Ensuring Adequate Rest for Nurses

Name and Constituency of Member of ParliamentMr Louis Ng Kok KwangMP for Nee Soon GRC

NOTICE PAPER NO. 1240
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022

Question No. 3129

To ask the Minister for Health (a) what is the minimum number of hours of rest a nurse should have between shifts; and (b) how does the Ministry ensure that restructured hospitals’ rosters allow nurses to have that minimum number of hours of rest.

NOTICE PAPER NO. 1240
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022

Question No. 3130

To ask the Minister for Health whether the Ministry will broaden the National Wellness Committee's scope of work to also include the working hours and conditions of nurses instead of only for junior doctors.

NOTICE PAPER NO. 1240
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 2 AUGUST 2022

Question No. 3135

To ask the Minister for Health for each year in the past five years, what is the average and median nurse-to-patient ratio for (i) general wards and (ii) intensive care units respectively.

NOTICE PAPER NO. 1240
NOTICE OF QUESTION FOR ORAL ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 2 AUGUST 2022

Question No. 3136

To ask the Minister for Health (a) what steps has the Ministry taken to reduce the administrative workload of nurses in restructured hospitals; (b) whether additional steps will be taken; and (c) if so, what are they.

NOTICE PAPER NO. 1240
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 1 AUGUST 2022

Question No. 1929

To ask the Minister for Health in each of the past five years, how many and what percentage of local and foreign nurses respectively have resigned from the restructured hospitals.

NOTICE PAPER NO. 1240
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON OR AFTER 2 AUGUST 2022

Question No. 1931

To ask the Minister for Health for each year in the past five years, what is the median and average salary for nurses and ancillary care staff in (i) private hospitals and (ii) restructured hospitals respectively.

Answer

Mdm Speaker, may I take questions 12 and 13 together?

My answer will also address question 36 for written answer from today’s Order Paper, questions 20 and 21 for oral answer, and question 53 for written answer raised by Mr Louis Ng from the Order Paper on 1 August 2022.

Thank you, Mr Ng, for your concern over our nursing workforce. I believe it is also not too late for me to wish all nurses in Singapore a Happy Nurses Day.

Over the last five years, there has been a slight overall increase in the attrition rates for local nurses. The attrition of local public sector nurses increased from 6.0% in 2017 to 6.3% in 2018 and 7.0% in 2019, then dropped to 5.4% in 2020, before increasing to 7.4% in 2021. For foreign public sector nurses, international competition has been more intense and attrition rate has increased more significantly, from 8.2% in 2017 to 9.1% in 2018 and 9.4% in 2019, then dropped to 7.0% in 2020, before increasing to 14.8% in 2021.

The typical nurse-to-bed ratio for general wards in the public acute hospitals is 1 nurse for every 4 or 5 beds. The typical nurse-to-patient ratio in the Intensive Care Unit (ICU) in the public acute hospitals is 1 nurse for each ICU patient and could be higher, such as 2 nurses for more complex ICU cases. This has not changed significantly over the past 5 years.

Mr Ng had asked for salary comparison between private and public hospital nurses. We are reluctant to provide this so openly, as we know that both sectors compete for manpower. We also do not have the data for the private sector.

I will however share a few data points. Staff Nurses (SNs) and Senior Staff Nurses (SSNs) form the largest proportion of our nursing workforce.  The median annual salaries for SNs ranged from $42,800 to $53,700 in 2017, and rose to $46,300 to $58,500 in 2021, while that for SSNs ranged from $65,000 to $79,700 in 2017, increasing to $71,200 to $87,600 in 2021. In general, it takes an average 4 to 6 years for a fresh graduate to move up to SSN. Hence, an SN in 2017 may be drawing the annual salary in the SSN range by 2021.

The key issue is to retain the services of nurses. Our strategy to stabilise the nursing workforce covers several key aspects. These include reviewing the scope of work that nurses are doing to enable them to spend more time on direct patient care. Equally important is to ensure remunerations are competitive, locally and also internationally.  

On reviewing the scope of work, our public healthcare institutions adopt a multi-prong approach to reduce the administrative workload for nurses and enable nurses to focus on patient care. This includes streamlining care processes and deploying dedicated administrative and support care to assist nurses. Over time, we have also introduced innovations in automation, technology, robotics, and AI-enabled technology to assist nurses and healthcare staff, to ease the load of non-clinical and administrative tasks. An example of such technology is the Nursing Software Suite, introduced by Singapore Health Services (SHS) in their hospitals to enable patients to self-help, such as enabling them to check their results, medications, schedules for tests, and indicating their requests to the care team.

Other than reviewing job scope and administrative workload, as our population ages, there will continue to be growing demands on healthcare manpower.  I also urge families and caregivers to be a partner in the care journey of your loved ones, as working together with us will help alleviate the workload faced by our healthcare staff.

Mr Ng also asked if the National Wellness Committee for Junior Doctors (NWC-JD) could broaden its scope of work to include the working hours and conditions of nurses. We would like to explain that the NWC-JD was formed to specifically address issues related to junior doctors. These need to be tackled differently in the case of junior doctors because of their regular rotations across the public healthcare system, compared to other staff groups who are employed directly by the respective public healthcare clusters. MOH and the public healthcare clusters have always been concerned about the well-being of nurses and other staff groups. For example, we had formed an internal cross-cluster Staff Well-being Committee in 2019 for clusters to share best practices with each other and provide feedback to MOH on enhancements to improve staff well-being across all categories of staff. One example of its recommendations was for MOH to look deeper into the issues of abuse and harassment of healthcare workers, hence we announced earlier in March 2022 the formation of a Tripartite Workgroup to address this nationally. Clusters have also enhanced their support measures for staff. For example, Chief Wellness Officers have been appointed by clusters to oversee and develop system changes to improve the well-being of all healthcare staff. Counselling services, peer-support networks and staff support assistance plans have also been put in place to support staff.

The rest day provisions and work hour limits for public healthcare workers are stipulated in the Employment Act or set out in the public healthcare clusters’ employment contracts, as previously explained to Mr Ng in Parliament in March. While the Ministry does not impose a minimum number of rest hours, duty rosters for nurses are planned in advance to ensure staff have adequate rest between shifts.

Even as we prioritise the well-being of our nurses, we appreciate the reality of their work, which is to deliver timely and quality patient care. The Ministry is working to ensure there are sufficient nurses on the ground. In fact, the registered stock of nurses over the past few years has remained stable, with a slight increase from around 42,800 in end 2019, to 43,000 in end 2021. Local nursing intakes have also increased from around 1,500 in 2014 to around 2,100 in 2021 to ensure that there is a stable inflow of nursing manpower into our healthcare system.

We understand the importance of recognising nurses’ contributions and the Ministry has worked on reviewing their salaries and allowances.  Over the last five years, the annual salaries of local nurses in public healthcare institutions – which comprises base salary, allowances and bonuses – have increased.

With the easing of COVID-19, public healthcare institutions have been allowing nurses to take time off work to rest and recover. This includes allowing foreign staff to return home to spend time with their loved ones, after a long period of time away from them in 2020 and 2021 when many borders were closed and travel restrictions in effect.  We know from clusters’ data that leave is being approved and allowed.

MOH remains committed to provide support to the public healthcare clusters in our efforts to ensure that there is sufficient manpower on the ground, and look after the well-being of our nurses as they continue to face pressures from COVID-19 surge waves and an ageing population.