Speech by Mr Ong Ye Kung, Minister for Health, At the 2024 Nurses’ Merit Award On 12 July 2024, 11.00am At Pan Pacific Hotel

Ms Paulin Koh, Chief Nursing Officer

Nurses

Distinguished Guests

Ladies and Gentlemen

1. Today, we gather to honour the exceptional dedication and unwavering commitment of our nurses, as they receive this year's Nurses' Merit Award.

Nursing as a Vocation

2. Young people searching for a direction in life, mid-career switchers, people from all backgrounds, join nursing as a career for various reasons. For many, they were inspired through witnessing the care and compassion shown by nurses for their loved ones. For others, a national crisis like SARS or COVID-19 inspired them to be part of a larger national cause.

3. At the core of their motivation is a deeply rooted desire to alleviate suffering, offer solace, and care for others in need. Above all, you recognise that nursing is not merely a profession - it is a vocation.

4. The term "vocation" originates from the Latin word "vocare", which means "to call". A vocation is different from other jobs, because it requires a special and distinct calling. To be well-intended, to serve others, persevere through challenging times, and to always improve and teach those junior to you. This intrinsic sense of purpose, compassion, continuity and constant improvement is the foundation of the nursing workforce and underpins the exceptional care that our nurses deliver every single day.

5. This intrinsic sense of purpose and compassion can be traced back centuries ago to the work of Florence Nightingale in the 19th century, who is widely regarded as the pioneer of modern nursing.

6. Nightingale was actually a statistician during the Crimean War. She was guided by facts and data while giving care to the injured. This enabled her to identify causes of deaths and infections and take steps to eliminate them. It brought a scientific approach to nursing.

7. She advocated therefore for strict sanitation and hygiene in hospitals, reducing the mortality rate significantly, and ultimately leading to significant improvements in healthcare practices.

8. Today, we don't just guide healthcare through statistics, but now we have research, Artificial Intelligence, NGEMR. Patients are constantly monitored for vital signs by nurses. The foundation of these was laid centuries ago.

9. Professional nursing in Singapore started through the formalisation of nursing education and training in the early 1900s, when the Singapore General Hospital established a nursing school. The Singapore Nurses' Board was established after World War II to provide oversight in nursing education and practice. This led to the establishment of professional standards and recognition of nursing as a vital component of our healthcare system.

10. Since then, nurses have been at the forefront of delivering competent care. Our nurses are highly skilled, dedicated and compassionate, widely regarded as one of the best around the world, and very importantly, respected by society.

11. Building on this, the Ministry of Health (MOH) has taken proactive measures to bolster this vocation, to meet the evolving needs of our healthcare system as our population ages. So today, on top of what Paulin has updated, let me give some updates on the state of this vocation.

Recruitment

12. First, recruitment. As our population ages, healthcare demand rises, and we need to expand our nursing force, for hospitals as well as community care organisations.

13. Last year, we set a national target to hire 4,000 new nurses, after experiencing high attrition in 2021 and 2022 due to COVID-19, as many of our foreign nurses were poached by other countries.

14. We have since turned the tide. Our public healthcare clusters have exceeded their target, and about 4,500 nurses were newly registered last year. They comprised both a strong local core, as well as foreign nurses. You have to train them. Once you integrate them, you have more hands and legs to train the next batch, so we can cross the hump.

15. In addition, clusters' nursing annual attrition rate has gone back to pre-COVID levels of around 7%. It is actually a healthy level. We will continue to build up our nursing workforce to meet current and future needs.

Education

16. Second, education. Ensuring a strong local core is key to our recruitment efforts. This in turn depends on MOH's commitment to developing nursing education and professional growth. The effort that we invest in to select, train and prepare a nurse upholds the professional standards and reputation of the vocation.

17. In the past, the pathway to nursing was distinct. I remember vividly because I was the CEO of the Workforce Development Agency (WDA) at that time and we dealt with nursing training. It was very distinct - from secondary school, you either joined ITE to become an Enrolled Nurse, or a Polytechnic to become a Registered Nurse. Today, the pathways have become varied, and our outreach to aspiring nurses is wide.

18. Whether you are a secondary school, ITE or polytechnic graduate, A-level or IB diploma holder, or mid-career individual seeking a career conversion, there is now a pathway for you to convert and be trained.

19. If you did not manage to fulfil the entry criteria for the nursing course, there are now avenues for you to meet them, through adult learning and acquiring the necessary credentials, such as the Workplace Literacy and Numeracy assessments.

20. With all these efforts, today, about one in 25 students will end up studying nursing. If you go to any Primary 1 class in a school, you know roughly one will become a nurse. We are therefore able to take in our fair share of local talent. Every year, during the application season, as an MP, and I am sure my Parliamentary colleagues have the same experience, I get numerous appeals from Singaporeans who want to get into nursing school, whether Nanyang Polytechnic or Ngee Ann Polytechnic, but could not. They all claimed to be very passionate about nursing. So never believe the assertion that nobody wants to join nursing. From time to time, we still hear that. Be like Florence Nightingale, follow the data and statistics, and let them speak for themselves.

21. Hence, we are working on increasing the cohort intake in our nursing schools - ITE, polytechnics and university. It cannot be a very big jump, but it should be an addition that is meaningful and help fulfil the wishes of our students who want to become nurses. Even so, it will continue to be an attractive and competitive course of study, even as we increase the number of places.

22. Our Institutes of Higher Learning will also be taking further steps to improve the education and training of nurses.

• The Institute of Technical Education (ITE) will be launching their three-year Higher Nitec certification to equip Enrolled Nurses with greater knowledge and skills;

• Singapore Institute of Technology will be launching its new five-year Integrated Bachelor and Master of Science in Nursing programme for candidates. This is a through-train undergraduate-plus-Masters over five years to allow the candidates to acquire more advanced nursing skills in the process; and

• National University of Singapore will be launching two new postgraduate programmes in Integrated Health and Critical Care Nursing. These are useful pathways for nurses to upskill themselves in specialised areas and allow graduates to stack up their skills towards a Master's degree in the future.

23. Other than formal education, we will continue to upgrade the skills of existing nurses, both in public healthcare institutions and also in our partner organisations in the community. With preventive care and Healthier SG being a key thrust of our long-term healthcare strategy, training of nurses in primary care has taken on greater importance.

One of this year's recipients, Assistant Director Ms Marine Chioh from the Agency for Integrated Care has been instrumental in developing the role of nurses working in the Primary Care Network setting. Marine helped developed the training frameworks and competency roadmaps, empowering nurses with the necessary skills and knowledge to adapt to the evolving demands of primary care.

Remuneration

24. Third, remuneration. It needs to be attractive, so that we can retain our nursing talent.

25. MOH has been reviewing the remuneration packages for nurses periodically, but a major move was made earlier this year when I announced that we will be introducing the ANGEL scheme (Award for Nurses' Grace, Excellence and Loyalty). This will be a long-term retention scheme.

26. Under the ANGEL scheme, new and in-service nurses working in the public healthcare institutions and participating community care organisations can receive a total payout of up to $100,000 over the next 20 years of their career.

27. This scheme aims to encourage nurses to build a lifelong career in nursing. We recognise that in any career, there will be moments of doubt, when there are competing purposes in life, because of family, children, spouses, aged parents, which lead us to doubt whether we can continue our current career paths, and some of us as a result switch paths.

28. The ANGEL scheme reminds us and our public healthcare institutions, to give ourselves a chance to work through these difficult junctures in life, so that we stay on course to do what we love to do.

Professional Environment

29. Hence, remuneration is actually not enough to retain our nurses. The fourth area we have been working on is the professional environment for nurses.

30. Good mentors and leaders play an extremely important role. They are people who have been there, done that, and can guide young colleagues with their experience and wisdom.

31. We are honouring a few mentors today, such as Ms Seri Rahayu Binte Mohamed Salleh, Nurse Clinician from Sengkang General Hospital. She provides constructive feedback and offers a listening ear to her team members, and has fostered a culture of open communication and trust, and a very positive work environment.

32. Institutions have been implementing flexible work arrangements to provide our nurses with more shift pattern choices with adapted scope of work, and help them better juggle between work and family commitments. We must be aware that nursing, like many other vocations, is not an office job. Our patients do not come according to flexi-work hours. Patients come any time they fall sick and need care. So we can offer more shift patterns, more options, but we have to be there for our patients.

33. In May 2024, Tan Tock Seng Hospital implemented a handover process initiative that has significantly reduced the handover duration to 15 minutes. As a result, nurses ending their shifts are now able to dedicate an additional 30 minutes to patient care instead of spending this time on handover procedures. All these are made possible by IT and digital technology.

34. It is important that we implement flexi-work arrangements in a practical and effective way, that continue to assure patients of good and consistent care.

35. Another award recipient, Mr Kiren Thanapalan, Nurse Manager from National University Hospital (NUH), demonstrated this. In the Intensive Care Unit ward in NUH, Kiren manages a virtual marketplace where he collates flexible work requests from all over, and matches them to fulfil as many requests as possible. The technology and mechanics of this may seem simple, but the impact is substantial, including increasing understanding amongst team members on the considerations that need to go into flexible work arrangements.

36. Another essential need that we have been striving to meet has been the safety and security of our nurses. All healthcare workers deserve to feel safe at work, so that they are able to do their work to the best of their abilities.

37. With the Tripartite Framework for the Prevention of Abuse and Harassment in Healthcare, healthcare institutions have MOH's full support to take decisive action against abusers of healthcare workers. The implementation guide has been developed and disseminated to all healthcare institutions. It outlines the specific ways in which healthcare institutions can empower and guide their staff, especially supervisors, in dealing with perpetrators of abuse and harassment.

38. Since the rollout of the guide, we have received anecdotal feedback that staff feel more supported and empowered to voice out, report and stop such incidents. Clusters have generally observed an increase in cases reported, with one cluster seeing a 10% increase, with half of these cases resulting in verbal or written warnings to the abusers. This is an encouraging sign, as it shows that our staff are now more aware when abuse happens, and are taking active steps to address the abuse. Make no mistake. When any abuser who then appeals to the Minister, I will ask if this is an abuser. If it is, I am sorry, you should be warned. It does not undo the abuse by appealing to the Minister. That, I promise you.

39. However, I have also heard that some are still unsure when it is worthwhile to make such reports. Let's continue to encourage and support each other along this journey, and make it our collective goal to make zero tolerance against abuse and harassment in our healthcare institutions a reality.

Closing

40. Today, we have come together to celebrate and honour your achievements in your careers thus far. More importantly, through the Nurses' Merit Award, we unite as a healthcare family - nurses, institutions, and with support from the Healthcare Services Employees' Union - to honour the contributions of our nurses.

41. This year, we have a total of 150 award recipients. Each recipient has consistently demonstrated exceptional performance and made significant contributions to the nursing profession, and I extend my heartfelt congratulations and admiration to every one of you. Congratulations and thank you!