Need a doctor? Just get the nurse

Staff Nurse Sapphire Teo giving medication to a patient. Nurses today are better educated and have structured career tracks and the autonomy to make clinical decisions.

When I left Singapore for Britain in 1990 to pursue my bachelor's degree in nursing, family and friends asked in disbelief: "You need a degree to be a nurse?" It was a sad reflection of how nursing was perceived.

What came to mind were simple tasks such as cleaning up sick people and dishing out pills, and following doctors' orders. Nothing more.

Many decades ago, nursing practices here were passed down through generations of nurses via an apprentice system and traditions. There was not always scientific merit to what was taught.

For instance, nurses decided with a series of tests if a tube delivering food and medicine to the stomach via the nose was in the right place.

Litmus paper was used to see if acidic gastric juices were present - if the tube was in the right place, the paper turned pink. Or the end of the tube was immersed into water to check for bubbles, which meant the tube was in the lung instead.

Research has taught us now that a pH indicator is a more precise way of telling if the tube is in place, by determining the exact pH value. A chest X-ray can clear any doubt.

When I returned from Britain to work as a young staff nurse in another hospital, I experienced culture shock because nursing care was so different here.

I was assigned to only one task for each shift, such as changing wound dressings for more than 40 patients, even though I knew clearly that many did not need dressing changes. I had to go with the flow even though, for certain patients, including those just out of the operating theatre, it was better to leave their dressings untouched for a while.

These days there are many more opportunities for nurses to upgrade our skills and knowledge, thanks in part to the support of the Government and healthcare organisations which recognise the critical role that we can play. At the National University Hospital (NUH) alone, about 50 nurses are sponsored for higher education each year.

Nursing research has also gained prominence.

Our contact with patients on a day-to-day basis gives us a deeper understanding of what they need, what they can and cannot do, and their circumstances - insight that is invaluable in research.

This explains why nursing research centres on patient care.

Take cancer patients, who undergo a form of treatment that helps the body's immune system fight the cancer.

Eight in 10 patients react to the medicine, suffering fever, chills, a drop in blood pressure and a higher heart rate during the process.

Monitoring a patient's vital signs is key. For those who can tolerate the first five-hour to six-hour cycle, their second cycle can be reduced to three to four hours.

But there is still a lot of discomfort to go through, with up to eight treatment cycles in total.

Literature from overseas has reported that the second cycle can be safely reduced to 90 minutes, without compromising drug efficacy.

Keen to bring this practice to our shores and make it a routine, our nurses conducted a three-year study of local patients, which confirmed it was safe.

The result was a much more comfortable process which saved patients a lot of time as well.

Our Evidence-Based Unit was set up formally in 2008 as a one-stop resource for nurses, providing access to medical journals, academic references and tools for statistical analysis, as well as nurse educators who coach and give advice to budding nurse researchers.

The unit has been a collaborating centre of Australia's Joanna Briggs Institute - a leading international not-for-profit research and development organisation - since 2009.

We have at least 10 ongoing research studies every year, in areas ranging from patient safety and preventing falls and pressure ulcers, to patient care for those with cancer, heart failure and kidney disease.

To support nursing research in a more concerted way, a Nursing Research Council will be launched at the NUH soon.

It is made up of clinical nurses who can generate research questions that will impact patient care.

Nursesare well placed to improve patients' lives in many ways through our own unique research approaches, which tend to focus on social and behavioural sciences.

Many of us now work in counselling, behaviour modification - changing the health behaviour of patients - patient education, and promoting of self-care, and the autonomy and ability of a patient to manage his own condition so that he sticks to his treatment plans and stays out of hospital.

We need to look more at health services and outcomes research, to evaluate patient outcomes and the use of healthcare resources, and the impact nurses and nurse-initiated programmes have on patients and their families.

Nurses today are better educated, have structured career tracks, do research and have the autonomy to make clinical decisions.

More nurses are also advancing beyond a basic diploma or degree. NUHhas six nurses with PhDs and about 100 with master's degrees (out of a total of about 3,000).

Many Singapore nurses are taking part in and making presentations at international conferences, sharing our practices and showcasing our research work.

And our 42 Advanced Practice Nurses, all with master's degrees, can perform some of the tasks currently undertaken by doctors.

They have the clinical knowledge and skills to diagnose and manage common and chronic conditions, such as diabetes, heart and lung disease, cancer and chronic pain.

Today, we are collaborative partners with the doctors.

In an ageing Singapore, we need to become experts in taking care of the elderly and helping those with end-stage illnesses to die well.

We also need to extend care to the patients in their homes and in the community.

The challenge ahead is not just about preparing the profession to tackle current issues, but to also anticipate new ones in our rapidly evolving healthcare landscape.

As we celebrate Nurses Day tomorrow, I would like to encourage all nurses too.

I am sure that as long as we continue our work with passion and compassion, and as long as we progress steadfastly as professionals, we will be able to step up.

• The writer is Chief Nurse at the National University Hospital.

About the author

Dr Catherine Koh, 44, is Chief Nurse at the National University Hospital.

She obtained her doctorate - Doctor of Nursing Practice - in 2010 at the University of Colorado, Denver, in the United States.

Her research focuses on breast cancer and surgery.

Dr Koh's career choice was made possible through a Public Service Commission Overseas Scholarship in 1990.

She graduated with Honours from Britain's Manchester University, where she also received the Master of Science in Nursing Studies (Cancer) in 2003.

Dr Koh has published numerous studies, especially in breast cancer care, in local and international journals.

A strong patient advocate, she oversees clinical standards and nursing practices in the hospital.

Her other passion is in advancing nursing practice, staff development and talent management.

This article was first published on July 31, 2015.
Get a copy of The Straits Times or go to for more stories.