Last year in January, data released by the Manpower Ministry (MOM) in Singapore indicated that in terms of PMET (professionals, managers, executives and technicians) jobs, registered nurses were one of the hardest positions to fill by locals.

There were 720 vacancies as of September 2014, with the top reason cited being that there was too much competition from other employers. It is notoriously hard for those in the nursing profession to catch a break.

Crucial to make sure that nurses are in optimal condition

Ideally, nurses scheduled for 12-hour shifts should get a minimum of three 15-minute breaks and one uninterrupted meal period – according to the guidelines of many hospital policies. But the reality is that nurses usually put patients’ needs first, even working through their unpaid lunch hours.

The result is that at the end of the day, nurses are exhausted with the added weight of knowing they face the same challenges the next day.

Investigations in nine European countries have given statistical backing to claims that patients' lives may be at risk when nurses are overworked. The study looked at survival rates of more than 420,000 patients aged over 50 from 300 hospitals, matching these against the workload and education of their nurses.

Each patient added to a nurse's workload increased the risk of a patient dying by seven percent. Every 10% increase in bachelor's degree-educated nurses was associated with a 7% fall in this risk.

Nursing shortfall in Singapore –chronic problem exacerbated by patients’ changing needs

In 2013, a World Health Organisation report stated that Singapore's ratio of 60 nurses per 10,000 in the population places it below 14 countries that have a count of at least 100. It came in 36th among 138 nations for which statistics were available.

However, the Nursing Board estimates that 1,000 to 2,000 foreign nurses are required each year to supplement local output. As of 2015, there are about 36,000 skilled nurses in the healthcare system.

In fact, from 2004 to 2014, the overall nurse-to-patient ratio has improved - the nurse-to-patient ratio for day shifts in the general wards in the public hospitals was 1:5 in 2014, as compared to 1:8 in 2004, said Senior Minister of State for Health Amy Khor in Parliament.

However, nurses are still overworked in Singapore because "[although] The overall ratio has improved, but caring for patients remains demanding because our patients’ acuity and needs have also increased over the period, partly due to our ageing population, and partly due to higher expectations," she added.

High turnover affects quality of nurses and efficiency

According to an anonymous contributor on a local site, nursing staff in Singapore are usually overworked with tons of patients to assist everyday, due to the numerous different appointments that have to be made for just one patient. The contributor said that many have to work over-time (OT) just to finish a day's work, so that it will not be carried over to the next day.

The nursing profession is characterised by high turnover rates – as of 2008, the turnover rate for Singaporean nurses was 9%. The Singaporean government’s response to this is often to offer scholarships to foreign nursing students, with six-year bonds and a promised starting pay of S$1.5k to above S$2k.

However, this further depresses nursing salaries for locals. As a result, the anonymous contributor observes that “permanent staff are all low moral and not motivate”. This leads to frequent taking of unpaid leave and MC, causing the rest to be even more overworked.

Malaysian public hospitals understaffed despite abundance of nursing graduates

Meanwhile according to healthcare authorities in Malaysia, more than 70% of government hospitals do not have adequate nursing staffs even though at least 109 universities and colleges in Malaysia offer nursing training programmes.

According to the WHO, the ratio recommended for nurses to population ratio in a country such as Malaysia is 1:200. However, in 2011, the ratio in Malaysia is one nurse for every 329 people, according to healthcare authorities.

There are some 80,000 nurses at hospitals and clinics nationwide, but only some 80% of the jobs are filled, with about 1,100 Malaysian-trained nurses working abroad, said the former Health Minister Liow Tiong Lai back in 2011.

Dr Ahmat Fakrudin, a general practitioner who used to serve in government hospitals, said most nurses, in general, are overworked.

“There are several factors contributing to the shortage of nurses in the healthcare industry,” said nursing science lecturer Mary Lim. Among them are that nursing school enrolment is not increasing quickly enough, and nursing colleges are turning away qualified applicants.

“Some applicants are rejected because they are thought to be over-qualified,” she said.

Hence, there are not enough high-level nurses to fill academic and faculty positions. “Out of the many who complete their diploma in nursing programmes, only a small percentage go on for advanced courses such as bachelor’s and master’s degrees. Therefore, there is only a small pool of nurses with advanced degrees available to be in the academic and clinical nursing fields.

“Addressing the nursing shortage means opening up the pipeline to move trained nurses to be teachers, hence producing more nurses,” Lim added.

Redesigning processes and using technology to improve productivity

The Singapore government has been looking into redesigning processes and using technology to improve productivity. For instance, the Closed Loop Medication Management (CLMM) System implemented in several public hospitals has "significantly improved efficiency and patient safety", even while the hospitals are handling increasing patient volumes.

To better meet the work-life needs of nurses, flexible work arrangements have been piloted at selected wards in the Changi General Hospital, KK Women’s and Children’s Hospital, Singapore General Hospital and Tan Tock Seng Hospital.

"Feedback from the pilot wards has been encouraging. The participants of the pilot generally welcomed the initiative," said Dr Khor. "We are making steady efforts to enhance nursing as a profession and will continue to invest in our nurses and support them in their work." MIMS

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