Hospitals and clinics here are so short of nurses that at least one private hospital group is offering a "finder's fee" of up to $12,000 for staff who can rope in an experienced nurse to join. Even a fresh-graduate nurse joining the hospital can bring the introducer a windfall of at least $3,600 at the group.

The Covid-19 pandemic has worsened the shortage of nurses, as the need for them grows even as more of them quit their jobs. Last year, for the first time in over two decades, Singapore saw a dip in the number of nurses working here.

There was an increase of 45 registered nurses but a fall of 617 enrolled nurses last year - a net loss of 572 nurses. Enrolled nurses generally work under the supervision of registered nurses.

At the end of last year, there were 42,096 nurses, a third of whom were foreigners. The drop in the number of nurses comes despite the 2,356 new registered nurses and 661 enrolled nurses who joined the profession last year.

The situation is worse this year, Senior Minister of State for Health Janil Puthucheary told Parliament this month. About 1,500 healthcare workers resigned in the first half of this year, compared with about 2,000 annually pre-pandemic. Close to 500 foreign doctors and nurses have resigned in the first half of this year, compared with around 500 last year.

Some have left because of the high stress and long hours that come with dealing with the pandemic, when manpower needs are higher and further exacerbated by reduced staff numbers.

"When there are more patients than resources, the staff is stretched paper thin," wrote one public-sector nurse recently, headlining her Facebook post "Desperate and Distraught". "And it only gets worse as the day passes."

Some foreign nurses who can no longer travel home for short visits have also called it a day.

A private hospital administrator, who spoke on condition of anonymity, said: "Nursing is in high demand everywhere.

"Foreign nurses use Singapore as a jumping board for better jobs in countries like Canada, since there is little chance of their getting permanent residency in Singapore. There is no future for them here."

Shortage of healthcare professionals is a global problem made worse by the pandemic.

Associate Professor Yong Keng Kwang, group chief nurse of the National Healthcare Group, said: "A spike in cases potentially raises the demand for healthcare services and manpower, and the shortfall in manpower is acutely felt when staff resign."

Those still in service end up shouldering the extra workload. To cope, Tan Tock Seng Hospital says it has to close four general ward beds in order to provide the manpower needed for one intensive care unit (ICU) bed.

Prof Yong said the cluster is working with Ministry of Health Holdings "to expand and diversify our recruitment options", such as non-traditional sources for nurses.

But there is a further constraint in the quota of foreigners allowed.

He said it typically takes about six months to train a new nurse. For speciality areas such as the ICU, it can take about nine months or more. New nurses need close supervision in the initial period, so this eats into their supervisor's work schedule.

Dr Noel Yeo, chief operating officer of IHH Healthcare Singapore, which has four private hospitals here, said the attrition rate this year has been exceptionally high.

He said: "Many of our foreign staff have emigrated to another country or returned to their home towns. Local staff who left said they were burned out from the long work hours and needed a break.

"At present, we are 500 nurses and 100 patient care associates short of full strength."

Patient care associates are ancillary staff to augment nursing roles.

Hence, it is resorting to offering a finder's fee to recruit more nurses.

During the pandemic, the group was involved in a host of activities, such as border testing and manning community care facilities. With the nurse shortage, it had to close some inpatient wards to cope, Dr Yeo said.

National University Hospital's (NUH) chief nurse Joann Pang said: "One of our greatest challenges now is to build up our nursing numbers and, at the same time, ensure these nurses are competent to deliver safe care to our patients."

She said NUH recruits about 200 nurses every year to keep nursing numbers above 3,500.

Dr Tracy Carol Ayre, SingHealth's group chief nurse, said direct hiring of foreign nurses has been impacted by the pandemic. To lighten nurses' workload, the cluster has recruited "basic care assistants" to take over the more basic aspects of patient care, and "care ambassadors" to handle non-clinical work. This frees up nurses, enabling them to concentrate on higher-level nursing care.

To try to improve the situation, the Singapore Nursing Board said it has worked with the Ministry of Health on several initiatives, such as offering temporary registration for foreign-trained nurses, to augment the local workforce.