Health Click produces resources for young people and those with disabilities, and for their parents, educators, therapists and care givers.

Nelson Nurses Blazed A Trail
May 13, 2014

It’s International Nurses Day on Monday – which doubles as Florence Nightingale’s birthday! The following is taken from a profile on Annette Milligan in Kai Tiaki Nursing New Zealand, and is reproduced in the Nelson Mail with their permission.




Nursing pioneer Annette Milligan is an interesting mix – articulate, innovative, wry, clever, determined, unafraid, high-energy, with a penchant for vivid colours and spiky hair. She’s also deeply pragmatic, a characteristic shaped by her upbringing on a 1000-acre Southland sheep farm, and honed through events in both her personal and professional life.


These characteristics have meant she’s still in business, 25 years after establishing the Independent Nursing Practice (INP) in Nelson. Initially, it attracted no government funding but plenty of opposition from the medical fraternity. The practice she and two other nurses established celebrated its silver jubilee in February – a “weird feeling” according to Milligan, the only remaining member of the original trio.


A confluence of factors prompted Milligan and two Nelson Hospital colleagues (Mary Griffiths and Flavia Kingturner) to establish the practice in 1989. The year before, a damning report on the inquiry into the treatment of women with cervical cancer at National Women’s Hospital had been published.


The Cartwright Report laid bare appalling treatment of women – and the complicity of too many nurses in that treatment.


“It was a terrible moment for nurses when Judge Cartwright stated in the report that nurses had been deafening in their silence,” Milligan says.


“A year after publication of the report, the way health care was delivered completely changed. Up until then, women’s health had been very much neglected and there were few choices for women in terms of their health care.”


Around the same time, the concept of independent nursing practice was emerging. So the three nurses, with scant funding but plenty of passion, decided to take the plunge.


The then Minister of Health, Helen Clark, opened the practice on February 12, 1989. Funding was from the nurses’ wages and $4000 of business funding which they used for professional research into Nelson women’s health needs. The research revealed a strong desire for family planning and sexual health services, and a need for health teaching and education.


A “dispiriting” finding was that many surveyed were prepared to pay just $5 for such services. That finding, plus the fact no government agency was prepared to offer any money, on the grounds such funding would open the floodgates to more demands on the health dollar, was somewhat alarming to the neophyte independent practitioners.


They continued working part-time at Nelson Hospital for close to two years, maintaining a punishing work regime between the practice and four shifts a week. They also had to cope with considerable opposition from doctors – and some nurses.


The first doctors the clinic employed had a “very hard time” from their medical colleagues, according to Milligan. While time has served to ease the pain, Milligan remains bewildered by the lack of support for the vision of independent nursing practice at a national nursing level at that time. “There was a fear we would become exploitative nurse employers.”


But local nurses were supportive. “Our colleagues at Nelson Hospital were prepared to give us our choice of shifts so we could work at the clinic, so I always worked two afternoon shifts and two weekend shifts.”


As well as anxiety over funding, there was some angst over the business model. “We all strongly believed nurses had the same right as doctors to earn their own income and, for that reason, we didn’t want to establish a charitable trust – we didn’t want the practice to be seen as a charity. So it was established as a “business with a social conscience and a strong ethical base”.


Milligan has remained committed to that vision. “I’m entitled to make a living but not an obscene living – there’s no flash car outside.”


Within two months of opening, the practice was paying its way, but not to the extent of paying wages to the nurses. It would be another two years before the nurses could draw $50 a week each.


A family planning clinic opened in September of the first year and a receptionist was employed before the end of that year. The services offered in the early years included stress management courses – “they were very successful” – communication and self development courses, foot care, some massage therapy, treatment of anxiety disorders and relaxation. “We modelled our therapeutic interventions on those of the United States nurse practitioners (NPs), that of the ‘knowledgeable friend’,” she said.


But it was hard to make that viable and the need for ongoing funding was ever present. Taking stress management courses into large Nelson employers provided much-needed ongoing funding. Milligan estimates she’s taken more than 1000 stress management courses over the years.


A Department of Labour-funded course to assist people in the transition from unemployment to work, which the clinic dubbed Health Yourself, was a financial godsend in those early days.


Milligan remains grateful to this day for “an angel” from the department who, on reading the clinic’s funding application, visited the practice and advised the nurses to rewrite the application to more closely meet the department’s specifications and suggested they were not charging enough for the course.


In the early 90s, the practice got a landmark contract through the Ministry of Health to provide sexual health services for those aged under 22, a contract it still holds.


Sexual health remains the cornerstone of the practice. It employs female doctors part-time to provide some sexual health and family planning services.


“The doctors are working in a nurse-led clinic with a nursing ethos. Many doctors have told me they practise differently when they come here,” Milligan said.


It is “mission critical” to have only women practitioners. “Women come here expecting to see a woman clinician.”


She defines the clinic’s nursing ethos as working in partnership with those who come to the clinic and seeing them as having expertise about their lives and health needs.


Milligan was an early supporter of the NP scope of practice, despite the benchmark for becoming an NP being set higher than she wanted and there being no process enabling existing independent practitioners to be recognised as NPs.


“I was sorry there was no grandparenting process for those who had pioneered the role, but I just had to suck it up and get in behind the Nursing Council’s proposals. By then, I’d learnt to pick my battles.”


In the mid-90s, the Accident Compensation Corporation offered contracts for occupational health providers and Milligan made a strategic decision to go in that direction, too. She established a company, Ramazzini, named after the pioneering 17th-century Italian occupational health physician, Bernadino Ramazzini.


It provides a range of occupational health services. In 2010, the practice’s name changed to INP Medical Clinic. “Doctors were part of the team – we couldn’t operate without them – and Independent Nursing Practice didn’t mean as much as it had in 1989. “Medical” implies conventional western medicine to the general public and that’s what our sexual health services are. While 95 per cent of our clients are women, we don’t exclude men.”


The clinic now has 30,000 clients on its books and sees around 7500 people a year. It employs three nurses, three doctors, two administrators, all part-time, a full-time practice manager and Milligan.


“The clinic really runs itself now – it takes less than a day a week of my time.”


Ironically, as a pioneering independent practitioner, Milligan no longer has an annual practising certificate (APC) for clinical practice. “I’ve given away clinical work and I was not meeting the Nursing Council’s requirements. I’d had my day and needed to move on,” Milligan explained.


But she does have an APC for her management roles. “My nursing is critical for the management roles I have. I still see myself as a nurse, and nursing knowledge is integral to what I’m doing now. As a nurse, I know the fundamentals of working in relationships and of sharing knowledge with people, so they can make their own choices and decisions.”


Before nursing, Milligan trained as a teacher and that training has also been useful in her work developing health education resources. In 1990, she established Health Click as a vehicle to develop sexual education resources for young people.


Health Click “staggered along” but Milligan has now returned to producing sexual and social education tools, this time for those with disabilities. Resources include illustrated ebooks and social story books, which provide step-by-step guides to toileting, showering, masturbation and developing friendships and deeper relationships.


There are voice-overs for those who cannot read. “Every word and image has been extensively tested on parents, workers and the young people themselves. The ebooks are ideal for young people with autism, as they can read/listen to them repeatedly and they don’t have to interact with anyone. Developing these resources has been one of the most satisfying things I’ve ever done. The need is huge, and I have been profoundly humbled and moved by what I’ve seen parents and caregivers dealing with.”


Milligan is taking her Health Click resources to the world, with Australia and the United Kingdom in her sights this year, the United States next year, and translations into European languages scheduled for 2016.


Another aspect of her work is the Safeguarding Children Initiative, which educates those working with children and families in the Top of the South on child neglect and abuse, and what to do about it.


Milligan wants the model rolled out nationally and is “hunting for funding. It’s a public health model aimed at empowering communities to confront neglect and abuse, and it works. Three people are in jail directly as a result of people acting on what they heard at our seminars, and children’s lives have been saved and transformed.”


As well as her health initiatives, Milligan has been on a number of boards. She believes every large professional organisation should have a nurse on its board – “the value nurses can bring to the boardroom is immense.”


As 60 looms, does Milligan have any plans to slow down?


“I hope to be still working in five years. I absolutely love it, and have lots of energy, and have been blessed with very good health. Retirement is an unknown concept to me but I realise I’ll have to slowly withdraw.”


What to do with the practice she gave birth to, threw her heart and soul into and nurtured through its growing pains to be a healthy, functioning and financially viable entity is a dilemma.


“It would be a wonderful practice for an NP. It has to continue – the need is great – and I have no doubt it will.”


Practising what she preaches, Milligan is “thoughtful” about what she eats, exercises daily, ensures she has lots of recreation – motorbike riding, ski-ing and travel are among her leisure pursuits – and has a very supportive partner.


“I’ve always been aware burnout is a very real possibility, so I’ve made sure that, in my daily life, I’ve practised what I’ve preached. While I love my work, it is not my whole life.” That said, if she won Lotto, she’d still turn up for work. “It gives me a sense of purpose. Trying to make the world a little bit better is extremely satisfying.”


– The Nelson Mail


Published: 12/05/2014
Source: The Nelson Mail

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