f you ask Ms Tay Yee Kian how she came to be a community nurse, she would tell you it was serendipity that brought her to the field. After all, she had already spent over 25 years in gerontological and acute care at the National University Hospital by 2014, the year her career took a decidedly gentle shift towards community nursing.

“Looking back, I’m quite glad that my role evolved and aligned with the Ministry of Health’s direction to move care to the community and focus beyond the delivery and provision of healthcare to the essentials and fundamentals of good health,” said the Assistant Director of Nursing at the National University Health System (NUHS) Regional Health System Office.

On 21 July 2020, Ms Tay became the first practising community nurse from the NUHS to be honoured with the President’s Award for Nurses, the highest accolade for the profession in Singapore, given in recognition of the significant contributions outstanding nurses have made to the profession and the community.

Ms Tay, together with Dr Alice Chua Foong Sin, both Advanced Practice Nurses (APNs) were among five nurses who received the award this year.

Dr Chua said, “The reward in nursing is unique as it offers the opportunity to make a difference in the lives of others. I started my career in paediatric oncology and transitioned to adult oncology. My satisfaction comes from being able to help our patients. Their appreciation has kept me going for many years.

“As a nurse, I’m always challenged by different situations and individuals because our patients come from all walks of life. They have shaped me both professionally and personally.”

Spearheading community nursing in western Singapore

Ms Tay recalled that during her years as a gerontological nurse, she saw how elderly patients tended to be unwell soon after discharge from the hospital due to inadequate care at home.

“Many of these patients needed readmission soon enough. That made me think of the need for us to move into the community to help care for these patients during the critical transition period,” she said.

Ms Tay got her chance to do exactly that in 2014 when she joined the Regional Health System Office of the NUHS, to help set up a community nursing unit for the western region of Singapore.

She leads a team of over 50 nurses and care coordinators who look after patients referred to the unit by the acute hospitals within the NUHS cluster, as well as those from a predictive list of patients with a history of readmissions.

“Our services run the gamut from good health promotion practices and disease prevention campaigns to pre-frail and end-of-life care. Community nursing is evolving and APNs contribute in the timely management of patients with the ability to order tests, establish differential diagnoses and prescribe or titrate certain medications,” she said.

Ms Tay on a visit to a patient enrolled in the
award-winning NUHS CareHub programme.

As a nurse consultant, Ms Tay is also often asked to contribute to the care planning for patients with highly complex medical conditions. She also makes sure care standards are established and maintained.

“The Master of Nursing programme at NUS Nursing prepared me well, especially in physical assessment and pharmacology. With Singapore’s ageing population, APNs have the ability to practice not only in clinical care, but also in educating caregivers to reduce the chances of their loved ones returning to the hospital,” said Ms Tay.

One community project that she is especially proud of is the award-winning NUHS CareHub programme, a nurse-led model of care which has reduced patients’ hospital stay by two days.

The post-discharge transitional care programme ensures that enrolled patients, often at high risk of readmission, can continue to receive the necessary coordinated, multidisciplinary care at home.

Among the services it provides are a personalised care plan for the patient after a discussion with the patient’s family and caregivers, follow-up telephone calls to check on the patient’s condition, and clinician consultations and rehabilitation services as needed.

On her receiving the President’s Award, Ms Tay said it is proof that community nursing is growing in significance in Singapore.

“I am deeply blessed and honoured to receive this award. It is not just for myself, but also for the community team. There is an increasing need for community nurses. Many patients need us to be there with them in their homes to help them manage their care.”

Dr Chua manages and reviews patients through concurrent consultations with surgical oncologists.

Driving nursing to greater heights

Dr Chua is also involved in numerous education committees at the hospital, cluster and national levels focusing on the professional development of nurses. The groups include the Committee for APN Competence (CAC), where she serves as chairperson and APN Centre lead mentor, and the SingHealth APN development committee as a member.

In 2018, she was appointed Deputy Director of the Nursing Allied Health Education Unit (Division of Cancer Education), where she facilitated the development of an Oncology Care Programme for nursing and allied health professionals.

“As an APN, I feel I am in a privileged position to guide, mentor and drive the nursing profession to greater heights by practising above our licence,” said Dr Chua.

As the first NCCS APN lead, she has mentored six NCCS APN interns into full-fledged APNs. She currently oversees 10 APNs and the Nurse Clinical Services.

Her aspiration after receiving the President’s Award remains centred on nursing education.

“I hope for the nursing profession to grow as a community,” she said. “Receiving this award is an honour for me and the team. It brings to my mind what one mentor used to say to me: ‘We have to always aspire to inspire before we expire.’ This award has really affirmed this for me.”