SINGAPORE - Although they make up the largest professional group of healthcare workers here, Singapore still does not have enough nurses.

As at the end of last year, there were more than 42,000 nurses registered with the Singapore Nursing Board.

And as at 2019, there were about 5,500 nurses not in active practice.

Nursing jobs were the hardest PMET (professional, managerial, executive and technical) positions to fill, according to the Ministry of Manpower's 2020 report on job vacancies. These jobs made up the biggest number of vacancies unfilled for at least six months last year.

Singapore General Hospital's (SGH) chief nurse Ng Gaik Nai said that with an ageing population, complex disease and advancement in care management, there is a demand for more nurses.

She said: "Nurses are also needed at the community level to educate residents on how to stay healthy... and to ultimately reduce the number of readmission cases."

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She said that with upcoming facilities on the SGH campus, such as a new emergency medicine building and elective care centre, more nurses will be needed to fill roles there.

Nurse retention is also a concern, said Healthcare Services Employees' Union president K. Thanaletchimi.

The former Nominated MP said: "Due to the long working hours and the heavy demands of healthcare professionals... many of them leave the profession as they feel mentally burnt out, or are no longer able to cope with both work and personal commitments."

And with the Philippines recently suspending permits for nurses who want to work abroad, the shortage could worsen. Foreign nurses make up about one-third of the overall nursing workforce in Singapore.

Private sector

Thomson Medical's director of nursing, Siti Hosier, said that recruiting nurses into the private sector has always been competitive. But the pandemic has made it more challenging as more nurses are joining vaccination and swab operations.

Private healthcare group IHH Healthcare Singapore says that half of its nursing workforce is made up of foreign nurses.

The healthcare group's director of nursing Josephine Ong, said: "The pandemic has added further strain to the manpower shortage as our nurses were redeployed to help set up quarantine and community care facilities, vaccination and swabbing operations."

The group operates four hospitals here, including Mount Elizabeth Hospital. To help ease its nurses' workload, some paperwork and non-clinical tasks were handed over to other departments.

Similarly, at Farrer Park Hospital, screening duties and health declaration processes are handled by other employees so that the nurses can focus on caring for patients and do clinical work.

Since January, the IHH Singapore hospitals have hired more healthcare assistants, and next year, new patient care associate jobs will be created to support nurses.

Ong said that there are plans to use robotics and artificial intelligence to assist nurses with some clinical tasks.

"Working longer shifts is not the solution to cope with a shortage of nurses as they need adequate rest to do their best for patients," she emphasised.

When Hari Shoran Silvarajoo, 34, was a Singapore Airlines flight attendant seven years ago, an elderly man fainted during a flight to Europe. He did not know what to do then, but thankfully, a doctor was on board.

Hari said: "I had the knowledge based on my basic first-aid training in SIA, but I did not have the confidence to actually attend to the man."

Hari later enrolled in a nursing course at an Australian university.

He has been a nurse with Woodlands Health for more than five years now, and is attached to Sengkang General Hospital's emergency department.

He said: "Time is crucial in the emergency department. Decisions have to be made within seconds. You can see the effect of your work immediately, which is very gratifying."

Like Hari, some nurses joined the healthcare sector as mid-career professionals. Most others joined after graduating from nursing courses in universities, polytechnics or the Institute of Technical Education.

Promoting nursing in Singapore

Over the years, Singapore has been promoting nursing and trying to retain nurses through campaigns, recognition and awards, salary adjustments, scholarships and education opportunities.

The Government announced salary hikes of 5 per cent to 14 per cent for nurses from last month.

Thanaletchimi said: "While the salaries of nurses in Singapore have increased considerably over the years, they are not as competitive as the salaries in some developed countries, especially for entry-level nurses."

Currently, the median starting salary for a degree-holding registered nurse is about $3,500.

Associate Professor Elaine Siow from the nursing programme at the Singapore Institute of Technology said the pay hike could make nursing more comparable to other professions here, and help improve staff retention.

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Singapore also aims to have up to 700 advanced practice nurses (APNs) who can prescribe medication for patients by 2030. As at May, just 57 of 294 of such highly skilled nurses had prescribing rights.

APNs are senior nurses who typically have a master's degree and can take on greater roles in diagnosis and treatment.

Ng said SGH is identifying and training suitable nurses to become APNs, as the hospital needs more of them to provide clinical supervision in wards.

Last year, the National Nursing Academy was set up to help nurses further their knowledge and skills through courses and training.

Bella Tan, Nanyang Polytechnic's programme director for nursing, said that nearly 500 nurse specialists are trained in the polytechnic's advanced and specialist diploma programmes each year.

A 2020 paper about the challenges of nursing in Singapore, published in the Asia-Pacific Journal of Oncology Nursing, stated that institutions' and the government's attempts to improve the nursing shortage over the years had met with limited success.

Existing programmes to attract aspiring nurses

But existing programmes have helped to attract aspiring nurses.

Workforce Singapore's (WSG) nursing-related professional conversion programmes have attracted more than 1,500 mid-career local workers since 2003.

Timothy Merrill Goh, 31, who is pursuing a diploma at Nanyang Polytechnic to become a registered nurse under one of these professional conversion programmes, aspires to be an APN some day.

He worked in the events industry for three years, but the pandemic affected the sector badly.

After completing his studies, Mr Goh will be a nurse at the National University Hospital (NUH).

He said: "During my clinical attachment at NUH, it was heartening to see patients getting discharged. Sometimes I would also receive a small word of thanks from them, which made me feel appreciated and certain I had made the right career choice."

In 2019 and last year, about 4,400 students in total enrolled in nursing courses at various institutes of higher learning, said the Ministry of Education.

Covid-19 has helped to raise the profile of nurses by highlighting their work as front-liners and healthcare heroes.

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This has translated to a rise in interest in the profession.

WSG said there was about a 70 per cent increase in placements for the nursing professional conversion programmes last year, compared with the 2019 numbers. And this year, there was nearly a 50 per cent rise in applications for the programmes, compared with last year.

Professor Emily Ang, head of the National University of Singapore's Alice Lee Centre for Nursing Studies, said the school received more than 1,100 applications for its undergraduate nursing programme this year, up from more than 800 applications last year.

She said: "Among the applicants, there are many who chose nursing over medicine and more prestigious courses, even though their results qualify for those programmes."

This article was first published in The Straits Times. Permission required for reproduction.