Speech by Dr Amy Khor, Senior Minister of State, Ministry of Health, at the SingHealth Nursing Conference 2018, 5 April 2018

Professor Fong Kok Yong, Deputy Group CEO, Medical and Clinical Services, SingHealth

Professor Kenneth Kwek, Deputy Group CEO, Organisational Transformation and Informatics, SingHealth

Professor Wong Tien Yin, Deputy Group CEO, Research & Education, SingHealth

Dr Tracy Carol Ayre, Group Chief Nurse, SingHealth

Nurses

Ladies and gentlemen  

1.            Good morning. I am pleased to join you today for the SingHealth Nursing Conference 2018. This year’s conference theme, “The New Frontier in Nursing: Leading the Transformation”, is a powerful reminder that nurses play an important role in driving care transformation to meet the rapidly evolving healthcare needs of our nation.

2.            With an ageing population and the rising burden of chronic diseases, healthcare demand is expected to rise in the future. Meeting the care needs of seniors sustainably will require us to do things differently and overcome the twin challenges of a slowing local labour force growth and finite financial resources.  Nursing must evolve, adapt and innovate in order to continue to provide effective patient care.  To develop a future ready nursing workforce, the Future Nursing Career Review Committee had identified three strategic areas of focus – Care, Community and Competency.

Focusing on Patient Care

3.               We need to enable nurses to focus on patient care. Through a time motion study and value stream mapping conducted by Tan Tock Seng Hospital in 2016, it was found that Registered Nurses (RNs) spent 35% of their time on direct patient care activities like patient assessment, medication and procedures. The remaining time was spent on care preparation, documentation, communication with patients and other healthcare professionals, handing over work to the next shift and topping up supplies.

4.               Increasing the amount of time nurses spend in direct patient care will maximise contributions of the nursing workforce. As much as possible, nurses should not be drawn away from caring for patients, who should be their primary focus. This may also erode their desire to remain in the nursing profession for the long term.  We have to enable nurses to do more of what they are trained to do and enjoy doing. We aim to do this in two ways, by reducing the non-core work of nurses through automation and redesign and by deepening and expanding the roles of nurses in patient care.

5.               First, we are leveraging technology and automation to reduce manual work by nurses. For example, patients’ vital signs such as their blood pressure and pulse had to be manually recorded and then entered by nurses into the Electronic Medical Record (EMR) system, which was time consuming and also prone to error.  With the implementation of Medical Device Integration (MDI) at several of our healthcare institutions, patients’ vital signs are now automatically collected from the monitoring devices and transmitted directly into the EMR system. The MDI provides real time data, and ensures that patients can receive treatment once they start showing early signs of distress. It also saves nurses’ time in patient care.

6.               Another innovative example of improving communication amongst nurses is the National University Hospital (NUH)’s MeC! App. Previously, communication to ward nurses was done through face-to-face staff roll-calls before the start of shifts, and staff who were away would need to browse the ward message book to be updated. NUH’s mobile app now disseminates messages which staff can read anytime and anywhere - on mobile phones, tablets or PCs. The app also incorporates roster information, relieving staff of the need to call the ward or print out their rostered duties. MeC! is utilised by more than 90% of the nursing staff. Its use has saved an estimated 15 minutes per nurse during each roll-call. While 15 minutes may not seem like a lot for each nurse, but when added up it is significant because of the large number of nurses.

7.            MOH has also been working with healthcare institutions to recruit and train support care staff so that they can take on some of the roles done by nurses. Support care staff can perform basic patient care activities such as sponging, bathing and feeding, and lifting and transfer of patients; particularly with automation equipment. This in turn allows nurses to take on expanded roles and provide more complex clinical care at the bedside.

8.            Our goal is to bring nurses back to the bedside as much as possible.  Our public healthcare institutions are embarking on efforts to automate and redesign nurses’ work in four key areas - documentation, food services, patient transport and inventory management. I encourage all nurses to contribute your ideas on how you can spend more time with patients while also improving efficiency. 

9.            Second, we aim to enable nurses to acquire more knowledge and skills and expand their clinical care roles and practice in tandem.  In the public healthcare sector, more than 1,000 nurses have been promoted to become Assistant Nurse Clinicians (ANCs) since the role was implemented in 2015. ANCs are experienced nurses with specialised clinical skills taking on the role of a team leader on the ground. They also train and mentor new entrants.

10.         Master-level trained Advanced Practice Nurses (APNs), who are another group of senior and experienced clinical nurses, are able to assess and refer patients for subsidised rehabilitation care in hospital and home settings. From 16 April 2018, APNs can further refer patients to subsidised community rehabilitation at senior care centres and day rehabilitation centres. This move enables APNs to expand and deepen their roles beyond hospital to the community.  

11.         As announced last month, MOH is introducing collaborative prescribing in the public healthcare sector to promote accessibility and continuity of team-based patient care. APNs who are trained will be able to legally prescribe medicines within a care team led by a doctor. They can bring greater convenience and more holistic care to their patients by reducing the waiting time needed to receive their medication.

Strengthening Community Nursing

12.         The second area of focus is strengthening community nursing. MOH has embarked on care transformation efforts to shift care beyond hospital to the community to better meet the needs of an ageing population. Nurses, in partnership with other healthcare professionals, play a critical role in anchoring care in the home and community. 

13.         Community nursing is an exciting area of growth. It brings a wide spectrum of care from health promotion, disease prevention, post-discharge care and palliative care to the community so that our seniors can age well in a familiar environment. For example, MOH has worked with the Regional Health Systems to introduce Community Nurse Posts, which are located in the Seniors’ Activity Centres (SAC), Residents’ Committees and community centres. At the nurse posts in the southeast and east, 30 nurses from the Singapore General Hospital (SGH) and Changi General Hospital (CGH) have attended to more than 260 seniors who suffer from multiple chronic diseases, many of whom have just been discharged from hospital or lack proper care at home. These nurses develop care plans for the patients, monitor their chronic diseases, assess health risk factors and make early interventions or referrals to General Practitioners (GPs) or the hospital where necessary. 

14.         In addition, to ensure that our elderly remain healthy and live well in the community, our nurses also conduct health screening and disease prevention programmes in the community together with trained lay persons and volunteers. For example, under CGH’s Community Falls Prevention Programme, nursing teams conduct falls screening and assessments, and provide patient education and follow-up intervention for seniors aged 65 years and above. Around 360 seniors living in the east have benefited from this programme, and a similar programme will be introduced to seniors in the southeast by the SGH campus nursing team this month. The nurses are also training community care coordinators to conduct vision and gait balance assessments, to augment the outreach for preventive health.

Developing Nurses’ Competencies

15.         The third area of focus is developing our nurses’ competencies to deliver more holistic care for an ageing population. Currently, nurses can acquire new knowledge and skills through multiple avenues such as employer-provided on-the-job training, specialty clinical skills training by the educational institutions and local and overseas attachments.

16.         With technological advancements, learning too can be transformed to be more just-in-time and bite-sized to meet specific needs, to be portable for recognition of skills attainment and to be stackable into skillsets. This will equip our nurses with the skills to be at the forefront of driving care transformation.  An example is the new part-time and modular graduate diploma in Community Health Nursing that NUS nursing will be rolling out this August. This new programme allows nurses greater flexibility as they can pursue part-time study while continuing to work.  Nurses can choose to take only specific modules and not the whole programme. Completing all modules will allow them to obtain a graduate diploma.  

17.         MOH will develop a more robust nursing continuing education and training system that is skills-based and industry-oriented, in partnership with employers, the institutes of higher learning and union. Nurses can look forward to more skills upgrading pathways and opportunities to acquire competencies at different points of their career.

Conclusion

18.         With the three areas of focus, nurses can look forward to an exciting and rewarding career in healthcare, and play a leading role in healthcare transformation.

19.         This year’s conference programme provides learning relevant to the three areas of focus.  I believe you will glean many useful insights that will help you define the way we deliver care now and in the future. I wish all of you a fruitful session ahead.

20.         With this, I declare the SingHealth Nursing Conference 2018 open. Thank you.