PS’ Opening Address at the 1st NUS-NUH International Nursing Conference 17 November 2011

I am honoured to join you at this inaugural NUS-NUH International Nursing Conference this afternoon.  

2    Nursing has come a very long way as a professional community in Singapore. In the early days, our hospitals did not have trained nurses and had to rely on untrained helpers for basic care duties. Nursing as a profession according to our history books started in 1885, with just four nuns from the local French Convent who answered the call to train as nurses and it has gone from strength to strength. Today, 126 years on, nurses make up the majority of our healthcare professionals delivering care at the frontline – with more than one out of every two healthcare professionals in Singapore being a nurse. This inaugural nursing conference provides a wonderful, timely opportunity to bring together nurses from different backgrounds and countries to share their experiences and examine the evolving role of nursing going forward.

Growing emphasis on community and home care

3    As you are aware, the demands on healthcare are ever-increasing, with an ageing population and the need to keep up with growing patient expectations. Healthcare itself is also moving forward with medical and technology advances and these are also creating challenges. The costs of providing healthcare will also go up with advances in medical treatments and newer drugs. What does this mean for all of us who work in healthcare? How do we ensure that we continue to keep healthcare costs affordable for the population that we serve?
 
4    There is a global recognition that healthcare has to be re-organised if we are to meet the dual challenges of an ageing population and the rising chronic disease burden. Thus far, Singapore has focused on building up our capabilities generally in the acute care setting and our efforts in this area have paid off. Today, we have an excellent tertiary care infrastructure that provides high quality and affordable care. But we cannot just address the challenge of this rising demand for healthcare by simply doing more of the same.

5    Going forward, we will need to extend healthcare into the community and the home. Hospitals continue to have an important place in the healthcare eco-system as a specialised unit for intensive treatment and acute care at critical junctures in the patient’s care. But hospital services with highly specialised and sub-specialised health professionals and sophisticated equipment are not necessarily the only nor the best solutions to meet the healthcare needs of patients at all times. Nor are they the most cost-effective!
 
Important role of nurses in community and home care

6    We want to support patients in hospital transition back home as early as possible. There is therefore a need to develop and grow the community and home care sector to better support patients and their caregivers. Nurses are the key health care professionals involved in community and home care, managing chronic diseases holistically through nurse-led interventions and patient empowerment. Today, nurses play important care roles outside of the hospitals in community health centres, primary health clinics, schools and patients’ homes. Nurses in primary care for example advise and help patients with the management of chronic diseases and common illnesses in primary care. Others bring the message of health promotion and disease prevention to schools and the community, and educate patients and their caregivers about health-related matters.  

7    As essential members of the healthcare team, our nurses need to be equipped not only with the professional knowledge and skills to work in the acute care setting, but also the competency to enhance care for patients in the community and home settings. They will need to learn critical skills such as how to educate patients and their families on relevant health matters so as to enhance their health literacy. This includes guiding patients’ families on how to improve the home environment to facilitate the caring process. We in Singapore are committed to providing more specialised training, through the Advanced Diploma programmes in chronic disease management and community health, to equip our nurses with these necessary skills and knowledge that they need to lead in the community and home care settings.

8    As we continue to train more nurses to support community and home care, I am heartened that we already have some highly-trained Advanced Practice Nurses who are making advances in community and home care today. Let me cite an example. Ms. Jasmine Kang, an Advanced Practice Nurse (APN) in Geriatric Care at Tan Tock Seng Hospital, is currently managing post-discharge patients in the Post Acute Care Hospital. She does home visits to frail elderly patients to review their conditions and empowers care-givers at home with the knowledge and skills to look after the patients at home and avoid re-admissions to the hospital. The work she does exemplifies the continuity of care from the hospital to the home and community that we are trying to achieve in the Singapore health system.  
 
Exciting Developments In Nursing As a Profession  

9    Besides community and home nursing, there are exciting developments in other aspects of nursing. Indeed, nursing as a profession in Singapore is pushing the boundaries of the practice of nursing and changing how healthcare is delivered. We have introduced nursing programmes at the Bachelor, Master and PhD levels at the Alice Lee Centre for Nursing Studies at the National University of Singapore.

10    In particular, our Master-level trained APNs are pushing the peak of specialisation, working as independent partners to the doctors in their respective areas of expertise and performing work of high complexity. APNs in Acute Care for example, are contributing to the care of very ill patients in the intensive care units. They are trained to perform invasive procedures and lead daily multidisciplinary patient rounds in caring for the patients. They also have to recommend treatments and procedures in a high-tech, fast-paced, and high-stress environment where the stakes are high. This is very demanding and complex work, but our APNs in Acute Care setting have risen up to the challenge and are charting new frontiers in nursing.   

Building New Nursing Capabilities

11    As the healthcare context evolves, it will open up new opportunities for the nursing profession in terms of roles and responsibilities. Multiple parties are involved in the care of most elderly patients. For example, a diabetic patient might need to see an endocrinologist, an ophthalmologist, a podiatrist, a pharmacist and a nurse clinician and the team works together to care for the patient. Nurses are often the primary human interface with the patient and coordinate the work of the care team.

12    The work of integrating care and ensuring continuity becomes all the more critical as care shifts from the hospital to the community, which can become decentralised. The nurse needs to play this interface and care coordination role in more than one practice setting. This requires a very different set of skills in pulling together the various parts of the system to work together in concert, for the benefit of the patient. The operative words for success will no longer just be ‘knowledge’, ‘clinical skills’ and ‘decision-making’. Nurses also need new capabilities such as the ability to partner effectively with other healthcare professionals and the ability to influence many parties and persuade patients, caregivers and others.  

13    I see that the next step forward will come with nurses taking on a ‘collaborating and leadership role’. Over the years, the momentum has built up with the nursing profession developing its depth of expertise and experience. I believe the nursing profession is poised to take on an integral role, not only in acting as the interface between the patient and the rest of the healthcare system, but also to lead the healthcare system in driving improvements. Recently, I set up a Healthcare Leadership College to drive the development of leaders at all levels in all health care professions. The nursing leadership in the public sector has been the single most aggressive group, in pushing their own capability development, as individuals and as a community.

14    I think this is wonderful because I believe that nurses are not simply part of the healthcare system. Nurses have a key role to play in ‘leading the system’, on issues such as patient safety, process and quality improvements. This requires nurses to take on a systems perspective, and lead not just their own profession, but also collaborate with partners across professions. They must learn to identify problems and bring people to work together in search of solutions that enhance the performance of the healthcare system.

15    I encourage the nursing community to seize opportunities to grow and develop new capabilities in leadership and other areas. Such skills and mindsets are best nurtured and transmitted through an enthusiastic and passionate community. I have seen that enthusiasm and passion shine through. I am happy to see nursing professionals come together as a community today, to discuss new possibilities for advancing healthcare. Such exchanges facilitate the exchange of experiences and the insights you get from the success stories serve to inspire others on the same path.

Conclusion

16    In conclusion, I see exciting developments and new opportunities ahead for the nursing profession. Nursing has long been a noble and meaningful profession through which one can make a real difference to the lives of others. It is now also a challenging and rewarding profession where nurses can aspire to achieve mastery in clinical practice, progress far in their careers and lead changes within the larger healthcare system.

17    On this note, I wish you all a very successful conference and a memorable stay in Singapore.

18    Thank you.