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

WHY do family nurses do the job?

It is not difficult to identify the characteristics of FNP that makes it so attractive to nurses. They see the programme as an opportunity to make a difference in a vitally important area of healthcare, while also extending and expanding their own nursing skills and experience.

"FNP to me is a more than a job," says one. "It's an opportunity to use all the skills and knowledge I've gathered over my 20-year nursing career and, indeed, recently while undertaking mandatory FNP training, to really make a difference and facilitate change in young people's lives.

"I believe I can use the therapeutic relationship to get a better understanding of my clients, their goals and desires that truly enables me to walk alongside them and support their growth."

The clear evidence on the impact of FNP on young people is the main motivator of nurses' interest in the programme.

"I became interested in FNP when I came across the research on the programme in America," says one. "The outcomes were impressive, with improvements in women's antenatal health, reductions in children's injuries, fewer subsequent pregnancies, greater intervals between births, increases in fathers' involvement, increases in employment, reductions in welfare dependency, reduced substance-use initiation and improvements in school readiness. The programme is based on over 30 years of evidence and is constantly evolving and developing to meet the changing needs of clients, their children and their families.

I felt that working within the structure of a license could help ensure delivery of a good-quality programme and replicate the positive outcomes in Scotland."

"FNP at its best is a fantastic concept," says another. "It's full of promise, with its preventative focus, its evidence-based underpinning and its roots in the critical areas of promoting connected families and attached babies. It's a privilege to have the opportunity to work so intensively, to build therapeutic relationships with young parents who take the risk of letting us in to their lives for two and a half years."

The extended time spent with young mothers or mothers-to-be is an especially attractive element.

"Our visits in FNP last longer and, due to the number of times you engage with clients, time does not seem so limited," explains one nurse. "You support the client to be part of the process of learning and to explore their hopes and dreams for the future. I believe this is why the length of our visits is so important. The topics covered do not appear rushed and due to the dosage^[7]  you can return to it many times. This doesn't mean you're not as busy – in fact, I've never felt so busy. But being able to follow a client through pregnancy until their child is two years old is fantastic."

"The main differences are the time and availability you are able to offer your clients," suggests another. "The time gives you the ability to assess the client's needs fully and across time, understanding what their priorities are and helping them achieve longer-term goals. It also allows you to drip-feed information, which can help in progressing women through stages of change. Barriers to trust are broken down with time, and you are offered more of their life story as this happens – it allows you to consider things from their perspective and identify internal motivators and challenges.

"In FNP, you're able to properly apply theoretical knowledge to practice. We spend a lot of time looking at clients' ecology^[8] and have the time to actually ask open questions and hear the answers, instead of rushing through a checklist. We've opportunities to contribute towards building self-efficacy,^[9] and we get to celebrate successes with our clients over a long period."

The role has its pressures, though.

"Working with a very young parent with very young children can be terrifying," a family nurse states. "Witnessing a parent finding it difficult to connect to their child or a child unable to find an attachment to their parent is heart-breaking. Observing a young person being unable to escape the lure of alcohol, drugs, inappropriate relationships and criminal activity is devastating.

And making numerous attempts to engage a young person with support services is exhausting.

"Nurses facing this range of emotions describe feelings of vulnerability. Thank goodness we have protected time for supervision and support from psychologists and other colleagues to allow nurses to explore the challenges they face through open and honest discussion in a safe, nurturing environment."

It is intensely rewarding to see clients and their children grow and develop and make positive changes in their lives. That's the good news story. But FNP nurses live in the real world.

"Some young people have had so many adverse events and trauma in their lives, they are too difficult to overcome," says one. "So FNP also includes the reality of some challenging child protection work when parents are struggling to meet their children's needs. The babies' needs are rightly prioritised, but this can jeopardise the therapeutic relationship with the client.

"Personally, I've learned that while FNP is extremely rewarding and meaningful and mostly effective, it also takes its toll at a personal and professional level, and for me it's a job that probably has a natural time limit of four to six years. The intensity of the work requires an emotional investment for the best outcome, but this needs to be balanced with keeping a close eye on professional boundaries and self-care. This is a difficult balance."

But despite the challenges, job satisfaction among family nurses appears to be high.

"The personal value of FNP for me is job satisfaction, the feeling that I've made a positive impact in the lives of the clients and children I work with," says one. "I'm proud to be part of FNP and feel that the work I do is valued by clients and managers. I'm aware that we operate within a licensed programme, but generally I feel it is supportive rather than restrictive."

"The value of FNP for me has to be becoming a part of the most exciting time of the young clients' lives and helping to support and guide them through all of the challenges that this time brings," says another. "By being reliable and gaining trust, you can develop a therapeutic relationship to help the client and family to make positive changes."

The FNP nurses feel that the role places them in a highly privileged position.

"I have had many fabulous opportunities throughout my career, but I feel like the luckiest woman in the world right now to be in my current post," one says. "It's such an amazing opportunity to spend time supporting young mums, developing therapeutic relationships with my clients and supporting them to build their own self-efficacy to be the best mum they can be while adhering to the fidelity of the FNP programme.

"This is more than just a job for me," she continues. "It feels like a huge honour to be a part of my client's journey while developing my own FNP journey. This has been a life-changing opportunity, building on the skills I already had while developing new skills and attributes along the way. Despite the challenges I face, I'll continue to grasp this opportunity with both hands and put my heart and soul into it."

"In my role as family nurse, being able to give clients the time, support and care they deserve is truly amazing," says another. "My own heart's desire is being fulfilled while delivering the FNP programme."

The journey through FNP is one of exploration and surprises.

"Every day of my journey so far on FNP has been different," a family nurse comments. "I'm constantly learning, sometimes with successful results and sometimes not. I work with a brilliant team, the data manager and the nurses support my role and I make every effort to do the best I can for them. I very much believe in FNP. I see the results, I hear the results, and I feel the results."

In the final analysis, while FNP builds on all the experiences the nurses have gained throughout their careers; ultimately, it is unique.

"I don't feel the FNP programme is comparable to other ways I have practised before," says a family nurse. "It delivers many more home-visit contacts and provides so much more detailed information in comparison to other ways I've worked as a practitioner.

"I feel that through FNP and with more home-visit contacts, a trusting professional–client therapeutic relationship can be built. This promotes increased engagement and facilitates client support through other relevant available family services. This input leads to better client satisfaction and improved outcomes for clients and their families.

"I enjoy developing therapeutic relationships with clients and their families. As the professional–client relationship strengthens, I have seen clients develop their trust and confidence in me by sharing information and requesting advice or guidance. This brings me a huge feeling of job satisfaction that I have not experienced in any other role."