Higher pay for nurses and more opportunities

Big push to draw more nurses...
Pay rises, greater autonomy for senior staff among the changes
By Linette Lai, The Straits Times, 7 Aug 2014

NURSES in the public sector here will be given pay rises, broader job scopes and better career progression, in new moves to retain them and attract new faces.

The Ministry of Health (MOH) is taking these measures, which it announced yesterday, even though the attrition rate has been falling, as more nurses are needed to meet the rising health-care demands of the ageing population.

The attrition rate was 8 per cent last year, down from 9 per cent in 2011.

MOH estimates it will need an extra 1,400 nurses a year between now and 2020, on top of replacing those who quit. Last year, the nursing population grew by only about 1,100.

A major change is how much nurses will get paid. MOH said yesterday that about 23,000 nurses in public health care and MOH-supported intermediate and long-term care institutions will get pay rises of between 5 per cent and 20 per cent in the next two years. They will also get an additional half a month's annual bonus from December this year.

This, said Health Minister Gan Kim Yong at the Nurses' Merit Award ceremony yesterday, is to ensure that their pay is "commensurate with their expanding roles and competitive with the market".

"Nurses play a very important role. They are on the front line; they are on the ground. They are the backbone of our health-care workforce," he said.

The changes were proposed by the National Nursing Taskforce, which was set up in December 2012 to chart the course of the profession. Yesterday, Mr Gan formally accepted its 15 recommendations in four broad areas.

Currently, enrolled nurses - the lowest tier and mainly graduates from the Institute of Technical Education (ITE) - earn about $1,975 a month in public health-care institutions. Registered nurses with diploma qualifications earn about $2,500.

"We hope that by enhancing their remuneration, we will signal greater recognition for this profession," Mr Gan said. Speaking to the nurses at the ceremony, he added: "I am not Santa Claus, but I think you deserve it."

Senior, experienced nurses will be given greater autonomy after the new changes kick in. This includes the authority to make some diagnoses or order certain medication and treatment.

For instance, a nurse clinician could immediately prescribe the appropriate medication for a diabetic patient having a hypoglycaemic attack, rather than having to wait for a doctor's go-ahead.

"We want to give our nurses greater autonomy so they can take on greater responsibility and do more complex functions," Mr Gan said. "In this way, we will be able to maximise their potential."

A new National Council of Nursing Education to coordinate nurse education across the various levels will also be set up.

Changes in the fourth area will ensure better career progression, especially for lower-tier nurses.

Previously, enrolled nurses from ITE needed to get a grade point average of at least 2.8 - out of a maximum of 4 - before they were allowed to further their studies to become registered nurses. Now, as long as enrolled nurses have at least three years' work experience and a good report from their employers, they will be eligible for the upgrading course.

"I'm very happy for the enrolled nurses who are my colleagues," said senior staff nurse Zarina Ahmad of Changi General Hospital. "It was a pity that they couldn't go further because of all the constraints."

MOH has accepted all 15 recommendations by the National Nursing Taskforce. These aim to develop and strengthen the...
Posted by Ministry of Health on Wednesday, August 6, 2014

Nurses eye bigger role in medical care and teaching
By Linette Lai, The Straits Times, 7 Aug 2014

WHILE nurses welcomed news of higher pay yesterday, what many say they are really looking forward to is the bigger role they can play in medical care and teaching.

Yesterday, the Ministry of Health (MOH) revealed a revamp of the nursing profession, including pay increases of between 5 and 20 per cent in the next two years, to make it more attractive.

Among the changes recommended by the National Nursing Taskforce, nurses will also get help in taking on more roles.

Public health-care institutions will provide support for senior nurses who wish to teach, for instance, at polytechnics which offer nursing courses, in addition to taking care of patients. The Health Ministry will also work with these organisations to better facilitate flexi-work and part-time arrangements, which will also benefit nurses with children.

"The creation of more advanced nursing roles adds depth and offers opportunities to make nursing even more exciting," said National University Hospital director of nursing Catherine Koh.

One newly created post is that of assistant nurse clinician, which Changi General Hospital senior staff nurse Zarina Ahmad is hoping to take up. The role will put her on a leadership track and see her mentoring younger colleagues. "There's more empowerment," said the 40-year-old, who has been in nursing for around 20 years, of the new job.

Experienced senior nurses will also be allowed to diagnose and carry out treatments in certain situations, without first having to get the go-ahead from a doctor.

For instance, they will be able to order an X-ray to check if a feeding tube has been correctly inserted, or begin preventive action for a diagnosed schizophrenic with suicidal tendencies.

"Many of them are already competent to do some of these things," explained Mr Yong Keng Kwang, director of nursing at Tan Tock Seng Hospital. "But they couldn't before, because of certain restrictions."

Advanced practice nurse Karen Koh, 38, who is with National University Hospital's cardiac rehabilitation unit, believes the extra autonomy will allow her to make better use of her qualifications and experience. Said the master's degree holder: "We are trained, we have the capability, and we are there all the time, by the bedside."

Health economist Phua Kai Hong believes the revamp could see a "big surge of nurses in the public sector", and make it tougher for private health care. He suggested that the private sector may also raise wages.

81 honoured with Nurses’ Merit Award: MOH
Channel NewsAsia, 6 Aug 2014

The Ministry of Health on Wednesday (Aug 6) honoured a record number of 81 nurses with the Nurses’ Merit Award for their outstanding performance and dedication to the healthcare industry.

The Award, which started in 1976, recognises nurses who have demonstrated consistent and outstanding performance for the past three years. Each recipient will be awarded a medal - to be worn as part of the nurses’ uniform - and a monetary gift of S$1,000, up from $200 in previous years.

The increase in the award value is one of the National Nursing Taskforce’s recommendations on raising recognition of nurses’ work. The taskforce, which was set up in 2012 to review and chart the future direction of the nursing profession, had all of its 15 “wide-ranging” recommendations accepted by Health Minister Gan Kim Yong on Wednesday.

Said Mr Gan: “Through their dedication and commitment, they have touched the lives of many patients and their family members. My ministry is committed to continue our efforts to support and promote the nursing profession.”

More men becoming nurses
By Linette Lai, The Straits Times, 6 Aug 2014

MORE men are signing up to be nurses, if the numbers at the polytechnics and health-care institutions are anything to go by.

Many of them cite job stability and the rapidly growing health-care sector as major pull factors.

At Nanyang Poly (NYP), 18 per cent of the 600 students on its nursing course this year are males. This is up from the 14 per cent in 2010.

At Ngee Ann Poly, male students made up 15 per cent of the cohort when its nursing programme started in 2005. This has since gone up to 20 per cent.

"The career prospects are very good because we have an acute shortage of nurses," said Ms Wong Luan Wah, NYP's director of nursing from the School of Health Sciences.

The additional demand for nurses each year is projected to be about 1,400 on average until 2020, said the Health Ministry.

Regional health-care clusters like SingHealth and the National Healthcare Group (NHG) have had more male nurses in the past five years. A cluster is typically anchored by a hospital but includes institutions like polyclinics.

The number of male nurses who are Singaporean and permanent residents employed by SingHealth has gone up by 52 per cent, said a spokesman.

Part of the reason for this is nursing is no longer seen as an exclusively female profession. "Nursing is no longer stereotyped or perceived by the public as a job mainly for women," said NHG chief executive Chee Yam Cheng.

And male nurses can be helpful in some situations. "An added plus is that their physical strength enables them to lend a helping hand when we manage the movement of immobile patients," said Dr Tracy Carol Ayre, group director of nursing at SingHealth.

Tan Tock Seng Hospital senior nurse manager Christopher Soh, 38, who has been in nursing for 13 years, said no one day is the same. "We see a diversity of patients here. No one patient is the same."

Some nurses find work 'too hectic'
By Linette Lai, The Straits Times, 9 Aug 2014

A MOVE to narrow the pay gap between public- and private-sector nurses might not stem the flow to private institutions, going by the views of nurses interviewed by The Straits Times.

Asked about government plans announced this week to raise the pay of public-sector nurses, eight nurses who left public institutions for private ones said pay was not the only push factor: A less harried work environment was also a key factor.

One nurse who declined to be named said it was "very hectic" in a public hospital where she worked for about a year. "Frankly, sometimes I didn't even have the time to think about what I was doing," she said.

The 27-year-old switched to a private hospital about two years ago. She said: "Here, you have more time to really talk to your patients and educate them about post-discharge care. But working in a public hospital is good for exposure to different things."

Another nurse said she left the public sector after eight years as she was "burnt out" and dreaded going to work each day.

The 30-year-old said she found private-sector life less hurried. "Over all, I'm quite happy with my work-life balance now."

Nurse educator Fiona Tan, 29, moved to Mount Elizabeth Hospital after six years in a public health-care institution.

"I wasn't sure if I would like it better at first," she said. "But nurses here are able to develop more critical thinking skills... and are given more autonomy."

There are 36,000 nurses here, with about a third, or 13,000, in the private sector.

On Wednesday, the Ministry of Health (MOH) announced pay hikes of 5 per cent to 20 per cent over the next two years to retain nurses and attract fresh blood.

Benefits like better career development and greater autonomy are also on the cards for nurses in public health-care and MOH-supported intermediate and long-term care institutions.

Currently, the starting pay for enrolled nurses - the lowest tier - is about $1,975 a month in public health-care institutions. Registered nurses with diploma qualifications earn about $2,500.

"With the competition for experienced health-care professionals among the public and private health-care players, staff movement between these two sectors is inevitable," said Ms Elaine Ng, group director of nursing at Parkway Pantai, which runs several private hospitals, including Gleneagles and Mount Elizabeth.

Offering competitive salaries is "only one of the ways" the group attracts and retains staff, she said. It also runs Parkway College, which offers advanced diplomas in specific areas of nursing, such as critical care.

Meanwhile, private home- care operators like Comfort Keepers said they would not be affected by the changes as they complement, rather than compete with, the public health-care sector.

The group, which has four outlets, employs some 150 caregivers, of whom only about 15 are registered nurses. Its business development executive Sally Benjamin said many of its nurses are retired and work flexi-hours.

"They don't like to do shift work, so they are quite happy here," she said.

Beyond pay, it's respect that counts with nurses
By Linette Lai The Straits Times, 1 Sep 2014

IN OCTOBER next year, public sector nurses will get their second pay rise in as many years.

The Health Ministry is dangling this carrot - part of a larger package - in the hopes that new faces will join the sector, and existing ones will stay.

But there is more to this than just a business deal, or a way to keep the lid on nurses' grouses a while longer.

As Health Minister Gan Kim Yong said of the pay rise: "I'm not Santa Claus, but I think these nurses deserve it."

In 2007, there was one nurse for every 205 people here. Five years later, this ratio was one to 154 - putting us slightly ahead of South Korea, with one to 211.

But in the same year, World Health Organisation figures show that Japan had one nurse for every 87 people in its rapidly greying population.

With Singapore's age profile headed in the same direction, the Health Ministry has projected a need for 1,400 new nurses a year between now and 2020 - when the health-care master plan comes to fruition.

Nurses are already in short supply, meaning that those already in the industry have to work that much harder.

For one thing, there is the arduous nature of the work.

Exactly how tough can a nurse's job get? For starters, there are some basic procedures every nurse must know: taking temperatures, dressing wounds, inserting feeding tubes and checking blood sugar levels.

Then, there are the specialists. Psychiatric nurses calm agitated patients; emergency department nurses resuscitate them. When the end draws near, nurses trained in palliative care will help ease their passing.

And of course, there is the dirty work involving bedpans and vomit bowls.

"The frustration as a nurse is plenty," said one, recounting how she had to rush from task to task with "no time to really think about what I was doing".

Another related how she used to be close to tears at the end of each shift. And yet another said that her job was like "being a punching bag".

This last description may not be too far off the mark. Last year, a Straits Times story showed how more health-care workers - most of them nurses - faced abuse from patients and visitors alike.

Sometimes they were shouted at, or had things thrown at them, or were treated like servants. Yet, they soldiered on - often with a smile.

There is also the fact that nurses are sometimes still seen as - in the words of one nurse - "handmaidens" to doctors.

Take this scenario: A patient needs an X-ray done to make sure that his feeding tube has been properly inserted.

But you, as a nurse with 10 years' experience, cannot order the X-ray. Instead, you must approach a doctor with that request.

Or perhaps you have a diabetic patient on your hands, one who is having a hypoglycaemic attack.

You will have to go to a doctor to prescribe the treatment you already know the patient needs, but may lose precious minutes of time doing so.

The ministry's new "care package" will allow senior nurses to make the call at times like these.

For it to fully succeed, doctors must also recognise that nurses do not play second fiddle but must be seen as competent professionals in their own right.

Finally, there is the perennial grouse of many enrolled nurses - that paper qualifications are worth more than experience.

These nurses - the lowest tier - had to meet certain grades at the Institute of Technical Education to become eligible for a course that would allow them to become registered nurses.

Those who fell short would stay enrolled nurses for the span of their careers.

The requirement has since been waived - as long as the nurse in question has at least three years' work experience and a good employers' report.

Take Madam Magaswary R. Balraju, 50, who is now a principal enrolled nurse after more than 30 years in the profession. Even with her degree of experience, she is still not allowed to administer certain controlled drugs. Until recently, this was as high up the nursing ladder as she could hope to rise.

"It's a very good opportunity for the younger enrolled nurses," she said. "Most of them are talented but didn't get the opportunity because of these restrictions."

As for herself? "If I get the chance, maybe I will try."

The changes are not a lowering of standards. Instead, they are an acknowledgement that real-world experience trumps paper qualifications - as it rightly should.

Perhaps, recognising nurses in this manner may even get patients to accord them a greater measure of respect.

So, look beyond the money when you evaluate the Health Ministry's announcement.

As one nurse put it: "Whether public or private, you don't go into this job for the pay."

Going by what nurses say, it is the acknowledgement of their dedication and competence that really makes the difference. This is what will have the greatest impact in lifting their morale and convincing them to stay.

When you meet a nurse, treat her or him with respect.

It is the least you can do for those who have made this profession their life's work.

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