child navigate the school bullying that spurred this crisis, while she barely has time to connect with her family once activities, dinner, and homework are complete?
And by the way, where’s the nurse who’s caring for her child?
She’s using the bathroom … for the first time in eight hours since her double shift started. She was already in overtime, but her coworker needed to attend a funeral (which isn’t covered by the bereavement leave policy).
However, this nurse loves her work and the patients she serves. Later, she’s able to take a brief dinner break as she catches up on delayed charting. Her coworker is doing the same, while discussing how to carpool for an older daughter’s hockey tournament while his preschooler is at home vomiting. His baby has already been out of daycare all week from hand-foot-and-mouth disease.
This coworker has called in sick for four consecutive days and received an email about a performance improvement plan. Tonight, he left his spouse over-extended to show up for work. The unit is short-staffed with high census, but they’ll manage. Why? The staff are skilled, experienced, and care deeply about their team and patients. And it’s just another day in the life!
If these scenarios sound stressful, that’s because they are. Perhaps they seem like dramatizations; however, many caregivers and families navigate situations like these on a regular basis.
Sure, some days are better than others, and certain stages of life bring more routine and peace. Nonetheless, it merely takes a glimpse into the unpredictability of family life to realize, “We’ve all been there at some point; that it either is us, has been us, or is likely going to be us in the future — and if not us, perhaps our friend, family member, neighbor, or colleague.”
For a striking visual of the tangled network of possible parental stressors, explore the following graphic — both dizzying, yet illuminating — crafted by Molly Dickens, Ph.D., creator of an exploratory initiative called The Maternal Stress Project.
The image represents a parent’s mind from pre-pregnancy through the teen years and beyond, to answer the question: “What are parents worried about?” It also shows the very real, system-based nature of these numerous parental pressures.
Dickens emphasizes the need to acknowledge “that most ‘stress management’ recommendations are not solutions, and we need to extend beyond individual responsibility and coping in order to have a real impact on health.”
HHS agreed the solution must involve more than individual efforts, which is why the surgeon general’s advisory “calls for a shift in culture, policies, and programs to ensure all parents and caregivers can thrive.”
“Better supporting parents will require policy changes and expanded community programs that will help ensure parents and caregivers can get paid time off to be with a sick child, secure affordable child care, access to reliable mental health care, and benefit from places and initiatives that support social connection and community,” HHS stated.
Nurses and other health workers often interact directly with families on a daily basis. And they often play a double role — caring for patients at work and supporting their own families. This perspective allows nurses to relate to their patients and more deeply understand the situation’s urgency.
“The way that nurses interact with patients, with parents, on that human level, is so valuable,” Dickens stated. “Emotional support [and education] are so valuable to decrease stress in health circumstances.”
The field of nursing also spans the health system — from direct patient care to education, research, and leadership. Nurses are in a unique position to advocate for systemic improvement, working to create broader social networks that intrinsically support families and children.
Dr. Murthy’s advisory “lays out actionable recommendations and an all-of-society approach that will move us toward the policy, programmatic, and cultural shifts needed to support the well-being of parents and caregivers.
At the most basic level, families and parents may counteract stress by:
However, action needs to extend beyond the individual family unit. In Dr. Murthy’s words, “Raising healthy, educated, and fulfilled children is at the heart of building a strong future. It benefits all of society. And it is a collective responsibility.
“Societal support through policies — such as those that invest in the health, education, and safety of children — and community involvement through friendship, practical assistance, and emotional support are vital to the well-being of parents and caregivers and beneficial for children as well.”
The HHS expands on Dr. Murthy’s advisory by laying out specific ways researchers, nurses, and other health professionals and systems can take action:
Higher-level actions by governments and employers could include:
As a healthcare worker, take an opportunity today to reflect on Dr. Vivek Murthy’s recent surgeon general’s advisory about parental mental health. Nurses can consider taking some of the following small, actionable steps to help:
Together, we can reinforce the message that families are not alone in their efforts to raise the nation’s children. They do not need to carry out this crucial work in a vacuum or without resources. A well-supported family helps produce citizens who can become healthy, productive members of society for many years to come. Now that is the gift that keeps giving.
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