Nurses Are Also Important in Healthcare
People normally give high respect to doctors, who have high social status, earn high salaries and play important roles in the healthcare system. Compared with the “elite” doctors, the importance of another indispensable group in the healthcare system — nurses — is often easily ignored. No matter whether we admit or not, nurses normally spend more time accompanying with patients than doctors. They observe more, communicate more and know more details of patients’ conditions than doctors, and thus may become more important roles than doctors in medical treatment sometimes. Unfortunately, the effort of nurses is more likely to be ignored by people than doctors.
This passage aims to use Singapore as an example, and to motivate basic understanding of nurses as well as to help understand the current challenge:
- Nursing Career
- Workload of A Nurse
- Demand and Supply of Nurses
Nursing Career
People usually take 2-year program to become Enrolled Nurses (EN), and 3-year program to become Registered Nurses (RN). A enrolled nurse helps a registered nurse to offer holistic nursing care. A registered nurse has a diploma or degree in Nursing, and can further develop nursing skills in various specialties.
There are 4 career paths that nurses can choose (Figure 1). Simply speaking, they are Management-Track, Education-Track, Clinician-Track and Research-Track. Most nurses we are interacting with in hospitals are in clinician-track.
Workload of A Nurse
There is an increasing concern on shortage of nursing workforce and complaints on heavy nursing workload. Of course, patient care is the top priority of nurses which requires dedicated nursing skills. By understanding the workload of nurses, we may have vivid idea of nurses’ work and figure out the opportunities for improvement.
Lim and Ang (2019) studied clinician nursing workload (RN: Registered Nurse, EN: Enrolled Nurse)in medical ward of Singapore General Hospital. Although the sample size is small (18 nurses), it gives us a vision on nursing workload in general (Table 1). (Please refer to the paper for the definition on the nursing activities. The category of activities is based on the International Classification for Nursing Practice, i.e. ICNP.)
The activities such as documentation and handover which don’t require much dedicated nursing skills take not a small portion of time. Procedures could be optimised and automatous pipelines could be built up to reduce the time spent on the activities not directly related to patient care. To name a number of potential interventions: integration of different healthcare information systems, development of automatous pipelines for data inputs and symptom monitoring, development of alert system on drug-related problems and food restriction based on patient’s medical conditions, development of appointment schedule system, symptom check and medication refills. The modern technologies and AI algorithms will play important roles on the improvement.
Demand and Supply of Nurses
Contrary to the high payment of doctors, Indeed.com shows that the average base salary of a registered nurse in Singapore is SGD 2,983/month, with some level of variability across different facilities (Figure 2). Compared with the average monthly salary in Singapore — SGD 5,783 (as of Jan 2021), and the median monthly salary — SGD 4,563 (as of Jan 2021), the payment of nurses is not attractive enough for people to consider (See details: https://www.resumewriter.sg/blog/salary-guide-singapore/).
Regarding the nurse to population ratio, Singapore is not low in Asia, but there is still an apparent gap when comparing with most of European countries (e.g. Normal: 17.7 nurses per 1,000 population, Germany: 12.9 nurses per 1,000 population), the United States (11.7 nurses per 1,000 population), Australia (11.7 nurses per 1,000 population) and Japan (11.2 nurses per 1,000 population). Considering the expanding and aging population, the tension between the demand and the supply of nurses in Singapore will be worsened. It is the time to think about re-emphasising the importance of nurses and taking advantage of modern technologies to automate manual works and to reduce the reliance on nurses which doesn’t require dedicated nursing skills.
Reference
- https://www.moh.gov.sg/hpp/nurses/career-practices/CareerNPracticesDetails/nursing-careers
- Lim, M. L., & Ang, S. Y. (2019). A time–motion observation study to measure and analyse clinical nursing workload in an acute care hospital in Singapore. Proceedings of Singapore Healthcare, 28(2), 124–128.
- https://sg.indeed.com/career/registered-nurse/salaries
- https://www.resumewriter.sg/blog/salary-guide-singapore/
- https://www.moh.gov.sg/resources-statistics/singapore-health-facts/health-manpower
- https://www.statista.com/statistics/283124/selected-countries-nurses-per-1-000-inhabitants/
