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Commentary: Creative solutions needed to tackle manpower shortage in healthcare

For any healthcare establishment to function optimally and efficiently, we need adequate doctors, nurses, other allied medical and nursing staff, healthcare facilities, and patients.

The author believes that more scholarships, with strings attached, should be offered to keep good nursing staff.

The author believes that more scholarships, with strings attached, should be offered to keep good nursing staff.

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For any healthcare establishment to function optimally and efficiently, we need adequate doctors, nurses, other allied medical and nursing staff, healthcare facilities, and patients.

At the moment, we are greatly short of allied medical and nursing staff.

According to news reports, in 2021, the attrition rate of local and foreign nurses working in the public sector was 7.4 per cent and 14.8 per cent, respectively. From what I have witnessed, even more foreign nurses have resigned and left Singapore in 2022.

As a medical doctor, I can personally feel the pinch.

Since 2022, as we began to live with Covid-19, I have had difficulty admitting sick patients to private hospitals as there are insufficient nurses. As a result, I have been sending many of them to the emergency departments of restructured hospitals.

Just two days ago, one senior surgeon lamented that his cancer patient needed to wait for at least two to three weeks instead of the usual four to five days to have his operation done, due to a shortage of operating theatre nurses, and ward nurses.

As a matter of fact, several private hospitals have closed some hospital wards and operating theatres, due to a shortage of nurses.

According to a report in TODAY, many nurses have relocated to New Zealand, Australia, and the United Kingdom.

Reasons cited include higher pay, better work-life balance, better respect from patients and co-workers, family reunion and free education for their children in these countries.

From my experience, it is not just our foreign nurses who are leaving. Our foreign allied healthcare workers, such as radiographers, operating theatre technicians, medical technologists, are also leaving.

Since the pandemic, there has been no overseas replacement for the lost manpower, so our pool of nurses and allied medical staff has shrunk significantly.

IMPACT OF NURSING SHORTAGE

Without an adequate number of nursing staff, many facilities such as operating theatres, hospital wards, and endoscopy suites become non-functional.

Waiting time for elective consultations and procedures such as digestive endoscopies, operations as well as investigations such as imaging studies, have become longer.

It also affects emergency care. When the private hospitals are full, ill patients at emergency departments in private hospitals are shunted to restructured hospitals.

This leads to a jam in the emergency departments at restructured hospitals and wards, which further affects their capacity to take care of elective cases.

And even when hospitals can hire locum or part-time nurses, or new nurses into their facilities, the standard of medical care will drop.

Numerous published clinical studies have shown that facilities with inexperienced nurses have longer procedure time, higher complication rate, and lower quality of care.

We can also learn from overseas experience. In New Zealand, when tertiary hospitals in major cities are short of nurses, they poach nurses in long-term care facilities which typically pays lower wages. As a result, some nursing homes in New Zealand have to close due to shortage of nurses.

In a tragic case, a 50-year-old New Zealand woman, first presented with a headache to the emergency department of a local hospital. She was told that she would have to wait for eight hours before being examined.

As a result, she returned home. But she later collapsed at home as the cause of her headache turned out to be a bleed in the brain.

Nobody wishes such serious consequences would happen in Singapore, so we must act fast.

HOW ARE COUNTRIES KEEPING NURSES?

Solving a manpower shortage in healthcare is a million-dollar question that every healthcare leader in the world is trying to answer.

Senior Parliamentary Secretary for Health, Ms Rahayu Mahzam, said in a Aug 2 parliamentary speech that MOH recognises the problem and is looking at the issue holistically and adopting a multi-pronged approach to improve the situation.

Solutions include reviewing nurses’ scope of work, use of innovative technology, ensuring remunerations are competitive internationally, encouraging families and caregivers to be active partners in patient care, increasing local nursing school intake at the Institute of Technical Education and polytechnics.

One of the efforts of healthcare leaders in New Zealand and Australia is to poach experienced nurses from Singapore.

They offer higher salaries, permanent residency for foreign nurses soon after their arrival, family union and free education for children below 18 years of age.

WHAT ELSE CAN SINGAPORE DO?

It is unlikely that Singapore can offer a similar solution as we are a small crowded city state, and cannot accommodate all the children of our foreign nurses.

But there is still much we can do to keep our foreign nurses.

First, we must improve their overall compensation.

New Zealand pays their nurses about twice that of Singapore. Though their living standard and taxes are higher, their take-home pay is still better. If we don’t match the salaries offered by New Zealand's and Australia's hospitals, more foreign and even Singaporean nurses will leave.

As part of their compensation package, we could provide paid return tickets for them to visit their families on an annual basis, to improve our attractiveness.

Nurses in public hospitals are getting a five to 14 per cent increase in their base salaries in 2022. There will also be a retention bonus of 1.7 to 2.1 months next year.

These are good measures but they fall short of the pay offered by New Zealand and Australia, where nurses’ pay is about double that in Singapore.

Second, we should offer more scholarships, with strings attached, to keep the good nursing staff.

Many local and foreign nurses have benefited from the extra courses, extra training, promotion and additional pay. But as they are bonded for several years after the courses, they cannot relocate to other countries till the end of their bonds.

Third, we ought to recruit new nurses from overseas, to replenish our shrunken pool of nurses. Just as New Zealand and Australia poach our nurses, we should also poach nurses from other countries.

And we should aim to hire foreign nurses who are single, or with grown-up children, as they are less likely to be enticed to leave for New Zealand or Australia.

Malaysian nurses are also more likely to stay in Singapore, as it is more convenient for them to see their families back home.

Lastly, and more importantly, we must make Singapore a place that foreign nurses want to work and live in.

Xenophobic feelings and expressions exist among some Singaporeans, and even politicians. This must stop. If foreign nurses don’t feel welcomed here, they would go elsewhere.

STOP-GAP MEASURES

For now, hospitals are hiring non-nursing staff to take over non-clinical duties. Food catering, cleaning, and laundry have been outsourced long ago.

Healthcare assistants are also hired to take care of daily, non-clinical duties, such as assisting patients to go to the toilet, transporting patients to imaging centres and other facilities within the hospitals.

Medical technicians or assistants have also been hired to take over clinical duties. For instance, at some endoscopy centres, endoscopy technicians are now trained and hired to assist in endoscopies. Instead of having two staff nurses assisting endoscopists during scopes, we only need one nurse and one endoscopy technician.

Many nurses are now doing longer shifts. Instead of the standard three eight-hour shifts, nurses are doing 12-hour shifts. But stretching our nurses in this manner is hazardous. Tired and sleep-deprived medical staff are more likely to make mistakes.

In China, family members must stay in with the inpatients, to assist in non-clinical duties such as feeding and bringing the patient to toilets. We may have to resort to this in the near future if our pool of nurses continues to shrink.

To avert such scenarios, all stakeholders, including MOH, private hospitals, patients, families and medical staff must be creative in making appropriate solutions.

If we do not act promptly and decisively, our healthcare standard will continue to deteriorate.

 

ABOUT THE AUTHOR:

Dr Desmond Wai is a gastroenterologist and hepatologist in private practice.

Related topics

nurses healthcare labour shortage MOH

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