Enhancing Skills and Capabilities of Nurses and Nursing Aides

17 Dr Tan Wu Meng asked the Minister for Health whether the Ministry will explore ways to up-skill and enhance the capabilities of enrolled nurses and nursing aides including those serving in nursing homes through measures such as training and certification.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health):Enrolled Nurses (ENs) and support care staff, such as healthcare assistants and nursing aides, are important healthcare staff in the delivery of care. They assist Registered Nurses (RNs) in the provision of nursing care. ENs are able to carry out tasks, such as inserting stomach feeding tubes and blood glucose monitoring.

As our population ages, healthcare needs will increase and become more complex. We agree with the Member that we should continue to up-skill ENs and support care staff to perform a wider scope of patient care.

ENs and support care staff can undergo in-house training provided by our public healthcare institutions.

They can also attend courses offered by training providers, such as the SingHealth Alice Lee Institute of Advanced Nursing Studies and the Agency for Integrated Care (AIC)'s Learning Institute.

ENs can also up-skill to be RNs through the Diploma in Nursing course offered by Nanyang Polytechnic and Ngee Ann Polytechnic. As part of the recommendations by the National Nursing Taskforce in 2014, more ENs can progress to become RNs by undertaking the Certificate in Bridging Studies for ENs course, and subsequently the Diploma in Nursing course, if they have at least three years of post-enrolment work experience and an employer's testimonial.

The MOH has also increased funding for our public healthcare institutions to support the upgrading of ENs to RNs. With these changes, the number of ENs enrolling in the Diploma in Nursing course increased by 7% from 237 in 2014, to 253 in 2016.

We will continue to study ways to enhance the roles, professional growth and career pathways for our ENs and support care staff, so that we can continue to deliver good quality care for Singaporeans.

Dr Tan Wu Meng (Jurong):I thank the Senior Minister of State for Health for her answer. I have one supplementary question to ask.

At present, my residents tell me, and from my own experience in healthcare, a patient's care-giver can learn how to give an insulin injection under the skin. This may be a spouse or a loved one, but in essence, a layperson can be taught this skill through a short course. So, I was wondering whether MOH will consider making these courses available for nursing aides, especially at our nursing homes. This will help them up-skill and also allow cross-training of staff, and improve deployability.

Dr Amy Khor Lean Suan:Allow me to explain first, that while a diabetic patient is trained, he can be trained to give himself a specific type of insulin injection for self-care, or the care-giver could be trained to do so. Healthcare staff, particularly those in healthcare institutions, are required to work with a broad range of different insulin on different patients, and this increases the need for safe care.

Nursing aides are currently not allowed to administer insulin and other subcutaneous injections to nursing home residents.

Such injections are to be done by nurses (RNs and ENs) with training. This is in view that insulin is classed under the group of high-alert medications, which are medications that are most likely to cause significant harm to the patient, even when used as intended. Although any medication used improperly can cause harm, high-alert medications cause harm more commonly, and the harm they produce is likely to be more serious and may lead to patients suffering and incurring of additional costs associated with care of these patients. For instance, insulin injection, if wrongly administered, may cause the patient to go into a coma, and further complications can arise.

Nonetheless, as I have noted earlier in my reply, we are looking at the expanding role and scope of patient care by up-skilling our ENs and support care staff, so MOH will work with the nursing homes to review whether nursing aides and other support care staff may be allowed, with appropriate training, to administer subcutaneous injections, while maintaining safe care.

Mr Leon Perera (Non-Constituency Member):Madam, just one supplementary question for the Senior Minister of State.

Does the MOH currently benchmark the level of professional training, specifically for nursing home staff, such as ENs and nursing aides, with other countries that may have a best practice in this area, like Japan, for example, which I think is known for high standards for eldercare and care in nursing homes, to see if there is scope to further improve the level of training and the level of continuous training that nursing staff receive in Singapore nursing homes? I suspect the level of training is rather uneven at the present moment when we look at the nursing home space.

Dr Amy Khor Lean Suan:I thank the Member for his question. Indeed, we do conduct study visits, as well as share information with healthcare institutions in different countries, including the Western developed countries, as well as Japan and Hong Kong.

As I am speaking on this, there is a committee that is looking at reviewing the curriculum and training of nurses, to expand their role and scope. It will also be looking at expanding the role and scope, and up-skilling of healthcare support staff.

1.30 pm

Mdm Speaker: Order. End of Question Time.

[ Pursuant to Standing Order No. 22(3), Written Answers to Question Nos. 20-22, 24-26, 29 and 31-32 on the Order Paper are reproduced in the Appendix. Question Nos. 18-19, 23, 27-28 and 30 have been postponed to the next available sitting of Parliament. ]