The future of nursing

By Medha Basu

Interview with Yong Keng Kwang, Chief Nurse, Tan Tock Seng Hospital.

Robots are taking over our jobs, and nursing is at the forefront of this trend.

Manual tasks are being automated, but there is a role that humans must play - empathising with the wounded and guiding patients through their treatment. The healthcare industry provides a guide to the massive changes that will affect all areas of employment as automation and robotics become more prevalent.

GovInsider caught up with Yong Keng Kwang, Chief Nurse of Tan Tock Seng Hospital (TTSH) in Singapore to find out how it is overhauling the role to fit the 21st century.

Robot watchers

The hospital plans to use robots to free up nurses from all manual and repetitive work. The hospital already uses robots to transport trolleys, documents and samples. It is now exploring tech to directly interact with the patients - like delivering meals to wards.

Another area for robots is to care for elderly patients. “We have looked at whether robots can be involved in managing patient falls, for example,” Yong says. The robot could be placed with patients “pre-identified as someone with fall risks” and will warn them if they try to get out of bed. “But while the idea is there, that needs a bit of work,” he adds.

The hospital is also using IOT and digital to automate tasks. For example, it uses an electronic inventory system to ensure wards are always stocked with medicines. “It's quite smart because every time we take medication out, the pharmacy will know and they will know whether we are running short,” he says.

Nurses stepping up

Advanced practice nurse

TTSH is redesigning nurses’ jobs, and will require them to play a more prominent role in healthcare. “You will see nurses stepping up. You will see less handover and deference to the doctors,” Yong says. Automation is freeing up nurses’ time so that they can focus on patient care.
“You will see nurses stepping up. You will see less handover and deference to the doctors."
As people in Singapore live longer, more patients will come in with multiple diseases, and must consult multiple specialists. Nurses will have the role of integrating all of this information for patients, and looking after their well-being. “The public will see more of nursing as a single touch point”, Yong says.

In addition, the hospital must eliminate “wasteful” tasks that do not add value for patients. For instance, Yong led a redesign of in-patient care wards so that nurses and patients spend less time moving around. The upgraded wards have key tools on hand so that nurses don’t have to step out to other parts of the hospital.

A new management role

Tan Tock Seng also wants frontline nurses to be more involved in policy decisions. It has set up nursing councils to ensure they have a say in management decisions. “I would say 50% to 70% of nursing policies [in the hospital] cannot be approved without consulting them,” he says. Half of the members in the councils are elected by staff and the other half nominated by Yong’s office.

TTSH has set up an “innovation fund” to allow nurses to test ideas to improve their work environment. “It’s really to see which of their ideas are worth exploring”, Yong says. The hospital allocates a total annual fund ranging from $10,000 to $30,000. Funding for each project ranges from a few hundred dollars to a maximum of $1,000.

Ideas must be simple and cheap to implement, and add value for patients. For instance, nurses pitched a “medication dropbox” to return unused medicines. It does away with paper forms, saves nurses up to four minutes per patient, and is now used hospital-wide.

More broad-based skills

Mr Yong with nursing staff

To cope with this new role, existing nurses must be re-skilled and nursing education must be revamped.

The hospital is training nurses to simplify communications with patients during their daily morning rounds. They are the single point of contact for all information from doctors, physiotherapists and other medical teams. “We put in a structure for the process on what needs to be spoken, rather than leaving it to free form,” Yong says. Nurses are being trained to use less jargon and be more succinct when speaking to patients.

Nationally, nursing education in Singapore will be less specialised in particular diseases. “A higher proportion of nurses are going to get more broad-based training,” Yong says. This will allow them to assimilate information from various teams and communicate better with patients.

Building public confidence

A key challenge to Yong’s work is building patients’ trust in nurses being in charge. Typically, doctors dominate conversations with families and patients, but more of this work will be taken over by nurses. “Public confidence has to be gradually built”, Yong says

Hospitals managers must “instill pride” in nurses. “The truth is the work is not going to be simple going forward”, he says. With a shrinking workforce and more complex diseases, “nurses will really need to dig deep into the meaning of their job” to stay motivated, he says.

TTSH is this month launching the Centre for Asian Nursing Studies to promote successes across the region. “The ultimate reason for doing this is to tell nurses in TTSH, as well as nurses in Asia: “You have a lot of things to be proud of,” he says.
As Florence Nightingale once said: “Wise and humane management of the patient is the best safeguard against infection.” Her maxim still stands - nurses are the human element of the medical machinery.

Nightingale’s solitary night rounds of wounded soldiers, with a lamp in hand, brought her to prominence. Now it is time for nurses of the 21st century to shine.