Childcare providers: Work stress and personal well-being

Work-related stressors for childcare providers

Because childcare was not considered a professional field for so long, ideas about occupational stress and burnout were not discussed in the context of the childcare profession until the late 1970s (Mattingly, 1977). Researchers later identified that caregiver stress stems from both individual and organizational characteristics (Barford and Whelton, 2010; Baumgartner et al., 2009; De Schipper et al., 2009). Documented stress factors for childcare providers are low wages, poor benefits, and difficult working conditions combined with high expectations (Goelman and Guo, 1998). High job expectations stem from unclear, overlapping responsibilities and role confusion (Manlove, 1994). Childcare providers are expected to both plan and implement curriculums, communicate with parents, and provide for the children’s daily needs in terms of meals, diapering, and emotional support (Goelman and Guo, 1998). Being pulled in so many directions leads to childcare provider depersonalization, lack of sense of accomplishment, and emotional exhaustion (Manlove, 1994).

Personal factors such as education level, social support, specific personality constructs, age, and job tenure are described as moderators of stress (Barford and Whelton, 2010; Goelman and Guo, 1998; Todd and Deery-Schmitt, 1996). Providers who had lower levels of the aforementioned characteristics and a more “neurotic” personality were seen to experience higher levels of burnout (Barford and Whelton, 2010; Goelman and Guo, 1998; Manlove, 1993). In particular, providers with lower education levels who were also caring for their own pre-school age children experience high stress levels (Todd and Deery-Schmitt, 1996). Additionally, those providers with lower education levels who have fewer training opportunities experience high stress levels.

Organizational and work-related conditions are also work-related stressors for childcare providers. Specifically, job demands, job control, and job resources create stress for childcare providers (Curbow et al., 2000). For instance, work conditions, including noise, isolation from other adults, and diminished privacy are work-related stressors for childcare providers (Baumgartner et al., 2009; Todd and Deery-Schmitt, 1996). Non-instructional activities such as paperwork have also been noted as a stressor (Baumgartner et al., 2009). Lack of social support in the workplace can also be a stressor for childcare providers (Goelman and Guo, 1998; Hamre and Pianta, 2004), particularly for those providers who work from their homes (Curbow et al., 2000). Home-based childcare providers may experience additional feelings of isolation from other adults because they oftentimes lack coworkers.

Impact of stress on caregiving

The impact of childcare provider stress has been studied in relation to how that stress impacts caregiving. Although this body of research is small, evidence suggests that increased stress levels of childcare providers result in less quality caregiving (De Schipper et al., 2009; Goelman and Guo, 1998; Hamre and Pianta, 2004). Providers who experience depression are less able to provide children with supportive and stimulating interactions (Goelman and Guo, 1998; Hamre and Pianta, 2004). Additionally, cortisol levels have been shown to predict the quality of caregiving. De Schipper et al. (2009) measured providers’ cortisol levels, through saliva swabs, three times throughout the morning and found that high levels of cortisol at the beginning of the day predicted lower quality caregiving (De Schipper et al., 2009).

Impact of stress on well-being

Information about the impact of childcare provider stress on well-being is minimal. However, studies suggest that 9.4–27 percent of childcare providers have clinically significant levels of depression (Fish, 2005; Hamre and Pianta, 2004). Assuming that the true rate of depression among childcare providers falls in the middle of this range, it is still higher than the national rate of depression for adults which was approximately 9.0 percent for the years 2006 and 2008 (Centers for Disease Control and Prevention, 2010). ¹ Because most childcare providers are female, it is also noteworthy to compare the rate of depression to females in the general population. One in eight females in the general population experiences depression during her life which is substantively lower than the suggested rate of depression in childcare providers (Mayo Clinic Staff, 2010).

Despite the high rates of depression and the high levels of job stress, childcare providers tend to feel a great deal of pride and accomplishment about their work. Those providers who experience high levels of work pressure, have a poor understanding of their work roles and expectations, and were least committed to their jobs experienced the most emotional exhaustion (Barford and Whelton, 2010). However, in general, providers are very engaged in their work even when they experience mental and physical exhaustion (Barford and Whelton, 2010).

Theoretical model

The effort–reward imbalance model can be applied to childcare workers to explain why their work environment and related stress may impact their well-being. The model hypothesizes that if the amount of work exerted is less than the reward received from that work (salary, benefits, esteem), disequilibrium will exist (Bakker and Demerouti, 2007). A persistent disequilibrium will cause stress in an individual (Van Vegchel, 2005). With child care providers, a great amount of effort is exerted in teaching children, while very little salary and virtually no benefits or professional recognition exist. Thus, this model suggests that the work of childcare providers will impact their well-being through stress from little rewards and great effort.

Prior studies

Research on childcare providers has not steadily progressed over time. Rather there are small amounts of information that appeared beginning in the late 1970s when childcare was just beginning to be considered a professional field (Mattingly, 1977). There was some research in the 1980s (Boyd and Pasley, 1989; Kontos and Stremmel, 1988; Mullis et al., 1986; Pence and Goelman, 1987; Pines and Maslach, 1980; Whitebook et al., 1981), but research on provider well-being has tapered off. Deery-Schmitt and Todd (1995) discussed the relationship between stress and turnover and proposed the only theoretical model, to date, for studying childcare provider turnover. In testing this model, researchers used qualitative data to indeed link job stress to turnover for childcare providers (Todd and Deery-Schmitt, 1996).

Four studies since 2000 have identified various work-related stressors for childcare providers, but none have specifically linked work-related stressors to well-being. Curbow and colleagues collected both quantitative and qualitative information from childcare providers (n = 96) in the Baltimore area in order to construct a job stress inventory specifically for childcare providers (Curbow et al., 2000). The inventory measures job demands, job control, and job resources of childcare providers. It also contains questions for home-based providers that capture the unique needs of childcare providers who work from their homes. Tuominen (2003) conducted in-depth qualitative research with 20 family childcare providers identifying work-related stressors in their work. One prominent stressor identified was the public perception of childcare providers as babysitters. Baumgartner et al. (2009) conducted focus groups with providers and found that stressful work factors described by childcare providers included work conditions, work events, client factors, and external factors. Similarly, Barford and Whelton (2010) conducted a study of Canadian childcare providers and found that burnout was predicted by a combination of work environment, personality, and social support.

There is increasing evidence that high levels of occupational work-related stressors can potentially contribute to a wide range of negative health outcomes, including musculoskeletal problems (Griffin et al., 1998), depression (Braun and Hollander, 1988), and cardiovascular disease (Hall et al., 1993). While the above studies identified work-related stressors, few studies emerged that linked caregiver emotional well-being, specifically depression, to caregiving skills (Fish, 2005; Goelman and Guo, 1998; Hamre and Pianta, 2004). These studies suggested high rates of depression among providers, but additional information is needed to understand the work-related factors that impact childcare provider well-being.

To summarize, the previous literature has identified a number of work-related stressors for childcare providers and other research has linked stress to lower quality caregiving. However, studies have not specifically examined the link between work-related stressors and the impact of work-related stressors on childcare providers’ well-being. Baumgartner et al. (2009) called for studies that further explore the stress that childcare providers face in order to advance knowledge and support for childcare providers. This study fills an existing gap in the literature by examining both work-related stressors of childcare providers and the impact of those work-related stressors on well-being.

Data collection

Focus group participants were recruited from childcare centres and family home care settings through snowball sampling. Three licensed centres were contacted by the researchers. Each centre agreed to advertise the focus groups to its childcare providers and to provide space for the focus groups. Providers at these centres were contacted through email and flyers posted at the centres. While centre-based childcare providers were recruited through their centre, home-based providers had to be recruited through other means since they are not geographically bound to one agency. In order to recruit home providers, a public list of both licensed and registered homes in the Central Texas area was obtained from the Texas Department of Family and Protective Services’ online database. A total of 86 home providers were identified through this search. Recruitment letters were mailed to each provider and follow-up calls were made to discuss the study with home-based providers. Of the 86 home providers, 20 expressed an interest in participating, but only 10 participated in three focus groups due to scheduling issues.

Focus groups for centre-based providers were held at centres either during lunchtime or in the late afternoon. Groups were coordinated to fit the needs of the providers who had agreed to participate. Focus groups for home-based providers were held on Saturday mornings and early afternoons at a local university that is centrally located. All providers were given US$15 gift cards for their participation. Home providers were also compensated for parking.

A focus group guide was developed by the research team to allow for a semi-structured conversation within the focus groups. The guide asked two primary questions addressing what stress providers encounter in the workplace and how they take care of themselves. A social worker with extensive experience working with childcare providers and conducting qualitative research led all the focus groups. Another research team member assisted with the focus groups by performing administrative tasks such as recording field notes, managing the recording of the group, and handing out gift cards.

Data analysis

All audio recordings of the focus groups were transcribed verbatim. Conventional content analysis was used to analyze the data so that themes were permitted to flow from the data (Hsieh and Shannon, 2005; Kondrack and Wellman, 2002). Conventional content analysis is also referred to as inductive category development (Mayring, 2000) because statements within the data are labeled and then grouped into broader categories.

An iterative coding process was used in order for the research team to gain a sense of the larger picture provided by the focus groups (Tesch, 1990). The first step of the process involved all research team members reading through the transcripts. After this initial reading, interviews were open coded by research team members meaning that researchers noted their initial thoughts and impressions (Hsieh and Shannon, 2005). In the second step, three members of the research team independently read the transcripts and coded statements. The research team then met to discuss the coding and proceeded to group the codes into themes and subthemes. In the third step, two different members of the research team coded statements into the broader themes and subthemes that were developed. Themes specifically related to stress and well-being were selected for inclusion in this article.

It’s not the kids, it’s the parents …

In every focus group, providers identified parents as the main focus of their stress. Almost without variation, providers stated that the parents are the biggest stressor at their work. Interestingly, the stress stemming from interactions appears to highlight an unacknowledged assumption on the providers’ part that they are more knowledgeable than the parents. Regardless of whether that assumption is true, it is possible that this assumption is a compounding factor causing their stress. One centre-based provider noted, “the most stressful thing working in daycare are the parents. Sometimes it’s not the kids.”

The stress stemming from parents came from a variety of sources. Several providers noted that overly anxious parents resulted in extra work for them. One provider noted that she had a parent who would inspect her child “head to toe” each afternoon. More commonly, parents who needed communication more frequently than normal created extra work for providers.

Stressful relationships with parents also developed due to inconsistencies between child’s home life and childcare. Providers noted that parents often do not reinforce the behaviors that they are taught at childcare. Several providers noted the lack of consistency between home and childcare in terms of potty training and discipline. In terms of potty training, one home-based provider noted that children cannot just be potty trained at childcare and put back into a diaper at home. The confusion for the child delays successful potty training. Another home-based provider commented on discipline stating that discipline had to be a shared effort between her and parents, but that parents did not follow the same rules at home. Providers noted that this lack of support is very stressful.

Along these same lines, one home-based provider suggested that parents needed to take classes in child development in order to be parents. She commented that parenting classes similar to the childcare licensing courses should be mandatory for parents and that “there needs to be some type of regulation in being informed on what it is that you’re really supposed to be doing as a parent.”

Throughout the focus groups, providers clarified that the issue with parents is stressful to them because it impacts their relationship with the child. Lack of communication and agreement with parents leave them feeling a disconnection with the child. One home-based provider stated,

I’ve had to over the years let families go because I felt I could not work with them. I can pretty much handle any child that comes along, but if the parents are difficult to work with then it affects my relationship with that child. And that’s not fair to the child, so it’s better if the child goes somewhere else.

When asked what they would most like changed about their work, one home-based provider responded, “Understanding parents. Parents that understand, and don’t just say it: mean it from your heart.”

Caregiving across age groups

Despite the fact that the perceived primary role of childcare providers is caregiving, only one theme emerged related to stress and caregiving: caregiving for multiple age groups at one time. Providers at three of the four centre-based focus groups and providers at one home-based group discussed this stressor. In particular, large age gaps were noted as barriers to providing individualized care for children. One home-based provider noted, “My children range from six weeks to age five. So we go from infancy to pre-school. It’s a lot developmentally.” A centre-based provider elaborated on this stressor by stating,

For me the age of our kids (is a stressor). There’s this wide spectrum. We have a boy who doesn’t walk, and we have kids talking paragraphs, running laps. It’s hard to meet what each child needs.

I worry about the children too …

Another strong theme that emerged from the focus groups was the commitment of the providers to the children. The commitment clearly stemmed from their dedication and affection toward the children in their care. In every focus group, providers noted how their commitment often led them to worry about children while the children were not in their care. Providers reported worrying about the general safety of the children, the lack of stimulation they receive at home, and their nutrition at home. Many providers relayed stories about children coming to their classrooms hungry. One home-based provider stated,

You find parents that are not willing to work with their kids at home. And they’re not doing anything with their kids at home, but putting them in front of a TV, and not giving them the nutritional meals. So with the kids you identify things. You see kids that may come in dirty or haven’t showered in a day or two. Or they seem really hungry or they’re really tired.

In some cases, the worry extends to the child’s general safety at home. As was discussed in the methodology section, three centre-based focus groups were held with providers at nonprofit agencies. At these centres, providers were often working with families with high level needs including families living in poverty and/or experiencing family violence. One centre-based provider working with families experiencing family violence stated,

Every child has a different 12 hours before they came back to you. You don’t know really how well they slept, what they ate, if they ate, who was fighting in the house.

The concern about child safety extended beyond those centre providers working with high needs families. Another centre provider working with families across an economic spectrum, noted that “Sometimes you realize that the only place they are safe is in our environment, in our classroom.”

Aside from their well-being and safety at home, providers worried about children being sick. In all of the focus groups with home providers, illness and sick policies were discussed. Their worry stemmed from (1) concerns about a child who was sick and (2) concerns about a child infecting other children. One home-based provider stated, “The sick thing is always looking over my head, all the time.” The balance between helping parents, meeting the needs of the sick child, and balancing the needs of other families were discussed as ongoing struggles that created stress for providers. One home-based provider explained,

One stress that I feel like I’m always addressing, all the time, is sick policy. You’re constantly worried—you don’t want to piss this parent off, because they’ve got to go to work. And they’re gonna get mad, and they’re not gonna want to pay you. But then they’re gonna infect everyone else that’s in the room because they’ve got green snot.

Several providers noted that parents were dishonest about the illness of the child. One provider reported a child being brought to school with digestion issues due to “worms.” Many providers reported children being brought to school with fevers; sometimes children were given medicine to reduce fevers right before parents brought them to school. One home-based provider stated that a parent dropped off a child who had chicken pox and claimed the child had been bitten by bugs.

I am not a counsellor …

Aligned with the work-related stressors discussed above, providers in half of the focus groups discussed their lack of expertise in dealing with the issues some families and children presented. For instance, providers discussed how they felt unqualified to provide advice about marital issues, child abuse, and mental health. However, they often felt that parents were soliciting advice or expertise from them. One centre-based provider stated, “when you have a kid, you know, and there’s something up. We’re just childcare providers, we don’t have the specialty to see what’s wrong with this kid, but we do the best we can.” A home-based provider stated, “I don’t have a (medical) degree. I don’t have all these things to say, ‘hey I think that your son or daughter is developing on a slow rate.’” In cases where providers feel confident that something does need to be addressed with a child, they reported feeling anxious about discussing issues with parents because parents have generally disregarded their concerns.

In addition to issues with the children, providers also reported feeling that they needed to assist the parents, particularly single parents. They discussed feeling empathy for certain parents because they knew the struggles that the parent was experiencing. One centre-based provider stated,

My heart is always going to her because her background, she never really had a mother, she was in and out of foster homes all her life. As an adult she’s never really had family, just someone she can go to.

In this provider’s situation, she reported feeling like a surrogate mother to this particular parent. She noted that she did care for the mother, but that the relationship added an additional caregiving role.

I’m not a babysitter …

Despite all the issues related to caregiving, the most dominant theme discussed by providers in every focus group was actually a factor external to their work: public perception of childcare providers. Providers reported friends, family, and society in general disregarding their work as simply babysitting. One centre-based provider stated, “they think you babysit. People think you sit and watch TV all day.” Another provider stated,

I feel that in society childcare is not something that’s deemed important. You’re not a babysitter, you’re not a care provider. You’re a childcare professional. That’s what we do. That’s what we call ourselves. I correct people daily … They’re like, oh you babysit. And I say, no I’m a childcare professional.

Even though they felt society downplayed the importance of childcare, providers reported feeling great pride in their work. They clearly articulated the importance of their work and discussed the time and energy they put into planning educational activities for children in their care. Several providers stated that children referred to childcare as their “school.” In general, they felt the importance of early childhood education was not taken seriously by society. One provider stated, “(People) don’t understand. Playing is very purposeful.” Another stated, “we have the highest expectations of any position possible, we get paid the lowest, and we get no respect from anyone.”

Impact on well-being

Given all the work-related stressors reported by childcare providers, it was not suppressing that a final theme emerging from the focus groups centered on personal well-being, specifically both mental and physical health. In four of the six focus groups, providers discussed aspects of their emotional well-being. Although no formal measures were taken to assess levels of depression or anxiety, symptoms of both were discussed by providers. Perhaps the most salient issues that emerged across the focus groups were dreams and sleep disruptions. One home provider simply stated, “I dream about them.” Another centre-based provider stated, “Sometimes I wake up in the morning—in the middle of the night—thinking about them.” Yet, another centre-based provider stated, “in my dreams, there’s always crying babies. There’s always just crying babies.”

In addition to the emotional well-being, providers reported some physical implications of their work including exhaustion. However, the discussion of physical health was less discussed than emotional well-being. One home-based provider did disclose information about her physical health and health problems she related to the stress of her work. She explained how her work became too much for her and she eventually had a heart attack. While she was still in the hospital, parents were calling to see when she would be back at work.

Differences between homes and centres

While there were many commonalities between home- and centre-based providers in the themes that emerged, there were some differences in work-related stressors that impact well-being. For home providers, physical space was a challenge. Home providers noted that living in the same place that they work causes difficulties in maintaining boundaries between home and work. Additionally, home providers noted isolation during the day as they are removed from colleagues. On the other hand, centre-based providers noted that lack of support from their administrators was stressful.

Caregiving is not the problem

Because caregiving can be emotionally stressful, providers in caregiving roles have been shown to have high levels of burnout and compassion fatigue (Dougherty and Krone, 2002; Figley, 1995; Kramer and Hess, 2002; Maslach, 1982). However, providers in this study consistently reported that children were not the work-related stressor. In other words, the actual work with children was not the issue; factors beyond their direct work with children were the primary concerns.

Parents were said to be the primary source of stress and the root of the stress from parents came from different sources. The relationship with parents manifested itself differently for home and centre providers. For home providers, parents are customers. There is no organizational buffer to assist home providers in enforcing rules and collecting payments. Therefore, the parents created a stress that might be considered organizational in the sense that they can create a difficult working environment for a home-based provider.

For centre-based and home-based providers, issues with parents and the child’s family in general created a stressful burden. In some cases, providers felt they were not qualified and/or did not have the support needed to handle the family problems such as food insecurity, lack of stable home life, and financial problems. The professional boundaries with families appear to be tenuous given the fact that the providers are responsible for caring for the families’ youngest members. Providers clearly care about families, but appear to struggle balancing their role as a provider with that of a mentor or friend.

Role of intentionality

The idea that caregiving was not an important stressor for childcare providers may be explained by the concept of intentionality. Intentionality is a multidimensional construct that captures a provider’s commitment to their work (Doherty et al., 2006). Intentionality is manifest through a provider’s commitment to the profession, their motivation for entering the profession, and their approach to work (Doherty et al., 2006). Higher levels of intentionality have been linked to higher quality care (Galinsky et al., 1994; Kontos et al., 1995).

Providers in this study reported high levels of intentionality during focus groups. They spoke of the pride that they have in the children they teach, the time they spend planning activities, and the genuine concern they have for the children when they are not in their care. When asked what they most wished to change about their jobs, their response was the parents, not the children. Thus, the impact of their work on children was critically important and for most, manageable even with the stress from external factors.

Professional identity

High levels of intentionality were manifested through the level of commitment providers described. Providers made it clear that their role was that of a teacher, not a babysitter. As with most helping professions dominated by females, childcare providers are devalued in society. Caring for and educating children has historically been viewed within the purview of a woman’s role. In most cases, the work related to education and caregiving is unpaid for women. Therefore, as childcare is an extension of a stereotypical female role, it is oftentimes not considered a profession by society (Tuominen, 2003).

The lack of value placed on their work is well-noted and disliked by childcare providers. Messages about their profession come from friends, family, and even their partners. In particular, comparisons to babysitters minimized the role of their work and the importance of early childhood education.

Impact of stress

Although prior research has explored work-related stressors experienced by childcare providers, research has not extensively examined the personal well-being of providers. Evidence from this study suggests that providers do experience personal strain related to their work. Many of the providers noted repeated dreams about children in their care and sleep disruptions suggesting some level of exhaustion with their work. Although mental health was not formally assessed, the levels of exhaustion, sleep issues, and physical issues reported by the providers suggest that depression and anxiety cannot be ruled out in this sample. Future studies of providers should assess for mental health problems, specifically anxiety and depression. In fact, the results from this study were used to develop a survey which contained specific questions and scales for the quantitative portion of the larger study project.

Interestingly, providers did not discuss work-related stress as interfering with their ability to care for children. Rather, they spoke of the impact of stress on their personal well-being. This finding conflicts with the prior literature that found that higher stress levels did result in less quality caregiving (De Schipper et al., 2009; Goelman and Guo, 1998; Hamre and Pianta, 2004). It may be that providers felt inhibited from discussing caregiving under stress, particularly as they were in a group with their peers. On the other hand, it may be that providers are too subjective and do not perceive stress as impacting caregiving when it actually does impact their caregiving.

Limitations

While this study has contributed to our understanding of childcare providers, there are limitations. The primary limitation is that this study comprised a small, nonrepresentative sample of childcare providers. Due to the exploratory nature of this study and the lack of prior research on childcare provider well-being, the methodology is warranted. An additional limitation of this study is that demographic information was not collected from focus group participants to allow for a more in-depth analysis of their responses by work experience or other factors.