Nursing

About Us

At our Nursing Department, we employ some 2,700 nurses whose focus is on providing care of the highest quality to our patients.

Our nurses form an integral part of our dedicated care team, backed by the latest in clinical and information technologies. Through the years, we have re-engineered the roles of our nurses to assume a higher range of clinical responsibilities, and adopted the use of the e-Rostering and Patient Acuity Systems to improve patient care as well as the work-life balance of our staff.

Nurses are encouraged to learn, grow and contribute to shaping our practices through continuing education programmes and evidence based nursing. Our mentoring and career development programmes serve to expand their supervisory and management skills, develop specialised clinical skills including advanced nursing practice, and grow their capabilities in nursing education and evidence based nursing.

While the dedication, commitment and team spirit of our culturally diverse pool of nurses form the foundation of the Department of Nursing, our vision, mission and philosophy aim to bring our professionalism and the level of care to new heights.

Our Nursing Vision
Nurses in NUH, as one, are committed to delivering professional and personalised nursing care to our patients.

Our Nursing Mission
We are committed to specialised nursing care of the highest quality, built upon continuous improvement as well as evidence-based practice within an environment of nursing research and education.

Our Nursing Philosophy

• We believe that our nurses have the primary responsibility of providing personalised, specialised and safe care to our patients
• We believe in the professional growth of our nurses in order to achieve the full potential of our staff
• We believe in working in collaboration with all concerned for the interest of our patients

Our Services

As nursing positions expand beyond the traditional hospital nursing roles, nurses have increased options and flexibility. The wide selection of patient care units and medical specialties offer a career enhancing setting for the professional nurse who desires to develop in bedside nursing. Opportunities exist in these nursing specialties and subspecialties:

Nursing Specialties

• Critical Care
• Emergency
• Medical
• Obstetric & Gynaecology
• Oncology
• Orthopaedic
• Paediatric
• Perioperative
• Surgery

Nursing Sub-Specialties

• Breast Care
• Chronic Disease Care
• Dermatology Care
• Diabetes Care
• Geriatric Care
• Neuroscience Care
• Orthopaedic Care
• Pain Care
• Rehabilitation Care
• Respiratory Care
• Upper Gastrointestinal Care
• Wound / Stoma / Continence Care

Breast Care
We adopt a multidisciplinary approach to care for patients newly diagnosed with breast cancer, and related breast conditions throughout the disease trajectory. As integral members of the team, the Breast Care Nurses provide ongoing information; practical and emotional support, coordination of, and quality clinical care to patients and their significant others. In collaboration with other healthcare professionals, our nurses conduct research and translate evidence into optimal care for our patient population.

Chronic Disease Care
NUH In-Patient Chronic Disease Management Programme is a 4-year funded programme by Health Promotion Board. Chronic Disease Care Nurses provide education to patients with diabetes, hypertension and/or hyperlipidaemia.. Patients are educated on the disease process, the importance of healthy living, medication adherence and regular medical follow-ups thus empowering patients to manage and take charge of their health conditions.

Dermatology Care
Dermatology Nurse Clinicians conduct nurse-led clinic for patients with chronic skin diseases, wart, and perform skin cancer screening and surveillance. Our nurses also perform a variety of skin biopsies, electrosurgery, cryosurgery, chemical peeling, and intralesional steroid injections governed by clinical protocols. In addition, our nurses educate and counsel patients and their caregivers on the long-term and home management plans for a wide range of common dermatological conditions.

Diabetes Care
To help patients with diabetes achieve good glycemic control and lead a normal lifestyle, Certified Diabetes Care Nurses work closely with a team comprising the endocrinologist, dietitian, podiatrist and diabetes foot care nurse to provide a high standard of coordinated care. Our Diabetes Care Nurses are also responsible for the development, implementation, evaluation of the standard in nursing and revision of guidelines for nurses in the care of patients with diabetes.

Geriatric Care
With the growing aging population, it is expected there will be increasing challenges in managing older adults with complex care needs. Our Geriatric Care Nurse Clinicians receive referrals, initiate comprehensive Geriatric Assessment, act as a resource person and collaborates with the Geriatricians and multidisciplinary team to optimise care needs and ensure continuity of care for the patients.

Our Geriatric Care Nurses are also responsible for developing, updating and educating nurses on practice guidelines to enhance the care standards of Geriatric nursing in the organisation.

Neuroscience Care
Patients with neurological issues such as stroke, traumatic brain injury and brain tumours may have disabilities that require special care needs. Our nurses in Neuroscience Care conduct nurse led anticoagulation clinic and case-managed patients via multidisciplinary approach under the neurology and neurosurgery discipline. Monthly support groups are introduced and organised for the patient groups and their families. The nurses are involved in raising public awareness by organising regular neuroscience related public forums. They are also committed to lead neuroscience nursing care in the organisation.

Orthopaedic Care
Orthopaedic Nursing is focused on the prevention and treatment of musculoskeletal disorders for patients of all ages, from infants to adults. The role of our Orthopaedic Nurse Clinicians include managing and improving care of patients with complex needs ranging from joint replacement, trauma, musculoskeletal oncology, diabetic foot, sports injuries, hand and reconstructive microsurgeries, spine conditions and paediatric orthopaedics. Our Nurse Clinicians are involved in the planning, coordination and evaluation of care delivery to patients and their family. They also act as a resource person; counsel and educate patient and family towards promotion of healthy lifestyle and disease prevention. In addition, our Nurse Clinicians conduct research projects and review evidence based papers for development of guidelines and application into clinical practice.

Pain Care
Our Pain Care Nurses promote and provide optimal pain care to patients. They collaborate with the pain care physicians to provide Acute and Chronic Pain Service which includes:

• Direct care of patient through daily pain round
• Patient education on pre and postoperative pain management
• Staff education related to pain management
• Develop practice protocols and standard procedures to guide pain care delivery

Rehabilitation Care
The care of patients requiring rehabilitation involves a multidisciplinary team effort. Our Rehabilitation Care Nurses collaborate with the multidisciplinary team to help patients achieve and maintain the highest possible level of functioning, optimal health and well-being.

Respiratory Care
Our Respiratory Care Nurses provide education to the patients and their caregivers on respiratory disorders. They conduct regular follow ups with our patients to monitor their adherence to treatment and work with patients to develop individualised self-management plan for better control of our patient's respiratory condition.

Upper Gastrointestinal Care
Our Upper Gastrointestinal Care Nurses provide pre-operative education upon diagnosis, conduct comprehensive programmes for postoperative patients with gastric cancer and provides follow up support service to patients and their caregivers. Our nurses have an additional role in weight management programme, providing patients with comprehensive and compassionate care, to meet each individual with treatment plan and lifestyle modifications.

Wound/ Stoma/ Continence Care
Our Nurses in Wound / Stoma / Continence care provide direct patient care by assessing, planning, implementing and evaluating patients with either wound, stoma or incontinence issues. They collaborate with physicians, nurses and allied health professionals in the care of this group of patients. In addition, our nurses are actively involved in staff education and in improving and maintaining nursing care standards in relation to wound/ stoma / continence care.

Our Nursing Education

Mrs Lee Kong Chian Centre for Nursing Education

Our Mrs Lee Kong Chian Centre for Nursing Education was established for the primary purpose of enhancing the knowledge and skills of our nurses.

On 26 May 2009, NUH became the first hospital in Asia to launch a simulation laboratory for critical care training. The 100 sq-ft laboratory consists of a High Dependency (HD) room and Intensive Care Unit (ICU) room (which are replicas of the actual setup). This means nurses can now practise their acquired skills in a simulated environment before attending to patients.

By keeping abreast with the latest developments in nursing practices and technologies, our nurses are well equipped to provide safe and quality nursing care to our patients.
We also pride ourselves in having a team of well-qualified and experienced Nurse Educators to cater to the learning needs of our nurses, including curriculum development and teaching methodologies - both didactic as well as practical. In addition, our Nurse Educators from varying clinical specialties provide support for our unit and translate theory to practice.

Role Enhancement Courses
In order to prepare our Registered Nurses for the expanded role, we conduct a series of Role Enhancement Courses to equip them in providing specialised care to the patients.

• Life Support Courses (Basic Cardiac Life Support, Automated External Defibrillator, Life Support Course for Nursing and Mass Casualty Induction Programme)
• Course on Venepuncture and Intravenous Cannulation (Accredited by Singapore Nursing Board)
• Course on Intraveneous Administration of Medication (Accredited by Singapore Nursing Board)
• Electrocardiogram (ECG) Course
• Physical Assessment Course
• Specialised In-Service Trainings
Structured SNB Specialised Courses (inclusive of clinical attachment)
We also provide comprehensive and structured courses. These courses are created to enhance the capability of the nurses to take on specialised roles.
• Advanced Emergency Course
• Advanced Nephrology Nursing Course
• Advanced Surgical Nursing Course
• Basic and Advanced Perioperative Course
• Cardiac and Cardiothoracic - Vascular Nursing
• Critical Care Programme
• NUH Paediatric Critical Care Nursing Course
• Paediatric Oncology Nursing Course
• TCI Oncology Nursing Course

Structured SNB Specialised Courses (inclusive of clinical attachment)
We also provide comprehensive and structured courses. These courses are created to enhance the capability of the nurses to take on specialised roles.

• Advanced Emergency Course
• Advanced Nephrology Nursing Course
• Advanced Surgical Nursing Course
• Basic and Advanced Perioperative Course
• Cardiac and Cardiothoracic - Vascular Nursing
• Critical Care Programme
• NUH Paediatric Critical Care Nursing Course
• Paediatric Oncology Nursing Course
• TCI Oncology Nursing Course

Clinical Attachment Programmes (with and without hands-on attachment)
As part of an ongoing commitment to enhance the knowledge and skills of nurses from other healthcare institutions locally and regionally, NUH offers both Clinical Observation and Clinical Attachments.

These attachments range from observational to hands-on practice designed to meet the learning objectives of the visiting healthcare professionals.

For enquiries on our Nursing programmes and Clinical visits/attachments, please contact the following people:

Evidence-Based Nursing Unit (EBNU)

The Evidence-Based Nursing Unit (EBNU), an arm of the Nursing Department, was established in May 2005 with the objective of building the capacity of nursing staff to adopt best practice standards.

The roles of the EBNU in propagating Evidence-Based Practice are:
• To promote the use of EBP by nurses to improve patient outcomes
• To organise training programme for nurses in conducting critical appraisals
• To support nurses to translate evidence-based findings
• To facilitate EBP projects in the hospital through Journal club and internship programme

EBNU Activities
The Evidence Based Nursing Unit has been involved in various hospital-wide projects to conduct evidence/systematic review and research, and translate evidence-based findings into clinical practice. Some of these projects include:

- Confirming nasogastric tube placement using pH and X-rays
- Use of colorimeter to confirm nasogastric tube placement (in progress)
- Checking of blood transfusion product by two registered nurses
- Implementation of oral hygiene assessment and management
- Assessing falls using Hendrich Falls Risk Model
- Implementation of targeted multiple interventions for falls prevention

Our Quality Improvement Framework

Our Nursing Department supports the hospital's strategic quality movement by continuously promoting and cultivating a learning culture for quality improvement among the nurses. We believe that with every improvement we make to our quality of nursing care, we can play an important role in ensuring better safety and outcome for our patients who come under our care.

Our Quality Framework
The Nursing Quality Improvement (NQI) Framework that the Nursing Department has adopted since 2005 aims to achieve the following objectives:

• Provide a coordinated Quality Improvement (QI) programme for nurses
• Ensure nursing services delivered are monitored for quality and appropriateness of care
• Establish monitoring and feedback mechanisms for evaluation and continuous improvement to service delivery
• Promote evidence-based nursing practice
• Promote a strong culture of QI among nurses

Under this framework, we have established committees to plan and oversee the implementation of the nursing quality movement. It emphasises a "bottom-up" approach in encouraging ownership and participation by nurses in quality improvement and patient safety initiatives. Nursing Standards Teams, comprising both junior and senior nurses, from the patient care areas are actively engaged in initiating and implementing quality improvement projects, performing RCA (Root Cause Analysis), and adopting problem-solving approach via the PDCA (Plan-Do-Check-Act) method to tackle nursing issues (such as falls and pressure ulcer prevention).

Our Activities
We organise monthly Quality Improvement (QI) Rounds to help spread the quality message and share useful quality-related information with all nurses. This forum provides an excellent platform for them to keep abreast of the latest developments in quality and patient safety initiatives, as well as to share innovative ideas to address common nursing issues.

We also encourage our nurses to attend in-house programmes such as the Clinical Practice Improvement Programme (CPIP), risk management courses and patient safety workshops. Clinical lectures are also organised in collaboration with other healthcare professionals to keep them updated on the latest evidence-based care. With the added knowledge and skills, we believe our staff will be better empowered to take on the responsibilities to improve our nursing care standards and quality.

To ensure that the quality initiatives are effectively implemented, the respective patient care units perform regular audits for compliance and to identify areas for improvement. Analysed results are shared to create awareness and action plans are formulated to address areas identified for improvement. Nurses are constantly encouraged to share and adopt best practices.

Clinical Outcomes
Under the Nursing Balance Scorecard, KPIs (Key Performance Indicators) such as inpatient fall rates and hospital-acquired pressure ulcer rates are measured and monitored to evaluate the effectiveness of the quality improvement and patient safety initiatives introduced. The clinical outcome of these indicators are trended and shared at the various nursing forums and meetings with our nurses on the ground.

Fall Rates
With the concerted and focused approach under the NQI framework, we have been able to reduce our inpatient fall rates in 2009. The table below shows the comparison of the rates (per 1000 patient days) with 2008 performance and with UK and US hospitals:

	2008	2009*	UK	US
Inpatient Fall Rates	1.06	0.85	4.80+	4.76

* Figure up to September
⁺Source: Institute for Clinical Systems Improvement (ICSI). Prevention of falls (acute care). Health care protocol. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Mar.

The inpatient fall rates for 2008 and 2009 are considerably lower than the overall fall rates reported by hospitals in the United Kingdom and United States.

Pressure Ulcer Rates
The hospital-acquired pressure ulcer rates (per 1000 patient days) have also reduced significantly with the implementation of a few initiatives to reduce the risks of patients developing pressure ulcers.

	2008	2009*
Inpatient Pressure Ulcer Rates	0.52	0.28

* Figure up to September

Develop with Us

For more information on nursing career tracks, career and development opportunities and sponsorship programmes, please click here.

Useful Links

Nursing Governing Bodies

• Singapore Nursing Board (SNB)
• Singapore Nurses Association (SNA)

Educational Institutions

• Nanyang Polytechnic
• Ngee Ann Polytechnic
• Institute of Technical Education (ITE)
• National University of Singapore (NUS)

Contact Us

Nursing Department @ NUH
Tel: (65) 6772 5108

Job Opportunities:
nursing@nuhs.edu.sg

Attachment and Training:
Li_Min_YAN@nuhs.edu.sg

Other Nursing-related queries:
Pauline_LYE@nuhs.edu.sg