Practising the

rofessionPThe Choice Institution for Great Nursing

2

ContentsMessage

05 Dr Tony Tan Keng Yam,

President of the Republic of Singapore

06 Dr Pauline Tan,

Chief Nursing Officer, Ministry of Health

07 Madam Kay Kuok,

Chairman, National Healthcare Group

08 Professor Philip Choo Wei Jin,

Chief Executive Officer, Tan Tock Seng Hospital

09 Mr Yong Keng Kwang,

Director of Nursing, Tan Tock Seng Hospital

Pre-nursingA path less chosen 10Band of brothers 14- Male nurses

Culture of care 18- Choosing TTSH

Nursing newbieDive into history 22Entering the environment 26

Nursing life Firm friends 30Go, have fun! 34Holistic pursuit of happi-nurse 38- Life outside TTSH

Interwoven yet individual 42- Nursing Manpower

Just superstitions 46Keeping the night vigil 50

3

When you watch over me 98- Letters from the patients

Nursing leadershipX-uberant and X-ceptional 102

Choice institutionYet we overcame 106- Remembering SARS

Zest for the road ahead 110

OthersMilestones 114Acknowledgements 118

Nursing development

68 Of reaching for the stars

72 Passage pavers

- Specialisations: Nurse Clinicians

76 Quest for advancement

- Specialisations: Advanced Practice Nurses

80 Rallying the troops

- Ward management

84 Standing on strong shoulders

- Nurse Educators

88 Through trials and tests

- Nursing research

90 Ushering the information age

94 Value-added qualities

- Nursing quality

56 Likeness in diversity

60 Making marks overseas

64 None left behind

- Continuing and community care

“I am of certain convinced that the greatest heroes are those who do their duty in the daily grind of domestic affairs whilst the world whirls as a maddening dreidel.

- Florence Nightingale

5

Nursing is an honourable profession. Besides the many tasks that our nurses perform to tend

to patients, our nurses also provide care by listening to, encouraging and reassuring them.

In attending to patients, our nurses put themselves at the risk of contracting diseases themselves.

Nursing is a calling that demands selflessness and devotion.

Tan Tock Seng Hospital has a long tradition in nursing excellence and is a pioneer in many

areas, including tuberculosis and neurosurgical nursing. Despite the ever-evolving challenges in the

healthcare sector, the nurses at Tan Tock Seng Hospital have stayed true to the founder’s legacy and

are passionately committed to care for the sick and the infirm in line with the hospital’s core values of

compassion and care. I am heartened to note that the nurses are committed to meeting international

benchmarks in key nursing outcomes and I encourage them to continue in their commitment towards

excellence in healthcare delivery.

This publication produced by Tan Tock Seng Hospital offers a glimpse to the lives and

experiences of our nurses and shares their everyday trials and triumphs. Our nurses are our daily

unsung heroes and they deserve our unwavering support and appreciation for their contributions to

our community and our nation.

I wish all nurses a Happy Nurses’ Day!

Dr Tony Tan Keng YamPresident of the Republic of Singapore

Message

6

Nursing is a noble profession that combines art and science. The art of nursing is anchored on

humanistic values framed by the profession’s ethical code of conduct. The science of nursing is

constantly informed by new knowledge and evidence-based nursing practice. The perfect blend of both

allows nurses to discover boundless opportunities and “moments of truth” to touch humanity and to give

meaning to what they do.

Nurses connect with the cadre of dedicated healthcare colleagues and, to a larger extent, the

community in the course of their work. They untiringly work with these individuals to improve lives,

strengthen our social fabric and make our healthcare delivery system better and safer. Over the years,

nurses have also influenced policies to recommend the right level, right provider and right approach to

deliver nursing care to improve quality, access and cost for our system. Although nurses are very much

on the frontline, they rarely shout about what they do, even though they are the lifeline that keeps our

healthcare system ticking. This book is a firm demonstration of the nurses of Tan Tock Seng Hospital who

stand committed to their mission to give their best to serve, care and heal. It affirms their resolve to excel,

grow new capabilities and maximise the collective wisdom of every nurse to make each patient experience

a truly special and marvellous one.

I congratulate you on the publication of this book. It will add to the heritage of our local nursing annals

and will serve as a reference book for new generations of nurses who need to know about the past in order

to strengthen the present and to build a better tomorrow for the profession. I am confident that nursing

in Tan Tock Seng Hospital will continue to set new benchmarks as a leader in the nursing arena, both in

patient management and nursing innovation.

Message

Pauline Tan (Dr) RN, FAANChief Nursing Officer, Office of the Director of Medical Services,Ministry of Health

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Nurses, while caring for their patients in the course of their healing journey, have formed many

synergistic partnerships with other healthcare professionals and built many strong bonds with

their healthcare partners over the years.

Such relationships are key today with Singapore’s rapidly ageing population and the higher

incidence of chronic diseases. Patients now need longer term and more personalised complex care.

As we shift our focus to more team-based and patient-centric care, our doctors, nurses and allied

health professionals will not only have to work more closely with one another but also beyond the

hospital walls – in the primary and step-down care sectors with community partners.

Nurses are the conduits and the partnerships they have built will form the foundations for better

patient care, where every profession plays a valued and integral role, complementing one another in

their different specialties.

This commemorative book on nursing – a first for Tan Tock Seng Hospital – will show, among

other things, how nurses have continuously diversified into different areas and specialised roles, as

well as evolved with their healthcare partners, to create a community of care for our patients today

and in the future.

My warmest congratulations to our nurses on this first undertaking in documenting their

changing roles and responsibilities. I wish them all the very best.

Madam Kay KuokChairman,National Healthcare Group

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Message

Professor Philip Choo Wei JinChief Executive Officer,Tan Tock Seng Hospital

With 9 per cent of the population above 65 today and these numbers expected to triple by the

year 2030, Singapore faces an increasing challenge in meeting the healthcare needs of our

ageing population. As life expectancy prolongs, so too will the cases of multiple chronic diseases.

These demands will critically shape the future nursing landscape. To cope with this, we need to

ensure that Singapore has an ample number of quality, dedicated nurses, rather than just meeting

the numbers.

Healing is more conducive in a nurturing environment. Nurses are a cornerstone of Tan Tock

Seng Hospital and we are committed to making sure that this institution is a great place for our

nurses to work and learn in.

This commemorative book celebrates the contributions of our nurses, who have helped mould

Tan Tock Seng Hospital into the world-class healthcare institution it is today. It also gives us a greater

insight into how nursing in Tan Tock Seng Hospital has evolved over the years, with technology,

education, research, dedication and compassion spurring nursing to greater heights.

Let Tan Tock Seng Hospital continue to be an environment for nurses to grow and fulfill their

greatest potential.

I wish all of you a very happy Nurses' Day!

9

Mr Yong Keng KwangDirector of Nursing,Tan Tock Seng Hospital

Nurses form the backbone of the healthcare industry. Evidenced since the days of Florence Nightingale,

nursing was especially poignant in Singapore during the SARS epidemic in 2003. The ensuing decade

witnessed the transformation of nursing culture into one that is open, inquisitive and daring.

The language of nursing today has thus evolved with it. Peppered with improvement

managements, breakthrough research, forefront innovations and higher value-added patient care

interventions, the Tan Tock Seng Hospital nurse is one in tune to the latest events surrounding him or

her. We envision building Tan Tock Seng Hospital as a choice institution for patients, fellow nurses and

healthcare partners due to great nursing work and culture.

This first-ever book on nursing at Tan Tock Seng Hospital provides a window into the psyches of

our nurses. By focusing on the stories of our everyday nurses, it chronicles their aspiration, insights

and hopes, through the rhythms and colours of the dynamic nursing environment. Its simple, yet keen

narratives aim not to laud the achievements of the administration but acknowledge the work of our

nurses. The tributes belong to the nurse, be it the one with the early start or the one who has journeyed

a thousand miles.

It begins with the young school leavers’ first decision to choose nursing, follows the nurses as they

made Tan Tock Seng Hospital “The Choice Institution for Great Nursing” and traces the memories back

to the veterans in a full circle. Together with the present and the past, the last chapter opens to the new

vista ahead for all our nurses.

This book dedicated to nurses is “from nurses, about nurses, for nurses”. We hope you enjoy this

memento served to you with a big heart.

A path

less chosen

An avid soccer player, Staff Nurse Muhammad An-Nur Bin Abdul Rahman (11C) became a nurse through Ngee Ann Polytechnic’s nursing course.

A A path

less p

chosenWhy choose nursing when there are

so many other varied choices? In a

career path fraught with challenges,

nurses relate their stories and how

the difficulties are outweighed by

far richer rewards

12

So you want to be a nurse. Isn’t it a dirty job? Won’t you have to face

long hours on your feet with demanding patients? What about having

to cope with death and suffering and all that emotional baggage?

Aren’t you afraid of getting infected?

All valid questions, among others, that may be swirling around you, as

you contemplate your choice.

Why did those who chose nursing do it? For some, it was due to a

traumatic, eye-opening moment. Nurse Manager Eugene Lam, who left his

pre-university course to pursue a Nanyang Polytechnic nursing diploma

after he witnessed a road accident, said, “I was struck by how I felt – I was

standing right there, but I could do nothing to help the injured person.”

Family also plays an important role in the decision-making process.

Staff Nurse Muhammad An-Nur Bin Abdul Rahman and his younger brother

Muhammad Hafiz chose to stick together and become nurses together,

joining Ngee Ann Polytechnic’s nursing course.

However, battling family objections to choose nursing made Senior

Assistant Nurse Anna Goh, an ITE graduate, and Unit Nurse Manager

Laura Ho more resolved about their career choice.

At a crossroad between teaching and nursing after her A levels, Chia

Gerk Sin chose to do a nursing degree as what she called a “practical

choice” in National University of Singapore, as she knew she would enjoy

a more hands-on vocation which directly applied what she had learnt in

school. A senior staff nurse now, she said compassion and a desire to

make a difference are essentials.

For Nurse Manager Tan Tit Chai, his decision was made at a time

when fear was rampant. It was in 2003 and the alarm over SARS was just

starting to spread. He volunteered for what was a dreaded job – screening

temperatures. He realised then that “society needs people who dare to

step forward in times of crisis”.

It made him re-evaluate his then ten-year career as an accountant,

eventually choosing to forge a new path in nursing. His advice for nursing

hopefuls: “When you find meaning in what you’re doing – the comfort that

Senior Assistant Nurse Anna Goh (10D) battled family

objections to join nursing.

Witnessing a car accident spurred Nurse Manager Eugene Lam

(Emergency Department) to leave his pre-university course and

pursue a Nanyang Polytechnic nursing diploma.

Opting for a mid-career switch from accounting to nursing was

Nurse Manager Tan Tit Chai (Nursing Service), who was involved

in a hospital wide ward renovation project.

13

“I always tell my nurses that we have miracle hands. If we choose to have sincerity in our hearts when we touch others, they would feel that difference, that therapeutic touch.

– Laura Ho Unit Nurse Manager (Level 5)

Senior Staff Nurse Chia Gerk Sin (Palliative Care Services)

chose a nursing degree as she knew she would enjoy a more

hands-on vocation.

you’ve offered to patients and their families – it pays you back manifold.”

Sharing the same view on nursing’s benefits, Gerk Sin added: “If I could

start all over again, I would still choose nursing because it has broadened

my perspective on life and how to live more fully.”

New nurses who come under Laura are always asked the reason they

became nurses. “About 80 per cent tell me their mothers wanted them to do

it,” she said.

With a sigh, she would ask them to come up with a better answer.

The veteran nurse of 18 years pointed to her hands and said: “I always

tell my nurses that we have miracle hands. If we choose to have sincerity

in our hearts when we touch others, they would feel that difference, that

therapeutic touch.”

Still uncertain? Well, the decision lies – in your hands.

Far from being the career choice of

only women, nursing for men is on the

rise. And male nurses bring more to

their role in caring for patients than

just strength of arm

Nurse Clinician Maran S/O Pakkirisami (TTSH Rehabilitation Centre) values the unique role and

ability of each nurse — be it male or female — in contributing to the team effort.

BBand of brothers

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Being a thorn among the roses is a familiar feeling for Rehab Nurse

Clinician Maran S/O Pakkirisami. “Although the numbers are rising,

we still don’t have many guys entering nursing, so we’re usually

surrounded by ladies,” he said. “But it’s not all about gender. Equally important

are each person’s unique role and ability to contribute well to the team effort.”

With changing times, the perception of nursing for men seems to have

progressed. For Nurse Manager Laley Bin Senawi, who joined Tan Tock Seng

Hospital in 1988, the resistance then was from his recruiter. “In my batch

of 1985, there were only 14 male nurses out of an intake of over 200. I still

remember during the interview, the recruitment officer took one look at me

and asked, ‘Are you sure you want to be a nurse? You look too manly’.”

Others, such as Assistant Nurse Muhammad Safiee Bin Abu Bakar

who started work in TTSH in 2008, met with resistance from their family

initially. Despite having an aunt, an uncle and a cousin who are nurses in

the family, Safiee’s father preferred his sporty son to opt for a career in

soccer, rather than nursing, which he thought of as a “soft kind of job”.

However, it was seeing Safiee’s confidence and knowledge when dealing

with sick family members that eventually won his father over. More recently,

some such as Staff Nurse Nigel Chua, who joined TTSH in 2011, said it was

family support that nudged him in the direction of nursing, even when he

could not decide on a course for his studies.

Answering the call of duty can sometimes

literally mean life on the edge for these male

nurses. Laley recalled: “My patient, who was in

an altered mental state, had climbed out of the

window and was standing on the parapet ledge.

I climbed out after him and grabbed him, saving

him from jumping off.” Subsequently, through the

entire treatment process, the patient treated him

like a brother. Although, due to his mental state

during the attempted suicide, the patient could

not recognise Laley, he later said something which

moves Laley to this day. “He said, ‘There’s a guy

who saved my life and he looks like you’.”

Initially met with familial resistance on his decision to become

a nurse, Assistant Nurse Muhammad Safiee Bin Abu Bakar

(STAR Team) eventually won his father over with his confidence

and knowledge when dealing with sick family members.

Family support nudged Staff Nurse Nigel Chua (7C) in the direction of nursing, who uses his

talents in balloon sculpting to bring joy to patients.

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At times, sitting with a patient for three hours while she cries, at

times having to endure punches or kicks by violently struggling patients,

male nurses — as do all nurses — follow the duties of being the patient’s

advocate. Pushing aside downsides such as disparaging remarks by

family members or patients, Maran summed up what keeps him going: “It

is the disease which makes a patient behave the way he does. It’s not the

patient’s fault.”

“I still remember during the

interview, the recruitment

officer took one look

at me and asked, ‘Are

you sure you want to be

a nurse? You look too

manly’.

– Laley Bin Senawi Nurse Manager (5D)

CNurses love working here for its nurturing environment, flat

hierarchy and kampung spirit

Culture of care

For Senior Staff Nurse Evonne Oh (7D), the kampung spirit and firm bonds with her colleagues are what keep her rooted in TTSH.

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A pivotal decision in a taxi brought Anni Dionne Liew to TTSH’s doors

five years ago. While looking for hospitals to work temporarily at

before entering university, a chance encounter with then Senior

Nurse Educator Pua Lay Hoon led her to a meeting with Mr Yong Keng Kwang,

now Director of Nursing and his predecessor, Madam Kwek Puay Ee. She was

struck by how they seemed to genuinely care for how her interests could be

furthered, rather than simply fitting her in to meet the organisation’s needs.

She felt it was a place where she would learn the most and there was a plan

charted for her.

But as she had planned earlier to sign an employment contract at another

hospital, she got in a cab after the meeting to head there. While in the cab, she

realised that if TTSH ticked all the boxes, there was no need to go elsewhere.

“That was when I made my decision and told the surprised cabbie uncle to

turn back – to TTSH.”

Senior Staff Nurse Anni Dionne Liew (Nursing Service) felt there

was a plan charted for her in TTSH. With the support of the

hospital, she recently completed her Bachelor of Science in

Nursing (Minor in Healthcare Management) at the University of

Pennsylvania.

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“At TTSH, I feel safe

at work. We have

established safe

practices and a constant

emphasis on patient

safety. In protecting the

safety and interests of

our patients, in essence,

we as nurses are being

protected.

– Cheng Hong Senior Staff Nurse (3A)

While the path to TTSH for most might not have been as dramatic as

Dionne's, many said that it was TTSH’s culture that made them choose it in

the first place and made them stay. Calling it kampung spirit, where everyone

looks out for one another, Dionne, now a Senior Staff Nurse, added: “Where

else can you find a workplace where everyone is so sincere?”

TTSH’s flat hierarchy is another feature regularly brought up. “It’s

the flattened hierarchy, where your manager is your friend – one who will

encourage you along the way,” said Senior Staff Nurse Cheng Hong.

When she first came to TTSH from China through an international

profession exchange programme in 2004, Cheng Hong did not have much

choice in the hospital she went to. After two years of training and four

years as a staff member, she “could do things blindfolded”. As she did not

want to be complacent, she left to join a private hospital. However, after

a stint that lasted slightly more than a year, she returned to TTSH. Her

time away taught her to “think a lot more about the consequences of each

action”.

“At TTSH, I feel safe at work. We have established safe practices and a

constant emphasis on patient safety. In protecting the safety and interests of

our patients, in essence, we as nurses are being protected.”

For example, there are clear policies regulating what nurses can do on a

verbal order. “There are rules are in place like documentation, to prevent any

mistakes from occurring as a result of mishearing, such as giving patients the

wrong medication dosage or something that they may be allergic to,” Cheng

Hong says.

As for Senior Staff Nurse Evonne Oh (7D), she chose TTSH seven years

ago for its convenient location to get to from her Woodlands home. Even

though other nearer alternatives have since sprung up, it is the kampung spirit

and firm bonds with her colleagues that keep her firmly rooted here.

“Once, just before my shift ended, a patient collapsed,” she related. “My

colleagues dropped their work and rushed to help me, so I could do other

duties like calling up the patient’s relatives.” At the end of her shift, she could

go home with the peace of mind that they had her back.

22

Take a detour down memory lane and trace

nursing moments captured in time from the

past to the present day

Dive into history

Staff of Middleton Hospital, which was set up as an isolation camp for infectious diseases and later became the CDC, made part of TTSH in 1985. Staff nurses are those with black belts (right-hand, second row from back). In the centre of the seated row (second row from front) of doctors and staff is Madam Louise Chew (in dark uniform with white collar), Middleton Hospital’s first Singaporean Matron from 1956-1969.

50s

D

23

Balmy breezes and a leisurely stroll along a tree-lined

avenue was the treat nurses enjoyed as they walked between

Pavilion wards 12 and 13.

en

Wheeling a patient on the way to the recreation hall (building in the background, right), with a nursing officer

(wearing a nursing veil on extreme right) watching on.

CDC: A lesson on reading X-rays for Tuberculosis department nurses in 1959.

Matron Madam Louise Chew observing the workings of the newly opened

mechanical steam laundry in 1957 which sped up the laundering process at

Middleton Hospital.

50s

50s

a60s

60s

24

Rehab nurses using spinal lifting technique to keep the body alligned.

Posing in front of the rehab ward signage, rehab nurses together with some

off-duty colleagues in 1986. Student nurses had stripes on their caps that

coincided with the year they were in, eg. Year one students had one stripe.

Nursing staff celebrating the first birthday with a child who is in an iron lung. Note the burgundy

shoulder epaulets on the white uniform then used to denote assistant nurses (third nurse from left)

and navy blue for staff nurses.

Doing their profession and nation proud – marching in a nurses’ contingent for

one of the decentralised venues for the National Day parade taking place on the

actual day at Ang Mo Kio.

Graduating class of 1988 reciting the Nurses’ Pledge, blue shoulder capes

differentiate staff nurses from the burgundy ones of assistant nurses.

om le

Along the corridor of time past - these subacute wards doubled up as

observation wards for A&E cases. Ward 1 housed Orthopaedic and Neuroscience

patients, Ward 2 was Surgical and Ward 3, Neuroscience female patients.

70s

id70s

70s

80s

80s

t80s

25

1993: Nurses here wear the peach uniform that TTSH adopted when it became

a restructured hospital in 1992. In the centre, wearing the blouse and skirt

uniform sporting a white bow of a Higher Nursing Officer (HNO) is Madam Ho

Shin Hiong who became Director of Nursing from 1990 to 1995.The nurse in a

white-collared uniform is an assistant nurse, while the rest are staff nurses. 25

2013: TBCU nurses with their heritage building workplace, the Tuberculosis Control Unit (TBCU),

as a backdrop. Attired in the current uniform with orchid prints, the nurse in blue uniform (fifth from

left) is a nursing officer who is flanked by staff nurses in blue orchid prints (for female nurses, left)

and a blue horizontal stripe (for male nurses, right) with an assistant nurse (second from left) with

burgundy prints.

Attending a briefing on nursing process reviews and acuity in 1988. Notice

the pure white caps which were painstakingly starched, ironed and tended to

maintain its shape and the peeking lace trim that were proudly hand-stitched

on by their staff nurse owners. As seen here, one stripe on the navy epaulet

denoted nursing officers.

At the Istana at then President Nathan’s (front row, centre) invitation for Nurses’ Day 2001. Next to the President is Madam Rosie Pereira, Director of Nursing from 1998 to 2001, and at the extreme night is then CEO Dr Lim Suet Wun. Nurses pictured are attired in the uniform that was adopted after the peach uniform at the end of 1999. Nursing officers wore a skirt and blouse; staff nurses had blue piping along the V-neckline while assistant nurses had burgundy piping.

At thMadNurwor

Catching a moment with ward colleagues in 1992. The nurse seated (foreground,

right) has a stripe on her burgundy epaulet denoting her as a senior assistant nurse.

ttend

80s

90s

90s

2000s

013: TBCU

2000s

26

Take a visual tour of the hospital – its departments in the

main building as well as outlying specialist centres

Entering theenvironmentETTSH Rehabilitation Centre: A "rehab" patient enjoys her daily therapy session using a Wii video game console to improve coordination.

27

Nurses of 11D are passing central report using “Wonderboard”, a communication tool which they can creatively customise their nursing information.

Central Sterile Supply Department and Theatre Sterile Supply Unit (CSSD/TSSU): Nurses (in green cap) supervise and train the healthcare assistants in this department to ensure surgical sets are safe for use on patients. This service is provided for National Healthcare Group Polyclinics, as well as National University Health System.

28

Travellers’ Health & Vaccination clinic: Besides travelling vaccinations and health assessments, this clinic also provides travel-related education, such as precautions to take when going to countries with high risks of dysentery or malaria.

Invasive Cardiac Laboratory: A nurse sets up an intravenous drip and assists in procedures such as cardiac biopsies or coronary angioplasties.

Buffer Stepdown Unit: This unit, which houses patients awaiting transfers to community hospitals or nursing homes, has its own patch of greenery to allow patients to participate in outdoor activities, such as gardening, while interacting with one another.

29

Renal Unit: Ensuring that each step of haemodialysis is performed correctly to protect patient safety, a nurse carries out the procedure in the unit where patients undergoing it are solely dependent on the procedure to keep them alive.

TTSH Multi-Purpose Hall: On certain Fridays of the month, nurses are allowed to leave their shift half an hour earlier for Fabulous Fridays, which has team-bonding activities that promote healthy living. Here, nurses are doing upper body strength exercises conducted by physiotherapists.

Equipment storage room in Endoscopy Centre: One of the first lessons nurses in this centre learn is not to bend the delicate and costly endoscope as the fragile fibreoptic wires may be damaged and the internal image compromised. Here, a nurse expertly handles and prepares the endoscope for use.

Subacute Ward 8: Integral to nursing, case presentations like this are opportunities to learn about complicated or rare patient events from the shared experiences of colleagues, to tap on expert opinions or to brainstorm solutions to a knotty issue.

30

F Firm friendsHaving inspirational, vivacious, supportive non-nursing colleagues

makes work such a joy. Here, we show our appreciation for them

“She is known for being funny and mischievous. Yet when it comes to

work, she is very systematic, efficient and organised and all the nurses

like to be nurse-in-charge when she is on that shift. Devi is someone

with a heart of gold. When she learnt that our previous healthcare assistant who had

been with us for many years was hospitalised for an amputation above the knee, she

found out which ward the amah was admitted to and visited her often, bringing food

and drinks to encourage her to regain her health and intake. And when the healthcare

assistant was stable enough to be transferred out of the ICU, Devi ensured that she

came to our ward so that we could "jaga", or watch over, her and that she would be

surrounded by familiar faces and encouragement for her rehabilitation.”

– Senior Staff Nurse Grace Tan, on Senior Patient Service Associate Punam Devi D/O Ramgura Singh (8C)

“When I f i r s t met th i s pe t i te

Vietnamese lady in 2004, she

spoke little English and seemed

jittery. Over the years, it was such a delight to

see her confidence grow and an irrepressible joy

lights her face as she eagerly picked up skills and

demonstrated such a commitment and dedication to

her patients’ care. She is someone who, when given

a task - no matter how small - would see it through

to the best of her abilities. It was so inspiring to see

how she strived to improve her language skills and

has now become one of our official Vietnamese and

Cambodian translators for patients.”

– Senior Assistant Nurse Shanmuga Priya D/O Nadaraj, on Healthcare Assistant Lam Thuc Yen (both from 13A)

From left: Punam Devi and

Lam Thuc Yen.

31

“Ov e r t h e

more than

10 ye a r s

I’ve worked with Frankel,

he’s always told me how

he appreciates the good

job that we nurses do in

caring for the patients.

So, wheneve r he can

help, he really goes out of

the way to do so. For example, he is always more than generous with food

quantity for ward catering or departmental orders and provides ‘mountains’

of fruits on every Nurses’ Day, much to the delight of our nurses.”

– Unit Nurse Manager Mariam Bibi Piperdy (Level 10), on Frankel Ng, Assistant Manager of Support Services (F&B)

“Without

P a n g

Hung’s

dedicated training and

help, we wouldn’t have

been able to start the

‘Let’s Walk’ rehabilitation

programme that brought

benefits like reduced length of hospital stays

for patients. He was a keen partner when I first

mooted the idea of nurses participating in patient

rehabilitation and diligently planned and conducted

a comprehensive training programme for our nurses

twice a week, over eight weeks. Now, our nurses

are so excited to be able to do daily light physical

therapy to help patients towards faster recoveries.”

– Assistant Director of Nursing K Patmawali, on Principal Physiotherapist Lim Pang Hung

“Dr Wu is well

known for

his kindness

and ap p r o a c h a b i l i t y,

always patiently going

out of his way to help.

Ever willing to listen to

nurse’s requests, even

when off-duty, you won’t

hear him raising his voice at staff or nurses.”

– Nurse Clinician Lim Meow Gek (Subacute Ward 8), on Dr Wu Huei Yaw

“Ask around the hospital and

you’ll find that Dr Tham’s

n a m e a lways p o p s up

when it comes to people who support

nurses. She firmly believes in nursing

education and wil l give her time to

conduct c l in ica l lec tures or gu ide

nursing officers when they are unsure of

clinical skills or knowledge. She is truly

a remarkable person who has no airs

about her, taking it as a matter of course

to greet each staff by name and thank

her nurses sincerely when she finishes

procedures or before she leaves work

each day.”

– Senior Staff Nurse Nyo Nyo Win, on Associate Professor Tham Kum Ying (both from Emergency Department)

Frankel Ng (centre) flanked by Chef Calvin Tan (left) and Chef Leo (right).

32

Here, we recognise some of the colourful nurses who have made

an impact on those around them and the nursing practice

“As a nurse with decades of experience,

Sister Low may come across as the

fierce matron when you first meet her.

But it only takes a moment to see that she is simply

straightforward. She doesn’t sugar-coat the truth but

tells what you need to hear in order to learn and grow.

Her pragmatism is tempered with a naturally positive

outlook on life that always leaves you feeling more

assured, hopeful and clear-headed after chatting with

her for advice.

Her strictness belies a heart of tenderness for

her charges to stretch themselves to reach bigger

dreams. On one of the overseas charity outreach trips

for underprivileged children she organised, she inspired

me about the unlimited areas that our hands as nurses

can reach, and to never lose sight of that open-hearted

gentleness for the people we touch. For me, she not

only role models the heart and professionalism of

nursing, but also exemplifies positive character traits

like cultivating a close-knit family too.”

– Staf f Nurse Koh Yu Han ( 9A) , on Nurse Manager Low Peck Sian

“Nurses have to juggle being ef fective communicators,

empathising with patients and being flexible with plans

for the efficient functioning of the ward while working

wel l in team of doctors, a l l ied health personnel and other health

workers. Staff Nurse Maria embodies these qualities while adding her

own quirky personality to the mix. With just the right sense of humour

to loosen up grouchy patients or crack colleagues up on a gloomy day,

she is fun-loving yet very competent at her work. With her colourful

presence, it really livens the ward and makes the working environment

so much more enjoyable.”

– Medical Officer Dr Mucheli Sharavan Sadasiv (Infectious Diseases Department), on Staff Nurse Maria Teresa Cruz Yunzal (CDC Ward 71)

33

“As our ward sister, Sister Rozana

represents the best of both worlds –

she’s a fun, effervescent team captain

who always energises her staff, but at the same time,

she’s an effective leader who is not afraid to make

tough decisions for the good of the team. Sensitive

and fair, she will tell her charges after disciplining

them that they now start on a clean slate.”

– Senior Physiotherapist Jayachandran Balachandran on Senior Nurse Manager Rozana Bte Arshad (6B)

“Gung ho and with exceptional resilience, Mah Yoke never gives up on

challenges. Instead she is one of the most innovative people I know,

always thinking of new ways to tackle a problem or improve work

processes. Whenever she is stressed, she uses jokes or funny stories about her

globe-trotting travels to relax and it rubs off in the positive attitude of her staff. It’s

all these qualities that make me look up to her as a role model. To me and our staff,

she is a mother and sister - all rolled into one. Who else but a loving family member

would be so willing to lend a listening ear anytime you feel down? I remember a

time when I faced what I thought were insurmountable challenges and wanted to

give up. She spurred me to go on, saying "Never, never give up. You. Are. Capable."

It was such an emphatic boost to me that it’s kept me going since.”

– Patient Service Associate Supervisor Kalsom Shariff, on Senior Staff Nurse Mah Yoke (Clinic B2B)

“Cheerful, responsible and committed, Johar is well-liked by patients

under his care. I often see how he attends to patients with a warm

smile and makes them feel comfortable by speaking in language

familiar to them. Other than his mother tongue, Malay, he has a surprising fluency

in Chinese dialects and Tamil too and often breaks into a repertoire of Chinese,

Indian and Malay songs to delight his patients with. It’s heartening to see them,

especially elderly patients, light up when they hear his songs. We regularly receive

positive comments and praise from staff, patients and their relatives about what a

great attitude he has and how personable Johar is.”

– Nurse Clinician Ismail Bin Mohamed, on Senior Assistant Nurse Johar Bin Salim (both from 11A)

“Sister Ho is someone who will not

leave her staff to struggle on their

own. If there’s any way that she

can help, she will step in to do so. At times when

I wish that I could split myself into a few persons

to get things done all at once, she truly makes me

feel like she understands what I’m going through

and calmly helps sort things out to ease my load.

It is testament to her wonderful personality that

everyone loves working with her.”

– Staff Nurse Vithya D/O A Asogan, on Nurse Manager Ho Sook Han (both from 5A)

From left: Johar Bin Salim, Rozana Bte Arshad and Mah Yoke.

33

34

Go, have fun!Share in the many moments of fun, laughter

and celebrations that nurses enjoy

Arrr matey! In their 2012 year-end party, nurses from Level 11 went all out to channel the Pirates Of The Caribbean vibe in their swashbucklers and plumed hats.

35

Displaying their talents, nurses as cast and crew sang, danced and performed to rousing applause at the Nanyang Polytechnic Auditorium for TTSH’s first large-

scale musical "So You Want To Be A Nurse?" in 2012. Front row from left: Wendy Goh, Sui Sui and Maybelline Caneda. Elderly couple from left: Kim Min Hwa and

Muhammad Afif. Centre row from left: Priscilla Fu, Farhana, Eric Koh, Faith Hwang, Mynelle R. Salas, Angielou P. Tinasas and Taufiq Mohd Othman. Back row from

left: Ezekiel Kok and Harnesh Kaur. Not in picture: Staff Nurse Eliel Tan.

A crowd favourite with the hospital staff, the ED Band has performed at D&Ds

and Founder's Day celebrations. Lead singer and guitarist, Staff Nurse Deney B.

Buenconsejo, is seen here rocking his heart out at the Art of Healing event.

Ward 10B’s nurses ringing in 2013 in their rest lounge with food, fun and

friends.

36

Nurses were delighted when celebrities such as Fann Wong made appearances as a show of support to nurses after the SARS outbreak for Nurses' Day 2003.

Former Director of Nursing Madam Kwek Puay Ee (second from right, in red) and current Director of Nursing Mr Yong Keng Kwang (centre in green) display the vitality of their leadership on Nurses' Day 2006.

Ward parties, such as this Christmas barbecue for Ward 13A, draw colleagues closer.

As part of the celebrations for Nurses' Day 2010, nurses have a fun day out at the Singapore Flyer.

Members of Nurses Inc, a welfare group for nurses, throw a party to celebrate TTSH Nursing's rebranding in 2008. Nurses Inc has since integrated under Shared Governance in 2012.

37

Colourful costumes and get-up-and-go lively beats encourage the nursing crowd to let their hair down and have fun at the Nurses' Day 2010 celebrations.

Teams at the all-nursing Dodgeball competition in 2012 put on their "game faces" going with themed costumes.

DJs from radio station 938Live surprised the nurse clinicians with a spontaneous party and lunch after picking Nurse Clinician Jane Chee and Josephine Anthony’s entry to its surprise office visit contest in 2010.

38

From sporting activities to volunteering – nurses share about their pursuits in

their free time

Holistic pursuit of happi-nurse

39

Nurse Clinician Vivien Lee (3B, second from left), a pioneer member of the dragon boat group that was started by NHG headquarters staff in 2003, said the team subscribes to the motto of “work hard, play hard”.

Outside of work, Vivien Lee (3B) gets her adrenaline kicks from the

competitiveness of dragon boating. Being out in the elements

and enjoying the sun and sea while churning the waves with a

team of like-minded comrades add to the thrill. Her sun-kissed skin gives

away her love of the outdoors as the nurse clinician from Ward 3B related

enthusiastically: “Rowing is an excellent cardiovascular workout and it

tones my muscles, plus teamwork is a breeze because our team spirit is

fantastic.”

A pioneer member of the dragon boat group which was started in

2003 by NHG headquarters staff, she found out about it when she met

other NHG institution staff at various events. Together with a group of

TTSH staff, mostly nurses, she started attending the weekly practices

near Kallang Water Sports Centre every Sunday at 4pm. Besides training

in the sea, they also mix it up with work outs on land with runs, circuit and

weight training.

The team subscribes to the motto of “work hard, play hard”. While

training is tough and battle scars like blisters on sore behinds are

accepted as part and parcel of their sport, they keep the atmosphere fun

“with lots of laughter in the boat”. They also frequently head out for dinner

after practice and make it a point to celebrate birthdays together. In all

that fostering of a tight-knit, co-ordinated team, Cupid has struck up a few

matches, leading to two couples walking down the aisle.

Besides indulging in hobbies, other nurses choose to use their free

time volunteering for various causes. When a colleague of Staff Nurse

Felicia Tang (6B) told her that relief organisation World Harvest Foundation

was recruiting medical volunteers for a food and medical relief mission

to northern Africa, she leapt at the chance and promptly emailed the

organiser of the Singapore team.

“Coincidentally, I had been thinking of going for a medical mission

overseas but these are usually rare, so when this opportunity came, I was

really keen to go,” she explained.

She used her annual leave to participate in the 10-day mission trip in

40

August 2012, where she spent two days in Kenya and eight in a base camp

outside the city. She recalled the sight that welcomed them as their plane,

together with land supplies on trucks, arrived: “People rushed forward to

receive us and we were surrounded. It was quite overwhelming.”

Leaving Kenya on a 12-hour ride, they ogled at wild giraffes and

antelopes while bumping along roads, their vehicles blowing up clouds of

dust, finally arriving at their destination: close to the border with Somalia.

“The Singapore team – four nurses, including myself, and a doctor –

and the Malaysia team – three doctors, a dentist and two other food relief

volunteers – set up our medical camp. The United States team of three

was mainly in charge of the food relief distribution, while the Africans were

cooks, safari truck drivers and medical volunteers from the city in Kenya.

It was all these amazing team members and the tight friendships we struck

up over the mission’s duration that were my most precious memories from

the trip.”

At the base camp’s medical tent, Felicia and her medical relief team

of Malaysians and Singaporeans prepared and dispensed medication like

deworming tablets and did simple wound dressing for patients. “We were

deeply touched by the hospitality and warmth of the people we aided. They

were so keen to share their culture and practices with us, such as their

rhythmic dances and singing, and plied us with their delicacies like dik dik

– an animal resembling the mouse-deer – which was spit-roasted over an

open fire. It tasted like mutton and was delicious.”

She shared: “I’ll never forget the moonlit showers we took in stalls

made with scrap metal sheets propped together, scooping paddles full of

murky water, or lying on the hard uneven tent ground before sleep took

me, listening to the myriad clicks, calls and chirruping resonating in the

African wilderness at night. The experiences were such a world away from

my familiar comfort zone. It was such an amazing time because I felt so

privileged that our simple acts of service for the African villagers were

received with such sincere gratitude.”

Clinical Nurse Educator Wang Xiao Na, a regular volunteer for

On her 10-day mission trip to Kenya and beyond in August

2012, Staff Nurse Felicia Tang (6B) was deeply touched by the

hospitality and warmth of the African villagers she aided.

41

“Through volunteering with the less privileged, I’ve learnt how fortunate I really am and I want to give back with what little I have.

– Wang Xiao Na Clinical Nurse Instructor (Level 10)

various activities including assisting at a free clinic, making home visits

and recycling medical supplies, agreed that small efforts can make a big

impact. When she sees how thankful the recipients are for the home visits,

medical supplies such as adult diapers and water thickener, she feels that

she gains far more than she has given.

“We look for ways to make ourselves happy. This may be a cliché, but

really, we won’t find it in material things. Through volunteering with the less

privileged, I’ve learnt how fortunate I really am and I want to give back with

what little I have,” said Xiao Na.

She started volunteering in 2004 as a student nurse when her senior

took her for a volunteering experience and has not looked back since.

Now, she helps coordinate volunteer doctors and nurses for a free clinic

in Redhill. The clinic provides free medical, dental and TCM services for

low-income patients, including foreign workers, as well as home visits,

which includes providing consultation, medication and physiotherapy for

low-income home-bound patients. Both services are under the Buddhist

Compassion Relief Tzu Chi Foundation (Singapore). She also collects and

sorts recyclable medical supplies to use in the free clinic, home visits or for

training purposes.

Despite Xiao Na’s volunteering activities which occupy two Sundays

and a Saturday monthly, she still finds time to spend with her loved ones.

“Since the recycling or free clinics take up only half a day, I have one and a

half days left of the weekend and plan it so I can spend time with my family

or friends then,” she said, smiling.

An avid proponent of volunteering, she encourages her colleagues

to join her in their free time. “Nurses just have that innate kindness and

willingness to help. But because of tight work schedules or physical strain,

to volunteer on their rest days can be tough. When they sacrifice a part of

this to help others, I try to ensure that they are not overtaxed and keep the

team spirit strong by working closely together. The people we reach out

to may not be able to afford paying for medical services. So we see the

fruits of our labour in reaching out to such people. That is what keeps our

passion for our noble job burning.”

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Wilma Krishnan (Day Surgery Centre) was given the opportunity to upgrade to take on expanded role of the Principal Assistant Nurse.

Flexible manpower policies which consider individual

needs offer staff more options. Nurses share how

they are reaping the benefits

Interwoven yet individual

43

44

Being able to return to work part-time after a year’s absence after

she became a first-time mom was a great help to Clinical Instructor

Charmaine Ting. “Coming back to work preserved my sanity because

I felt like my brain cells were becoming dull,” she said.

She started a year of no-pay leave in August 2011 after her son’s birth and

returned to TTSH in 2012 on a part-time basis. Her hours were decided after a

discussion with her supportive supervisor, whose advice about taking no-pay

leave first and then exploring other options at a later stage proved invaluable.

The flexible work arrangement fit her needs as her husband travelled for

work a fair bit and she had to be available for her family. “Of course, certain

days are more physically or mentally challenging,” she added, “but I think as a

nurse, we learn to be very adaptable. People are always amazed by how much

I can accomplish even though I’m a part-timer.”

School of Nursing graduate and Day Surgery nurse Wilma Krishnan had

reached the highest rung of career advancement as senior assistant nurse

after 24 years in nursing. Then, in a national initiative to upscale nurses,

nurses like her who were not able to go beyond a certain level because of

their educational constraints were given the opportunity to upgrade to take

on expanded role of the Principal Assistant Nurse (PAN). This is the apex of

career progression for an Enrolled Nurse.

In June 2008, Wilma was the part of the second batch of graduates

to complete the pre-requisite three-month advanced certificate course.

Promoted to PAN in July 2009, Wilma enthusiastically related how she was

empowered to take on more job functions. Her responsibilities expanded to

include tasks which were traditionally done by a Staff Nurse.

The flexibility to redesign jobs also helped Rachael Koh to find her niche

in nursing. She was exploring the possibility of a post with more regular hours

which would also allow her to develop her interest in geriatric nursing. The role

of Geriatric Nurse Co-ordinator (GNC) was created to cater to the needs of

the frail and elderly patients, which were becoming more complex.

Working as a staff nurse on rotating shift at that time, she was looking for

a change and approached her ward sister as well as Nirmala Bte Karmaroon,

Deputy Director of Nursing, who was in-charge of manpower, for a chat on her

With the support of her supervisor, Clinical Instructor Charmaine

Ting (Education and Practice) was able to return to work part-time

after a year of no-pay leave following the birth of her son, Ethan.

45

“My heart has always been for the elderly. In my new role, I can engage my patients in a more in-depth way, where I follow through with their family and home environment.

– Rachael Koh Geriatric Nurse Co-ordinator

options. The GNC role was offered to Rachael, a position that appropriately

matched her interest in geriatric care.

Of her new position, Rachael explained: “There was no specialised role

before to handle the complex discharge cases which may take more time,

such as explaining homecare for elderly patients to their families or dealing

with their queries on the patients’ social or functional needs. So my job now is

to be there to see them through each step of the way.”

Sister Nirmala shared: “We value each staff and consider their needs as

individuals. We also want to retain expertise within the clinical environment.

In the past, there were fewer options but, now, with positions like Rachael’s,

there are more diversified work schedule choices available.”

Rachael added: “My heart has always been for the elderly. In my new

role, I can engage my patients in a more in-depth way, where I follow through

with their families and home environment. That’s where I receive my biggest

fulfilment. And I also continue gaining clinical experience, which is a big plus.”

46

Just superstitions?Despite professing to be men and women of science, nurses do

encounter incidents which cannot be explained with logic

“If there are frequent mishaps in the ward or if you feel that evil may be trailing

you, it’s best to bathe or wash yourself in water immersed with a special

seven-flower blend. If once is not good enough, bathe seven times in it.”

– Senior Staff Nurse Sanipah Bte Yusoff (11B)

47

48

“There is a special view from bed

27 and 28 in Ward 71. Over

the years, patients have told

me they see a white figure on the tree just

outside. They describe that it flies from tree

to tree and rests hanging upside down and

they would often be kept awake by the loud

rustling in the trees. Just three weeks ago,

a patient asked me when I was doing my

morning rounds, ‘Are there monkeys in the

trees here? All night, I heard things moving

among the trees’.”

– Senior Assistant Nurse S.V. Jayalakshmi, who has been in TTSH for 36 years and is currently in CDC Ward 71, where she has been for 14 years

“Most nurses and doctors know this common superstition:

Never eat a bao before, during or even after your shift –

because then you will bao patients. In Mandarin, bao

refers to a bun but also means to wrap or cover. It is also our lingo for

handling patients who pass away on our watch. So don’t ever eat bao. If

you do, don't tell anyone.”

– Staff Nurse Tan Yi Ling (5D)

“The number ‘3’ has special significance for nurses because

we think that death or unfortunate situations like sudden

collapses usually occur in threes. So, when one takes place,

we anticipate that the second and third will follow in succession within the

same day. This chart shows three deaths recorded in one night.”

– Nurse Clinician Salina Bte Mohd Yacob (10A)

“We ’ r e s u r r o u n d e d b y

g r e e n e r y i n t h e C D C

grounds. But there were

two big trees along the pavement and a third

near Ward 76 which formed a triangle which

we tried to avoid. We had heard a lot of

stories about how large tree branches would

fall on nurses just as they walk within this

triangle. One nurse even had a snake fall on

her while walking there. The worst incident

happened to a security guard. One night,

while patrolling on his bicycle, he heard a

voice calling his name just as he went past

the two large trees. Getting off his bike, he

walked within the triangle of trees to see who

was calling him. Suddenly, out of thin air, he

felt a hard slap on his face. His colleague

told us that he could still see the clear hand-

shaped outl ine on his cheek when they

exchanged shifts the next morning.”

49

“At the ICU, we usually have about

eight nurses on night duty. One

early morning in 1997, all eight

of us separately saw something that we would

never forget. It was around 5am and we were

seated in our individual cubicles when, one

by one, we saw what we later described as a

severed head hovering outside the building

windows. It appeared to be the head of a man

and it floated slowly past the windows of one

cubicle to the next and was witnessed by each

of us in turn. We all kept mum about it until

much later in the morning, when someone

caut iously ra ised a quest ion. When we

discussed it, we realised that we had all seen

the same inexplicable thing that morning.”

“Different departments have their own ways to keep new

admissions at bay during their shift. Some general wards

place empty beds that are facing the door at an angle so

that they are not facing it directly. Those in ICU are told that placing a pair

of scissors on empty beds works. I used to scoff at it until I found that it

really does work. Now, I always keep a pair of scissors handy to ‘cut away’

any possibility of more patients being admitted. In CDC, the broom that

is placed at the main entrance to each ward serves a multi-purpose – to

‘sweep away’ any new admissions and keep away unfortunate events, such

as patients acting up or collapsing.”

– Senior Staff Nurse Inderjit Kaur D/O Dhian Singh (6C) and Staff Nurse Alicia Chua Wee Peng (6B)

“At the now defunct Ward 55 in

the old building, where I used

to work, patients seemed to be

drawn to the windows for some unexplained

reason and many tried to climb out of the

windows of this high floor. Once, in 1988,

I caught sight of just a person’s f ingers

gripping hold of the window sill from the

outside and dashed over just in time to see

that it was a female patient dangling from the

window. I quickly called for an amah’s help.

Together, we were able to pull the patient

back to safety. When I gently talked to her

later, she appeared confused and said that

she was on her way to the toilet and didn’t

know what happened.”

– Unit Nurse Manager Mariam Bibi Piperdy, who has been in TTSH for 40 years and is currently in Neuroscience Level 10

50

Keeping the night vigil As part and parcel of nursing life, the night shift charts

both meditative moments of routine quiet as well as

sudden bursts of adrenaline when emergencies occur

Night shift nurses take over from the previous shift. With three rotating shifts,

good handover is essential for care continuity.

Geriatric Monitoring Unit (GMU): located in Ward 7B, the GMU is the only where Bright

Light Therapy is used to regulate sleep-wake routine of dementia patients. It encourages

them to stay up during the evening hours, then sleep better throughout the night.

21:15 22:00

51

Monitoring telemetry: Nurses observe the telemetry monitor 24/7, and

alert doctors to proximal atrial fibrillations (PAF). Ward 10B.

23:15Paperwork: The still night hours are the best time to catch up with the

numerous documentations that needs to be done.

23:28

00:14Admission: A new patient, who required assisted ventilator support, admitted into Medical ICU (6B) from the Emergency Department. Nurses from different

bed locations coming together to effect a smooth transfer.

52

Constant watching: whether it is day or night, ensuring the right patient for

the right procedure never stops. Be it via PDA or oral verification.

00:17On a break: Quiet chatter and the low buzz of the telly reign in the break

room as nurses take their break to have dinner, rest and relax with colleagues.

00:39

Standby mode: A nurse from Recovery Ward 83 taking a check on her patient before moving on to those who require more attention.

02:4502:45

53

Helping out: A nurse from the STAR (Specialised Transfer and Acuity

Response) team taking a blood sample. STAR team nurses are also

deployed as floaters to the area with critical shortfall for the shift.

01:05Quality control: Performing a quality control test on the Glucometer, a night

shift nurse from Subacute Ward 8 seeing to one of her nightly duties usually

done around 2am.

02:20

Nurse Manager Cheong Yoke Ling has been with TTSH since 1960 and is

on permanent night shift which is quite a feat. Here she skillfully handles a

restless patient with the junior staff.

03:04Brief respite: A nurse from the Emergency Department taking a break in

front of an Incredible Hulk sculpture built by the department staff.

03:20

54

Summing up: The night shift report is the chance to sum up and review the day’s events, outstanding concerns, and to remind follow up to action plans to

the morning’s team of doctors and nurses, as the nurse from CDC Ward 75, a tuberculosis ward, is doing.

04:00

Kicking into action: In the fast-paced Emergency Department, paramedics

(in dark blue) admit a new patient onto the resuscitation table while nurses deftly

handle the situation.

06:44Final checks: As the morning light peeks through the window, a night

shift nurse (extreme right) completes morning assessments while morning

shift nurses check on state of condition and details such as IV lines in

readiness for the handover report.

07:05

55

Essential checks: Having finished turning and completing suctioning for her patient, the gowned nurse from Surgical High Dependency Unit (6C) rechecks

the alarm settings on the monitor to ensure that everything is in order, repeating this routine two- to four-hourly throughout the night.

05:59

Signing off: At their lockers, rehab nurses chatting as they prepare to

change out of their scrubs at the end of their night shift.

08:09Well-earned rest: Smiles all around as night shift nurses, changed into their

own clothes, head home after a night’s work.

08:19

56

Even though our nurses come from diverse

backgrounds and different countries, they

make the effort to understand where one

another is coming from

Likeness in diversity

L

57

Foreign nurses from different parts of the globe in their national costumes. From left: Staff Nurse Joel Yap Eng Joo (6B), Staff Nurse Thiri Lwin Maw (10A), Staff Nurse Mya Su San (6B), Assitant Nurse Gaco Rosseanne Jade Capitan (7C), Staff Nurse Shen Lijin (Recovery Ward 85), Senior Staff Nurse Sindhu Thayyil Philip (10C), Staff Nurse Tan Nianche (6B), Assistant Nurse Bolis Viva Mungcal (9A), Staff Nurse Moe Moe Thwe (7C), Staff Nurse Nyo Mi Hlaing (8D), Assistant Nurse Jaya Paul Jaya Mabel (9C), Staff Nurse Zune Pwint Phwe Phwe (Recovery Ward 82), Staff Nurse Kim Min Hwa (9C), Staff Nurse Chong Seow Li (6B), Staff Nurse Lee Wan Lih (6B), Assistant Nurse Agnat John (6B), Staff Nurse Thwe Ni Oo (Recovery Ward 86), Senior Assistant Nurse Maung Kyaw Min Soe (10A).

58

From left: Assistant Nurse Ehimwenma Rachel Akhigbe

(Subacute Ward 9), Advanced Practice Nurse (Intern) Tan

Hongyun (Geriatric), Assistant Nurse Maria Karen Guevarra

(Invasive Cardiac Laboratory), Senior Nurse Manager Geeta

Pattath Raghavan (6A) and Staff Nurse Ma Yin Yin Chit

(Subacute Ward 8).

Senior nurse Manager Geeta Pattath Raghavan makes it a point

to chat with new nurses joining her ICU and sharing her own

experiences. “I tell them I know what it’s like to come in for the first

time and be shocked by all equipment or emergency action that they see in

the ICU. But I remind them not to lose heart. I was new to Singapore, new to

TTSH and had no clue about the ICU practices here, so I observed carefully

and heeded my ward sister’s advice that in the fast changing pace of the

ICU, you have to work as a team. We had people from different countries,

including Australia, Malaysia and India, but we learnt to blend together,”

says the 18-year ICU veteran who joined 1995 with a nursing degree from

Kerala, India, accompanying her husband on his work posting here.

When Hongyun came to TTSH in 2002 on a professional exchange

programme from Sichuan, China, she was surprised by the duties that nurses

here performed. “I saw them doing basic care like cleaning and changing

patients. In China, that’s the responsibility of the patient’s family members

who stay by their beds as caregivers, while nurses do the more technical

tasks like inserting catheters or drawing blood. I was initially resistant to

carrying out such basic care. But in Singapore’s different social environment,

family members may not be able to do the same. I recognised then that in

coming to a Singapore hospital to work, I not only met the stringent criteria

set out, but also have the privilege of being chosen for my abilities and

dedication to contribute. Although it takes a mindset change, I realised that

picking up the practices and standard of care here was vital. When patients

thanked me sincerely after I helped them, I appreciated how important our

duties, such as basic care, are in caring for our patients,” she said.

Sometimes, it was not understanding or not being understood that

was the most challenging aspects of a new environment. Assistant Nurse

Ehimwenma Rachel Akhigbe was very disheartened by how her colleagues

could not understand her when she spoke. She often had to go over to

where they were to show them what she meant. The gap in communication

frustrated the Nigerian mother of three who came to Singapore with her

husband when he was transferred here for work in 2000. “At the end of the

day, I would go home and cry like a baby,” recalled the former high school

teacher who underwent a two-year nursing course to make the career switch.

Ward Sister Letchimi, learning from her colleagues about this rift,

stepped in to help Rachel establish rapport with her colleagues. “Sister

59

Letchimi was a big support to me,” says Rachel. “She helped to ‘translate’

what I was saying to my colleagues, making it light-hearted. Over time, I

spoke slower and they learnt to understand me better.” She also credited

Sister Letchimi with giving her good advice on handling people. “She said,

‘See what you can do to involve them. If you stay apart from them, they will

definitely not understand you. If you involve them, you are together all the

time, then they will surely understand you’. That really helped me. It was in

this ward that I learnt to adapt to Singaporean customs and its lingo. Even

though I miss my previous Ward 8C where we learnt to be sisters together, I’m

enjoying my time in my current Subacute Ward 9.”

Homesickness is another challenge that many living in a new country

experience. Being in Singapore was the first time being abroad for Maria Karen

Guevarra, who hailed from Angeles City in the Philippines. Gathering with

colleagues for meals, barbecues and even badminton tournaments helped. She

also remembered how her nurse educator checked on her periodically during

her first year. “I didn’t feel abandoned and left to drown,” she said.

Hongyun remembered fondly her first taste of lontong during a training

session and outings to places like Botanic Gardens, which were part of then

Nurse Educator Lee Leng Noey’s efforts to integrate newbies into Singapore.

As for concerns on career development prospects, Sister Geeta said

there are plenty of opportunities available. Starting in 1995 as Staff Nurse, she

became a Nurse Clinician in 2003 after a supportive push from then Nurse

Manager Neo Chee Hoon. “She told me she had faith in me and encouraged me

to apply for the post.” In 2012, she was promoted to Senior Nurse Manager.

Staff Nurse Ma Yin Yin Chit, who is from Myanmar, related how she

expressed an interest in learning more about behavioural difficulties in the

elderly and was sent for such training courses.

Currently an Advanced Practice Nurse intern, Hongyun said that it was

the strong educational backing and emotional support that she is grateful

for in TTSH. “Back in China, if you’re deemed inadequate, you’re left behind.

But here in the hospital, there are so many people who have encouraged and

supported me. Sister Laura and the late Sister Norina Bte Bukari singled me

out for the Nanyang Polytechnic advanced diploma. Geriatrician Dr Chong

Mei Sian and APN Jasmine Kang were the ones who told me that although

the Masters in Nursing (Clinical) course was tough, I could accomplish it.”

“We had people from different countries, including Australia, Malaysia and India, but we learnt to blend together.

– Geeta Pattath Raghavan Senior Nurse Manager (6A)

60

Making marks overseasWhether it is in extending help beyond Singapore’s shores or growing ties

with overseas counterparts, connections abroad bring mutual benefitsM60MM MakinoverseaWhether it is in extending help beyon

with overseas counterparts, connecti

In 2004, just days after the devastating Indian Ocean tsunami, a relief mission team by the National Healthcare

Group and Singhealth set off to Trincomalee, Sri Lanka, to provide medical relief. (Photo courtesy of Leslie Tan,

Singapore Red Cross volunteer)

61

About a week after the tsunami that devastated 14 countries – hitting

Indonesia, India, Thailand and Sri Lanka the hardest – struck on

Boxing Day in 2004, Senior Nurse Manager Christopher Soh was on

his way to Trincomalee, Sri Lanka, to provide medical relief using skills from

his emergency department background.

Even though he was newly married, having tied the knot just a month earlier,

it took him only a day to deliberate over his decision. He did not hesitate as male

nurses were needed for a relief mission by the National Healthcare Group and

Singhealth, under the banner of Ministry of Health and the Red Cross.

“My wife who is also a nurse at TTSH saw the terrible effects of the

disaster on the news. Despite the dangers of further aftershocks and

Trincomalee’s political instability, we both agreed that this was an opportunity

to help people in genuine desperate need. With my emergency experience,

I was trained for and familiar with this, and I felt I could make a critical

difference by going,” he said.

In the 11 days he had before deployment, he and the team of about 20 –

made up of nurses, doctors, pharmacists, community care and operations

staff from hospitals including TTSH and NUH, nursing homes and the

Singapore Red Cross – took nine days to organise and conduct a needs-and-

risk assessment. Once they arrived, it took another three days of travelling

from capital Colombo to the seaport of Trincomalee, which was under the

Tamil Tigers’ control.

What he saw when he arrived were the effects of the incredible power of

nature.

“It was a truly desolated landscape. What were once entire villages with

buildings and homes were reduced to a surreal painting of broken metal

foundations sticking up here and there from the muddy earth. Like what we all

saw on news channels later, huge marine vessels looked eerily out of place,

marooned far inland among the debris.”

There was massive displacement of the Trincomalee population and

most were housed in quickly set-up refugee camps, living with donated tents

and rations. “We had expected to have contact with dead bodies and severely

injured casualties, but they had already been tended to by NGOs and relief

teams arriving before us.”

Sanitation and waste disposal were limited in the camps, so the team

TTSH nurses from different disciplines, ranks and age groups

visited Thailand's Songklanagarind Hospital and Siriraj

Hospital in February 2012 on an overseas training trip.

The relief mission team members saw an average of 200

patients daily. In their off-duty time, they reviewed their efforts

or visited other affected sites. (Photo courtesy of Leslie Tan,

Singapore Red Cross volunteer)

62

visited different camps each day with a mobile treatment centre to meet

as many needs as they could. The team members saw an average of 200

patients daily, mostly for non-critical illnesses like diarrhoea or coughs, with

a few having airway difficulties and wound sepsis. In their off-duty time, they

reviewed their efforts or visited other affected sites.

Christopher’s most memorable experience was encountering a group

of bubbly children playing next to an almost completely destroyed school

building. After chatting for a bit, they repeatedly asked the team for study

materials and stationery supplies, so that they could resume their studies.

“It was heart-wrenching, the earnestness in their eyes. But we had hardly

anything to offer them in the way of those items, since we only had medical

supplies. We gave them the few pens and notepads that we had.

“That made me realise that, while medical efforts to aid victims physically

were important, support and recovery for rebuilding lives should equally not

be overlooked.”

Christopher continued: “As medical volunteers, we always think that

we’re there to help the people in need, but from this experience, I gained so

much from the exposure as well. It taught me that, just like the way we care for

our patients so well in TTSH, a holistic approach is needed for disaster relief

missions to ensure that each person’s needs are fully met.”

An important feature in a hospital’s connections abroad is its ties with

partner hospitals and other medical institutions for training and educational

exchanges. For Senior Staff Nurse Tang Choy Fung (9D), what stood out

during her overseas hospital training in Thailand last year was the genuine

warmth that the staff exuded to visitors and patients alike. She said: “With the

warm, hospitable nature of Thai culture, the hospitals there have a practice

at the start of each shift where the ward’s nursing officers greet each patient

personally. That warmth continued as they attended to them throughout the

day. We saw patients responding to it kindly in return.”

The team, comprising a fair mix of nurses representing different

disciplines, ranks and age groups, visited Songklanagarind Hospital in Hatyai

and Siriraj Hospital in Bangkok over 2½ days in February 2012.

The goals of the trip was to observe the key process improvements using

lean principles, hear and see their transformation highlights and adoption of

During a study trip, Nurse Manager Tan Tit Chai (Nursing

Service) gamely tried on the "Madonna jacket" which was

specially designed for fathers. The aim was to allow husbands

to be aware of challenges faced by their breastfeeding wives.

In January 2013, the roles were exchanged when TTSH

hosted a group of 14 nurse leaders from four Thailand

institutions, under the initiation of Her Royal Highness

Princess Maha Chakri Sirindhorn (left).

63

“It taught me that, just like the way we care for our patients so well in TTSH, a holistic approach is needed for disaster relief missions to ensure that each person’s full needs are really being met.

– Christopher SohSenior Nurse Manager (Emergency Department)

the lean culture and to establish network amongst Thai fellow colleagues and

exchange experiences in lean culture and projects or initiatives in different

cultures. We also wanted to expand our understanding on the principles of

lean management in an Asian healthcare organisation.

Amidst the packed schedule of walk-abouts and sharing sessions, Siriraj

Hospital’s emphasis on innovation impressed the trainees. Staff members

there were encouraged to turn their innovative ideas into reality with actual

prototypes, which were then showcased and even sold in its innovation shop

as well as on its website (www.creativesiriraj.com). These useful innovations

included padded seat restrainers and gel-filled pressure-relieving mats.

The Thai hospitals’ “No Shame, No Blame” approach in handling staff was

another practice that the participants noted as a useful approach to adopt in TTSH.

About the impact the Thai hospitals’ training had on her, Nurse Manager

Salbiah Bte Atan (8C) shared: “I was inspired by how passionate and

committed our nursing counterparts are from both hospitals. Like us, they too

have limited manpower and financial resources, and high patient loads, but

theirs is on a more acute level. ”

“Yet despite this, they demonstrate great pride and a sense of ownership

in their work, and took the initiative to bring an atmosphere of joyfulness to

their workplace while improving quality care for the lives that they touch. This

reminds me to constantly seek to improve in my pledge as a nurse – to bring

comfort and care.”

Following this training trip to Thailand, the roles were exchanged when

TTSH hosted a group of 14 nurse leaders from four institutions in Thailand for

two weeks in January 2013. Supported by Temasek Foundation (TF), the TF-

TTSH Nursing Specialist Programme in Occupational Health & Safety Training

was initiated by Her Royal Highness Princess Maha Chakri Sirindhorn, who

chose TTSH for its ties from the previous training trip. It aimed to enhance the

knowledge and experience of these nurse leaders in preventive technology

and innovations, such as safe handling of patients.

It comprised senior nurse leaders from Mahidol University Faculty of

Nursing, the Thai Red Cross College of Nursing, King Chulalongkorn Memorial

Hospital and Siriraj Hospital. They had field attachments in TTSH wards and

found the hands-on experience, such as the use of innovative transfer aids for

safe transfers, invaluable.Christopher Soh (extreme right from first row) and the

medical team in Trinconmalee, Sri Lanka. (Photo courtesy of

Singapore Red Cross)

64

None left

behindThe three arms of the Department of Continuing

and Community Care (CCC) go beyond the

hospital to care for patients in their homes,

senior activity centres and nursing homes

Post Acute Care at Home (PACH)Provides homecare follow-up for patients with complex

needs after hospital dischargeOn their visits to patients' homes with doctors, PACH nurses evaluate

their patients’ well-being, including a physical assessment and review

of their mental status and social concerns. PACH’s primary focus is to

render treatment at patients’ homes where they feel more comfortable and

familiar. This is to prevent unnecessary hospital readmission.

They also enlist therapists such as physiotherapists, occupational and

speech therapists and advise on home safety modification.

Nurses sometimes extend help beyond medical aid. This could involve

the sensitive issue of home hygiene. The first time Senior Staff Nurse Tan

Yen Peng saw a bedbug, she did not know what it was. “I saw a small dark

insect crawling into the patient’s diaper.” She found out it was a bedbug

and roped in a medical social worker and the town council to have the

home fumigated.

N None left

behindThe three arms of the Department of Continuing

and Community Care (CCC) go beyond the

hospital to care for patients in their homes,

senior activity centres and nursing homes

Post Acute Care at Home (PACH)Provides homecare follow-up for patients with complex

needs after hospital dischargeOn their visits to patients' homes with doctors, PACH nurses evaluate

their patients’ well-being, including a physical assessment and review

of their mental status and social concerns. PACH’s primary focus is to

render treatment at patients’ homes where they feel more comfortable and

familiar. This is to prevent unnecessary hospital readmission.

They also enlist therapists such as physiotherapists, occupational and

speech therapists and advise on home safety modification.

Nurses sometimes extend help beyond medical aid. This could involve

th iti i f h h i Th fi t ti S i St ff N T

65

Senior Staff Nurse Joey Yeo (PACH) views PACH as a more personal form of care as patients know the nurses by name and nurses are able to create a special rapport with each patient and their caregiver.

66

What is special about what PACH does? Senior Staff Nurse Joey Yeo

explained: “I get to see patients in their home situation. So I can see the

real reason they don’t take their medication. It’s also a more personal form

of care: they know us by name and we’re able to create a special rapport

with each patient and their caregiver.”

Community Health Engagement Programme (CHEP)Conducts an act ive-age ing programme in sen ior

activity centres In a one-year comprehensive programme of fered to seniors called

Stepping Out Into Active Life, the CHEP team runs twice-weekly exercise

classes and conducts health and safety assessments. It also does

quarterly individual evaluations to track the seniors’ progress. In addition,

interactive health education classes are held. Stepping Out’s main aims are

fall prevention and promoting balanced active lifestyles.

Home visits are scheduled for high-risk participants, such as those

with high fall risk, to assess their home environment. “Some patients take

their medication once a day instead of the prescribed thrice, thinking they

can stretch out the supply,” said Senior Staff Nurse Mohammed Nizam Bin

Urip. “We educate them on such issues.”

Over time, bonds are forged, with participants asking after missing

nurses or fellow participants and celebrating one another’s birthdays.

Project CARETrains nursing home staff and facilitates Advance Care

Planning discussions with patients, their families and

nursing home staff on end-of-life care issuesThis pilot project initiated in 2009 aimed to raise nursing home staff’s

capabilities and reduce unnecessary hospital readmissions. Project CARE

nurses conduct 12 tutorial sessions with the seven nursing homes they

collaborate with. They are also on call 24/7 to support the nursing home

nurses with intravenous cannulation and administration of intravenous

Senior Staff Nurse Mohammed Nizam Bin Urip (second from

right) and Nurse Clinician Rohana Bte Basri (far left) hail from

the CHEP team, which runs twice-weekly exercise classes

and conducts health and safety assessments for seniors.

A happy exchange of farewells between Staff Nurse Sherlyn

Lee Zhi Ling (PACH, far right) and her patient.

67

“We walk with the patient’s family to the end to assure them that their relative’s wishes will be honoured.

– Amutha D/O Muvigasin Staff Nurse (Project Care)

medication, as these nurses are not trained to do these procedures.

Advanced Care Planning is also offered to nursing home residents.

Through this, the Project CARE team, made up of doctors, nurses and

medical social workers, facilitate discussions with the residents, their families

and nursing home staff on how they would like to be cared for when they fall

sick in the future. Issues dealt with include whether they would like to receive

treatment in the nursing home or hospital.

Loved ones would then be able to carry out their wishes in the event that

their conditions deteriorate and they are no longer communicative.

Once discussions are completed, the residents will be recruited under

Project CARE. Project CARE will co-manage them in the nursing home when

they become unwell.

“We walk with the resident’s family to the end to assure them that their

relative’s wishes will be honoured,” says Staff Nurse Amutha D/O Muvigasin.

68

OOf reaching for the stars

Support from family,

friends, colleagues and

supervisors plays a large part in

helping nurses go back to school to

upgrade themselves

From left: Staff Nurse Her Zhiyuan (Recovery Ward 85), Nurse Educator Dinah Djong (Education

and Practice), Nurse Manager Maheas D/O Thanmugam (5C) and Senior Assistant Nurse M.

Kowsula Kaur Patel Utkar (Clinic 5A) embarked on further education with the support of TTSH

and their families.

69

70

Dr Margaret Soon did not plan in advance for each of the academic

courses leading to her PhD. She certainly did not anticipate

becoming the Assistant Director of Nursing when she f irst

graduated from the School of Nursing in 1993. It was the feeling of being

handicapped by her lack of knowledge in her work that led her to consider

furthering her studies.

Her hard work has paid off — she became Tan Tock Seng Hospital’s

first Doctorate of Nursing holder when she completed her PhD in 2012.

For others, the decision to pursue further education came at a later

stage. For Assistant Nurse M. Kowsula Kaur Patel Utkar, to say that

hitting the books after a gap of 22 years was a struggle would be an

understatement. She had two O-level passes when she started as a nurse

in 1989. Then marriage and other family commitments, such as looking after

her father who had a stroke, kept her from pursuing further studies. She was

finally able to take a three-month bridging course when her daughter was

18 and son was nine. She admitted facing tough times learning the basics

during the course. But having crossed that hurdle, she shared excitedly

about her next step: entering Nanyang Polytechnic at the same time as her

daughter, who is doing chemical and pharmaceutical engineering, to do her

nursing diploma.

Many who took up the challenge of further education said it was the

loving support from spouses and family which made it possible. “When the

scholarship for my doctorate came through in 2008, my supportive husband

resigned from his position as an engineering director and even went to a

restaurant to learn how to cook. It took a leap of faith with my family moving

to the United States for my four-year doctorate with my husband looking after

all of us, but I believed that God would bring us through – and He has indeed.”

said Margaret, whose daughter was four and son was newborn at that time.

She related how the hectic routine of clocking research hours in the hospital

and attending group discussions left her with little time with her kids and three

to four hours’ sleep nightly.

Nurse Manager Maheas D/O Thanmugam recalled how she handled

the time when, in the midst of her exam period, her father suffered his third

Assistant Director of Nursing Service Dr Margaret Soon, seen

here with her family, became TTSH’s first Doctorate of Nursing

holder when she completed her PhD in 2012.

71

stroke and was admitted to TTSH. “I remember going to his ward after

work each day with my textbooks, so I could revise while he was resting.

It was very draining but it helped when my brother who saw this strain told

me not to worry and to concentrate on my exams.” Maheas, who did a

bridging course after re-taking her O levels at 30, went on to obtain a slew of

sterling results: a merit award for her diploma, an achievement award for her

advanced diploma and a pass with distinction in her nursing degree.

Encouragement and backing from colleagues and supervisors were also

crucial for those going back to school. “Nurse clinicians from my ward readily

offered resources and nursing contacts who could provide more in-depth

details necessary for my course projects,” related Staff Nurse Her Zhiyuan.

Kowsula, who used to fail every Maths and Science exam in school,

went on to ace all her bridging course subjects. She shared: “I was so

grateful to my NO’s for granting me leave to prepare for my exams. When my

results came out, I was so excited. I attained all As.”

With all these educational advancement opportunities made possible

through the hospital’s sponsorship, Maheas, one of the many recipients, is

thankful. “I am so glad that we have an organisation that is so enthusiastic in

sending us to upgrade ourselves.”

As others like her who have chosen to upgrade their knowledge can

attest, the benefits outweigh the challenges. Zhiyuan, recipient of the NUH

Achievement Award for his outstanding results in his Advanced Diploma in

Nursing (Orthopaedics), said: “For me, the true aim of the course was to

learn more about my specialty and also interact with others; the award was

a bonus.”

Dinah Djong, a nurse educator with a post-graduate diploma in higher

education, said further studies not only enhanced her role as an educator,

but on a personal level, she grew more patient from learning to work with

others in group projects.

Maheas agreed that opportunities abound. “The bridging course really

opened my eyes. I viewed my polytechnic diploma as a doorway which

opened to a lot more possibilities for me than before.”

“The bridging course

really opened my eyes.

I viewed my polytechnic

diploma as a doorway

which opened to a lot

more possibilities for

me than before.

– Maheas D/O Thanmugam Nurse Manager (5C)

72

Nurse Clinician Lam Chin Chin (Diabetes Care) educating a caregiver on insulin and its administration.

73

P Starting a specialist clinic is not easy, but these nurse

clinicians took the initiative to learn how to educate patients

and manage staff

Passage pavers

When specialist clinics first started, patients were hesitant about

having to pay for counselling conducted by nurses. “It was about

$7, but more than the amount, I think people were surprised that

the time we nurses spent educating patients on issues was something that

was even chargeable. Some would ask us, ‘How come I have to pay for you to

talk to me?’,” said Senior Nurse Clinician Philomena Anthony.

“But now, people see the value of the work we do and we seldom get any

protests. In fact, some patients even thank us for explaining things.”

Most of the nurse clinicians who run specialist clinics were initially roped

in as part-timers. Rising patient numbers and the increasing need for patient

education and counselling led to the clinics’ expansion and the part-timers

converted to full-timers, rising from the most junior positions to being the

nursing officers in charge.

Senior Nurse Clinician Heng Lee Choo, who runs the Urology Clinic,

recalled: “When I came on as staff, I was the most junior and took orders from

above. But then, as the team grew to meet the demands and my seniors left,

suddenly I was now the senior in charge. I was taken aback at the jump it took

to learn to manage people.”

Today, the NCs helm clinics in specialisations such as diabetes, infection

74

control, urology and even sub-specialties like dementia, within geriatric care’s

speciality, with staff strength ranging from four to eight.

Coming to the specialisations without extensive experience, they faced

steep learning curves. They had to take the initiative to research on the

Internet, read medical tomes, attend attachment courses and conferences

and even sit in with doctors during consultation to pick up as much knowledge

as possible. Sister Philomena remembered going through the process

of setting up nursing assessment protocols in her clinic for new patients

in discussion with doctors, as there were no precedents to follow. There

was also the move to a multi-disciplinary approach – involving podiatrists,

nutritionists, dietitians and other medical experts coming together –

to manage the needs of a patient, unlike in the past, where patients were

often referred to other departments to handle the various issues arising from

their ailments.

Although the NCs were thrown into the deep end, they could tap on a

valuable resource – others who were in the same boat – for ideas and shared

experiences. “We had a peer support group of nurse clinicians sharing

knowledge and helping one another. The more established clinics were

available to advise those starting up,” said Philomena.

Nurse Clinician Loo Yen Leng (Fall Care) testing the four limbs power to assess the patient's strength as part of evaluating patient's walking ability.

Nurse Clinician Karen Chng (Continence/Urology). Easy does it. These delicate percutaneous nephrostomy tubes drain urine into the urostomy bags which are changed regularly to prevent skin breakdown.

Correct mask fit is one of key component to staff protection against infective airborne organisms. Nurse Clinician Toh Cheng Yen (Infection Control Unit) demonstating N95 Particulate Respirator Training and Fit Test for employees.

75

“Now, it’s much more

fulfilling because, with

practice and experience,

I’ve learnt what to

explain and how to do

so in a way that patients

can understand and

benefit from.

– Ng Poh Leng Senior Nurse Clinician (Diabetes Care)

This advice ranged from help on clinical practices and documentation to

managing manpower issues. Sometimes, the more experienced NCs simply

provided a supportive shoulder to lean on. Together, they helped one another

as they grappled with the newness of managing staff. Sister Heng shared with

a laughing: “I remember when I first started to manage people, I would regularly

run to the diabetes clinic, which was one of the earlier ones set up in 1994, for

help. It was such a relief to have someone who had experienced what I was going

through, to whom I could vent.”

For Senior Nurse Clinician Ng Poh Leng, a mindset change was

necessary. Instead of a top-down approach, which the nurses had been

used to as juniors, there was a more equal footing and open communication

between nursing officers and their staff.

As each clinic developed, they encountered memorable milestones.

Infection Control unit’s Senior Nurse Clinician Poh Bee Fong remembered

how the clinic’s consultative role in coming up with policies came to climactic

head during the 2003 SARS outbreak. They had to scramble to work out

safety protocols, produce training videos overnight and quickly set up an

inter-department task force involving housekeeping and facilities to make

rapid preparations like converting rooms to house quarantine features. The

clinic was able to apply the valuable lessons learnt then to handle the H1N1

swine flu pandemic in 2009.

Asked about rewards, Sister Heng cited how patients were grateful

for her experience and the comfort it brought. “After I did a catheterisation

procedure for a patient, he said, ‘Missy, you do very good, no pain at all’.”

Looking back on the journey it took to get here, Sister Poh Leng

shared about the satisfaction she gets from her job. “When I first started,

I would nervously rattle off a whole list of instructions in 15 minutes to my

patients. At the end of that, you could see in their blank faces that they

took in very little.

“Now, it’s much more fulfilling because, with practice and experience, I’ve

learnt what to explain and how to do so in a way that patients can understand

and benefit from. Now, they get it. It’s so rewarding to see that, after I’ve

talked to them, their faces just light up.”

The best results for a four-layer bandaging over lower limbs

afflicted with vascular conditions comes from specially skilled

hands. Here, Senior Staff Nurse Tina Lai (Stoma and Wound

Care) intensely focused on getting it right.

76

QAdvanced Practice Nurses bridge the gap between

doctors and nurses

TTSH welcomed its first group of Advanced Practice Nurses (APNs)

in 2004. Since then, driven by the desire to enhance their clinical

knowledge in order to improve bedside patient care and safety,

nurses such as Geraldine Ng, Serene Tan and Jennifer Wong are among a

group of APNs who had completed the 24-month Masters in Nursing (MN)

programme at the National University of Singapore and are on the Clinical

Nursing track.

Geraldine, an APN intern in General Medicine, shared her journey

towards obtaining her APN licensure. Since graduating in 2012, she has

been undergoing her internship under the mentorship of her medical

consultant in General Medicine. The gruelling one-year internship requires

Quest for advancement

77

Advanced Practice Nurse (Intern) Geraldine Ng (General Medicine) conducts an informal discussion with nursing students.

her to complete 12 case studies and clock over 1,000 clinical hours of

bedside patient clinical practice. While the MN programme equipped

her with advanced clinical knowledge and skills for patient management,

the internship would provide opportunities for her to hone her skills in

areas such as critical analysis and clinical decision-making skills. These

experiences would enable her to do guide the nurses.

“For example, if the patient takes a turn for the worse and becomes

drowsy, nurses monitor parameters and conscious level closely and await

further instructions from the medical team. As an APN, I can guide them

while intervening quickly by initiating investigations and treatment while

waiting for the doctor,” she said.

78

Serene, who obtained her APN licensure in 2011 and currently

cares for neurosurgical patients, affirmed that she was better able to

understand and appreciate the process of diagnosing patients after her

training. She cited the example of how high or low sodium in a patient

could be due to many causes. She was able conduct the appropriate

physical assessment and history taking, interpret and associate the

physical signs and symptoms to the laboratory results and physical

examination, and initiate early intervention. She passionately shared her

clinical expertise by conducting regular clinical nursing rounds to improve

bedside nursing care and patient safety.

As an APN, besides other duties, Serene made it a point to teach

nurses and students how to look for signs of dehydration, be attentive

to slight changes in body temperature and take note of elevated blood

pressure, which they might miss when they were busy with other duties.

She added: “As they perform their routine work, they would be on the

lookout for these signs. A step down the the road to recovery for a patient

depends on the nurses’ attention to details, as well as the APN’s ability

to catch signs early and take the necessary steps. Even though they

may seem like small tasks, they make a huge difference.” These details

handled by APNs have positive impact on the management of a patient’s

condition.

With their unique education and training, the APNs possess the best

of both worlds and bridge the gap between nurses and doctors. APN

Jennifer Wong from the Heart Failure Service said her role placed her in a

unique position: “As nurses ourselves, we understand where our nursing

colleagues are coming from and they feel more comfortable coming to

us with questions. At the same time, because we work so closely with

doctors, we can see from their perspective too.” She is able to clear the

air between the two when misunderstandings arise and “educate both

ways”, she said.

She shared how hear t failure patients of ten have a long l ist of

medication with many that may potentially lower their blood pressure.

Often, nurses are hesitant to give the medication to a patient whose Advanced Practice Nurse Serene Tan (Neurosurgery) demonstrating a physical examination of a patient.

79

“As nurses ourselves,

we understand where

our nursing colleagues

are coming from

and they feel more

comfortable coming

to us with questions.

At the same time,

because we work so

closely with doctors,

we can see from their

perspective too.

– Jennifer Wong Advanced Practice Nurse (Cardiology)

blood pressure was already low. Nurses may find it difficult to approach

and ask the doctors about i t , while doctors may wonder why the

nurses do not give the medication as prescribed. Jennifer finds herself

explaining the rationale to both sides to clear misunderstandings.

“As APNs, we have our fair share of being misunderstood by our

colleagues, peers and even patients,” she said.

Serene added: “Despite our close collaboration with the medical

team, we are still nurses, we are not doctors or physician’s assistants.”

She went on to share that the APN track is far from being glamorous;

rather, it involves long hours of study, hard work and perseverance.

Jennifer concluded: “At the end of the day, what keeps us going is

our passion to improve our patients’ clinical care.”

80

Ward sisters are the stalwarts of the team – they are

supervisors, confidantes, protectors and motivators,

all rolled into one

RUnit Nurse Manager Tay Meow Hoon manages the Intensive Care Unit and High Dependency Unit. Supervisors from ICUs on Levels 3 and 6 preparing for latest updates from their lead nurse.

Rallying the troops

81

82

At the height of the SARS epidemic in 2003, when the fear of infection

was a very real concern and colleagues were falling sick, then Nurse

Manager Tay Meow Hoon stepped out from the sanctuary of her

office and went personally to the wards to rally the nurses.

“As a manager, I didn’t need to go into the wards as often as my staff

to tend to the patients, but I made it a point to, so that my staff knew that

whatever they were going through, I was in it with them,” said the current

Unit Nurse Manager of the ICU.

In the same vein, Nurse Manager Sulimah Bte Sarmin (Emergency

Department) was on permanent night shift during the taxing SARS period

and made the opportunity to talk one-on-one with her staff so that they

could have someone to share with or vent to about the day’s trials during the

quieter wee hours.

Besides being a good listener, a ward sister also needs to be a protector

of not just her patients, but also the nurses working with her.

Nurse Clinician Akhterun Nisha Bte Idris recalled a harrowing incident

about 10 years ago in which a HIV-positive patient, who was also a drug

abuser, holed up in the toilet and threatened to inject anyone who tried to

enter with a syringe filled with his infected blood.

A great way to bond with staff. Nurse Manager Yeoh Kim Choo

at the beach with nurses (12C).

Nurse Manager Sulimah Bte Sarmin (Emergency Department)

who was on permanent night shift during the SARS period

avail herself to staff to have someone to share with or vent to

about the day’s trials during the quieter wee hours.

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“My team knows that if anything happens to them, I’ll be the first one beside them.

– Yeoh Kim Choo Nurse Manager (12C)

Her number one concern at that moment was for the nurses in her

charge. She said: “I knew that they were concerned that the patient could

self-harm, but I said that there was no point in being a hero and that we

should wait for help to arrive. My first thought was for the safety of my staff.”

It was the right call, as the police later arrived to take charge of the

situation and no one was harmed.

The care, concern and camaraderie shown towards one another in the

nursing team are crucial, and no one knows this better than Nurse Manager

Yeoh Kim Choo (12C).

Standing with her hands on her hips, she cuts the stereotypical image

of an authoritative, no-nonsense matron nurse. But spend just a moment

with her and that image quickly disappears as she wins you over with her

quick talking, can-do attitude and warm sincerity.

Sister Yeoh, who won the Director of Nursing Award’s Best Supervisor

Award in 2012, makes time to bond with her team over chatter in the

tearoom. The nurses know that they can count on their ward-in-charge,

be it to be a listening ear when they face personal problems or to provide

unwavering support in moments of crisis, such as when they had to run

the ward at half the necessary staff strength for months in 2007 due to an

unusually large number of staff going on maternity leave or falling sick, with

mostly freshly graduated staff remaining.

The team spirit in her ward, 12C – which interestingly has one of the lowest

attrition rate in TTSH – is so strong that, if faced with a staff member who cuts

corners to get work done, a quiet word is all that is needed to set things right.

Sister Yeoh said: “I tend to bring my staff in to talk things over first,

rather than be ready to ‘shoot’ them. I will tell them that we have to be held

accountable for whatever things we do.”

Fostering a culture of where the doors of communication are always

open means that the nurses know there is a strong support system for them,

both personally and professionally.

Sister Yeoh added: “My team knows that if anything happens to them, I’ll

be the first one beside them.”

Nurse Clinician Akhterun Nisha Bte Idris demonstrating how

she did night shifts in CDC 1 with her trusty umbrella which

could prevent head injuries from falling fruits, and could also

be doubled as a cane to ward off snakes.

84SStanding on strong shouldersNurse educators are not only passionate about

imparting skills and inspiring their charges, they

also lend a listening ear to those in need

85

For as far back as she cauld remember, Hnin Nwe Oo had always played the

role of a teacher. She recalled playing school as a child, where she would

lay out papers neatly in a row on a staircase, like notes for her pupils.

“Maybe even then, I was visualising myself in the lecture theatre —

played out on tiers of that staircase — speaking to my students,” she said,

chuckling at the memory.

What led her to become a nurse educator was the enjoyment she

derived from being able to share her knowledge with others, she said.

Inspiring a new generation of nurses, the same way she was, makes her

a passionate teacher. In a way, she is standing on the strong shoulders of

those who came before her.

Senior Clinical Nurse Educator Kala Narayanasamy (Education and Practice, second from left) kept her lessons fun, upgraded her knowledge by taking a two-year Masters in Clinical education course and constantly evolved her classes to make sure her students take to her lessons.

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Sister Kala Narayanasamy, who has been

a nursing officer running a ward for 10 years,

has a wealth of teaching exper ience while

supervising her staff. So it was not a big leap

when then Unit Nurse Manager Zing Mee Seng,

who has since left TTSH, suggested she take on

a clinical nurse educator role in 2002. Coming

from a family with five siblings, of whom two

are nurses and the other three are teachers,

she noticed that after her job task switch, she

began to relate to and see more similarities with

her teaching siblings. “We’d exchange stories

about how important it is to keep your students

interested in what they’re learning. I found that

if you teach the same stuff over and over again,

even you would be bored of it, not to mention

the students.”

So she kept her lessons fun, upgraded her knowledge by taking a

two-year Masters in Clinical education course and constantly evolved her

classes to keep abreast of improvements and current issues to make sure

her students took to her lessons.

Being kept on her toes, having ready contingencies and going with the

punches when things do not go according to plan are what thrills her about

her current position as a Senior Clinical Nurse Educator.

“When you’re in the ward by the patient’s bedside, what you learn in

theory – that you follow steps A to C – doesn’t always happen that way in

reality. That’s when it gets exciting. And that really puts my skills to work

as the students experience first-hand real-life situations and observe how I

handle them. ”

She recalled an incident where she defused a tense situation.

Distraught family members were holding back the admission process of

an elderly patient. Most of the young nurses, wary about dealing with the

intimidating-looking group, were unsure what to do.

Basic Cardiac Life Support (BCLS) Instructors conducting

competency assessments.

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“I tell my students that

I have sat where they

now sit and I constantly

think of ways to tailor

my teaching to suit

each student’s learning

strengths.

– Hnin Nwe Oo Nurse Educator

Sizing up the situation, she quickly went

forward to show her concern for the patient

by touching his hand and assuring his family

members that their father would be well taken care

of here. Suitably assured, they willingly went with

her suggestion of leaving him in their care while

they went for a meal and that they would return to

find him comfortably settled in.

“My students saw how everyone was visibly

relaxed by what I did. I told them the most

important thing to do when we first see patients

is to make a connection to let them know that

we’re there to care for them. It could simply be a

touch on the hands. When family members, who

are already under emotional distress with their kin

ill, see this, they feel more assured as they know

their loved ones are being looked after,” she said.

But it is not always about imparting wisdom. Nurse educators also

motivate and provide them a safe space to share about work or private

struggles. Deputy Director of Nursing Pua Lay Hoon explained: “It’s very

common for new nurses to find it hard to cope under the pressure of their

own expectations. Sometimes, it’s not a knowledge deficit that stands in the

way. It’s that they are so stressed that they need someone to encourage and

affirm them in their abilities. And that’s what we are there for. The nurses

don’t feel any threats in confiding their struggles with us because nurse

educators are usually their first contact person as a new nurse in TTSH.”

Hnin’s students, who clearly appreciate their teacher’s efforts, said they

were “blown away by how well-planned the lessons were”. Not only did they

take away knowledge of nursing, they also found the whole process fun.

Hnin said: “I tell my students that I have sat where they now sit and I

constantly think of ways to tailor my teaching to suit each student’s learning

strengths. I want to be there for them, to show them the ropes or support

them through the ups and downs of their nursing life.”

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T For a department newly set up in 2007, the Nursing Research team has

garnered quite a few notable achievements. These include several

national research grants – MOH Small Innovation Grant in 2009;

Nursing Research Grant in 2009 and 2010; Healthcare Quality Improvement

and Innovation Fund in 2011. The team has also won Bronze and Silver placings

in Singapore Nursing Award at Singapore Health and Biomedical Congress for

two consecutive years.

One of the breakthroughs was the Decision Algorithm

to check feeding tube placement. Incorrect placement in

the lungs can lead to dire consequences and even death.

Prior to the Decision Algorithm, the most definitive way was

using chest radiography. However, frequent exposure to

radiography is harmful and a financial burden on patients.

The most common bedside method of the acid-base

indicator strip has its limitations to confirm placement.

The Decision Algorithm the team came up with

“overcame some of the limits in the acid-base indicator

strip by directing nurses to systematically examine

more factors to rule out the likelihood of a non-gastric

placement before deciding whether chest radiography

is necessary”, explained Nurse Researcher Isabel Ng.

With nurses performing all necessary verification at the

bedside using the Decision Algorithm, it led to another

breakthrough by empowering nurses to order chest

radiography on a doctor’s behalf.

The Nursing Research Department yields important breakthroughs

and earns accolades for TTSH

Through trials and tests

From left: Nurse Researcher Isabel Ng, Executive Assistant Crystal Sim, Senior Staff Nurse Grace Tan and Senior Staff Nurse Stephanie Tai.

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These achievements would not be possible without a pioneer trailblazer.

The trailblazer is Chan Ee Yuee, who is now pursuing her PhD at University of

Sydney. As a Senior Nurse Researcher, she and others in her team had envisioned

a Clinical Decision Support System for managing chronic wounds. Now this

dream is realised with a new electronic system which the nurses can know the

recommended wound product and care for different wound types based on

scientific basis after entering the wound characteristics. “Collaborative feedback

from ward nurses made the Decision Support system possible. In addition, the

nurses can mark the wound location on the electronic chart. Nurses soon would

be able to view the exact wound pictures from the system and monitor healing

trajectory without overexposing the wounds,” shared Nurse Manager Betty Khong,

who is currently handling the project.

Said Deputy Director of Nursing Lee Leng Noey, who heads the Nursing

Research Department: “It was really revolutionary when we decided to invest

in an Nurse Researcher role, which we never had before. This role required a

trailblazer who could dream big, yet concretise the ambitious wish lists to meet

organisation needs. Thus, we roped in Ee Yuee who had accumulated in-depth

clinical experience in Intensive Care and was passionate about pursuing research

as her next career. We gave her opportunity to pursue a Masters in Health

Research Methodology. The first few years were tough but our results have paid

off.”

One such result was seen in Nursing Research's first major clinical trial,

spearheaded by Ee Yuee, in collaboration with the Orthopaedic Department.

The study aimed to improve pain management for patients undergoing knee

replacement surgery. Other firsts were the development of the Decision

Algorithm and electronic wound care system, which are expected to make

TTSH renowned in international standing.

The perseverance and hard work endured in the research process had

gradually brought big rewards for the nursing profession in TTSH. Isabel

elaborated: “The medical field now appreciates the value of the work we do to

improve patients’ outcomes in ways that may not necessarily come from drug

trials. Our department’s vision is to engage more nurses interested in translating

research into practice. There are so many things to discover each day if we

challenge our current practices and mindset continually. The new knowledge

generated ensures that the nursing care we give to patients remains relevant and

safe.”

“ The new knowledge generated through research ensures that the nursing care we give to patients remains relevant and safe.

– Isabel Ng Nurse Researcher

Senior Nurse Researcher Chan Ee Yuee is the trailblazer of the Research team “who can dream big dreams, yet concretise these ambitious wishlists to meet present and upcoming needs”.

90

UCutting-edge IT applications help nurses save time and effort as well as cut

down on errors

Benefiting from IT

Radio Frequency Identification (RFID) technology and

SmartSense Vital Sign Monitoring SystemWhat it is: A system using Radio Frequency Identification (RFID) technology

to track a patient’s location as well as body temperature.

wards and reduced time taken to locate patients out of the wards. It promotes

Ushering the information age

The RFID tag is used to track patients' locations, monitors patients' temperature and keep electronic

records of patients' vital signs.

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better coordination of patient flow, better manages utilization of limited

resources and provides real time status of ward capacity to the Emergency

Department (ED), Bed Management Unit (BMU) and wards.

temperature and wirelessly upload the readings to electronic clinical chart. It

also keeps a permanent electronic record of vital signs like blood pressure,

pulse and respiration, which are entered manually to the system.

Benefits: Principal Assistant Nurse Mageswary D/O Thambirajah said: “The

RFID tag reduces my workload as a patient’s temperature is automatically

captured every half an hour and I can view it from any computer, instead of

having to spend time walking around looking for that one clinical chart. Trends

in a patient’s vitals and sudden changes are indicated, making them easier to

spot. I especially appreciate that the new system is user-friendly. What a far cry

from the old days of disinfecting fragile glass thermometers in ‘printol’ solution (a

common disinfectant then) and drying them before use.”

Intellivue Clinical Information Portfolio (ICIP)What it is: A comprehensive patient-data management system, which

compiles their parameters, assessment and notes from doctors, nurses and

Allied Health Service (AHS) staff in one place for easy referring and sharing. It

was previously known as Carevue. The system is used in intensive care units.

Benefits: Staff Nurse Wendy Goh Geok Chin said: “With ICIP, the records are

much neater and clearer, especially when it comes to reading changes from the

doctors or reports by fellow colleagues. By eliminating illegible handwriting, it

also prevents errors. There are preloaded words and sentences in the system

that saved us a lot of time when we are entering our reports. Doctors, nurses

and AHS staff can now easily share a holistic view of a patient’s treatment and

collaborate towards a common goal. I definitely prefer these electronic records

over paper documentation.”

Closed Loop Medication Management System (CLMMS)What it is: An electronic system for the processes of medication prescribing,

reviewing, dispensing and administration to ensure that the correct medication

is served to the right patient at the right time. It consists of three components:

Adminstration Record (eIMR-iMAR) – e-records for medication prescription,

Principal Assistant Nurse Mageswary D/O Thambirajah

scanning the patient’s wrist tag using glucometer to ensure the

blood glucose test is done for the right patient.

With CLMMS, Senior Staff Nurse Alyssa Chua (13B) finds it

easier to understand the orders. This, in turn, reduces the risk

of committing medication errors.

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medication review and administration purposes.

administration system used by nurses to administer medications. Paired with a

PDA to scan the barcodes of medication and patient's identification on the wrist

band, it ensures that the right patient is given the right drug at the right time, and

even indicates any allergies or contraindicative medication.

efficiently managing, storing and dispensing medications. The guiding lights

guide the user to the desired location in the cabinet to remove the correct

medications. Other safety features include bin-locked compartments and

controlled access such as thumbprint verification. The system also facilitates

medication inventory process and triggers resupply of medications to the

specific Omnicell cabinet.

Benefits: Senior Staff Nurse Alyssa Chua Xing-En described its advantages for

both patients and nurses. “We used to strain our eyes to read medication orders

with tiny or scrawling handwriting but with CLMMS, it is far easier to understand

the orders and has greatly reduced the risk of committing medication errors

such as misreading orders. Not only that, the standardised medication serving

process minimises interruptions and helps to prevent medication error. All

these greatly increase patient safety. Now, medication orders can be viewed by

multiple users from any computer station. With Omnicell, I don’t have to waste

time and effort searching for medication. It improves workflow and patient care

by ensuring supplies are readily available. CLMMS not only enhances patient

safety, it also reduces waste steps and save time. This allows us to spend more

time on direct patient care.”

When nursing meets technologyInformatics Nurse Manager Chen Li finds her job exciting with its scope that

includes testing new IT products and systems whenever a new project starts and

developing new software applications for them. For example, she gets to test out

applications for administering medication on the latest iPad mini.

The nurse manager is proudest of her contribution to the Medical Device

Interface (MDI) Solution – a system which auto uploads and documents vital signs

readings to an electronic clinical chart.

She said: "Not only did it eliminates transcription errors and thereby improves

Staff Nurse Wendy Goh (3B) can now easily share a holistic

view of the patient’s treatment from a collaborative standpoint

among doctors, nurses and AHS staff with ICIP.

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“Nurses come to me when they’re facing difficulties like system workflow issues and just like caring for patients, I handle their queries, ask them questions to troubleshoot the errors and guide them through till the ‘bugs’ are gone.

– Chen Li Nurse Manager (Informatics)

patient safety, we were also able to cut down the average time spent on vital signs

documentation per patient by half, from 3 min 11 sec to just 1 min 40 sec."

Soft-spoken and methodical, her sentences consisted of technical jargon,

such as “dropped connectivity” and “seamless integration of applications”. Yet

just as easily, she switched to plain speak, such as when she has to present new

systems or conduct software training.

“In nursing care, nurses come to me when faced with difficult and complex

cases. Now, just like caring for patients, I manage their queries, and guide them

to find answers to resolve the ‘bugs’ that they encounter,” she said.

However, she was quick to point out that, although an IT nurse provides

technical support at times, the difference between an IT nurse and technical

support staff is in the former’s main duty. Nursing informatics combines nursing

knowledge with computer and information science to create resources, software

applications and devices which optimize the gathering, storage and retrieval

of information in nursing practice. This supports nurses and other healthcare

providers in their decision-making and other work processes and often lightens

their load by intelligently automating what were more labour-intensive tasks.

Besides providing nursing input to develop new information systems and

technologies, she also evaluates these systems to ensure that they do indeed

help nurses provide efficient and effective nursing care.

The challenges she face in her job includes having to continually update

her knowledge to keep up with rapid technological changes and high user

expectations of the IT systems used. “I think we want IT systems to always work

perfectly to meet all our expectations and needs. However, for any IT system to

achieve this and have good outcomes at the same time is tough. Nonetheless

our department is constantly striving to attain this.”

About her role, she added: “I see my role as a link that ties all the different

protocols of nursing practice together with technological advances to improve

patient care management and make work for my nursing colleagues safer, more

efficient and easier.”

Different protocols of nursing practice together with technological

advances that improves patient care management and makes work for my

nursing colleagues safer, more efficient and easier.”

94

The Quality team chat candidly about how

striving for improvements that add value to

nursing is a team effortV The Quality team chat candid

ving for improvements tha

rsing is a team effort

Value-added qualities

Helmed by Assistant Director Hoi Shu Yin (SY ) , the Quality

department comprises Nurse Manager Betty Khong (B), Nurse

Manager Candice Leong (C), Senior Staff Nurse Anni Dionne Liew

(D), Nurse Manager Tan Tit Chai (TC) and Nurse Manager Tan Tzuu Ling (TL)

are proponents of achieving qualities such as a safer and happier workplace

and a happier for nursing practice. They share about what they do.

Tell us about some of the projects you’ve been involved in.

B: For me, planning the hospital’s first-ever nursing election was both

thrilling and nerve-wrecking.

First thing to tick off my long to-do list: kick-starting the election

campaign for the governance councils (GCs) through the Nurses One stOp

Gateway (NOOG) website, which was fast approaching.

Next, a jumble of things to think about, including budget and logistics.

All these items had to be top-notch and well thought through, otherwise

they wouldn’t meet Quality’s standards.

The most nail-biting part was when I had to provide the voting

results within half an hour of the election ending, scrambling to generate

them while ensuring that the data was reliable and accurate. I think that

summed up the whole Quality process for me, where we often go through Nurse Manager Betty Khong

95

Assistant Director of Nursing Hoi Shu Yin

repeated rounds of planning and thinking, checking and verifying, all while

time’s not on our side, yet giving our all to maintain our reputation of being

fast, good, accurate and reliable.

TC: That’s true. But other than faster, better, cheaper and safer, we’ve

also included: easier, nicer, kinder and happier – because our main work is

with and for people: our patients and colleagues

TL: Yes, one example of this is in post-fall huddles for patient falls

resulting in level 3 injury or incidents that require further investigations.

Shu Yin initiated them last year and, as a team, we’ve been working on

visiting wards and conducting these huddles.

By doing this, we aim to create awareness of the incident immediately

and promote effective teamwork, where teams are empowered to offer

solutions based on what had actually happened.

Ultimately, we want to encourage staff to have the willingness to

report all safety events and near misses without fear of retribution, but with

an understanding of accountability.

SY: (nodding) It’s really important to address the issue, yet prevent it

from looking like we are pinning blame. So, my team members and I do it

by gathering the staff involved in the primary nursing care team, including

nurses, and their managers in a private space to talk about three things.

The first and usually overlooked question is: How are you coping?

After an unfortunate event, such as a fall where a patient sustained injuries,

staff may feel emotionally distressed and blame or question themselves,

such as “Why me?”, “What did I do wrong?”, “Maybe I should have done

it this way instead?”, “What is going to happen to me?” and “What will my

supervisor or the management think of me?”. A simple question such as

“How are you coping?” offers them the avenue to discuss their fears and

concerns and allows us to encourage and let them know we support them

at this tenuous time.

Then, we ask the nurses to talk about what happened and try to

identify some key issues together.

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Finally, we end with a discussion on what we have learnt from

the event and what we can do together to hopefully prevent a future

occurrence. As Tzuu Ling has shared, there is an emphasis on team effort.

I’ve found these huddles to be one of the most rewarding initiatives.

After every session, I often leave with a heavy heart. It saddens me to

see that nurses who have already tried so hard to give their best care to

patients suffering as second victims. Yet, at the same time, each session

with the nurses gives me a greater resolve to continue to do what I am

doing – identifying system issues and working to improve the system – and

I deeply hope that the nurses will have the courage to move on.

What do you enjoy about your job?

TC: That it allows me to keep trying, failing and trying yet again. I truly

appreciate the bandwidth that my bosses have given me to come up with

better solutions. Nothing beats the feeling of finally hitting on a good idea

and being able to help people out of sticky situations through my projects

or processes. Sometimes, when colleagues tell me that they, too, agree

that something is not quite right in a situation, but are equally baffled

about the solution, I feel like I’m no longer the only person standing there

scratching my head. Or when they say, “I really like what you’re trying to

achieve”, I feel so understood and validated.

C: Yes, I agree with Tit Chai. Having great bosses goes a long way.

Despite being even busier now as the recently promoted Assistant

Director, Shu Yin never fails to ensure that all of us as her team members

are doing all right. She usually has small chats with us as we start the day

together to gauge whether we need help or support in any way.

Occupational hazards?

SY: (gesturing at her watch) The work often does not stop when it’s time to go

home. Many times, the Quality mind does not rest till a solution is thought through

and this often extends to time at home and late into the night. As there are no easy

solutions to the complex problems we face these days, I often have to take certain

risks and make the decisions necessary to move us forward. When our decisions

give us problems, we learn from them to become better and move on.

Nurse Manager Tan Tit Chai

Nurse Manager Candice Leong

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Name some challenges that you face.

SY: It’s not unusual for us in Quality to feel discouraged or uncertain, as

the work involves much problem-solving and working with different people.

It also requires us to pluck up our courage as we face senior doctors or

directors in our quest for creating solutions to Quality-related problems.

Much is at stake, as we carefully craft our proposals to articulate our

interests. Often, with counter-proposals, we are handed the challenging

task of creating win-win solutions that provide value without adding on to

our colleagues’ workload.

D: Since my area of focus – shared governance – is a relatively new

concept to most, to fully engage the ground in decision making at the

hospital level will require some momentum, although we are seeing many

encouraging signs. It will also take time after setting up GCs to build up

their capability to run independently.

TL: Another challenge is in enabling others to understand the urgency

to change. Other factors that enable change to take place could be

leaders at the forefront championing it, a system change or staff being

empowered. We need to move towards a healthcare system that treats

errors not as personal failures but as opportunities to improve the system

and prevent harm.

What’s Quality to you?

SY: At first glance, we tend to think of Quality as managing standards and

ensuring clinical governance. But when we delve deeper, we realise that

the work itself involves understanding human interaction and behaviour, as

well as recognising an individual’s learning, motivation and resilience. Our

Quality executives in the team are learning that execution of plans alone

does not necessarily bring about Quality. Instead, we need to have a deep

desire to understand how our minds work within our complex environment

and the determination to bring out the best in our people to achieve this

moving target called Quality.

Senior Staff Nurse Anni Dionne Liew

Nurse Manager Tan Tzuu Ling

98

Patients and their family pen heartfelt letters to the nurses, saying they are

thankful for the little things done for them

Dear nurses of the TTSH rehab centre,It’s been 7½ years since I was an inpatient at the rehab ward, but I still remember my time there vividly.

hen I rst came in, I had suffered a spinal cord in ury from a fall and was paralysed from the nec down. I was totally dependent on the nurses. It was very challen in ad ustin to this, especially being ex-military and used to calling the shots. I had to get others to help me instead, even to drin water or answer my handphone. hat made it ust that bit easier to cope was the genuine warm smiles that the nurses had for each of us patients, despite their busy-ness, while tending to our every need.

My family of six siblings, friends and ex-colleagues regularly came to visit over the almost-one year I spent there. But facing the four walls for months on end wasn’t easy. For me, the longest hours to endure were at night. The nurses, however, seemed to have an internal antennae that’s sensitive to their patients and took particular care to come and talk to me during the night, keeping me company to while the long hours away. There were also the times when nurses would make it a point to come to me and say, “I

heard that you had a fever last night, but I’m so happy to hear that your fever has gone down

W Patients and their family pen heartfelt letters to th

thankful for the little things done for themWWWWW When you watch over me

99

today”. Those may be small gestures to

some, but they made a world of difference to me.

there for the low points. To feel gen

uinely cared for. That makes you a gr

ade above, in

my eyes, and I truly appreciate those tim

es.

From the comical episodes with the Chinese nurses teachin

g me Mandarin that

their way to assist with processes

or documentation so that my wife wouldn’t have

to run around doing so, the rehab nurses have be

en nothing short of angels for

my family and I.

I’m sure that the nurses that I m

et at the rehab ward, some of whom have

bigger here. I want to encourage you t

hat you truly make a differen

ce to your

patients and their families as you care for them. Whether in a lar

ge visible way or in

small intangible things, what you do really matters and is appreciate

d. I am one of the grateful

recipients of that care.

I would like to extend my heartfelt tha

nks to all the nurses who made such a dif

ference to

me. In particular, I would like to sho

w my appreciation to these nurses:

With sincere gratitude,

Richard Chua

100

Dear nurses at TTSH Subacute Ward 9,

things like taking the brunt of kicks or

punches from distraught, struggling patients.

seriously ill, his prognosis after h

e regained consciousness was very bleak. He would be

bedridden and immobile from the neck down.

recovery ward where he spent the most time. Initially, dealin

g with Desmond was no mean

feat. He didn’t understand why he needed to be there and would struggl

e violently, kicking and

shouting at the nurses. Over time and with lots of patient coaxing, he improved cons

iderably.

were tough, such as while helping him to practise

using certain muscles or le

arning a new

tank for Desmond’s therapy sessions.

Through small improvements incrementally, he can

now walk with the aid of a walking

achievement swelled my heart as much as a sp

ectacular accomplishment and I know from the

love I see in the nurses’ eyes

that they are truly happy

to see Desmond progress t

oo.

The nurses also took the initiative to en

gage him because he became bored easi

ly. Sister

materials, he would play the

drums to an encouraging audience of nurses who gathered around

to support him.

101

When I was hit by despair at the situation he was in, the nurses had proven to be strong

my thoughts and fears, was such an inexpressible comfort. Then she gave me a hug which

spoke to my heart – about being understood and that I wasn’t standing alone – far better than

words ever could.

well-being. I am sincerely thankful for what the nurses and staff have done – from bearing with his struggles at the beginning to cheering him

This is Desmond’s message for you:Thank you and I want to play the guitar and drums in my church again. With warm affection,Jacqueline Lee & Desmond Lim

102

Nursing leaders. Front row from left: Wee Fong Chi, Wong Mui Peng, Lim Siew Geok, Leong Yoke Yin, Kwek Puay Ee, Goh Lee Lee and K Patmawali.Centre from left: Chia Yeow Peng, Yong Keng Kwang and Pua Lay Hoon. Back row from left: Lee Leng Noey, Jamie Lim, Hoi Shu Yin, Shirley Tay, Margaret Soon, Nirmala Bte Karmaroon, Zee Ie Chuen and Tham Chui Min.

103

When Madam Kwek Puay Ee took on the role of Director of Nursing

Service (DN) in 2001, she saw her position as being a “transitional

leader”. She says: “I wanted to break the mould in which being a

Director of Nursing meant that you stayed there till your retirement.”

Right from the start, she had an uphill climb. As the youngest Director

of Nursing Service ever appointed in Tan Tock Seng Hospital at 39 – with her

last position as a Geriatric ward nursing officer – she had to prove her worth

while bridging a gap that she saw in the lack of communication between the

management and staff.

“I held forums with all levels of staff including health assistants and

ward clerks. I knew that I could not reach out to every single staff, so my

aim was to touch every supervisor – 250 in all. I’d regularly meet up with

them, group by group per floor or area,” she said.

As she leaned forward, sharing with an enthusiastic sparkle in her

eyes, it is easy to see how the self-confessed emotive speaker captured

the hearts and minds of her staff. “During the SARS period in 2003, my

staff saw me going through thick and thin with them and that sealed our

relationship. I also realised how important youthful leadership was. At 41

then, I had the energy needed to deal with the crisis situation,” she said.

X When Madam Kwe

Service (DN) in 2

leader”. She says

Director of Nursing meant th

Right from the start, sh

of Nursing Service ever appo

Youthful leaders chart new paths for the profession through innovation, while

helming the ship as champion of the staff

X-uberant and X-ceptional

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The current Director of Nursing, Keng

Kwang, added: “Usually, once you become

Director of Nursing, you can stay in the position

for quite a number of years until you retire. But it

was Puay Ee’s initiative to step aside to refresh

and renew leadership.”

Madam Kwek star ted to choose a next-

generat ion leader to take her place at the

beginning of her ninth year in her position.

Referring to the fact that the vocation consists

mostly women, she said: “Picking a woman

would have been easier, but I chose Keng

Kwang based on his ability.” In 2011, after a 10-

year tenure, she “stepped aside”, passing the

baton to Keng Kwang, then 40.

With a degree in nursing from the University

of Manchester, Keng Kwang, whose sole employer

has been TTSH, joined in May 1996 as Senior Staff Nurse. He spent roughly

eight months each at the medical, surgical and Neuro-ICU wards. Then,

in 1998, he accepted an offer to take the full-time administrative route,

assuming a project management role in nursing quality, and climbed from

Senior Staff Nurse to Deputy Director over the next 13 years.

It is clear as you speak to him that statistics, processes and analysis

are among Keng Kwang’s strengths. Yet, as he carefully weighs his thoughts

before giving his answers in calm, measured tones, his demeanour belies

a quick intellect, gentle humbleness and warm care; the last especially so

on the topic of his staff.

A need he wanted to address when he assumed the director role was how,

as students, nurses are trained to provide patient-oriented care, but when they

enter hospitals and other institutions, red tape and administrative processes

detract nurses from their core work – to provide care. “You speak to any nurse

and you’ll find that they are willing to blur the boundaries to improve patient

care. My aim is to remove such non-value-added work, so that the true work of

Unit Nurse Managers. First row from left: Ramasamy Letchimi,

Lee Mui Whung, Julien Tan and Kunjuraman Suvaseni. Middle

row from left: Senifah Radi, Mariam Bibi Piperdy, Kalaichelvi

D/O G Govindaraju and Laura Ho. Back row from left:

Magdalene Lim, Tay Meow Hoon and Quek Lee Kheng.

105

“The young ones (nurses) are the innovators and we the senior ones are the stabilisers.

– Kwek Puay Ee Former Director of Nursing

nursing can be realised and more visible”.

Creating the Ward of the Future, which

included redesigning ward cubicles to cut down

unnecessary legwork, such as in stocking or

searching for supplies, by 50 per cent is one of

the inroads to this, together with innovations

like the Omnicell, an automated stock-tracking

system for medication. He also places a priority

on engaging with staff through new media on a

blog he writes and staff tête-à-tête sessions.

Of their diverse styles, Madam Kwek said:

“It’s the combination of two different skills that

brought us to where we are today.” This winning

combination led to what they both call their “best

breakthrough” – a 2004 study whose findings,

when presented to the Permanent Secretary in

2006, resulted in the first five-year manpower

funding in nursing. Badly needed manpower numbers were finally increased,

as did staff satisfaction in nurses being recognised for their work.

It was the culmination of the work that Keng Kwang, then in Nursing

Quality, and his team did in replicating a 1989 MOH manpower study

to produce up-to-date findings; and Madam Kwek, then the Director of

Nursing, in knocking on the right doors to reach the decision makers.

“I always tell my nurse supervisors, ‘The young ones (nurses) are the

innovators and we the senior ones are the stabilisers,” said Madam Kwek.

It is an apt analogy for their current roles with Keng Kwang at the helm and

Madam Kwek, who is now Executive Secretary in the Singapore Nursing

Board, continuing to contribute to TTSH in mentoring nurse leaders.

They may be a study in contrasts, but they share one heart in being

their nurses’ champion of causes, cheerleader and chief. Summing this up

in his main goal as a leader, Keng Kwang said: “My job is to find the right

match for their training and interests, so that every nurse’s potential can be

unleashed and their passion for the profession fulfilled.”

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The SARS epidemic may have broken out 10 years ago, but its

impact on how nurses work lingers to this dayY106YY The SARS epidemic may have b

impact on how nurses work ling

Yet we overcame

From left: Associate Professor Leo Yee Sin, Dr. Balaji Sadasivan, then Minister of State in the Ministry of Health, Dr Lim Suet Wun, then Chief Executive Officer of TTSH and Professor Philip Choo, current Chief Executive Officer of TTSH, in one of their regular SARS discussions.

107

“When the SARS epidemic first broke, we

realised that lines of communication to

disseminate information quickly were

very important. They would maintain the ground staff’s

trust of the organisation and let them know how it was

dealing the situation. We gave them information as we

found things out, rather than them hearing it through other

sources like news outlets. The CEO would hold regular

townhall meetings with the latest status updates. As and

when breaking news occurred, we would also have unit

or ward meetings to inform the ground staff. I attribute

our success in containing the spread to how nurses

and staff pitched in to open and close wards. It was

truly amazing to see how quickly they adapted to their

changing environments to work well as a team together.”

– Unit Nurse Manager Lee Mui Whung (Level 13)Staff of Ward 91 at the completed container wards. After only two weeks of construction, 40 isolation beds were created in record time at CDC Ward 1.

“The unity and comradeship in leadership were some of the key

factors that helped us overcome SARS. From the hospital

management to nursing leadership, we all knew what our

individual roles were and worked as one towards our common purpose. I

think that single-mindedness was pivotal because it translated all the way

down to the ground staff, who mirrored what they saw and felt in their leaders.

It was what kept us all going, knowing we were brothers- and sisters-in-

arms together in this battle. Topmost in our minds was how to provide a safe

environment and to protect the safety of our nurses and healthcare workers

before they were put on the frontline. ”

– Dr Lim Suet Wun, former CEO, TTSH

“SARS was an invisible enemy that we didn’t know enough

about. We were fighting against time and the worst part was

seeing your colleagues getting sick, while you could only

standby helplessly.”

– Senior Nurse Manager Harbhajan Singh

Ten years on – the smiles on their faces depict triumphs. Clinical Instructor and SARS survivor Ashirdahwani Bte Asmawi (centre) with her family and Prime Minister Lee Hsien Loong at a recent SARS memorial event at the NUS Cultural Centre.

108

Singapore General Hospital (SGH) nurses with Madam Kwek Puay Ee, then TTSH’s Director of Nursing (middle in floral blouse), at an appreciation tea party for the SGH team.

“Ten years on, the continuing impact of SARS is the state of emergency

preparedness. In the ICUs, equipment such as powered air purifying

respirators (PAPR) are charged daily and all nurses undergo annual

recertification in PAPR use. The outbreak has further strengthened our fortitude

to be ready for ‘out-of-routine’ duties as a quick response to crises. For example,

when the H1N1 outbreak was announced, nurses immediately shifted mental gears.

They started to make necessary preparations, such as the ICU nurses gearing up

CDC 2 ICU to open four beds there.”

– Nurse Manager Abdul Wahab Bin Hassan (6B)

“It was very moving to see how self less and commit ted my

colleagues were in rising to the challenge at a time of crisis and

unifying towards a common goal. We have taken away many

lessons from the experience and have risen to be stronger than before.

It fills me with a positive belief that, should there be more bumps and

challenges ahead, our resilient spirit will prevail again.”

– Director of Nursing Yong Keng Kwang

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“At the CDC where I was admitted, I was isolated

immediately and it was really emotionally difficult

fighting the disease on my own. The nurses’ sincerity

during such a frightening time deeply impressed and touched me. It

was what later motivated me to enrol into the National University of

Singapore nursing degree programme. My mother is also currently

working in the healthcare industry. She wanted to give back to the

profession that had such a profound impact on her, to touch the lives

of others and to be a source of strength for her patients’ families.”

– Staff Nurse Daphne Lim, who was 14 when both she and her mother caught SARS

“In this millennium, where new emerging infectious diseases such

as H7N9, the Middle East Respiratory Syndrome and many

more are growing threats, as frontline staff, nurses have to be

constantly prepared to face the challenge of a pandemic outbreak. Nurses

can draw on the knowledge and experience gained in the management of

SARS and H1N1 to handle these unknown viruses. Even then, it remains

critical for nurses to adhere to infection control practices while remaining

vigilant in their day-to-day activities. A disciplined and proactive approach

is still the best safeguard against any new outbreak.”

– Senior Nurse Clinican Poh Bee Fong (Infection Control)

“As I traced my life’s milestones in the years after

SARS, I count my blessings. From being ‘Single

And Really Sexy’, I moved on to being ‘Steadily

and Accountably Raising off-Springs’. I have four beautiful

children – two boys and two girls. I constantly emphasise the

importance of caring for patients as if they were our loved ones to my

students. I was blessed with the first-hand experience of being nursed

back to health by my own colleagues when I was sick. The genuine care

and support really helped me through those difficult times. Now’ I can

empathise with the patients and really understand the importance of

emotional support for better recovery.”

– Clinical Instructor Ashirdahwani Bte Asmawi, a SARS survivor

A nurse in the ICU isolation room communicates with her colleague outside the room so as to minimise cross infections.

Nurses handing over reports of patients to the next shift during a shift handover.

110

Veteran nurses pass the torch to the next generation as the

hospital looks forward to exciting developments in the profession

Zest for the road ahead

Members of the four Governance Councils and the Pathway Committee gather together for their first Pathway Fiesta in May 2013.

111

Imagine a crowd of spectators on filled stands

watching a relay race. The first runner of

a team completes his lap and passes his

baton into the backward stretching hands of the

next runner. For a few moments, the first runner

continues to run alongside the second, cheering

his compatriot on as he picks up speed. In the

midst of encouraging whoops, the second runner

finds his momentum and springs off to overtake

his competitors.

The t rans i t ion of leadersh ip f rom one

generation of nurses to the next is akin to a relay

race. It is a tough race where many eyes are looking

up to the team to deliver. Therefore, the passing of

the torch must be planned and coordinated with

the predecessors bequeathing their accumulated

wisdom and skills to the next generation so that

the successors can take flight to greater heights.

The hand-holding by the predecessors will be

for a moment and then it is for the next generation to lead others in a whole

new world.

“One thing I would like the succeeding generations to know is that

discipline and mastery, coupled with compassion, will drive the motivation

to serve and care from our hearts for the many long miles,” shared Wong

Mui Peng, Deputy Director of Nursing.

Former TTSH Director of Nursing and current Executive Secretary

of Singapore Nursing Board, Madam Kwek Puay Ee, who has 34 years of

nursing experience, said: “We often associate volunteerism as giving of

your time and talents through missions to whole-heartedly help the needy

or the sick. Well, nursing in a sense is volunteerism with pay. Every day, we

are rewarded financially to use our skills to tangibly help people when they

are most in need and it comes with the satisfaction knowing that our work

brings care and comfort in the lives we touch.”

As one of the pioneers, Nurse Manager Chio Cheng Kay, 71, who has

more than 50 years nursing experience, had this to say, “Coming from the

Staff Nurse Chong Chai Min (right) was so inspired by her mum, Senior Assistant Nurse Yeo Keng Mui that she followed in her footsteps and joined nursing.

112

older generation of nurses, it is stirring to see

how the profession is being brought to a higher

level. Nurses are now called upon to use clinical

reasoning, critical analysis and evidence-based

nursing to improve the level of patient care.”

Nurse Manager Leong Wai Lin, 69, added,

“Now, nurses are empowered to connect the

parameters that they take with thinking through

and participating in decisive action for patients’

treatment. What an invigorating leap from my

time! I can’t wait to see the bigger dreams and

greater milestones that our next generation will

think up and see come true in their future.”

Also looking forward to the energising road

ahead, based on her experience of more than 20

years, is OT anaesthesia nurse Senior Assistant

Nurse Yeo Keng Mui, whose example illustrated

another legacy of caring. Her daughter, OT Staff

Nurse Chong Chai Min, was so inspired by her

mum that she followed in her footsteps and

joined nursing.

On the hor izon for TTSH nursing are a

number of exciting developments. First, embarking on the prestigious

American Nurses Credentialing Centre Pathway To Excellence programme,

which honours nursing excellence and leadership through positively

transforming practice environments and creating a healthy workplace

for nurses.

A development under the Pathway To Excellence programme that is

currently being rolled out is Shared Governance (SG), which is a platform

for shared decision-making between frontline nurses and nursing leaders

on organisational-wide practices and workplace issues. Through SG,

nurses are encouraged to make ground-up initiatives – as opposed to

changes traditionally made from the top down – to play an active role in

Senior Nurse Manager Harbhajan Singh hopes the new generation to remember the importance of human touch for patients while improving their IT skills.

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suggesting and implementing improvements that affect their practices

and work environments.

Cutting-edge technology is continually harnessed as automation

takes over some of the manual routine work that nurses do. In the near

future, automated remote monitoring through devices which wirelessly

record vital signs, video motion detection for fall surveillance and

automatic detection of abnormal ECGs in telemetry monitoring will help

enhance nurse productivity at the bedside.

As the longest serving nurse in TTSH with 54 years under his belt,

Senior Nurse Manager Harbhajan Singh, 72, had seen how technology

has benefited the profession. But what he hoped to pass on to the next

generation is this: “Technology has aided nursing tremendously – from

easing the burden of manual tasks to giving us an edge over the illnesses

that we stand with our patients to battle. But we will always be mindful

that, at its core, nursing is about ministering the human touch.”

As part of a newer generation receiving the baton, Senior Staff

Nurse Jasmine Tay (9C), who has close to six years’ nursing experience,

agreed heartily: “My grandma once told me that caring alone may

sometimes be good enough to cure someone or make him feel better.

When I asked my patients what they thought of this, they agreed that

medicine alone did not help them. It was the human touch and the care

that they received that did. There’s no other path I’d rather be on than

nursing and I’m excited about being part of and adding to a heritage of

care that will make a mark for nursing’s future.”

Looking back on nursing’s journey in TTSH’s 169-year history, it is

clear that the nurses has witnessed ground-breaking firsts and overcome

great challenges. Now, as they looks forward into the future, Director

of Nursing Yong Keng Kwang shares his vision of bright possibilities:

“In our profession, we’ve been given the noble task of cushioning the

suffering of our patients while celebrating their joys and that will remain

indispensable to the nursing practice. Thanks to the foundation set

by our predecessors, we have a wealth of wisdom to build on. This

will ensure that TTSH remains the Choice Institution for Great Nursing

and that the passion for care is caught and passed on to the many

generations to come.”

As part of a newer generation, Senior Staff Nurse Jasmine Tay (9C) adopts motto of “love and caring can cure”.

“Thanks to the foundation set by our predecessors, we have a wealth of wisdom to build on. This will ensure that TTSH remains the Choice Institution for Great Nursing and that the passion for care is caught and passed on to the many generations to come.

– Yong Keng Kwang Director of Nursing

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Milestones1956Early nursing innovation and development of

the cholera bunk bed.

1972Neurosurgical Operating Theatre Suite (OTS)

set up by Staff Nurse Chai Teong Neo.

1973Singapore's first department of Rehabilitation

Medicine is set up for treatment of stroke and

other neurological disorder, spinal cord and

head injuries, arthritis and other orthopedic

conditions.

1975General Surgery OTS set up by Staff Nurse

Wong Wai Cheng.

1981The Neuro Assessment Chart introduced

in Ward 43 Intensive Care Unit (ICU) of the

former TTSH. It was incorporated into the

Neurosurgical ICU Carevue system in 1994.

1989TTSH opens Singapore's first Geriatric Unit.

1995Nursing training and education became a full-

fledged unit under the purview the Department

of Nursing Administration.

1997First local Emergency Department (ED) to

protocolise Tab Panadol prescription for pain

and fever at Triage - result of a study by a

second batch of Advanced Diploma in Nursing

(Emergency) students.

1998First use of protocolised lower limb X-ray

orders by ED RNs to facilitate early treatment

and management.

1999Start of life in a brand new hospital. Merging

of centralised and theatre sterile processing

services (CSSD/TSSU) for wards/departments

and operating theatres.

Maheas D/O Thanmugham, Bessie Lioh

and Navaletchumi are among the first batch

of Enrolled nurses to attend the bridging

programme leading to upgrade in Diploma in

Nursing.

First local ED to protocolise administration of

IM Ketorolac by RNs.

Telemetry monitorings in general wards was

started in Level 8.

Urodynamic studies procedures were started

at Rehabilitation Centre.

2001Non-invasive Ventilation Unit (NIVU) first

started at Level 7. Moved in 2002 to its

permanent place in Ward 8A.

First Nursing Resource Utilisation and Process

Improvement (RUPI) Committee. Since 2001,

RUPI has been initiating, reviewing and

designing quality and process improvements

until they were integrated with Shared

Governance in 2012.

2002Clinical Nurse Educator position formalised for

first four nurses to enhance support clinical

supervision and teaching.

Peripheral Intravenous Catheter Clinical

Practice Guidelines (CPG) Launch.

Prevention of Pressue Ulcers CPG Launch.

2003Nursing Officer Hamidah Ismail who caught

the Severe Acute Respiratory Syndrome

(SARS) virus while on duty passed away. The

Hamidah Award established in her name is

awarded to nursing students with outstanding

performance.

First nurse-led Clinical Practice Improvement

Programme (CPIP): Reduction of Falls.

Management of Urinary Incontinence CPG

Launch.

2004L7 CPIP on “Reducing Inappropriate Use

of Diapers” awarded the Most Outstanding

Project at MOH Quality Conference.

A protocol-based initiative that uses the

Post Anaesthesia Discharge (PAD) score to

empower Registered Nurses to discharge

patients from the Day Surgery Ward.

CPIP: Reducing ventilator associated

pneumonia rate in MICU. Multi-disciplinary

effort among clinicians, nurses and respiratory

therapists to reduce 50% ventilator-associated

pneumonia for intubated patients. Measures

included the use of MDI instead of nebuliasers,

elevation of bed to 30 degrees and use of

ventilator bundle guidelibes.

2005TTSH achieved first Joint Commission

International accreditation. Nursing embarked

on major review of practices and processes in

preparation for accreditation.

Prevention of Falls CPG Launch.

A knowledge survey of fall prevention

measures found that existing fall risk

assessment tool over identified high fall

risk patients. A study to compare different

validated fall risk assessment tools followed in

June to December 2006. The current WheFra

(Western HEalth Fall Risk Assessment tool) fall

risk assessment was adapted and introduced

in 2007.

Nurses Inc was formed. It supported nurses’

welfare, gathered feedback and helped

facilitate new nurses into their respective

roles. In 2011, Nurses Inc formed an Executive

Committee which creatively revamped

dialogue sessions and organised sport

competitions to energise the nurses.

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2006April. STAR (Specialised Transfer and Acuity

Response) team services commenced. The

service was extended to Invasive Cardiac

Laboratory (ICL) in August and Chaperone

service was started in November of the

same year.

First Nursing Continuous Quality Improvement

(CQI) Day.

First nurse-led Multidisciplinary Committee:

Hospital Falls Committee.

Ward 7C CPIP Project “To Elimination of Fall

Incidences in the Night” was the recipient of

the Most Outstanding Project on TTSH Quality

Day. This led to change in staffing norms of

night shift for better patient supervison to

reduce falls.

Ward 12B. Continuous Quality Improvement

(CQI), Replacement of “sponge hand elevator

with Brook’s sling” in orthopedic wards. The

cost saving sling also reduces the risk of

cross-contamination from shared use. With a

cost saving of $3,013.19, it was the Champion

at TTSH Nursing CQI Day 2007. Since then,

the Brook’s sling has been in use in all

Orthopedics settings.

First two Clinical Instructors: Joanna Lee and

Mary Leong Jan Mui.

Ward 11C. First use of 4L (conventional 2L)

urine bag for continuous bladder washout for

post-transurethral resection of prostate. It

improved BWO management for all

post-TURP care.

2007Use of radio frequency identification (RFID) to

track CSSD/TSSU instruments. A project with

A*Star to increase efficiency and effectiveness,

reduce time and effort in inventory

management and enable hospitals to provide

higher and safer quality of care for patients.

March 1. Day Surgery Ward RNs are authorised

to dispense “take home medications”. This

post-operative one-stop service frees

patients and families from queues to collect

medications at the Pharmacy.

October. Research. Alcohol handrubbing

and chlorhexidine handwashing protocols

for routine hospital practice: A randomised

clinical trial of protocol efficacy and time

effectiveness. A collaborative project with

Infection Control physicians. Outcome: Alcohol

handrubbing covering all hand surfaces is the

most time-effective protocol for routine patient

care activities in busy general wards.

November. Electronic Meals Ordering System

(EMOS) was implemented. The online meal

ordering system eliminated the onerous

manual system. The kitchen receives the

orders directly and meal amendments

becomes a fuss-free process.

2007 to 2009. Healthcare Quality Improvement

Fund (HQIF). Teamwork and Communication

via SBAR/Appropriate Assertion and

Integrated Resuscitation Drill – a prelude to

rapid response. Led by Dr Tan Hui Ling and in

collaboration with Nursing.

Post-operative Vital Signs Monitoring in

Surgical Wards. The results of the study

explored the possibility of reducing existing

post-operative vital signs monitoring during

the initial first 24 hours.

Low height beds introduced in Geriatric

settings in Wards 7C and 7D and have reduced

the number of falls. The beds were adopted

by other Geriatric wards and Rehabilitation

Centre.

2008April. Buffer Stepdown Unit (BSU) Ward 79 for

non-acute patients waiting for nursing homes or

shelter home placement was set up. This was

followed by Wards 77 and 78.

November 2008 to September 2009.

Research. HQIF. “Reduction of Methicillin

Resistant Staphylococcus Aureus Infections

in Medical Intensive Care Unit with Active

Surveillance Cultures and Chlorhexidine

Wipes”. Study outcome: Active surveillance

and decolonisation with chlorhexidine wipes

resulted in a significant reduction in MRSA

infection rates in MICU. Second runner

up in poster competition at the 7th Annual

Healthcare Quality Improvement Conference

October 2010.

December. SmartSense Vital Signs monitoring

system. Led by Mr Yong Keng Kwang, it

uses radio frequency identification (RFID) to

monitor body temperatures and track patients’

locations.

December. First patient seen at home by Post

Acute Care at Home (PACH) nurses.

Quality Improvement: To minimise pressure

ulcer formation related to aplication of BiPAP

mask and straps. Nurses implemented

strict two-hourly release of bipap masks

as tolerated, strict application of mapilex

dressings amd application of cotton bandage

to release pressure of straps on the ears.

This saw a decrease in 40% of BiPAP related

pressure ulcer formatiion in 6 montsh. In

2010, a follow up on this project was the

procurement of total full face BiPAP masks.

Evidence-based Practice: Translating Evidence

Into Oral Care Practices: Oral Hygiene for

Functionally Dependent and Cognitively

Impaired Patients. Outcome: Ensured that the

oral hygiene practices are in alignment with

MOH CPG and based on the latest available

evidence.

Research: Nurses’ Nasogastric tube feeding

practices: A Survey. This led to reinforcing

correct practices in NGT feeding.

Intellivue Clinical Information Portfolio (ICIP)

implemented in the ICUs/HDs provided shared

views of care plans among 2008 last fact

healthcare professionals.

2009“Let’s Walk” Programme implemented in

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Rehabilitation ward. This daily walking training

programme led by nurses helps to enhance the

patients’ mobility. The project was reported in

The New Paper and Lianhe Wanbao on August

2012 and September 2012 respectively.

August. First Community Health screening

of elders for Falls by Community Health

Engagement Programme (CHEP) nurses.

September. First batch of nursing home

residents screening by Project CARE at St

Theresa Home.

September. First in-house comprehensive

nursing leadership programme “Nurse Leader

Management Preparation Programme” to

prepare nurses as leaders.

October. First visit to a participant's home

by a CHEP nurse to review the medication

management in CHEP Stepping Out Programme.

Ward 7A collaborated with Food & Beverages

department in a “6S” project: “Auto Top Up

for Rations”. It was eventually implemented

across the hospital.

7C/7D CPIP project “To improve accessibility

to acute beds in the ACE unit” was awarded

the most outstanding project in TTSH

Quality Day. It was also the finalist in the

MOH 9th Health Quality Improvement Poster

Competition.

June 2009 to March 2011. HQIF. Reducing

inappropriate catheter-associated urinary

tract infections through use of UTI bundles

in identifying patient populations. Five-point

catheter care and algorithm for nurse-led

catheter removal was implemented.

Quality Improvement: “Patma Stopper”

was implemented to achieve zero falls from

commode in the Rehabilitation ward. The

innovation was adopted across inpatients.

Research. Comparing the effectiveness

of Glycerine Magnesium Sulphate paste,

Hirudoid Cream and Warm compress in

Treatment of Post Infusion Phlebitis. It led to

a hospital-wide change practice in monitoring

the post-cannula site for further complications

without active topical treatment with Glycerine

Magnesium Sulphate (was eventually removed

from the market) or Hirudoid.

2010First nurse-led LEAN Ward of the Future

v(WoF) project.

CLMMS, eIMR, EMARS, Omnicell ADC were

implemented to reduce medication readings

and prescription errors, minimise interuption

during medication servings.

January. First flu vaccination given by a PACH

nurse in a patient’s home.

March. For the first time in the history of a

nursing home, a Project CARE nurse nursed

a resident in the nursing home on a syringe

pump for end-of-life symptom control.

April. First collaboration between Home

Nursing Foundation and TTSH on Integrated

Home Care Programme.

May 1. Enrolled Nurses from STAR team

were empowered to perform cannulation and

venepuncture after office hours.

July 2010 to February 2011. CPIP: To measure

post void residual urine within one hour of

voiding for incontinent patient. This was

followed by the implementation of enuresis

alarms across inpatient wards in July 2011.

August. Use of simulation in nursing and

interprofessional training commenced.

Quality Improvement: Outstanding award for

Flu Vaccination Project that increased uptake

of annual Influenza Vaccintation among HIV

patients from 27% to 80%. TTSH Best Quality

Improvement Project Competition held in

conjunction with TTSH Quality Day 2010.

External Cooling Methods for Treatment

of Fever in Adults: a Systematic Review.

Published in Joanna Briggs Institute.

Quality Improvement: Pressure Ulcer Care

Bundle Launch.

Research: Use of Barley Drink on Urinary Tract

Infection prevention.

2011January. First nurse-led Advance Care

Planning (ACP) done in a nursing home.

June. Decision Algorithm for Nasogastric Tube

(NGT) Placement checking - A pilot. It won a

Bronze placing for Singapore Nursing Award

at the 2011 Singapore Healthcare Biomedical

Congress.

December. First nurse-led Advance Care

Planning (ACP) in the home of the patient by

the PACH nurse.

December. Implementation of X-ray order on

doctors’ behalf to confirm NGT placement.

It won a Silver placing for Singapore Nursing

Award at the 2012 Singapore Healthcare

Biomedical Congress.

“Comprehensive Vaccination Program” (CVP)

a Healthcare Quality Improvement Fund (HQIF)

project based on the 2010 project. It seeks to

provide comprehensive nurse-led vaccination

services such as vaccination against Influenza,

Pneumococcal, Hepatitis A and B infections

for eligible HIV Patients.

Research: Predicting the Terminally Ill:

Validating the prognostic tool.

Research: Postoperative pain following

hospital discharge after knee replacement

surgery: A patient survey. The study aims

to determine patients’ pain experience and

potential barriers to effective pain relief after

discharge. The results suggested that more

could be done by the hospital to ensure

optimal use of pain medication and non-

pharmacological strategies to improve

patients’ quality of life and satisfaction.

2012January. E-Wound for digital documentation of

wounds was implemented.

January. Peritoneal Dialysis (PD) nurses were

trained in scrub and circulating roles to assist

Renal clinicians in the operating theatre.

February. Medical Device Interface (MDI)

was implemented to streamline vital signs

documentation process and to reduce human-

associated entry and transcription errors.

February. A study trip to Bangkok Siriraj

Hospital by 24 nurses.

February. Works start on the first two of 24

subsidised wards to be renovated under the

“Wards of the Future” Project. In addition

to creating better working and healing

environment in the wards, the project aims to

better patients’ experience by increasing nurse

presence at the bedside and improving nursing

processes through infrastructural changes.

April. Improved staffing norms for better nurse:

patient ratio.

May. Nursing orders and treatments ordered

by nurses on CCOE/Aurora.

117

June. Five-day work week started for better work life balance for nurses on shift.

August. Shared Governance was formed, seeing our first nursing election to form the Governance Councils.

August. Glucosemeter with IT connectivity was implemented to allow better user management and traceability is linked to data management system which can populate into electronic charts.

October. TTSH’s first Nursing Musical “So You Want To Be A Nurse” raised $34,000 for TTSH Community Charity Fund.

November. Certified as approved training center to conduct ITE skills certificate in healthcare (INPATIENT) by ITE.

December. Research: Pre-Operative Fasting Experience among Elective patients.

Ward 10B saw the first Enrolled Nurses trained in Paroxysmal Atrial Fibrillation (PAF) monitoring.

Research: Validation of decision algorithm to verify nasogastric tube (NGT) placement. Factors such as pH trend and the use of proton-pump inhibitors are part of NGT placement assessment.

Acute exacerbation of asthma is a common condition managed at Emergency Departments (EDs) globally. Patients seen at the ED with poor asthma control were directed to the new Fast-Tracked-Clinic (FTC) to stabilize and optimize asthma control. A CPIP conducted later further reduced default rate appointments to FTC from the current 50% to less than 10%.

2013 January. Inaugural collaboration with Temasek Foundation on Occupation Health and Safety Training for Thai Nurse Leaders.

March. Enrolled Nurses trained as BCLS and AED Instructors.

March. Pre-professional Education Office set up to support clinical education for pre-registration healthcare providers which include nursing trainees.

April. E-Wound Computer Decision Support System (CDSS). First Hospital in Asia to Introduce e-Wound CDSS. The Intelligent Platform improves nurses’ wound care management, reducing wound deterioration and

complications for patients. A groundbreaking initiative by Nursing Service and Wound Care Nurse Clinicians, the new system empowers nurses with the knowledge to handle more complex wounds and standardise their assessment and management of wound care practices, providing a new paradigm of wound management practice in Asia.

May. 116 staff resources from Jurong Health Services deployed to support our surge situation due to dengue, MERS-CoV and H7N9.

July. TTSH’s first nursing commemorative book “Practising the Profession: The Choice Intuition for Great Nursing” was published and given to TTSH nurses to commemorate Nurses’ Day.

An Initiative to detect deterioration in condition: Early Warning Sign (Aggregated Warning Score, AWAS).

Research: Review of routine-replacement of peripheral intravenous cannula every 48-72 hours: Are nurses optimising the cannula use?

Directors of Nursing, TTSH1970-1975 Lousie Chew 1975-1977 Tan Yew Hiang 1977-1979 Seah Geok Cheng 1979-1984 Loo Pai Cheng 1984-1987 Yeo Soo Har 1987-1990 Kang Gek Inn 1990-1995 Ho Shen Hiong 1995-1996 Sim Teck Meh 1996-1997 Dianne Campbell 1997-1998 Anne Irani 1998-2001 Rosie Pereira 2001-2011 Kwek Puay Ee 2011-present Yong Keng Kwang

First specialties with Advanced Practice NursesOctober 2006 Jamie Lim Chuen, Cardiology

February 2008 Kamilah bte Shekh Jabin, Neurology

April 2010 Jasmine Kang, Geriatric

June 2010 Quek Poh Seo, Respiratory Care

September 2010 Ang Ching Ching, Palliative Care

October 2011 Serene Tan Leong Hwee, Neurosurgery

October 2011 Tan Soak Buay, Orthopaedics

October 2011 Jiang Yan, Coronary Care Unit

November 2011 Jennifer Wong Chee Mei, Heart Failure

March 2012 Audrey Wong Yoke Poh, Psychiatry

April 2013 Choo Li Ming Elaine, Renal

First specialties with Nurse Clinicians1981 Lily Lang, Infection Control

1993 Lai Yee Khim, Diabetes Care

1993 Ann Yin, Stroke Nurse

1994 Mary Choo Geok Kim, Dementia Care

1994 Pong Lee Yeng, Rheumatology, Allergy and Immuniology

1995 Chen Mui Lee, Rehabilitation Centre

1995 Tay Ai Choo, Stoma & Wound care

1995 Eliada Yap, Palliative Care

1996 Jamilah Che’Mat, Acute Pain service

1996 Chia Hwee Huang, Continence/Urology

1996 Tang Chwee Ying, Clinical Immunology/ Allergy

1998 Patmavathy Chellaiyya, Breast care

1998 Lathy Prabhakaran, Respiratory care

1999 Hee Yik Lan Melina, Cardiac Rehabilitation

1999 Lim Beng Hee, Fall Care

1999 Jeff Thayalamurugan Naidu, Infectious Disease

2000 Rohana Bashri, Geriatric Assessment

2000 Jamilah Che’Mat, Spine and Chronic Pain Service

2008 Lee Kong leng Christopher, Orthopaedics, Casting and Traction

2009 Wong Toh Luan, Oncology

2012 Sun Tao, Home Ventiliation and Respiratory Support Services

118

Acknowledgements3Caps Consulting

Anonymous donor

Context Architects Pte Ltd

Dr Lim Suet Wun

Globalwide International Pte Ltd

Hospimek Pte Ltd

ISS Facility Services Private limited

King's Dental Surgery (Kovan) Pte Ltd

Kwek Puay Ee

Laerdal Singapore Pte Ltd

Lee Leng Noey

MJ2L Fund

Poh Bee Fong

Prema and friends

Tan Tit Chai / Susiwaty Luhur

Total Jet Services Pte Ltd

TTSH Department of Rehabilitation Medicine

TTSH Emergency Department

UE Managed Solutions Singapore

Yeqi Pte Ltd

Sponsors

We would like to extend our heartfelt appreciation to the

following people and organisations for their generous

support to make this book a success:

119

01 Deputy Director of Nursing Lee Leng Noey

02 Senior Staff Nurse James Ang Wei Kiat

03 Nurse Clinician Prema Harrison

04 Senior Nurse Manager Rozana Arshad

05 Nurse Manager Tan Tit Chai

06 Staff Nurse Samuel Ho

07 Senior Staff Nurse Benita Bangar

08 Senior Staff Nurse Joey Yeo Jia Yang

09 Senior Staff Nurse Candy Koh

10 Senior Staff Nurse Mohd Hiedayyat

11 Staff Nurse Ginny Lim Jing Mei

12 Nurse Researcher Isabel Ng

13 Nurse Clinician Quek Hwee Chen

14 Nurse Clinician Josephine Anthony

15 Staff Nurse Jeremy Teo

Nursing editorial team

The nursing editorial team worked hard for the birth of this long awaited "baby"!

ISBN 978-981-07-6987-1

First published on July 2013

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means,

electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the Publisher.

Published by

Tan Tock Seng Hospital

Produced by

Focus Publishing Limited

(A subsidiary of Singapore Press Holdings)

Printer

KHL Printing Co. Pte Ltd

Focus Publishing team

Publishing Consultant: Seow Choke Meng

Editor: Sng Shu Min

Writer: Sharon Sim

Photographers: Lee Tiah Khee, Seyu Tzyy Wei, Jonathan Yeap

Creative Director: Kenz Chew

Designer: Li Mandy

Project Managers: Lam Zhi Xin, Lee Whei Ting

TTSH in-house photographer

Henry Lim Seng Tiong

Practising the Profession: The Choice Institution for Great Nursing

Special thanks to Singapore Red Cross for contributing photos to the publication.