Driving change: The movement for more nurse autonomy

Image: Melissa Freeman FACN at work in the clinic.

The movement for more autonomy for nurses had a win over summer, with NSW Health changing immunisation regulations in a key step for nurse immunisers in that state. Here’s the story of the nurse who drove that change.

As a nurse working in ED, Melissa Freeman FACN was at the coalface of the mounting chronic disease burden in Australia. She and her colleagues were caring for more and more acutely unwell patients presenting for unplanned care. Self-described as “annoying enough to say, ‘no, sorry – that’s not right’”, she proposed solutions to try to relieve the rising pressure building on the hospital system.

But, she says, her ideas were met with resistance. So, she quit – but not without a plan. Her drive was to make changes outside the hospital system. She turned her spare bedroom into the HQ for a nurse-led wound care service. A bucket became the receptacle for the dressings she would carry to patients’ homes.

“Because I couldn’t afford anything else,” she says. Melissa Freeman: “I was so scared to go and do it.”

But she did, setting off on a journey marked by tenacity and a refusal to accept the status quo.

“If someone tells me, ‘no, you can’t do it,’ I’m like, ‘hold my Coke Zero – I can do it.’”

And so it was, with her plan to administer vaccinations in her clinic. It was thwarted for more than a year by state government regulations – but Melissa refused to let her dream go, with what could be important ramifications for nurses state (and country)-wide.

 

Image: Melissa Freeman FACN holding “The bucket”

Nursing at her core

Born in Sydney, Melissa grew up in the beachside suburb of Cronulla. Her mum worked in retail, and her dad was a fitter and turner. Visiting her grandparents in hospital as a child, she was struck by the kindness and professionalism of the nurses. After finishing school, she earned her enrolled nurse certificate at TAFE, later going on to become a registered nurse through the University of New England.

With experience ranging from bush nursing to acute medical, emergency and lastly anaesthetics in regional hospitals across Australia, Melissa’s passion for nursing has not dimmed, but evolved. She’s fuelled by a drive to give back to her supporters, and she says she draws courage from the sense of safety she feels in her relationship with her partner, Jeff (a former wardsman she met over the operating table), and from being a mum to Lewis.

“I’ve had some really beautiful people in my life that have helped,” she says. “I have a lot to give back, you know. I really do. I have a lot of people to make proud.”

The evolution of the Port Macquarie Wound Care Clinic

From the spare bedroom, the clinic then relocated to a ‘shed’, occupying half of it. It then expanded to the rest before taking over the entire property to become a fully accessible clinic, in 2022. It’s now an operation that she estimates has helped thousands of patients.

“On any one day, we have up to 15 full-time equivalent nurses and support staff going out in all different directions of our community doing up to seven to eight nurse visits to patients a day,” says the clinical nurse specialist. Some are quite a drive away – one visit involves going through six farm gates to get to a remote property. “We see probably between 50 to 80 a day. At the moment, we’re sitting on about 100 people that we’re seeing regularly.”

The clinic’s nurses take a holistic approach to their work. Beyond wound care, they also manage needs including chronic disease management, catheter care and palliative care. If something is outside of their scope they refer on.

“We book everyone into a 45-minute or one-hour appointment and we do the whole picture. So people might come in for a venous leg ulcer, but they will have their blood pressure checked. If they’re a diabetic, they’ll have their sugars checked. Their weight if they’re struggling with weight issues, or education if they’ve got kidney disease or if they’re a diabetic.”

The clinic prioritises supporting its clients to self-manage their care.

“One of my frequently asked questions is why have you chosen to come here over going to emergency?” says Melissa. “A lot of them now are saying, because I’ve been educated, or have been taught what to do in instances of wound breakdown or catheter changes.”

A missing piece

Over the last year, NSW Health officials experienced Melissa’s gracious persistence, via her refusal to accept regulations that prevented nurses from delivering vaccinations without a medical practitioner present.

It made no sense to her that, in a community of vulnerable people, she and her nurse immuniser-qualified employees could not deliver vaccinations because public health regulations did not allow it unless she employed a doctor.

“I started to collect data about how many people were presenting at emergency with things that are preventable – and the amount of pressure [it is putting] on our local emergency department and the surrounding areas like Kempsey – which is primarily an Indigenous community – and how many illnesses, and how many people die under 50,” she says.

With the support of the Australian College of Nursing (ACN), she had an opinion piece published in The Newcastle Herald, which caught the attention of respected social scientist and former nurse, Professor Julie Leask, who connected Melissa to the NSW Health Department.

And, just in time for Christmas, came the big news. The NSW Chief Health Officer, Kerry Chant, updated the Authorised Registered Nurse/Midwife Vaccination Standards and Authority to remove the requirement for a medical officer to be contactable for medical advice during a vaccination clinic.

“I honestly couldn’t have done it without ACN,” she says. “People wouldn’t have listened to me – that’s why being a member is so important.”

Melissa is now in the first cohort of nurses studying to become a designated nurse prescriber. Next on her agenda is to lobby for funding reform to enable nurse-led clinics to operate sustainably.

And that bucket – now with a broken handle – still sits in her office.

“I will never ever lose that bucket,” she says. “That’s what I started with. It’s so symbolic to my journey. It shows that anyone can start something with nothing. It doesn’t matter what it is.”

ACN’s immunisation courses

Find out more about ACN’s immunisation courses and how they can help you strengthen your expertise, meet professional requirements, and stay up to date with best practice.

This article was originally published in the Autumn 2026 edition of ACN’s quarterly member publication The Hive. Members can access all past editions of The Hive on MyACN. Non-members can get a sneak peek by viewing our open-access articles.