Speech by Dr Amy Khor, Senior Minister of State, Ministry of Health, at the Nurses’ Merit Awards 2015 Dinner and Dance, 24 July 2015

Nurses,
Distinguished Guests,
Ladies and Gentlemen

Introduction

1.            I am very happy to join you today to celebrate Nurses Day and the achievements made by our nurses.  As we celebrate 50 years of nation building this year, we also celebrate 130 years of nursing in Singapore. The nursing profession is a noble and impactful one. Nurses have always constituted the core of the healthcare workforce, and continue to play key roles in delivering exemplary care to Singaporeans.

2.            From Singapore’s early days, nurses were at the frontline of national efforts to ensure the health of our population despite the lack of basic amenities like clean water, sanitation and electricity.They had to travel to the kampungs and nearby islands to reach those who needed care. They managed with simple equipment and instruments, even having to sharpen and boil needles manually. Today, healthcare technology and facilities have improved greatly and nursing has come a long way against the backdrop of changing needs and demands of our population. But one thing remains the same - nurses continue to care for their patients with the same selflessness.

3.            I sincerely thank you, our nurses, for your outstanding dedication and commitment. To celebrate the rich history of nursing in Singapore, I am happy to share that we will be launching a print advertisement on “Nursing through the ages”. Do keep a look out for it next week around Nurses’ Day!

(I)           Update on Implementation of National Nursing Taskforce Recommendations

4.            This time last year, the Ministry of Health (MOH) accepted the 15 recommendations made by the National Nursing Taskforce (NNT) in the areas of Career Development, Autonomy, Recognition and Education (CARE).  We are making steady progress on implementing the CARE package recommendations. Last year, more than 22,000 nurses in the public healthcare clusters and MOH-subvented Intermediate and Long-Term Care (ILTC) institutions received the first of two rounds of monthly pay increases of 3-10% and the Nurse Special Payment of half a month. This coming October 2015, they will receive the second round of monthly salary increases of another 3 to 10%. They will also receive the annual Nurse Special Payment, which is half of their monthly base salary for 2015, in December this year.

5.            We have also revised the eligibility criteria for the Certificate in Bridging Studies for Enrolled Nurses (ENs) from Academic Year 2015, to enable ENs with below 2.8 Grade Point Average (GPA) in their NITEC nursing course, and who have at least three years of post-enrolment nursing work experience and employer’s testimonial, to apply for the part-time bridging courses. Close to 180 ENs have enrolled in the bridging courses at Nanyang Polytechnic (NYP) and Ngee Ann Polytechnic (NP), as compared to 45 last year at NYP. This four-fold increase in the number of ENs signing up for the Bridging Studies is encouraging news as we see more ENs embrace opportunities for them to upgrade to become Registered Nurses (RNs). This is in line with our SkillsFuture initiative to help Singaporeans upgrade and maximise their potential. 

(II)         Nursing – A Fulfilling Lifelong Career

6.            Nursing is a meaningful profession, and we want to help our nurses build fulfilling lifelong careers.  First, to provide better career progression opportunities, we have created a new “Assistant Nurse Clinician (ANC)” role. Close to 400 or 17 percent of the Senior Staff Nurses Grade I in the public healthcare clusters are being promoted from July 2015 to the ANC grade. ANCs will be ward team leaders who contribute to capability building by providing clinical supervision and guidance to their nursing colleagues. 

7.            For example, ANC Zarina Bte Ahmad from Changi General Hospital was promoted to ANC on 1 July 2015. She is now a team leader who guides a team of nurses. Zarina reviews assignments for the team, and also undertakes the care of clinically complex patients in her ward.  

8.            Another example is ANC Satran Kaur from Choa Chu Kang Polyclinic. With her new role as Assistant Nurse Clinician in the children’s health services, she assists the nurse manager in leading the nursing care team in the polyclinic. This includes looking at ways to strengthen the delivery of children’s health services and to mentor other nurses. 

9.            Second, we are grooming more public sector nurses to become Advanced Practice Nurses (APNs) who can provide complex nursing care to patients. Today, we have 145 APNs who practise across four specialty areas of acute, medical/surgical care, community as well as mental health. This year, the Master of Nursing course at the NUS Alice Lee School of Nursing has seen an increase in the intake to 33 students, as compared to an average of 25 over the past three years.  We will continue to develop more APNs, to serve the growing elderly population and those with chronic conditions.

10.        Third, we recognise that our nurses also play multiple roles. As much as they are caregivers to their patients, they are also mothers/ fathers, wives/ husbands and daughters/ sons. To better support our nurses in balancing their personal and career aspirations, we are also looking into implementing more flexible work arrangements in public healthcare institutions. Since the start of this year, a workgroup comprising MOH, nursing and HR representatives from the hospitals have been working with nurses in selected wards in the Changi General Hospital, KK Women’s and Children’s Hospital, Singapore General Hospital and Tan Tock Seng Hospital to pilot flexible work arrangements. 

11.        In these pilots, nurse leaders worked with their nurses to review existing work processes and how best to meet their service needs while accommodating flexible work patterns. For example, some of the pilot wards have brought forward the start of the afternoon shift, so that the nurses on the afternoon shift can now spend more time with their families and friends after work. Feedback from the pilot wards has been encouraging. The participants of the pilot generally welcomed the initiative, with 80% wanting even more flexibility in their shift patterns.

12.         As the pilot institutions continue to refine their practices, we are also exploring the use of IT systems to help the nurse managers in their scheduling. The IT systems will cut down the time nurses spend on scheduling, and allow them to explore more work arrangements to accommodate the different work-life needs of nurses and to expand the care we provide.

13.        Fourth, we are also working towards better retention of experienced nurses who wish to continue working beyond the retirement age in the public sector. Close to 300 of our nurses are already working beyond age 62. Their dedication and commitment to public service is an example to all of us. Our public healthcare institutions are actively implementing measures for experienced older nurses to continue contributing meaningfully in their roles. For example, to tap on the wealth of experience and expertise older nurses bring with them, some also take on the role of mentors to guide the next generation of nurses.

(III)       Keeping At the Forefront & Supporting Care Transformation

14.        We want to continue empowering our nurses through technological improvements. For instance, the National University Hospital has piloted the use of Visimobile to monitor patients’ vital signs remotely, and automatically trigger an alarm should any deterioration in patients’ conditions be detected. This is a step up from existing vital sign recording systems as it can also monitor respiration rates. In the ILTC sector, nursing homes such as Man Fut Tong Nursing Home, St Andrew’s Nursing Home and Peacehaven Nursing Home have also started productivity projects to facilitate nurses in taking the vital signs of their residents.

15.        The Singapore General Hospital, KK Women and Children’s Hospital and the National Heart Centre will be piloting a project where patients’ vital signs are automatically transferred in real-time into electronic medical records and updated to a clinical dashboard. The project also includes the Unified Digital Communication System which enables nurses to communicate using voice command through a wireless hands-free device while on the move.

16.        With the help of technology, our nurses are empowered to take on expanded roles and as a result derive a greater sense of satisfaction from being able to provide a higher level of care to their patients.

Nursing for the Future

17.        With an ageing population, the need for healthcare provision will continue to grow, especially in new growth areas of community and home care.  The work of integrating care will become all the more critical as care shifts from the hospital to the community. Nurses will play a key role in working closely with healthcare professionals in the different settings, and also with the patient and his or her family, to ensure that the patient continues to be well-cared for.

18.        We have been growing the pool of specialty trained nurses in the community. Under the Social and Health Manpower Development Programme – ILTC (SHMDP-ILTC), around 150 nurses in the ILTC sector have received training in specialised skills over the past five years to deepen their skills and knowledge in relevant areas such as gerontology, palliative care and chronic disease management. We are also training more community-based APNs.

19.        The community APNs will work with patients with subacute medical conditions who are frequently hospitalised, detect acute exacerbation and flag them early to the home medical team or other primary or tertiary healthcare providers for intervention. This would reduce unnecessary attendance at Emergency department and admission. By connecting the dots with other service providers to support the elderly, it would allow the elderly to age in place.

20.        We currently have 2 APNs in the ILTC sector: APN Sylvia Lee at Dover Park Hospice and APN Kahvidah at HCA Hospice. APN Sylvia Lee became an APN in 2006. Since 2012, she has been serving at the Dover Park Home Care - an Integrated Palliative Home Care Services, which is a new model of care. Sylvia performs comprehensive palliative care assessments that reflect holistic care such as identifying the physical, psychological, social and spiritual needs of patients and families. She is also involved in various initiatives to drive the development of Palliative Care Nursing in Singapore.

Conclusion

21.        To conclude, nursing has come a long way. The role of nurses will not diminish but only grow in importance in the future. We are making steady efforts to enhance nursing as a profession and we will continue to invest in our nurses and support them to be at the forefront of healthcare tomorrow.

22.        Thank you.