The Nurses & Midwives (Amendment) Bill

21 Apr 2005

By Mr Khaw Boon Wan, Minister For Health

Venue: Parliament

Mr Speaker, Sir, I beg to move, "That the Bill be now read a second time."

The purpose of this Bill is to establish a Register for Advanced Practice Nurses, so that we can systematically develop this category of clinical nurses with a "Master in Nursing" degree, to contribute to our healthcare system.

Background

This is not a new idea. In 1999, the Nurses & Midwives Act provided for the setting up of a Nurse Specialist Register. The objective was identical. It was to promote the development of nurse specialists who can, through formal training, acquire the necessary knowledge, skills and competencies to play a greater role than that traditionally performed by nurses. Over the years, some of our nurses have, on their own efforts, acquired such expertise and many more have expressed an interest to pursue such advanced training.

My Ministry encourages this trend. First, it raises the status of the nursing profession. Second, it recognises and maximises the potential for some nurses to take on added responsibilities. With proper training, such nurses can competently perform tasks like:

     -  physical assessments of patients;

     -  ordering and interpreting diagnostic tests; and

     -  initiating treatment according to an approved protocol.

Internationally, such a development is not new. In the US and the UK, such a category of clinical nurses has evolved over 30 years to become an important player in their healthcare systems. Increasingly, they have also switched to call such nurses "Advanced Practice Nurses" instead of "Nurse Specialists". 

This Bill will essentially update and amplify the existing provisions in the Nurses & Midwives Act, which pertain to the certification and regulation of nurse specialists. In so doing, we shall re-name nurse specialists as "Advanced Practice Nurses (APN)", in line with international nursing nomenclature.

Benefits of APNs

APNs bring benefits to patients, doctors and nurses. International experience suggests that APNs are effective in initiating management of common acute illnesses and injuries. APNs are also valuable in managing stable chronic conditions with particular emphasis on health promotion and disease prevention. They can promote better patient compliance with treatment.

Many studies have been conducted to gauge the quality of care provided by APNs. Early studies found that in an appropriate setting, patient care and outcomes were of equivalent quality to that provided by doctors, and patients were satisfied with their care. More recent studies have shown that APNs' intervention and care contributed to shorter length of stay, fewer hospital admissions, reduced readmission rates and healthcare costs.

Such outcome studies confirm the positive impact of APNs and establish them as cost-effective caregivers of quality healthcare.

For doctors, the services provide by APNs complement their care.  This makes APNs useful partners. APNs' extended scope of practice allows them to take on some of the routine duties of the junior doctors. This frees up the junior doctors to spend more time on patients who require their higher level of expertise.

As an example, in primary healthcare setting, APNs can work with family physicians to manage nurse-led follow-up clinics for patients with chronic diseases. They can also conduct patient education and counseling sessions which will include re-enforcement of self-management skills, emphasis on medication compliance and evaluation of treatment.

For the nursing profession, the APN Register opens up an alternative career track to allow experienced and skilled nurses who have the necessary advanced qualifications to remain in clinical setting without compromising their career development. This is one way to retain good nurses in the profession.

To prepare for this development, the National University of Singapore started its "Master in Nursing" programme in 2003.  This was a milestone in local nursing education.  It launched our APN training programme. The first batch of 14 graduates will complete their 1 year internship next month. They will then be eligible for appointment as APNs.

Main Features of the Bill

Let me highlight the key amendments.

Advanced Practice Nurses

Part V of the principal Act has been repealed and re-enacted in the Bill. This will amplify the existing provisions relating to the certification and regulation of the practice and conduct of APNs. It covers the use of job titles, qualifications, training, education, standards and scope of practice, professional conduct and ethics of APNs.

The nomenclature of nurse specialist or nurse specialist register has been updated to Advanced Practice Nurse or Advanced Practice Nurse Register, wherever it appears in the Act.

Continuing Professional Development

The Nursing Board intends to implement mandatory Continuing Professional Development for the renewal of the APN Practising Certificate. This is similar to mandatory Continuing Medical Education for doctors.

As nurses enlarge their roles, it is essential that they uphold the quality of nursing care by keeping abreast with the changes and developments in medical science. Clauses 7 and 22 of the Bill amend sections 18 and 44 of the Act to mandate such a requirement. The new provisions will also allow the Nursing Board to exercise this requirement for other categories of nurses, if the need arises in the future.

Other Amendments

Sir, let me now move on to the other amendments which will enhance the administration of the Act.

Establishment and membership of Board

Currently, the Nursing Board comprises 14 appointed members (including 11 nurses) and 3 ex-officio members. The ex-officio members are the Director of Medical Services, the Director-General of Education or his representative and the Chief Nursing Officer.

Traditionally, the Board is chaired by the Director of Medical Services. In this House, Dr Lily Neo has previously argued for the Board to be led by a nurse. I support her view on this. Clause 4 of the Bill provides for the Director of Medical Services or his representative to be a member of the Board. This technical amendment in Clause 4 will facilitate such a development.

Administrative/Civil sanctions

Clause 8 of the Bill amends section 19 to increase the range of disciplinary actions that the Nursing Board may take. The range of penalties includes issuing of warning, censure, imposing a financial penalty, suspension or cancellation of registration. This would give the Board greater flexibility in administering disciplinary actions.

Clause 21 empowers the Board to prescribe compoundable offences and to compound offences.  Clause 6 will enable it to decriminalize minor offences such as the failure to inform the Registrar of a change in address or other particulars. This is in line with the move to promote the greater use of administrative and civil sanctions.

Disclosure of information

Currently there is no explicit provision for the Board to disclose information to government organisations for policy planning purposes. The new subsection (6) in clause 6 of the Bill will allow the Board to release such information. This is similar to the provision in the Medical Registration Act which allows the Registrar of Singapore Medical Council to disclose the information in the registers as prescribed by regulations made under the Act.

Power to invest funds

At present, the Act does not allow the Board to invest its surpluses. Clause 20 of the Bill amends section 42 to empower the Board, with the approval of Minister, to invest its funds. This would allow for prudent management of reserves.

Conclusion

Mr Speaker, Sir, this year, the Singapore nursing profession celebrates its 120th Anniversary.  Over this long period, the profession has made significant progress.

Our nurses have kept up with the rapid advancement of medical science and technology. Their job scope has grown in breadth and complexity.

They have become valuable partners of our doctors and other healthcare professionals. Some of the credit for the high standard of healthcare in Singapore should go to our nurses. The critical role played by our nurses in the battle against SARS is still fresh in our memory.

For the profession to remain valuable partners in our healthcare team, they must continue to upgrade and keep in step with global development. This Bill will help to contribute to this. 

Advanced Practice Nurses can potentially become a key player in our drive to keep healthcare cost affordable while maintaining quality. Let us actively embrace them and incorporate their services into our healthcare delivery systems, for the benefit of our patients.

Mr Speaker, Sir, I beg to move.