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The Family Clinical Nurse Specialist: Promoting Health in People with Mental Health Conditions

What is a Family Clinical Nurse Specialist (FCNS)? An FCNS is an advanced practice registered nurse, who has earned a master’s or doctorate degree. FCNSs are clinical experts in a specialized area of nursing practice. The FCNS has a unique role to integrate care across the continuum of three spheres of influence: patient, nurse, and system. In each of these spheres, the primary goal of the FCNS is continuous improvement of patient outcomes and nursing care.

I graduated Mercy College in 1999 with a specialty in family nursing. I am the current FCNS at the Sterling Community Center (SCC) of the Mental Health Association of Westchester. I am responsible for the treatment of health/illness states, disease management, health promotion and prevention of illness, and risk behaviors among individuals, families, groups and the community. To put it more simply, I have the traditional roles as care giver and care provider in a non-traditional setting. In the traditional setting, I was limited in what I was allowed to do, decreasing my ability to help.

So, where does a FCNS practice? Traditional settings include emergency rooms, long term care, and now something that may have never been done before, a community center that is focused on recovery. The SCC of the Mental Health Association of Westchester is a peer run service aimed at helping people with mental health conditions move forward in their recovery and reengage in their natural communities.

How is my role different from nursing care in traditional settings? For one thing, when I worked in a hospital, it would have been professional suicide to reveal I had a mental health condition. Unfortunately, I had to be a “professional” and not show how I felt. This was not healthy for me or the patient. You see, while I was personally able to empathize and relate with the patients, I had a limited ability to help. On a psychiatric unit, it is “us” and “them,” and you do not want to be perceived as “them.”

This is where SCC is different. Now I am the nurse and also a peer. By identifying myself as a peer, I am disclosing that I know what it is like to be a psychiatric patient in a hospital. I know from both sides: patient and nurse. My dual role as FCNS and peer, combined with my experience as a provider and patient has positive interactions with participants with whom there is mutual trust and concern. Please note I use the term participant, as opposed to patient, in referring to the people who attend SCC.

One example that comes to mind is the case of Paula. Paula was a participant of SCC who was upset about the fact that she had run out of her medication. She was agitated and loud, visibly distressed and in emotional pain. Paula’s Recovery Specialist and I went with her to a clinic where a social worker asked if she could go one night without medication. Paula ran out of the office yelling that no one understood her.

In the elevator, Paula told me that she could not do without her medication for one night. I responded with “I don’t like to be without medication for any length of time either.” Paula said, “you understand” and became quiet and less agitated. Paula and I then went to the emergency room. In the emergency waiting room, we talked quietly about my experience. Had I not been a peer, this would not have gone as well. Paula and I waited three hours in the emergency room to get one night’s medications. The emergency room was so busy; the only space available was a stretcher in the hall. I was able to sit with her and was allowed in the emergency room because I was a nurse.

Emergencies came and went, and we waited patiently. I reassured Paula that we would be seen and all we had to do was stay calm. Had she been as angry as she was upon arrival, she would have been admitted, no doubt. Developing trust and showing concern, turned a potentially poor result into Paula getting her medication and getting her needs met. As a peer and a nurse, I helped facilitate a positive outcome from a negative experience.

The influence of an FCNS as a peer is synergistic. It is similar to when you take two medications at the same time and the result of the two is more potent than one. This is a very potent role. It produces a result not independently attainable. As seen in the example of Paula, a crisis was averted due to my dual role as a nurse and a peer.

How else do I promote health with the participants at SCC? I perform the usual nursing skills in conferring with participants regarding medication, blood pressure, smoking cessation, weight management and other issues. I assess, plan and evaluate immediate concerns, such as vomiting, sweating, dizziness and headaches.

Here is where the rubber meets the road. I conduct medication safety, advanced directives, shared decision making and sexual awareness classes. Why are these classes so different? Being a peer, there is created relationships of shared power and equality. I am not “better than” as a professional, I am an equal. These classes have integrity in that we are all in recovery, and working on our hopes and dreams together.

People with mental health conditions die on average 25 years younger than the general population. Wouldn’t it be something if people with mental health conditions lived to a ripe old age? This is where the importance of a FCNS in a mental health setting comes in. The implementation of this new program at MHA, has given me, a FCNS, and a peer expert, the opportunity to help others build recovery from physical and mental challenges. I, in turn, am able to build a better life for all involved.

Change is a difficult and sometimes an uncomfortable process. The turmoil of emotional and physical pain does not have to be a hindrance in the quality of life. Health is the right of everyone. With a commitment to recovery and a desire to improve health, you too, can knock it “out of the park.”

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