Over 7,000 young mothers and their newborns in Scotland have now received support through an innovative programme led by specially trained nurses and midwives, according to a report.
However, while setting out the positive aspects of the role, the report also noted that staff often felt challenged and emotionally drained by the workload they faced.
Launched in Scotland during 2010, the family nurse partnership is an intensive, two and a half year home visiting programme for first-time mothers aged 19 and under, and eligible 20-24 year olds. The scheme is also available in parts of England since 2006.
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Family nurses support mothers to give their baby the best start in life and with their mental health and confidence, housing, education and employment, noted the Scottish government.
There are currently over 200 family nurses in Scotland, delivering the programme across 11 health board areas, and a new national report has found that 82% of eligible mothers have taken part.
It was first implemented in NHS Lothian in 2010, before being rolled out to nine other boards of the next five years. NHS Dumfries and Galloway subsequently introduced the programme last year.
“Family nurses tend to describe the experience of working as a family nurse as both intensely rewarding yet extremely challenging”
The report stated that, in the past nine years, over 6,000 young women had benefited from the programme with over 2,800 graduations to date.
The review found that family nurses “added value” through the supportive nature of their client relationship and their holistic approach to breaking intergenerational cycles of poor caregiving, reducing the risk of abuse and bringing intra-generational equity to this segment of the population
They also supported maternal outcomes including mental health, confidence and self-efficacy and education and employment, supported children’s development and positive parenting approaches, and improved inter-agency working and reduced the workloads of other services.
For example, the work that family nurses do with clients who are struggling with mental health issues, such as providing them with coping strategies, was credited by one manager of a community mental health service with decreasing the need for their services.
Similarly, the report said others expressed the view that family nurses’ work with clients enables other professionals to focus specifically on helping clients using their professional expertise.
However, the report also highlighted that, when asked to reflect on it, family nurses described a “tension between the rewarding nature of the job” and its “immensely challenging nature”.
“Some nurses highlighted the fact that while they do love working as family nurses, they believe that it is not sustainable long-term career”
The report stated: “Family nurses tend to describe the experience of working as a family nurse as both intensely rewarding yet extremely challenging.”
One respondent quoted by the report described being a family nurse as both being the “best” and “hardest” job they had ever had, that felt like a “rollercoaster at times”.
There were “so many happy, enjoyable times along with some very challenging situations which has tested my inner strength, resilience, organisational skills and time, and home-life/work balance,” they said.
According to the report, family nurses “noted finding the job challenging for a number of reasons, particularly relating to time and workloads, and the emotionally draining nature of the work”.
With a full caseload, a family nurse will have 25 clients, said the report – titled Revaluation of the Family Nurse Partnership in Scotland (see attached PDF below).
For each one, they must prepare and deliver the programme with each visit tailored to the needs of the client, as well as delivering the full heath visitor pathway, attending training, weekly supervision and team meetings, writing up each visit, and conducting a large amount of data on outcomes.
One family nurse partnership supervisor described in the report how family nurses “feel frustrated that they are unable to deliver every aspect of the programme to every client”.
As a result, this supervisor warned in the report that family nurses could either “begin to burn out because they push themselves too hard to reach all their targets, or they lose morale because they feel that they are failing to reach their targets”.
“For nurses working in both urban and rural settings, the challenges of this heavy workload can be compounded by the need to spend long periods of time driving either long distances in rural areas or through congested city traffic, between clients’ homes,” said the report.
“This initiative has helped thousands of young mothers build the confidence and skills they need”
It noted that family nurses also spoke of finding their work “emotionally draining”, with clients often having multiple, significant vulnerabilities, and were unwilling to engage with other services.
“As a result of the stressful, all-consuming nature of the job, some nurses highlighted the fact that while they do love working as family nurses, they believe that it is not sustainable long-term career for them,” said the report.
“Others, however, spoke of trying to find ways to ensure that they were able to avoid burning out and to continue working as family nurses as long as possible,” it added.
Speaking on the report, Scottish public health minister Joe FitzPatrick said: “This is an excellent example of the vital role nurses and midwives play in our communities.
“This initiative has helped thousands of young mothers build the confidence and skills they need to provide the right support for their baby,” he said.
He added: “Together with the introduction of the baby box, this programme supports our vision that every child in Scotland is given the best start in life and mothers receive the right care and support.”
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The family nurse partnership programme began under license from the US in Scotland in 2010. The initiative was expanded to include eligible mothers aged 20-24 years old in 2016.
There are currently 202 nurses delivering the programme across 11 health board areas. In 2018, the scheme was expanded to include Dumfries and Galloway and 25 nurses joined the service.
A formative evaluation was undertaken over four years with a summary report produced in 2014.
A review of the same programme in England, which was published in 2015, concluded that the family partnership scheme had not produced the improved health outcomes it was expected to.
The programme did not help expectant mothers stop smoking or lower the rates of a second pregnancy within two years, according to an independent study, commissioned by the Department of Health and published in The Lancet.