Giving patients a life worth living through rehabilitation

Dr Lim Su Fee, Class of 2015 (PhD)

Dr Lim Su Fee became an Advanced Practice Nurse (APN) in rehabilitation medicine, thanks in part to the mentorship of Associate Professor Peter Lim, founding head of the Department of Rehabilitation Medicine at the Singapore General Hospital (SGH).

Prior to becoming an APN, Dr Lim was a nurse clinician for three-and-a-half years at SGH. When SGH set up its Rehabilitation Unit in 2000, the hospital appointed her as the unit’s nurse case coordinator and subsequently, the ward’s specialty care nurse. At the time, since there were no nurses trained in rehabilitation medicine, she was attached to A/Prof Lim.

“I would follow A/Prof Lim on his rounds and observe his interaction with his patients. He would often hold their hands and speak to them at eye level. Many of his elderly patients would cry because they were touched by his sincerity.

“I learnt a lot from his clinical teaching rounds and developed a special interest in caring for people who have suffered a debilitating illness or injury, requiring rehabilitation,” says Dr Lim, whose unit helps these patients maximise their potential, regain their functionality and lead as normal lives as possible. “It is not enough to keep them alive; we must give them a life that is worth living,” she adds.

To specialise in advanced nursing practice in rehabilitation medicine, Dr Lim was sent to the Rehabilitation Institute of Chicago in 2002, the Michael E. DeBakey Veterans Affairs Medical Center in Houston in 2006, as well as the Durham Veterans Affairs Medical Center and Duke University School of Nursing in Durham, USA, in 2014, for further studies.

In between these courses, in 2004, she also enrolled in the Master of Nursing course, becoming the second cohort of nurses in Singapore to be trained as an APN at the Division of Graduate Medical Studies of the Yong Loo Lin School of Medicine.

The APN role, says Dr Lim, epitomises the expansion, evolution and progression of nursing in Singapore and is one of the most versatile and autonomous nursing roles today. “APNs can examine and diagnose patients, order tests, initiate and evaluate treatment, and now, even prescribe medicine. But that is not all we can do. We conduct research and present our work at conferences. Many of us are also adjunct faculty at educational institutions,” adds Dr Lim, who spends 70 per cent of her time on clinical work, 20 per cent on teaching and 10 per cent on research.

Dr Lim is also actively involved in APN training, internship and examination on the national level.

Advanced Practice Nurse Dr Lim Su Fee divides her time between teaching and research, in addition to her clinical role.

Aside from advanced practice nursing, community nursing is also shaking up the traditional role of nursing. Dr Lim leads a new community nursing initiative at SingHealth where a team of 30 acute care trained community nurses provide healthcare services to pre-frail and frail elderly residents at Senior Activity Centres, Family Service Centres, Residents’ Committees and even two mosques in southeastern Singapore.

“We believe that all residents need a ‘family nurse’ who can keep close tabs on their health and manage them through their entire life span. We want our nurses to be part of the neighbourhood and to be very accessible to the residents to help them keep well and age well,” explains Dr Lim.

These nurses, who are trained in specialties such as chronic disease management, geriatrics, oncology or palliative care, provide services including health assessment, medication management, early interventions to prevent diseases, as well as monitoring of and education on chronic diseases.

Dr Lim explains that they also make home visits when necessary, and coordinate with other health and social care agencies to provide the necessary support.

Dr Lim leads a team of community nurses, based across Singapore, who manages the health of elderly residents. Photo Credit: SGH

A new service, where nurses visit the homes of patients to give antibiotics injections, has managed to reduce a total of 30 hospitalisation days and saved costs.

“Community nursing is a very independent practice as nurses have to go to residents’ homes alone, innovate improvisations and make good clinical decisions,” she says. Her nurses at the SingHealth Community Nurse Posts also take the lead in managing their residents’ care by communicating and collaborating with primary care doctors.

“This initiative allows nurses to work independently, drawing not only on their nursing skills but also on their organisational and clinical decision-making competency. In community nursing, nurses are not just passive followers but take the lead in the collaborative care of residents,” she states.

With SGH currently building in the institutional processes for nurses to prescribe medicine, this will be even more groundbreaking and useful for community nursing practice, explains Dr Lim, who is a certified Collaborative Prescribing Practitioner and graduate of the inaugural National Collaborative Prescribing Programme hosted by NUS Nursing and NUS Pharmacy.

Community nursing is a very independent practice as nurses have to go to residents’ homes alone, innovate improvisations and make good clinical decisions.

The winner of the President’s Nurse Award in 2015 did not always aspire to be in the field. Her childhood dream was to become a policewoman. It was her first encounter with nurses when she was hospitalised as a child that helped her to develop a shine for the profession. Later, her cousin, who was studying in Singapore, mailed her a recruitment advertisement for nursing students by SGH and the National University Hospital. Dr Lim came to Singapore from Malaysia for the interview, and the rest is history.