Speech by Mr Gan Kim Yong, Minister for Health, at the Nurses' Merit Award 2014 Presentation and Lunch, 6 Aug 2014

Nurses,

Distinguished Guests,

Ladies and Gentlemen

Introduction

           It is my pleasure to be with you here today to recognise and celebrate the achievements of the Nurses’ Merit Award winners this year.

2.              The nursing profession in Singapore has come a long way since it began in 1885. Today, the 36,000^[1] skilled nurses form the backbone of the healthcare system. They work across the entire healthcare spectrum, from health promotion, disease prevention, care coordination to acute care and palliative care. Nurses care for their patients and families in a holistic way that often goes beyond clinical care to also include social, emotional and psychological support.

3.              The scope and practice of nursing has also expanded over the years in response to our evolving healthcare needs.  With an ageing population and rising incidents of chronic and more complex conditions, nurses have increasingly taken on greater roles and heavier responsibilities such as instituting first responder interventions, active patient and caregiver education, specialised nursing treatment and management of chronic diseases.  The introduction of the three nursing career tracks – Clinical, Education and Management – in 2001 has allowed nurses to advance and take on bigger roles in ensuring that patients receive safe, appropriate and cost-effective care.   

Changes in the Healthcare Landscape

4.           To keep up with a growing demand for healthcare needs arising from an ageing population, we are building more capacity under the Healthcare 2020 masterplan.  We are also introducing Medishield Life to enhance the affordability of healthcare for all Singaporeans. However, beyond increasing healthcare capacity and affordability, we need to also transform the delivery of care.

5.           We need to step up upstream efforts on preventive health and encourage more Singaporeans to adopt healthy lifestyles so as to prevent or delay the onset of chronic diseases in the first instance. We need to rely less on acute hospital care and focus more on primary care in caring for seniors with multiple conditions. There is also a need to build up the Intermediate and Long Term Care (ILTC) sector to support an ageing population.

6.           Nurses are at the forefront of this effort to transform our healthcare system, through the myriad of roles they play.  It is an exciting time to be a nurse, as opportunities abound across care settings.  More nurses will be needed, and we must equip our nurses with higher skills and knowledge and allow them to practice at the top of their license and lead the change in our healthcare system.

National Nursing Taskforce Recommendations

7.              With these challenges in mind, the Ministry of Health set up the National Nursing Taskforce (NNT) to chart the future direction for the nursing profession.  Chief Nursing Officer Dr Pauline Tan and Group CEO, Alexandra Health System Mr Liak Teng Lit, led the Steering Committee of the Taskforce. The Taskforce comprised more than 60 representatives from nursing, medical and administrators from the public and ILTC sectors, as well as representatives from nursing education and the Ministry of Health, to recommend ways to boost the attraction and retention of nurses, strengthen the Singaporean core in the nursing workforce and support the growth and development of the nursing profession. I would like to thank Pauline, Mr Liak and the Taskforce for their hard work.

8.              The Taskforce has made 15 wide-ranging recommendations, which have been accepted by my Ministry. The recommendations are in four key areas – (i) Career development, (ii) Autonomy, (iii) Recognition and (iv) Education – or “CARE” in short. The “CARE” programme will strengthen the development of the nursing profession and empower nurses to take on expanded roles.  Through “CARE” for our nurses, we hope that our nurses can in turn become better patient advocates.  Let me now elaborate on the key recommendations in each area.

Career Development

9.           On career development, nurses are an essential part of the healthcare workforce, and we want to give our nurses attractive career opportunities and pathways, so that they can fulfil their aspirations.

10.       First, more Enrolled Nurses will have the opportunity to be upgraded. Today, Enrolled Nurses can progress to become Senior Enrolled Nurses and Principal Enrolled NurseS. We also recognise that many Enrolled Nurses aspire to become Staff Nurses so that they can take on higher responsibilities.

11.       To help these nurses fulfil their aspiration of becoming a Staff Nurse, we will revise the eligibility criteria for the part-time bridging course so that Enrolled Nurses who did not meet the requirement of 2.8 GPA in their NITEC nursing course will be eligible to enrol into the Nanyang and Ngee Ann Polytechnics’ bridging courses, as long as they have at least three years of post-enrolment nursing work experience and employer’s testimonial. This recognition of prior working experience for upgrading will provide more progression opportunities for Enrolled Nurses.

12.       Second, the apex of the nursing track will be re-designated from ‘Director of Nursing’ to ‘Chief Nurse’ to better recognise the size and span of control of the top nursing job.

13.       Third, we will introduce a new Assistant Nurse Clinician (ANC) role to expose nurses to leadership development and opportunities earlier in their career. The creation of this new role will also enable good performing Senior Staff Nurses to assume supervisory and leadership roles earlier, under the guidance of their Nurse Manager and Nurse Clinician. ANCs will be team leaders who will contribute to professional capability building by providing supervision and clinical guidance to the less experienced colleagues. 

14.       Fourth, we will strive to make flexible and part-time work arrangements more accessible to nurses who need them. Very often, we hear about a nurse colleague who has to take a break from her career as a nurse because she finds it a challenge to balance her work with family commitments. For a profession where over 90% are female, and who may also have to care for young children or elderly parents at home, we can do more to provide flexible work arrangements to retain such nurses. With an aging nursing workforce, part-time work options can also allow us to better tap on the experience of older nurses who would otherwise have retired.

Autonomy

15.       Our nurses must not only have a sense of purpose, mastery in skills and competencies, but also the autonomy to discharge their roles effectively. Autonomy is our second area of focus under CARE.

16.       First, we need to expand nurses’ clinical accountability and decision-making authority, as we enhance the training of our nurses. Nurses’ roles will be expanded to enable them to make protocol-based diagnoses and investigations for certain disease profiles and to order treatment. MOH will also be working towards granting experienced senior nurses, i.e. the Advanced Practice Nurses (APNs) and Nurse Clinicians, the authority to prescribe medicines for stable patients when they work alongside doctors collaboratively.

17.       With advancement in nursing education, nurses are capable of taking greater initiative for patient management. They will play greater roles, for example, in running nurse-managed rehabilitation wards, nurse-led clinics and nurse-initiated referrals. Some of these ‘expanded scopes’ are already successfully practiced in our public healthcare institutions.

18.       For example, APNs Karen Koh and Ng Wai May, this year’s President Award winners, have successfully initiated and are managing APN Cardiac Rehabilitation and APN Stroke clinics, respectively.

19.       Karen helps post-discharge cardiac patients to have better control of their conditions. She supports them to adopt a healthier lifestyle. She typically reviews patients’ rehabilitation progress, detects emerging signs and symptoms and looks out for any side effects of medications. She orders the necessary investigations and manages medical treatment as required.

20.       At the Stroke Clinic, Wai May does a comprehensive assessment of patients with neurological deficits and monitors their recovery. She orders appropriate investigations, detects any adverse effects of medications and works with patients to manage their risk factors. She also provides stroke education to patients and their family members.

21.           In KKH, Nurse Midwives provide independent midwifery care for low-risk pregnant women in the 28- to 38-week gestation period. They also follow up on postnatal mothers with uneventful normal delivery.

22.          My Ministry will work towards enabling nurses to practice at the top of their competencies, training and education.

23.          Second, nurses need to be supported by automation and the use of technology.  As part of the drive for higher productivity and innovation in the healthcare sector, public healthcare institutions have been adopting technologies that will help ease the workload of nurses and support them in their work.

24.          Tan Tock Seng Hospital (TTSH) implemented SmartSense system in 2008 to automatically monitor and record patients’ vital signs in real-time. Their nurses are able to perform these checks unobtrusively on patients, without disrupting rest. The potential for human errors in vital signs recording has also been minimised. This year, the system has been enhanced with the Aggregate Warning Score (AWAS) algorithm to expand the real-time monitoring to include patients' systolic blood pressure, heart rate, respiratory rate and oxygen saturation.  This smart hospital system now alerts nurses on any clinical deterioration, and proactively highlights the urgency and scale of attention needed. Treatment has become more timely as a result.  This technology not only improves the productivity of nurses by reducing the amount of time they spend monitoring vital signs, it is also transforming the way nurses are delivering care by raising the bar on patient safety and quality.

25.          Khoo Teck Puat Hospital (KTPH) has also eliminated the need for nurses to do manual charting of vital signs, as the medical device interfaces now allow the data to flow directly into the Electronic Medical Records system. IP telephony and instant messaging have also been implemented to improve communications and strengthen collaboration between nurses and doctors, instead of relying on conventional phone calls and SMSes.

26.          We will continue to encourage nurses to lead project teams to identify, engage and disseminate best practices across the healthcare institutions to promote better patient care and system optimisation. Besides investing in automation and use of technology, we will also invest in upskilling support care staff to better support the nurses by taking over work delegated from nurses.

Recognition

27.          I have covered the ‘C’ and ‘A’ in CARE – Career Development and Autonomy. Let me now move on to ‘R’ – Recognition.

28.          To ensure that the recognition for nurses is commensurate with their expanding roles and competitive with the market, the NNT has reviewed the pay of public sector nurses. Nurses in public healthcare and MOH-subvented ILTC institutions can look forward to two key enhancements. First, they will receive a 5 to 20% increase in their monthly base salaries, in two stages: in 2014 and 2015. Second, a new annual Nurse Special Payment of 0.5 month will be introduced with effect from December 2014.

29.          These salary enhancements are part of our continuous efforts to better attract and retain nurses in the public healthcare sector, and ensure salaries remain competitive.

30.          In recognition of the important work of nurses, we will enhance the national nursing awards. These will include the President Award for Nurses and Nurses Merit Award. I’m pleased to note that the Lee Foundation has also expressed their support by stepping up the quanta for the Tan Chin Tuan Award for Enrolled Nurses.

Education

31.          Finally, we need to invest in Education to help our nurses develop to their fullest potential.  We must constantly support them in acquiring new knowledge and skills and to practise to the full extent of their training and education.

32.          The NNT recommends better support for nurses in acquiring advanced knowledge, inquiry skills as well as leadership capabilities, and to practise nursing at the top of their license.

33.          APNs play a key role in our healthcare system as leaders and educators. The APN internship will be enhanced to make it more structured and standardised across the healthcare systemto meet national needs. To address expanding healthcare needs, we will develop more APNs to be based in the wards to manage Inpatients, helm APN clinics to manage chronic diseases at the Polyclinics and Community Health Centres and lead community and home care teams in the ILTC sector.

34.          Next, post-registration nursing training will be recalibrated to be broad-based with an added emphasis on community nursing and rotation to the intermediate and long term care. This change is necessary to equip nurses to manage patients who today, present with multiple clinical care needs and co-morbidities regardless of setting or institution. It will also help enable nurses to deliver holistic and integrated practice across the various care settings.

35.          At the same time, more nurses can look forward to sponsorships for upgrading programmes. My Ministry will increase funding for sponsorships for EN bridging courses, diploma and advanced diploma courses as well as, degree and masters programmes so as to support nurses in lifelong learning and the continuous development of their skills and knowledge.

36.       To anchor our efforts in nursing education, a National Council of Nursing Education will be set up under the auspices of the Chief Nursing Officer’s (CNO) office to oversee and enhance nursing education training and development. The Council will serve as a national level body to coordinate and monitor the quality, adequacy and standards of nursing education.

Conclusion

37.       Through their dedication and commitment, they have touched the lives of many patients and their family members. My Ministry is committed to continue our efforts to support and promote the nursing profession.  Together, we can make a difference to the lives of nurses who have made a difference in ours.

I congratulate our 81 Nurses Merit Award recipients. On this note, I wish you all a Happy Nurses Day!

^[1] Nurses registered with Singapore Nursing Board as at 31 Dec 2013.

Visit the CARE for Nurses microsite.