Family Nurse Partnership - a family nurse's perspective: 10 year anniversary

WHO are the family nurses?

The family nurses who provided testimonies all have nursing or midwifery backgrounds, but the variety is huge. They come not just from midwifery and health visiting, children's nursing and school nursing, but also from intensive care, mental health, emergency departments, learning disabilities and a range of other specialties. The diversity of experience is vast. What they have in common, though, is years of clinical and leadership experience and a willingness to learn.

Several were teenage mums themselves, so understand from personal experience the challenges pregnancy and motherhood can bring to young people. Their own experiences of teenage motherhood taught them that services need to be more supportive of young people, and that the need for education on relationships and sexual health is high.

Despite the variety in backgrounds, family nurses share a common vision that includes understanding that young people need to be involved in and, if possible, lead their own care, that all nurses are in education roles and need to know how best to educate, and that issues of inequality and public health underlie many of the challenging issues young people face. And, for some, FNP offers an opportunity to break free from the frustration of not having the capacity to develop truly sustained and meaningful relationships with their patients/clients, mostly due to the time pressures and nature of their former roles.

The impetus to become a family nurse sometimes comes from experience of nursing from the patient/parent side.

"My daughter broke her arm when she was four years old," recalls one family nurse. "I had never experienced seeing my child in such pain and I felt terrible distress."

"When we arrived at the hospital ward, a nurse escorted us to a four-bedded room where other children were sleeping. The nurse touched my hand. She said: 'I'm going to pull the screens around the bed. Right now, you need each other, so if I find you in the bed, under the covers holding each other tight, I'll try my hardest not to disturb you. If it's okay, I'll wake you in the morning before the early shift begins – not everyone appreciates the importance of the bond between a parent and a child. If they did, we would use less pain relief in this ward.'

"That nurse highlighted so wonderfully the power of the relationship formed between a mother and a child," the nurse continues. "It's well recognised now that children who have a connectedness to their parents will most probably go on to form secure relationships throughout their lives, and hopefully have strong family relationships. As a family nurse working with very young parents, it's astonishing to hear how so many of the young women and men had no connectedness to either parent or significant other, and how challenging many relationships had been throughout their lives. It was so sad to hear that so many had had nobody to hold tight to."

"It seemed in the beginning when I was speaking about attachment that I was speaking in a foreign language, but it was remarkable to hear some parents talking about responding to baby cues and watching for signs that their baby was communicating with them as their understanding of the importance of attachment evolved."

Personal life experience is also a crucial element in the desire to be a family nurse.

"The number of phone calls we received from women who had been affected by intimate-partner violence but who wanted to drop the charges against their partner assailant evoked great compassion and empathy in me," recounts a family nurse. "Despite having been promoted and having a young daughter to provide for, I wanted to do more to help the vulnerable people I was encountering. I applied to commence my nursing career despite my parent's concerns about me giving up a secure job. A couple of decades later, here I am in FNP."

The challenges of the post are many, and family nurses recognise a degree of resilience is required to get through.

"FNP challenged me in new ways from the outset," one notes. "I had to attend training alone a long distance away from home and build new relationships in a new environment. I found this quite challenging at times, but it helped me understand self-efficacy on a personal level, which in turn has helped me recognise how new challenges may make my clients feel."

"I was making a big change to my career and lifestyle at this time and undergoing my own behaviour changes. Delivering the programme has given me new understanding of behaviour change and I have seen changes in myself that I may not have reflected on before."

Some family nurses seem to have been almost on an inevitable trajectory, collecting the skills and experience they need for the FNP role throughout their nursing careers.

"As soon as I reached the required age of seventeen-and-a-half and had the entry qualifications, I was off to start my nursing career," recalls one. "General nursing, then mental health nursing, a wee trip working abroad, then time with child and adolescent mental health (CAMHS). The CAMHS experience brought a light-bulb moment to me."

"Most of the young people I worked with in CAMHS had experienced childhood trauma, and their very early relationships were difficult. This inspired me to take a career diversion towards health visiting, where I saw an important role in supporting families at an early stage, hoping early support might help parents to have more positive early relationships with their babies. But it wasn't quite as simple as that."

"Health visiting was rewarding, satisfying, hard, stressful and frustrating work. The root of the frustration was the feeling of never having quite enough time to work with families in sufficient depth to really understand their needs and support them to make meaningful changes in their life. Then came the opportunity to become a family nurse. It was my perfect job – a limited caseload that would protect time to work intensively with families, an evidence-based programme, and the chance to return to working with young people. It felt like the completion of a circle."

For other family nurses, the journey to FNP has occurred almost as happenstance.

"I was happy in my previous role as a specialist midwife so was not actively looking for a different post, but it just kind of happened," says one. "Something made me look on the NHS Scotland Recruitment website and there, jumping out at me, were FNP posts. When I read through the job description and the family nurse role, my heart skipped a beat and I thought, 'WOW, this role sounds amazing!'

"Learning more about FNP in the lead-up to interview and reflecting on my career over the years, I realised I had been delivering care that reflected FNP, but just didn't realise it. I remember one case, when I was a fairly junior midwife, of a pregnant young woman I spent time with, listening to her story, discussing options, supporting her to make a fully informed choice going forward. Several years later, I was in a shopping centre and received a tap on the shoulder. It was the same young woman, now a mother, holding a little girl's hand. She said to me, 'If it wasn't for you, my daughter wouldn't be here today. You listened, you understood me, you didn't judge me, and you helped me feel I could do this and was not a failure. Having my little girl is the best decision I've ever made!'

"It made me realise the importance of care and compassion, being non-judgemental and providing women-centred, strength-based care, finding out what the client already knows and providing individualised care.

All of these skills are central to the FNP role."

Another FNP nurse recalls how she heard about FNP through word of mouth while working as a health visitor and thought it sounded like a new and exciting opportunity.

"It was difficult at that time to find information online and I ended up contacting a family nurse who was in post. She took time to chat with me about what it was like to work within the FNP programme.

I remember she told me that it was the best, but also the hardest, job she'd ever had, and this really stuck with me. It reflects a lot of what I feel about my job. It was her enthusiasm and passion when she described her role that convinced me to apply."

Sensitivity to people, especially those who are vulnerable, is a common part of the family nurse make-up.

"What stands out for me most is that family nurses generally just value people," observes one. "The connection we make with others is so important. Before we meet most of our clients, they have very minimal knowledge of us and the service we provide. The FNP learning programme places a lot of emphasis on getting those first connections right, as this lays the foundations of the therapeutic relationship. Clients need to feel the genuine compassion from a nurse, as so much of their journey and the outcomes of the programme rely on the relationship they form with their nurse."

Another family nurse recounts how empathy with the client group is a must.

"My own experience tells me that health services need to be more supportive of young parents. FNP starts with the strength-based approach. It considers the clients we work with to have the potential to change their lives and have an impact on their health and wellbeing now and in the future. It's not about telling clients what they need to do – it comes from a strong feeling of empathy and a belief that regardless of what is happening in their lives or the impact of their life experience, they have the capacity to make positive decisions and changes."

The process of applying for and settling into the role can allow individuals to cast a light on themselves and identify what makes them tick.

"I found the initial interview and the introductory training unlocked so much about me as a person as well as a nurse," says one. "We found ourselves sharing stories about ourselves, both personal and professional. We scrutinised our hopes, fears, experiences and values. This sharing of information bonds you with the other nurses you train with. Returning to training sessions with the larger group provides a boost to my confidence and self-esteem and re-energises my enthusiasm for the role."

"Previously I would have found it difficult to address any concerns with clients."

I would feel awkward or maybe sound apologetic. Training in areas like motivational interviewing^[2]  and communication skills practice has helped me to become more confident in addressing challenges and facilitating behaviour change. My clients appreciate that we can have difficult conversations and may have differences in opinions, but that I will still visit them and work through their difficulties with them.

"My training has also helped when communicating with other professionals working with the families. I believe that one of my biggest achievements since working as a family nurse has been my ability to challenge other professionals in a non-threatening, non-confrontational way, which has led to more positive joint working."

FNP graduates are often the most important recruiting agents for the service, as one family nurse recalls.

"I worked closely with one particular patient as a health visitor, and she is the reason I applied to FNP. This young woman had come through the programme, and despite the multitude of adversities she had in her life, she had the most fantastic and impressive little two-year-old girl who was confident, articulate and very well bonded to her mum.

I felt that things may have been very different for this family if they had not had intensive support.

"The opportunity then arose to apply for a family nurse post. It wasn't an easy choice for me to leave health visiting, but I felt the role would be suited to my skills and would meet my desire to provide the type of care I wanted to deliver. When I suggested to my health visitor colleagues that I might apply, one immediately replied 'That is YOUR job, FNP is YOU, you have to go for it!' I was fortunate enough to get a post and have now been in the role for seven months."