Health officials in strong defence of nurses

Lauded as high-skilled, highly valued professionals following error in White Paper footnote

By Salma Khalik, The Straits Times, 10 Feb 2013

Health Minister Gan Kim Yong has expressed regret over a "factual error" in the Population White Paper that described nurses as "low skilled" workers.

The mistake, contained in a footnote on Page 40, triggered dismay and anger when it emerged last week.

It has now been amended following calls from nurses and their unions. On Friday, Deputy Prime Minister Teo Chee Hean apologised in Parliament for the error and acknowledged the contributions of nurses.

Mr Gan told The Sunday Times: "I regret the emotional distress that it has caused some of our nurses. Nursing is a profession that requires a high level of clinical skill, dedication and passion.

"Nursing capabilities and scope of practice have also expanded to keep up with the increasing needs of the population."

Meanwhile, other health-care workers were quick to defend Singapore's 34,000 nurses as high- skilled, highly valued professionals.

"If there were no nurses, there will be no hospitals," said Mr T.K. Udairam, head of Eastern Health Alliance, which includes Changi General Hospital.

He added that they are responsible for patient safety and doctors cannot work without them.

An operating theatre nurse is not only there to provide doctors with all the correct instruments, said Mr Udairam, but she also "has a right to stop a surgeon from carrying on an operation if his integrity is compromised".

This means if a doctor has touched something that makes him no longer sterile, the nurse will stop the operation until he has scrubbed down again. Mr Udairam said this is certainly not the job of a low-skilled worker, but of a highly skilled professional.

Professor K. Satku, an orthopaedic surgeon and director of medical services at the Health Ministry, posted on the Internet: "As a surgeon, I work with very highly trained nurses, without whom much of my work would have been impossible.

"In the operating theatre, nurses ensure that the most complex operations are carried out smoothly. In the wards, nurses work to ensure the well-being of our patients and continue to do so long after everyone else has gone home."

Associate Professor Lim Swee Hia, president of the Singapore Nurses Association, welcomed the correction. In a letter to Deputy Prime Minister Teo Chee Hean and Mr Gan, she said nurses today "have deep expertise".

She added: "In our public health-care institutions, many have taken on clinical tasks which used to be performed by doctors.

"We see more of our bright and young choosing to join the profession. They become much better qualified, possessing a bachelor of science in nursing, master's, PhD or specialisation certificates."

Student nurse Desmond Loo said it was disheartening that the Government described nurses as "low skilled". He felt that such poor regard for the profession could deter youngsters from joining it.

Mr Gan said: "As we celebrate Chinese New Year, it is important that we pay tribute to our nurses and health-care workers as the important backbone of the health- care system."

Regrettable error
"I regret the emotional distress that it has caused some of our nurses. Nursing is a profession that requires a high level of clinical skill, dedication and passion. Nursing capabilities and scope of practice have also expanded to keep up with the increasing needs of the population."
HEALTH MINISTER GAN KIM YONG

Essential staff
"If there were no nurses, there will be no hospitals."
MR T.K. UDAIRAM, head of Eastern Health Alliance

Big responsibilities
"In the operating theatre, nurses ensure that the most complex operations are carried out smoothly. In the wards, nurses work to ensure the well-being of our patients and continue to do so long after everyone else has gone home."
PROFESSOR K. SATKU, an orthopaedic surgeon and director of medical services at the Health Ministry

Deep expertise
"In our public health-care institutions, many (nurses) have taken on clinical tasks which used to be performed by doctors."
ASSOCIATE PROFESSOR LIM SWEE HIA, president of the Singapore Nurses Association

Nurses are specially trained: Health Ministry medical services director
By Priscilla Goy, The Straits Times, 9 Feb 2013

Nurses work to ensure the well-being of patients and continue to do so long after everyone else has gone home.

The healthcare system here would also not function without them.

That is the view of the Ministry of Health's medical services director, Professor K. Satkunanantham.

"Nursing is not a job that just anybody can do - it is a profession," said Prof Satkunanantham in a post on the ministry's Facebook page on Saturday morning.

"It takes a special kind of person to be a nurse - someone who is compassionate, caring, and who is willing to put the interests of others above their own."

He added that nurses are often specially trained and need to keep up with new developments in their field.

They also work in difficult situations, and have to remain professional in the face of challenges.

"I daresay they are often under-appreciated and taken for granted - but our healthcare system would not function without them. Whether it is our hospitals, clinics or hospices they rely on our nurses," said Prof Satkunanantham.

"Nurses, even though we don't always remember to say it - we appreciate you and your expertise. Thank you for being a nurse."

Prof Satkunanantham's post comes after Deputy Prime Minister Teo Chee Hean apologised in Parliament on Friday for a footnote in the Population White Paper that referred to nursing, retail and personal services as low-skilled jobs, and asked for it to be deleted.

Said DPM Teo: "This classification of low-skilled jobs is not correct. I would like to apologise to those whose professions have been unintentionally misrepresented.

"I personally have the greatest respect for those in the nursing profession, which is a noble and caring profession, which all of us and our loved ones depend on and appreciate."

On Friday night, Chief Nursing Officer, Dr Pauline Tan also made a similar post on Facebook, apologising for the misrepresentation in the White Paper that nursing is a "low-skilled" job.

Today’s nurses are better qualified, have wider job scope

About three in four nurses here have at least a diploma, can make more independent decisions on patient care

By Neo Chai Chin, TODAY, 15 Feb 2013

He had downloaded the Population White Paper and was reading it on the morning of Feb 6, when he spotted the footnote stating nursing as a low-skilled job.

This left former nurse Brandon, 26, who declined to give his full name, “a bit shocked”. He took a photo of the footnote and posted it on Facebook, which was then quickly shared over 500 times.

Around the same time, the Healthcare Services Employees Union’s (HSEU) leaders were going through the White Paper, and received feedback from social media and among the leaders’ network, HSEU Executive Secretary Patrick Tay told TODAY.

Mr Tay said he then alerted Deputy Prime Minister Teo Chee Hean to the error, on behalf of the union. On Feb 8, Mr Teo, the Home Affairs Minister and Minister-in-charge of the National Population and Talent Division, issued a corrigendum to the error in Parliament.

Prime Minister Lee Hsien Loong as well as leaders in the healthcare sector, including Health Minister Gan Kim Yong, Director of Medical Services Professor K Satku and Chief Nursing Officer Pauline Tan, have also apologised to nurses.

Brandon told TODAY that he also wrote to Mr Gan, the Singapore Nurses Association (SNA) and the Singapore Nursing Board (SNB) about the error. Although he has left the profession, he is still registered with the SNB and said nursing is a “noble” profession that he hopes more locals will join.

Others in the profession said nurses have become better qualified over the years, and are integral to the healthcare system.

Nursing has undergone “quite a lot of job redesign” in the past decade and nurses are now able to make more independent decisions when tending to patients, said SNA President Lim Swee Hia.

Intensive Care Unit nurses, for instance, are now able to adjust the dosage of drugs within parameters specified by doctors.

All registered nurses, as well as some experienced enrolled nurses in hospitals, are trained in Basic Life Support and are now able to initiate resuscitation of patients whose hearts stop or whose conditions worsen while calling for doctors, said Associate Professor Lim. These were duties they could not undertake five to 10 years ago. And nurses continue to be advocates for patient safety, she said.

Statistics show that nurses have become better qualified over the years, even as their numbers have increased. According to the 2011 SNB annual report — the latest available — there were 31,467 nurses here in 2011, up from 26,498 in 2009.

About three in four nurses here are registered nurses with at least a diploma. The rest are enrolled nurses with National ITE Certificates in Nursing. The pool of Advanced Practice Nurses — registered nurses with at least three years’ experience in their chosen clinical speciality and who have completed advanced education at the master’s degree level — has grown from 37 in 2009 to 78 in 2011, 77 of whom are Singaporeans or permanent residents.

Over a quarter of the nurses who are members of the HSEU are degree holders and above, said Mr Tay.

Registered nurse Irene Ong, who trained at the School of Nursing at the Singapore General Hospital in the 1970s, said the nursing syllabus now is more complex than before.

“My daughter, who is in her first year, is now studying what I learnt in my third year,” said Ms Ong, who owns two nursing homes and remains “hands-on”, taking over when her registered nurses are not working.

“People who have been to hospitals will appreciate nurses,” said Ms Ong.

Her daughter, Ms Lovelle Huang, 24, graduated with a business studies degree before deciding to take up nursing. Now doing her diploma, Ms Huang said her interest in nursing has grown and she plans to pursue further studies.

Most people her age choose to pursue nursing because it is a “steady job” and “they have a heart for it”, said Ms Huang. “I had quite a bit of exposure because my mum is a nurse. But I didn’t want to join, until my father got ill and I saw my mother tending to him herself,” she said. “I (then) thought, I want to be able to care for my mother when she is old and sick.”