Starched cuffs to university caps: one nursing leader's journey

August 2016 Vol. 16 (4)

After nearly 50 years in nursing and 35 years in nursing education JUDY KILPATRICK is set to retire at the end of the year. The self-declared “happy chappie” talks to FIONA CASSIE about a lucky career spanning starched cuffs, life-threatening illness and major milestones for the nursing profession.

Judy Kilpatrick

The young Judy Kilpatrick fancied herself as a lawyer … or maybe a history teacher.

She was definitely university-bound but in the December after leaving school she spontaneously popped into Christchurch Hospital and walked out having signed up for the January nursing intake. 

“Much to my father's dismay,” recalls Kilpatrick with a laugh. She did have an aunt who was a nurse but the young Kilpatrick had never expressed any interest in the caring profession before.

She’s still not totally sure what prompted her – possibly the practical nature of the course and having some doubts about teaching, which the associate professor and head of the University of Auckland’s school of nursing now finds a little ironic.

But the result was that in January 1968 she pinned on her “little starched cap” and put on her “little starched apron” and “little starched cuffs” over her blue, long-sleeved uniform, and began her training in the very proper Christchurch School of Nursing. “We looked ever so smart and crisp.”

These were the days when you might be learning the theory of ENT (ear, nose and throat) while working in orthopaedics – “so nothing made a lot of sense really”. And this was also when appendix patients stayed in so long that they ended up being put on ward tea trolley duty. “Patients are sent home now as sick as when they used to be admitted in those days.”

Those were also the old-school days when any hungry student queuing for lunch had to stand back to let more senior nurses go first.

It was quite a harsh regime – if you didn’t toe the line, the next minute you were gone. Kilpatrick’s class was considered ‘lazy’ from the beginning as they were the first students to get two whole days off a week. The stereotypically tough ward sister was still very much a reality, but Kilpatrick says they knew their stuff and were much to be admired.

The good old days

And after a tough day at the bottom of the nursing pecking order, there was always someone to unwind with over a coffee back at the nurses’ home. “Or even try and sneak a little gin bottle into the nurses’ home occasionally – you know, the things you shouldn’t do.”

The social life even came to them, with Lincoln College sending a bus in on Saturday nights “and off we used to go to the parties … it was all very good”.

“You were paid a pittance, but you were kept ‘warm, fed and watered’ by the nurses’ home; there was always companionship around and some of those friendships became lifelong.”

Those companions rallied around when as a new nurse Kilpatrick returned shattered from an afternoon shift, having just witnessed her first death. “It was dreadful. I was giving a lovely old lady a pill and she died. I was quite sure I had choked her to death. Fortunately I hadn’t. But it was quite astounding – I was all by myself and then ‘bang’, off she went. And all I could think was that I had done it.”

Looking back, she says she “really, really enjoyed her training” – and has no regrets as that’s how it was – “but it wasn't right really”.

“People were just thrown in and if you survived that was good … but there were a number in the class who did not. They either just went – or had a meltdown and were told to go.”

The high attrition rate in nurse training in those days – up to half of some cohorts – led to the critical **itals** Carpenter Report** being released the year after Kilpatrick graduated, and ultimately the first pilot polytechnic courses being offered in 1973.

For her final year of training Kilpatrick transferred to Auckland Hospital. Her family had also shifted north and she soon realised she had not only changed islands but also hospital cultures. “Oh I arrived and they were wearing these white, flimsy little dresses – I thought they were the scruffiest things I’d ever seen,” she recalls with her ever-present laugh.

But having lost time in her Christchurch student days from injuries and burns due to lifting equipment out of old-school sterilisers, she was most impressed by “these wonderful little dressing packs” containing disposable plastic forceps 

Kilpatrick graduated in 1970 and her first staff nurse job was at Greenlane Hospital A&E (accident and emergency department), which she recalls with fondness as an “amazing place” with a great staff culture.

During downtime on quiet shifts – Kilpatrick says you could have downtime back in 1970, unlike today’s “poor sods” – they used to get up to “some crazy, silly kids’ stuff”, like making balls out of plaster or grabbing some crutches and having an improvised hockey game out the back of A&E. And if ambulance officers had time on their hands on afternoon duty they’d do a ‘burger run’ to the local hamburger bar. “You could be sure that then A&E would get busy and we’d have to reheat our hamburgers at the end of the shift, which might end up being 2am or 3am in the morning, rather than the scheduled 11pm if there was a car accident or other emergency.”

Kilpatrick says the hands-on nursing job she loved the most was working in A&E as “you’d never know what would happen next” and what people did to themselves constantly amazed her.

Teaching, study and career about-turns

But then that ‘thing’ she had about teaching nudged again.

First she was called back to the central nursing school at Auckland Hospital to teach and then in 1977 headed south to Wellington to study at the New Zealand School of Advanced Nursing Studies (SANS). The “amazing” residential programme saw 60 nurses from across the country (plus 10 from overseas) given a one-year fully-paid sabbatical to study for their post-registration Diploma in Nursing.

Not that Kilpatrick was always that enamoured with the study element. “I think they were a little cross with me … I remember in the May break being called in and asked did I really think I should be there as I seemed a bit bored. I thought ‘that’s a bit charming’. I was having a lovely time but I was a tiny bit bored (with the classes)… but I knuckled down then.” And while she found the curriculum a little “same old same old” she says looking back she learnt a lot about nursing as a profession and it gave her time to reflect on what she wanted to do – which was to put teaching aside once again and go back to clinical nursing.

So she returned to Greenlane where she became a charge nurse under the “wonderful matron of the time – Margaret Taylor”. She was “quite a stern woman” but ready to be embracing of staff with new ideas. The new idea Kilpatrick and a colleague were given the freedom to try was shifting to patients having a primary nurse responsible for their care and away from having task-based team nursing where no one nurse really knew a lot about the patient. She and her colleague (Mia Carroll, who went on to be director of nursing of Auckland District Health Board and is now again a colleague of Kilpatrick’s at the University of Auckland) were given a ward to work with and their other mini revolution was allowing nurses to set their own roster. “It was very empowering.”

Kilpatrick went up the ranks and in her late 20s became the senior supervisor (like assistant matron) of Greenlane.

She managed the hospital’s general (non-cardiac) services, including the A&E, and was on the path to becoming a matron herself when around 1980 the latent teacher within was given another nudge.

Second teaching nudge

The nudge took the form of meeting Yvonne Shadbolt – who sadly died this year – the founder in 1975 of Auckland’s first polytechnic-based nursing diploma at the then Auckland Technical Institute (now Auckland University of Technology or AUT).

Tertiary led nurse training instead of the apprenticeship-style model appealed to Kilpatrick the teacher and Kilpatrick the nurse. “I thought ‘my word’ you could actually teach nurses as students, have them learning something at the same time they were putting it into practice and hopefully give them some space to reflect on that. And have teachers who are focused on them rather than just coming in for block courses. It seemed magical.

“So in 1981 I decided not to be a matron – though people most likely think I’m like a matron now – and I went and joined Yvonne at ATI at its new North Shore campus.”

(Kilpatrick actually delayed starting with ATI as her father was managing the North Shore campus during the transition to ATI and “I couldn’t work for my father – dear sweet God, that would have been more than I could have borne, though I loved him dearly. So when he moved out I moved into what is now AUT.”)

Yvonne Shadbolt was to be Kilpatrick’s second great mentor – a sharp, ‘new world’ thinker who was at the cutting edge of moving nurse education forward. “She gave me my head more than anybody else I ever worked with.”

Kilpatrick set herself the ambitious task of progressively teaching each year of the three-year curriculum. “It nearly bloody killed me. But I thought if I’m going to do this properly I’m going to have to understand the curriculum properly.”

It was an eye opener for the A&E nurse turned lecturer who thought, for example, that she knew all about shock until she had to teach it. “I thought – oh God, I don’t know anything.” She clinically knew what to do, and could do it well, but didn’t know the theory behind what she had been doing. “I found that fabulous – I was almost learning with the students and just keeping a few steps ahead.”

Around the time she ended her self-imposed, three-year teaching apprenticeship, she moved onto a “little farm” and her first cohort of students – who she’d taught from “day one to course end” – gave her a “little black sheep” for her farm. “It survived a very long time but eventually I did something wrong and it met its demise,” says Kilpatrick, who remains a hobby farmer.

The always would-be teacher loved her new job. She became the leader of the third year and loved teaching adults in a learning environment where innovation was encouraged. It was also fun and staff had time to look after their students.

Meanwhile hospital-based training continued in parallel across the harbour at Auckland Hospital “which was really difficult for the students”. And despite the new polytechnic programmes being half clinical, she had to listen in frustration to “old-school” nurses, including her aunty, telling her “how terrible it was these polytechnic students didn’t get any clinical training”.

“Those pioneering students most likely had to be stronger than we were. We (our generation) had to be strong because we didn’t know any better. These nurses were strong but they knew what they were doing. I just loved that. I loved that they wanted to nurse and wanted to know what they were doing at the same time.”

Kilpatrick was anxious not to lose her own clinical skills – so when she moved to her little farm near Auckland’s Paremoremo Prison she used to do some weekend and night shifts at the maximum security facility. “It was an environment that was quite foreign to me but, interestingly enough, prisoners who are bad, mad, a mixture of both, or just sad kids, really just want the same nursing as everybody else. I got on with them quite well.”

Meanwhile her teaching career progressed and she became first associate head of school under the very clever Margaret Horsburgh – under whom the nursing school’s bachelor’s degree was developed– and then later head of school herself (CHECK)[1] 

Nursing Council, NPs and a professional shift

In 1996 Kilpatrick became chair of the Nursing Council of New Zealand at a time when nursing education was going through another surge of change.

The council was reviewing post-registration education, which had yet to catch up with the shift to nursing being a degree-entry profession and the push for more advanced practice roles like nurse practitioners.

“Nursing had so many certificates – you could do a course in anything and get a certificate that went in your bottom drawer.” Kilpatrick says that certificate might reflect you were an expert in your field but it had no academic clout or cred 

She says the shift in the 1990s to first the undergraduate degree and then a clinical postgraduate framework offering postgraduate diplomas and master’s degrees for nursing – while frightening for some – was “amazing” as it was when nursing finally let go of the last of the apprenticeship model and truly became a profession. It also gave nursing a voice in a health sector that had changed so much and where “huge things” were being asked of nursing.

Being Nursing Council chair in the years leading up to the approval of the first nurse practitioner in late 2001 is one of the things she is most proud of in her career. “It was amazing but I think it damn near killed me really.” For a start the nursing corner was not totally united behind the new role and also had to face a “huge backlash” from some colleges and organisations in medicine’s corner.

Supporting the nursing leaders calling for advanced practice roles was then Health Minister Bill English who set up the 1998 Ministerial Taskforce on Nursing (that backed the NP role) and in 1999 amended the Medicines Act 1981 to allow nurse prescribing. Under Annette King and Helen Clark’s watch the Ministry of Health and Nursing Council launched the new NP scope of practice in 2001.

Then just this year –15 years after the first NP was approved – the first funded, dedicated NP training programme got underway at Auckland and Massey universities – that is linked to employment and will make the role work, believes Kilpatrick. “That’s taken a lot of energy over a long period of time.”

Nursing, medicine and being politica 

Back up in Auckland, with her nursing education hat on, Kilpatrick was increasingly convinced that advanced nursing practice should be taught alongside medicine.

“We needed to teach nurses right alongside ‘the docs’ so we could lift the expectations of nursing and have the doctors see what those expectations were.”

She had also long bristled a little at nursing calling itself the “caring profession” and believed it was time for the profession to show that it was not only caring but that its caring made a difference.

“We cannot own ‘caring’ as just ours. I haven’t met anybody in health worth their salt who doesn’t care – we need to also be able to stand proud and show we make a difference professionally.”

These thoughts culminated in the late 1990s when Kilpatrick and Mia Carroll (nursing leader for what was shortly to become Auckland District Health Board) approached then University of Auckland medical faculty dean Professor Peter Gluckman about having a school of nursing alongside the medical school.

Massey and Victoria universities had been offering degrees in nursing studies since the 1970s and with the merger of Wellington Polytechnic with Massey in 1999 came the first undergraduate nursing school within a university. Down south in 1998 the University of Otago’s Christchurch School of Medicine had started offering a master’s level clinical paper for rural nurses in a foretaste of what was to become Otago’s Centre for Postgraduate Nursing Studies.

Kilpatrick says Gluckman (now Sir Peter Gluckman) saw the merits of her and Mia’s argument and made the nursing school happen.

“I saw he got the Blake Medal [for leadership] the other day and said he was most proud of opening the Liggins Institute. I’ve meant to send him an email to say he should be most proud of opening the nursing school,” cackles Kilpatrick.

In 1999 Kilpatrick and Dr Margaret Horsburgh left AIT (which became a university itself in 2000) to become founding directors of the University of Auckland’s school of nursing, which was officially established in 2000 with the enrolment of its first undergraduate and master’s students.

Which begs the question: how did AUT take the ‘defection’ of its nursing school top brass to found a competing school across the harbour? Kilpatrick pauses and says “that’s a difficult one really” as she had a great time at AUT and had “huge respect” for AUT vice-chancellor John Hinchcliff, but she thinks he understood that nursing needed to make the move.

More than 15 years on, the long-time head of school is looking to hand over the reins of a school that now has a capped undergraduate intake of 100 students a year, has more than 20 students a year doing clinically focused PhDs, and staff getting Health Research Council grants. “We could be seen as an academic department but my pride is that we’ve done it through clinical.”

To top her final year in nurse education the first global ranking of university nursing schools saw Auckland ranked 32nd in the world – the highest global ranking of any school in the university’s medical and health sciences faculty and the sixth highest ranked school in the university overall.

This more than meets Kilpatrick’s dream as school co-founder to see the school respected – “because I think it has still been a bit of a battle to get respect at the university” – and her hope nursing would find a place “somewhere in the middle” of the university’s many disciplines.

“When nursing applies itself, nurses are clever and smart as well as still good at what we do best – nursing. That’s what the Margaret Taylors, the Yvonne Shadbolts and the Margaret Horsburghs taught me.”

Establishing nursing in a medical-centric faculty has also required some “robust discussions” on occasion, from which Kilpatrick hasn’t shrunk. 

She thinks nursing should do more of that – fronting up to talk to the people with influence “and influencing them about why you matter”.

The need for nurses to “get political” is a message she shares when she talks to undergraduates as the profession’s future nurse leaders. ‘Getting political’ to Kilpatrick means engaging with the power brokers and sensibly articulating what you want to achieve. “I don’t see anything wrong with that.”

Life-threatening illness and luck

Kilpatrick has been skilful enough at articulating her vision for nursing education to have become the head of a globally ranked university school of nursing without having a PhD or master’s degree.

“I was one of the lucky ones, love,” says Kilpatrick when asked how she managed it, then goes on to reveal a little more.

“I was on the cusp, I had my undergrad degree (a BA in education from the University of Auckland) and I was starting my master’s when I had a brain haemorrhage…”

She adds it was a subarachnoid haemorrhage – a rare form of brain bleed that is often fatal – that “knocked her out for a little while” and then changes the subject. On further questioning, she admits it was a “bit of a life-threatening occasion”. It was early 1997, she was 49, head of AIT nursing school and chair of the Nursing Council at the time (so her dry aside earlier in the interview that pushing for the NP role “nearly killed me” takes on new meaning).

“I ended up in the department of critical care at Auckland Hospital after a second bleed. It was thought I wasn’t going to make it and the whole family was around the bed…”

But the treatment and care she got was “outstanding”. “The way those people fought for me – you are going to make me cry shortly – I guess that makes you think you’ve got to give something back.”

Then in 1998 she was “stunned” at being awarded the Companion to the New Zealand Order of Merit (CNZM) for her services to nursing education and says, “That little trinket gives you the confidence to go on really.” And it didn’t stop her pursuing the dream of a nursing school alongside the medical school.

“No-one would get my job now with my credentials – no-one– but I did and I’m not apologetic about that. My job was to open the school of nursing and make it successful, which I did.”

Conclusion

“I think I’m one of those little unique apples,” sums up Kilpatrick, reflecting on what she has achieved in a world in which by most accounts she shouldn’t have succeeded. But it also helped that she was smart, ready to take risks and was around at the right time with the right people to support her.

Kilpatrick adds she “may also have a bit of a reputation for being a bit of a hard nose”.

“I’m not going to apologise for that because we need more nurse leaders to stand up and work with the system but never accept the system. Be solution-driven, treat people with respect and work at it to change their minds – even if it sometimes takes 15 years, like the efforts to gain backing for a dedicated NP training programme. 

And at the end of the day, she says, never forget to laugh. “I never forget to laugh at myself first. Don’t sweat it too much – and have a gin,” she says with a grin in her voice.

Retirement will see her having more ‘me’ time to enjoy her “gorgeous” lifestyle property, her lovely partner, son and first grandchild. “I’m a pretty happy chappie overall.”

And any regrets about wandering into Christchurch Hospital all those years ago and coming out having signed up for nursing?

“Best bloody thing I ever did.”

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