Refreshing the Nursing Career

17 May 2005

By Mr Khaw Boon Wan, Minister For Health

Venue: YWCA Fort Canning Lodge, Singapore

Mrs Reena Bose, President of Commonwealth Nurses Federation

Ms Tan Wee King, President of Singapore Nurses Association

Friends and Colleagues

Refreshing the Nursing Career

This year, Singapore celebrates 120 years of nursing. This is a major achievement, considering the fact that modern Singapore was only founded in 1819. Over this long history, our nurses have kept up with medical progress and contributed significantly to our health.

During the battle against SARS, our nurses stood shoulder-to-shoulder with the rest of the healthcare workers and fought the enemy with courage and dedication. Two of them made the ultimate sacrifice.

During non-crisis times too, our nurses make us proud. For Singapore's high standard of medical care, much credit must go to the commitment and competence of our nurses.

I have the privilege of working with many excellent nurses during my career. They impress me with their devotion to their patients. This is despite the occasional abuse that some patients and relatives unfairly hurl on them. Without their commitment to the profession, many would have become burnt out.

Profiling Our Nurses

That is why I welcome events to profile nurses' achievements and their sacrifice. When Singaporeans' generosity during SARS led to the establishment of a fund, I advised the trustees of the fund to create an annual award with an annual ceremony, to regularly remind Singaporeans of the sacrifice of the hospital workers in general, and nurses in particular, in our battle against SARS.

As a result, we now have the annual Courage Awards to recognise the nurses who have gone the extra mile.

But public campaign and image management aside, sustaining public respect for our nurses require substantial efforts. Respect by peers, doctors and patients have to be earned.

To do so, our nurses have to keep upgrading their skills and pursue lifelong learning. This is the only way to keep in step with scientific advances.

In this respect, I would like to highlight a few important recent initiatives.

Equipping and Empowering our Nurses

Local Nursing Degree

First, we are starting a local nursing degree course in the National University of Singapore. Compared to other countries, we have been slow on this front, but better late than never. NUS will start the first intake of 50 students from next year. The need will however be far greater than this.

Today, 13% of our nurses have acquired a foreign nursing degree. I see the possibility of this proportion going up to 20% in the medium term. Indeed, there is a large appetite for nursing degree courses, not just from Singaporeans, but also from the region. I will not be surprised if we can eventually support more than one local nursing degree course.

Advanced Practice Nurses

Second, we have just amended the Nurses & Midwives Act to set up a register for Advanced Practice Nurses. Again, we have been rather slow on this front, and are now playing catch-up.

The first batch of APNs will complete their internship soon and be eligible for registration. We should ensure that these pioneers perform up to expectation and gain the respect of and acceptance by our doctors and patients. This will establish a viable clinical track for the experienced and skilled nurses who have the necessary advanced qualifications to remain in a clinical setting. This will help retain good nurses in the profession.

Job Restructuring

Third, we are regularly reviewing our hospital work processes, to see how we can better recognise and incorporate the higher potential that our nurses are capable of achieving. This is a continuous process of re-engineering, with no end point. But every year, if we can re-engineer more processes to benefit patients, besides enhancing the job scope of our nurses, I would call that success.

With more opportunities for higher education and professional development, nurses can take on new duties that are previously the sole domain of doctors. With structured training, and rigorous credentialing, nurses can do a competent job. This would make some otherwise costly procedures more accessible and affordable to a larger number of patients, and allow doctors more time for the complex cases.

Revival of Interest in Nursing

With the global shortage of nurses becoming more acute, we have a strong interest to ensure that the nursing career remains attractive.

Nursing is a respectable and meaningful career. We have been tireless in promoting nursing as such a career, with numerous career exhibitions and talks at schools. The results are beginning to show. I have observed a strong revival of interest in the nursing career among the young. The intake of local nursing students at our Nanyang Polytechnic has more than doubled from 322 in 2000 to 752 in 2004.

Besides targeting the young, in 2003 we launched a manpower conversion programme to allow mid-career workers who are interested to take up nursing. This programme has been well-subscribed. Interestingly, we see a higher percentage of men amongst this group of mid-career entrants: 30% versus the 8% in the total registered nurse population.

Accelerating Training Capacity

This year, the nursing student intake is expected to surpass our projection target again. We may have to turn away many applicants who are well-qualified to do the nursing course. This is a pity.

Let's ramp up our training capacity. Next week, a second polytechnic, Ngee Ann Polytechnic, will begin offering the Nursing Diploma course. It will start with a modest intake, but will expand quickly to help meet the rising demand.

The nursing schools would need to employ more nurse educators and clinical instructors. Innovative teaching models need to be explored in order that education standards are not compromised. Self-directed learning, projects and greater use of IT could be included in the curriculum to lessen the demand for didactic teaching.

To enlarge the faculty, suitably-qualified nurses in healthcare institutions could be appointed as adjunct nurse educators. This is a win-win situation. The hospitals would have a better understanding of the demands in nursing education while the nursing schools are kept abreast of the developments in clinical practice.

A good source of potential clinical instructors will come from senior nurses who are contemplating a second career. They can supervise nursing students during their clinical attachments. They are good role models and will help pass on strong professional values to the students.

Transforming Healthcare

As I see it, medical practice cannot remain unchanged. Globally, from China to US, patients are crying out against rising healthcare cost.

More of the same cannot do. The traditional paradigm of hospitals simply passing down rising cost to patients or insurers or government is not sustainable. The US healthcare is already sucking in 14% of its huge GDP, but there is no evidence that this is the ceiling. Indeed, all projections point to rising percentage of GDP going to healthcare.

All over the world, medical inflation exceeds the general CPI. If there is no transformation in the way healthcare is delivered, healthcare must eventually bankrupt all economies.

We need to find creative ways to deliver more with less, maintain if not raise standards, while cutting out wastages and squeezing out inefficiency. On this front, see a role for nurses to play.

For example, I see our Advanced Practice Nurses running follow-up clinics in the primary healthcare setting, and charging fees for their services. Patients with stable chronic conditions like diabetes and hypertension can be effectively managed by APNs. They can monitor the blood sugar and blood pressure level, discuss dietary restrictions and advise on exercise regimes, and even make adjustments to medications if necessary. International studies have shown that APNs can promote better patient compliance with treatment.

We should also actively learn from one another, and not having to reinvent the wheel. For example, I am told that Aravind Hospital in India is doing outstanding work restoring the eye-sight to tens of thousands of patients, at a fraction of the cost in developed countries. Apparently, the key to their success is the large number of highly-trained nurses and technicians that allow the doctors to do what they do best: diagnosis and surgery. We should find out more to pick up useful lessons for ourselves.

Conclusion

Nursing transcends boundaries, race, religion, language and culture. Today's meeting as an example involves delegates from 23 countries.

Nursing is a noble profession. The service that you provide is valued by your family members, relatives, friends, the community-at-large and internationally. This is seen in the significant flows of nursing talent across borders. You deserve our respect and support.

To all delegates, I extend a warm welcome. I hope your programme allows you some time to explore Singapore and to get to know us better. On this note, I wish you a productive and fruitful meeting.