International Nursing Conference

30 Mar 2005

By Prof K Satkunanantham, Director Medical Services

Venue: Raffles City Convention Centre

Mr Chua Song Khim

Chief Executive Officer, National University Hospital

Mrs Lee Siu Yin

Director of Nursing, National University Hospital

Ms Catherine Koh

Chairperson, Organising Committee

Distinguished guests,

Ladies and gentlemen

Introduction

Thank you for inviting me to join you today at the opening ceremony of the International Nursing Conference on Advanced Nursing Practice. 

Before I go further, let me extend a warm welcome to our overseas speakers and delegates. Thank you for taking time from your busy schedules to be with us.

In these times of rapid medical developments, technology proliferation, spiraling health care costs and growing patient expectations, we as healthcare professionals are challenged to re-examine our practice and plan new, efficient models of healthcare delivery.

These socio-economic forces provide opportunities for the nursing profession to transform itself.  It is thus timely for the National University Hospital to organise this conference, when the Ministry is looking at how the professional role of nurses, especially clinical nurses with masters degrees, can be expanded.

It will be useful to examine how Advanced Practice Nurses, or APNs can impact healthcare in Singapore.

History of Advanced Practice Nursing

Internationally, the concept of advanced practice nursing is not new. It has evolved over the last 30 years to become an important component of the healthcare systems in the US and UK, and in many other parts of the world.

In Singapore, the National University of Singapore started its Masters in Nursing programme in 2003, to launch advanced practice nursing and prepare advanced practice nurses for clinical leadership roles. It was a landmark achievement in nursing education in Singapore. The first cohort of Masters prepared nurses from NUS will be completing their 1 year internship in May 2005. They will then be eligible for appointment as APNs.

With this prospect the question that should be addressed at this conference is how APNs can position themselves and make a visible difference in healthcare. You should use this conference as a platform to discuss the issues and challenges that face APNs.

Improvement in Outcomes of Care

International experiences demonstrate that APNs are effective in initiating management of common acute illnesses and injuries as well as managing stable chronic conditions with an emphasis on health promotion and disease prevention.

Many studies have been conducted to gauge the outcomes of care provided by APNs. Early studies found that in an appropriate setting, patient care and outcomes were of equivalent quality to that provided by physicians, and patients were satisfied with their care. More recent studies have shown that APNs' intervention and care contributed to decreased length of stay, fewer hospital admissions, decreased readmission rates and decreased healthcare costs. Such outcome studies clearly define the positive impact of APNs and establish them as cost-effective caregivers of quality healthcare.

The challenge for us in Singapore is...as advanced practice nursing is introduced into our healthcare system and the scope of the APNs is mapped and expanded, to measure rigorously, the impact of APN interventions on our healthcare processes.

In this respect, I am glad to note that a section in this conference is devoted to a discussion on measuring the impact of APNs on patient outcomes. I encourage you to make use of this time to formulate robust outcome indicators so that we can measure and monitor advanced practice nursing interventions.

Demonstrating a positive outcome would make advanced practice nursing visible in the eyes of policy makers, other healthcare professionals and the public.

Role Development of Advance Practice Nurses

Let me share with you my vision of a healthcare delivery system integrating APNs. In our current practice be it in the primary care setting or acute care setting significant gaps can exist.

In the primary care setting I would like to see APNs take primary healthcare a step forward. APNs working with family physicians, can manage nurse-led follow-up clinic services for patients with chronic diseases. They can also conduct patient education and counseling sessions which will include re-enforcement of self-management skills, emphasis on medication adherence and evaluation of treatment.

I have illustrated the APNs role in a primary care setting. APNs trained in other settings should be able to position themselves similarly.

In an acute tertiary care setting although the specialist physician is available and directs the care, the demands placed on him generally do not allow him to deliver all aspects of the care personally. He relies on his team to do this. His team comprises among others, junior doctors in training. These doctors may have only recently taken up their position in the department and hence lack specific experience.

As they learn the skills the senior amongst them work beyond normal limits to ensure that the care delivered is of consistently high quality. When APNs, trained in an acute care setting, are available as part of the healthcare team, I expect the prescribed care to be delivered consistently with ease.

Challenges Facing Advanced Practice Nurses

Here in Singapore, advanced practice nursing is new. How will the nurse at the bedside view an APN?  How does the medical profession view APNs?  Being part of a team, APNs require the support of other healthcare professionals in order to be successful. To reduce role ambiguity and promote understanding, we have to clearly define, integrate and articulate their roles, boundaries and objectives to relevant stakeholders.  

Important in this scheme of things is that neither the medical nor nursing personnel be profession centric. They must see themselves as healthcare professionals, collaborating to deliver patient centric quality care.

I am currently working closely with the Chairmen Medical Boards, Chief Nursing Officer's office and Directors of Nursing to articulate the potential role of APNs in Singapore.

Although international experience will tend to dictate the role for APNs here in Singapore, we must review our own needs and wants and position APNs so that their potential will be optimized within the framework of healthcare delivery in Singapore.

Nurses as Educators

Before I conclude, I would like to emphasise another crucial point not only for APNs but for all nurses. It is the role of every professional nurse to be involved in teaching of the student and junior nurses. I am not suggesting that all nurses should pursue an education track or be academics. Rather, I would like to see more nurses involved in education either voluntarily in their work settings, in continuing education lectures or seminars or as adjunct staff with the various Schools of Nursing.

My vision is as we start on this journey, to equip nurses with the pedagogical skills to teach and guide the student and junior nurses and in so doing ultimately prepare themselves and their students to deliver high quality and effective care to their patients. 

I am pleased to inform you that my Ministry has collaborated with the National Institute of Education to offer a part time Postgraduate Diploma in Higher Education for Healthcare Professionals. This program, which will commence in April this year, will provide the knowledge and pedagogical skills to be effective educators. I have also spoken to the Directors at the Nanyang Polytechnic and the Institute of Technical Education College to conduct short courses for nurses to equip them with the knowledge and skills of being an Educator.

Such programs have the ability to influence the effectiveness and quality of nursing education, and ultimately impact on student learning and outcomes in clinical settings.

I encourage all of you to take up these courses and engage in the process of educating the nurses of tomorrow. As professionals, working on the ground, your involvement as adjunct teachers or casually in teaching, will also result in you constantly upgrading yourself, transforming yourself into a lifelong learner and life long teacher. 

Through effective teaching and mentoring, you will foster the development of your profession. I have no illusions that the better teachers amongst you will be snapped up by our teaching institutions and will be a significant loss for our healthcare institutions but if this means, in the long term, better educators for the profession  we should gladly welcome it.

Conclusion

Summing up, I would like to emphasise that the APN will be a new health professional here in Singapore. Undeniably, they have the potential to be key players in the provision of cost-effective quality healthcare services. Let us seize this opportunity to restructure aspects of our healthcare delivery systems, incorporate the services of the APN and improve the provision of healthcare for the benefit of our patients.

On that note, I wish you all a fulfilling conference and an enriching experience learning and sharing with each other as we begin a new journey.