December 2023 will mark 20 years since Terry Swanson was endorsed by the Nurses Board of Victoria as a nurse practitioner – one of the first in Victoria.
Terry arrived in Australia from the USA in 1988. Her husband had taught here in the ‘70s and had always wanted to come back. ‘And I always wanted to live some place out of Springfield, Illinois. I just didn’t know I’d come so far!’
She had been working as a neurosurgical nurse for several years in the States but initially had trouble finding work in country Victoria. Even after she secured a job in Terang, her new director of nursing admitted to being nervous. ‘She told me: “I’ve never worked with an American before”,’ Terry laughs. ‘I replied: we’re in the same boat – I’ve never worked with Australians before!’
On her first day, she ‘rocked up’ wearing her lab coat, pocket organiser and stethoscope, only to be mistaken for the new doctor. ‘When they found out I was the new nurse, they took my stethoscope off and said: you won’t be needing this.’
Moving into a new medical and nursing team meant Terry had to rebuild her credibility to her level of practice back in the USA where, as part of the diagnostic and treatment team, she would call a doctor and they would ask: ‘What do you think we need to do before I get there?’
Always hungry to learn, Terry started taking herself off to conferences, which is how she first learned about wound management. After one, she came back to Terang and asked her DON why they didn’t practice any of what she had learned.
‘She replied: okay, well you can be in charge of it.’
This was the start of Terry’s specialisation in wound management. ‘I saw a need,’ she says. ‘And I’m the kind of person who will always come to you with a problem if I see it. But I try to also come to you with the solution.’
Wanting to offer solutions is also how Terry became involved with ANMF. ‘When I was 25, I found my voice. I realised that if I wanted my needs met, I actually had to articulate them. And with me being able to voice my own needs, I then thought I could advocate for others.’
So she attended her first union meeting and was immediately hooked. She became a Job Rep almost by accident – having offered to attend a meeting in Melbourne in place of the existing Reps, who couldn’t make it – and has been one ever since.
Becoming a nurse practitioner
Terry was a grade 5 clinical nurse consultant when she applied to become a nurse practitioner (NP). She was encouraged by someone who saw potential in her, but the application process was challenging – for example, although management allowed her to submit an application they also encouraged her not to put too much effort into it, saying ‘you won’t be successful’.
She also had to grapple with complex government forms, in an office without air conditioning, during a sweltering heatwave, and at the last minute her computer crashed and she lost everything – two days before it was due.
With the deadline ticking down, she had to re-do all her work, then print and bind six copies. This meant she missed the final courier, so she asked her husband to drive the copies to Melbourne – a journey that required navigating through bushfire smoke and ash. He made it, and a month later Terry learned her application had been accepted.
‘I was determined,’ she says. ‘People sometimes think that just because we’re in the country we can’t have a level playing field, due to the tyranny of distance. But when people tell me no, that’s not the end of the conversation; it’s the beginning of negotiation. I get told “no” a lot. But it’s never stopped me. I wouldn’t be doing what I’m doing if I took no for an answer.’
When she went for her interview with the nurse’s board, they asked her: how will endorsement change your practice? ‘The only thing that is going to change is that I don’t need a double signature,’ she replied. ‘Because I was already working at that level.’
She acknowledges, however, that the reality of endorsement at the time did differ from her vision – mostly because, as one of the first four NPs endorsed in Victoria, she had to overcome opposition from some of her colleagues. In addition, her first year as an NP was really scary, she says.
‘I’d been co-signing prescriptions already, but now it was just my signature. The buck stopped with me. Our scope of practice is deemed on our competence, confidence and knowledge. I had the knowledge, I had the competence, but I still had to work on my confidence.’
20 years as a nurse practitioner
‘It took me a long time to become comfortable with being termed an expert,’ Terry says. ‘I still don’t know if I’m comfortable with the term, but now I own my skill set because when we don’t own and value our expertise we do nursing a disservice.’
Terry tries to pass this onto her students, and her colleagues. ‘I’ve been fortunate in my life that people have seen potential in me,’ she explains. ‘So now I try to do the same for others. And I try to lead by example, to show that a woman from the country can achieve these things, for my hospital, for the profession; that the tyranny of distance doesn’t have to be a limitation. That being a nurse doesn’t have to be a limitation to having your voice heard.’
Terry has recently started the Australian Wound and Skin Alliance with some colleagues including a podiatrist, another NP and an advanced practice nurse. They will hold their first summer school in February 2024 at the Carson Conference Centre in Melbourne. ‘Our vision is that we’ll have experts and novice practitioners so that they can learn from each other and mentoring can occur.’
The alliance is part of her dream of giving back to the profession, and the specialty. ‘I hope that long after I’m gone this organisation will continue to mentor and promote good practice,’ she says.
But she doesn’t plan on going anywhere soon. ‘Nursing has been so rewarding for me, and I’m as passionate now as I was 20 years ago. When I don’t find the joy anymore, then I’ll hang up my boots.’
