If you think a nurse is simply a sidekick who carries out a doctor's orders, think again.
More nurses in Singapore are prescribing medicines, ordering tests and even doing medical procedures, a trend taking place in many countries where healthcare is delivered by adjunct medical staff who are not full-fledged doctors.
Healthcare institutions say this move eases the manpower crunch by freeing up doctors to focus on complex cases. It also improves care because patients get more face time with medical professionals.
According to the National Nursing Taskforce, senior nurses will be able to prescribe some types of medicines by the end of the year.
Institutions such as the National Kidney Foundation (NKF) and National Skin Centre (NSC) have already hopped on the bandwagon.
Usually, I see the doctor only once in two months, so I am closer to the nurses... I don't doubt that they are as qualified as doctors because they are very professional and caring.
MADAM SAPIAH ISNIN, dialysis patient
Last year, NKF started training some of its nurses to review blood tests and tweak the dialysis treatment accordingly. For example, if the level of waste products in a patient's blood drops, the nurse is able to prescribe a longer length of time that he will be hooked up to the dialysis machine for the waste to be removed.
Eight of its nurses can do that without needing to obtain approval from the doctors. It aims to roll this pilot out further so that all its 26 centres have at least one nurse who can make such decisions.
"With the increase in patients and a limited number of renal physicians, we embarked on plans to have nurse-led centres where they work with physicians to ensure that patient care is not compromised," said an NKF spokesman.
Over at the NSC, nurses have been able to do medical procedures such as photodynamic therapy since late last year. Photodynamic therapy is a treatment for serious skin conditions performed by only doctors in the past.
"With the escalating high cost of medical care and the need to promote patient-centric care, this is done to reduce inconvenience to patients," said NSC's head of nursing Brenda Lim.
Before, patients had to wait to see specialist doctors for these low-risk procedures. Now, they can get an appointment slot a week earlier than usual and save at least half an hour in waiting time to be treated.
It also costs them $300 to $700 less because the cream needed for the treatment can be shared among patients since appointments are scheduled closer to one another.
SingHealth, Singapore's largest group of healthcare institutions, started training senior staff nurses and nurse clinicians to take on expanded responsibilities previously performed by doctors back in 2010.
So far, 126 nurses have been trained to carry out selected physical examinations, order investigations and perform procedures such as removing surgical drains and taking blood specimens.
SingHealth intends to double the number of nurses who can carry out such roles to 250 by 2020.
"This has helped ease doctors' workload and enabled them to dedicate more time to care for patients with complex conditions," said Dr Tracy Carol Ayre, group chief nurse of SingHealth. She added: "More importantly, increased autonomy to manage patient care has provided our nurses with greater job satisfaction and sense of purpose."
Ms Lucy Lu, an advanced clinical nurse from NKF, feels more empowered now. "I have been with the organisation for 15 years but since last year, I was able to be part of the decision-making process," she said.
"Nurses have the knowledge but are not using it much, so this move will encourage nurses to stay on as they will find the scope more challenging and rewarding."
Dialysis patient Sapiah Isnin, 59, said she opens up more to the nurses. "Usually, I see the doctor only once in two months, so I am closer to the nurses and will share with them more personal details, such as when I get constipation when taking a certain iron supplement."