To the bedside and beyond

My Career as a Community Nurse

Name: Chua Yu Ru

Job title: Senior Staff Nurse (Community Nurse), Singapore General Hospital (SGH)

Educational Background: Graduated from the National University of Singapore with a Bachelor of Science (Nursing) with Merit degree in 2013. Attained an Advanced Diploma in Chronic Disease Management in 2017.

Professional Background: Worked in the Hospital’s General Surgery/Trauma ward for four years before being posted to the Community Nursing team in 2018.

A: When I was working in the Hospital’s General Surgery ward, a group of patients left a deep impression on me: they had poor diabetes control, were more vulnerable to infections in the lower limbs, and required amputation when their wounds went unchecked. I felt that what I was doing as a surgical nurse seemed limited. In 2017, I took up an Advanced Diploma in Nursing specialising in chronic disease management as I wanted to teach patients about chronic diseases and how to value their health. A month later, SGH was recruiting nurses to provide community nursing services as part of the Ministry of Health’s nationwide plan to bring healthcare closer to home. I grabbed the chance to be part of this because I knew the role of a community nurse would be in line with what I really wanted to do for my patients.

A: I care for community-dwelling elderly residents aged 60 and above, and/or have at least three chronic diseases. I review them either at the Community Nurse Posts or at their homes. I also conduct health coaching and general geriatric assessments to screen for dementia or depression. In addition, I monitor their chronic diseases and empower them to manage their own medications. At times, I also coordinate with community partners to ensure that holistic care is delivered to the elderly residents. These are done through phone calls, joint home visits or case discussions.

A: Most of us specialised in Geriatric Care, Chronic Disease Management or Oncology before joining community nursing. And all SGH community nurses also undergo the Community Palliative Care training organised by Lien Centre for Palliative Care to equip us with the knowledge and skills to deliver general palliative care in the community. As we often conduct home visits on our own, we also undergo a basic Self-Defence Course to better protect ourselves in possibly dangerous or compromising situations in the community.

A: In the community, we are responsible for making clinical decisions and troubleshooting independently, as resources like healthcare peers and equipment are not as easily and immediately available as in hospitals. But this also trains us to think on our feet and be resilient.

 A: Most of the elderly residents desire to live in the community for as long as possible. Being able to help them fulfil that desire and remain safe in the community – especially for those who are frail, those with dementia, or those living alone, gives me a huge sense of satisfaction. Empowering others to change their health behaviours can be a long and arduous journey. When I’ve successfully managed to prevent complications from worsening and ensure that residents receive appropriate care, I receive great joy knowing that the interventions we do have a long-term impact on their health and lives.

A: You’ll need lots of patience and perseverance, as our work primarily aims to change health behaviours, which takes time. Many elderly residents are wary of healthcare professionals. But as long as you make the genuine effort to see things from their perspectives, they will naturally open their hearts to you. In time, they will be receptive to your interventions. Being able to converse in a wide variety of languages and dialects is a huge advantage as many elderly in the community only converse in their mother tongue.

A: A community nurse not only looks into the health aspect of the resident, but we also look into their social, environmental and financial areas of life.

My Career as a Palliative Care Nurse

Name: Henry Kong

Job title: Senior Staff Nurse (Palliative Care), Khoo Teck Puat Hospital

Educational Background: Graduated from the National University of Singapore with a Bachelor of Science (Nursing) (Honours) degree in 2013. Attained an Advanced Diploma in Palliative Care in 2018.

Professional Background: Worked in the Hospital’s Geriatric ward from 2013 to 2018. Became a member of the Palliative Care specialist team in 2018.

A: I find palliative care nursing meaningful and rewarding as it entails caring for the holistic needs of the dying and the terminally ill. It encompasses the physical, psychosocial and spiritual aspects of nursing care.

A: I belong to a unit that provides specialised palliative care services including symptoms assessment and management, disease modification, grief bereavement support and discharge planning. My typical day starts with a team handover meeting where we highlight and discuss the issues that need to be sorted out for patients on our client list. After the meeting, I will review these patients in the wards with the doctors to see how we can manage their care. My team and I also assess and manage the care of new patients referred to us throughout the day by the hospital’s primary medical teams. In addition, I attend multidisciplinary team meetings with my healthcare colleagues where we discuss how to work together to better manage our patients’ conditions. A large part of my work also involves initiating Advance Care Planning discussions with my patients and their families. With an understanding of their preferences for end-of-life care, I can better advocate for their wishes.

A: As nurses, we are trained to intervene, advise and act on our patients’ conditions to improve their outcomes. However, taking the time to listen, empathise and show compassion are things that could possibly be more valuable in the care of palliative patients. I constantly remind myself that palliative nursing is not about being a saviour but a companion. Just being present and sitting in silence with my patients as they receive the bad news, and grieving along with them, is at times all that matters. 

A: The phrase, “You Only Live Once” is heard a lot. But people underplay the fact that we only die once. Therefore, the difference a palliative care nurse makes in his patient’s last stage of life is highly impactful. To fulfil my patients’ last wishes, my team and I have organised birthday parties and wedding celebrations, and at times, arranged for patients whose preferred place of death is their homes to be discharged back to their residences to spend their last days with family. The bonds I’ve forged with my patients and their family members last long after death – and this is what makes the job rewarding. 

A: The NUS Nursing curriculum equips students with a good foundation in communication, ethics, pharmacology and pathophysiology. After graduation, specialised courses can be pursued to gain deeper understanding of palliative care. Of course, good clinical experience will arm new nurses with the necessary skills to manage palliative patients as well. In my workplace, we also hold regular journal clubs and textbook sharing sessions to encourage continuous learning. I learn a lot from experienced doctors and allied health colleagues and by attending palliative care conferences.

A: Palliative care is not all gloom and doom, as many patients live for many years after their diagnosis. And palliative care is a growing specialisation that also allows you to work across the acute care, community care and long-term care sectors.

My Career as an Advanced Practice Nurse

Name: Tan Min Yuan

Job title: Advanced Practice Nurse (APN), National University Hospital (NUH)

Educational Background: Graduated from the National University of Singapore with a Bachelor of Science (Nursing) (Honours) degree in 2010. Completed the Adult Neuroscience Nursing Course organised by NUH in 2013. Received her Master of Nursing degree from NUS Nursing in 2018.

Professional Background: Worked in the Hospital’s Medical Intensive Care Unit (ICU) and various wards after graduation. In 2014, she became a senior staff nurse at the Neuro-medical and High-dependency ward. In 2020, she became an APN at the ward.

A: When I started my nursing career, I found that direct patient care gave me the greatest joy and satisfaction. I enjoyed the personal touch of building relationships with patients and their caregivers at the bedside. Knowing early that clinical nursing was my interest, I worked towards inhouse credentials in neuroscience before applying for a Master of Nursing degree course that would qualify me as an APN. The Neuro-surgical ward was my first ward posting after graduation, and quickly, it became my first love. Neuroscience nursing offers the best of both worlds: the adrenaline rush that comes from managing emergency cases such as patients suffering from hyperacute stroke, and the satisfaction that arises from building bonds and connections with people living with conditions such as dementia.

A: I start the day at the ward with a quick scan to ensure that everything and everyone are in running order. This includes looking through manpower and getting a handover of any incidents that need urgent attention. I then screen through our patients in the ward to identify the ones who require our attention, before making my clinical round with my nurses and the healthcare teams to discuss care. The day will be filled with reviewing and following up with the management of the flagged patients. I do this by looking through their case history extensively, performing a comprehensive physical assessment, and also communicating with the patient and family members to educate and include them in the management plans. This information will then be conveyed to and discussed with the multidisciplinary team for better collaboration of care, and with community partners whenever necessary to ensure proper handover of care. At the same time, we also attend to emergencies that occur during the day.

A: I started work in the Hospital’s Neuro-surgical general ward before moving to its Medical ICU, and subsequently, the Neurology/Neuro-stroke general ward with High Dependency. Along the way, I was trained to take on various roles, including reviewing transient ischemic attack patients in the Emergency Department, assessing and managing patients presenting with a hyperacute stroke, and managing discharge plans for general ward patients. The wide exposure and on-the-job training complemented my formal inhouse and Master’s qualifications.

A: Achieving better work-life balance.

A: As an APN, I have the opportunity to affect my patients’ recovery from a debilitating illness by pre-empting and managing their needs and conditions. Being able to impart various skills and knowledge to my nurses to encourage critical thinking and pique their interest in the art and science of nursing also gives me tremendous satisfaction.

A: Nursing is a journey of non-stop learning! Come with an open mind and get ready for an adventure of discovery and exploration.

A: An APN’s role is multi-faceted. Not many people know that we are trained to diagnose and manage common medical conditions, including chronic illnesses.

My Career as an Emergency Nurse

Name: Nur Fadilah Binte Jubir

Job title: Emergency Department Staff Nurse, Ng Teng Fong General Hospital

Educational Background: Graduated from the National University of Singapore with a Bachelor of Science (Nursing) (Honours) degree in 2015.

Professional Background: Worked in the Hospital’s Operating Theatre for two years before joining the Emergency Department (ED) in 2017.

A: In junior college, I watched the film, “Pearl Harbour” and was inspired to be an ED nurse after seeing how the Army nurses depicted in the film, one of whom was played by lead actress Kate Beckinsale, tended to the scores of wounded with toughness, strength and tenacity. Wanting to acquire nursing knowledge and skills in disaster medicine, I enrolled at NUS Nursing with an ambition to participate in disaster relief in my future career. After graduation, I requested for a posting to the operating theatre for two years to equip myself with peri-operative nursing skills before moving to the Emergency Nursing department.

A: I care for patients who are in urgent need of medical attention when they come through the Hospital’s Accident and Emergency department. They can have a wide range of conditions, from wounds and injuries to cardiovascular and gastrointestinal problems. I use clinical knowledge and critical thinking skills to triage patients and assess their acuity level in order to provide timely treatment. I also monitor their vital signs, record their symptoms, administer medications, and assist physicians in procedures for patients within this acute care setting. In addition, I coordinate patients’ admission and discharge from the ED, providing education and support to them and their families.

A: My undergraduate programme at NUS Nursing provided foundational training to be a registered nurse. This was then followed by on-the-job training during my probation period at the Hospital, and when I made the switch from the Operating Theatre to the ED.

A: ED nurses have to thrive in highly stressful environments. We have to be on the constant alert as we respond to life-threatening cases and patients on the brink of death. Amidst the unpredictable and fast-paced scenarios we encounter every day, I have to deal with my emotions so that it would not have a negative effect when I go home after an adrenaline-pumping day at work.

A: Being in this career fulfils me because I get to save the life of a fellow human being and am empowered to make a difference.

A: The best way to learn is to be in the ED environment and have hands on experience in handling and managing stressful situations. Being an ED nurse requires patience and a lot of receptiveness to learning. It demands resilience, determination and persistence.

A: As an ED nurse, many of the skills you acquire will come in very handy when you face emergencies in your daily life.