Resident Nurses:

the Vanguard of Quality Care

Ms WOO Guan Yi

Assistant Nurse Clinician

Resident Nurse for Medical Oncology

Ms PHUA Jie Ying, Jacqueline

Assistant Nurse Clinician

Resident Nurse for Orthopaedic Surgery

National Seminar on Productivity in

Healthcare 2016

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Extending Clinical Care

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Enable nurses to practice at the top of license

Improve patients’ access to care interventions

and provide continuity of care

Request from medical team to expand nurses’

role in anticipation of medical residency and

program requirements

Background Information

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Distribution of Resident Nurses

0

10

20

30

40

50

60

70

80

SGH KKWCH NHCS NCCS SKH

To date: 22 specialties

Nu

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of

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Started in:

• 2010 – KKWCH (1 specialty)

• 2012 – SGH (4 specialties)

• 2012 – NHCS (2 specialties)

Profiles - Registered Nurse for 6 to 10 years

4 have graduated from Master of Nursing,

10 are pursuing

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Core Modules (Hospitalist Framework) + Clinical attachments

Structure of Resident Nurse Programme

1 Year Programme for SGH

Structured Training & Internship in Specialty (Medical Preceptor + APN Mentor)

Theory

Case studies, Tutorials, Examinations

Practical MiniCEX, OSCE, Clinical Log, Clinical Gem

Core Modules (Hospitalist Framework) + Clinical attachments

Theory

Case studies, Tutorials, Examinations

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Core Modules (Hospitalist Framework) + Clinical attachments

Structure of Resident Nurse Programme

1 Year Programme for SGH

Structured Training & Internship in Specialty (Medical Preceptor + APN Mentor)

Theory

Case studies, Tutorials, Examinations

Practical MiniCEX, OSCE, Clinical Log, Clinical Gem

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Involves

Collaborating with medical doctors and complementing in

patient care

Detailed medical history taking according to approved

protocols, physical examination / assessment

Ordering of investigations according to protocols

Performing selected medical procedures per protocol

Daily ward rounds, post-operative review

Communicate with patient/family on plan of care; discharge

planning

Resource personnel

Registered Nurse Role Expansion

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Management Protocols

Discipline Protocols

Surgical • Mastectomy • Colectomy • Total Knee Replacement • Nephrectomy Procedures • Transsphenoidal Pituitary Surgery

Internal Medicine • Cellulitis • Pneumonia • Urinary Tract Infection • Dengue Fever • Congestive Cardiac Failure

Medical Oncology • Elective Admission for Chemotherapy • Elective Admission for Biopsy • Neutropenic Fever

Neurology • Epilepsy • Parkinson’s Disease • Stroke

Renal Medicine • Elective Native Kidney Biopsy • Elective Tenckhoff Catheter Insertion

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Performing of blood culture

Performing male urinary catheterisation

Removal of :

- surgical drains

- central venous catheter / peripherally

inserted central catheter line

- external ventricular drain

Simple toilet and suture

Manual bladder irrigation

Stoma intubation and irrigation

Flushing of nephrostomy tube and catheter

Privileged Medical Procedures

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• Participate in Induction Program:

i) General Surgery

ii) Internal Medicine

iii) Medical Oncology

iv) Neurosurgery

v) Orthopaedic Surgery

• Facilitator for Problem-Based Learning:

i) Colorectal Surgery

ii) Medical Oncology

• Participate in ICA, CEP Program

(Neurosurgery)

2014

2015

2016

New Services/Pathway

& Initiatives

• Weekly Colorectal

Surgery Recovery

Program

• Pre/post op teaching

(Colorectal Surgery)

• Weekly Caregiver

Training teaching for

CVC, Cope Loops

(Medical Oncology)

Conduct In-House Training New Services / Pathway & Initiatives

• Medical Oncology: Multidisciplinary meeting with rehabilitation team for

Oncology patients

• Neurology: Movement assessment clinic for Parkinson patients

• Neurosurgery:

i) Update of teaching materials: Crainotomy & Transphenoidal Surgery

ii) Development of clinical pathway/protocols on deep brain stimulation

surgery

• Urology: Initiation of prostate cancer specialty nurse role

Teaching in the Region

• Qing Hai (July): Orthopaedics Surgery & Neurosurgery RNP

representatives

• Kolkata (October): Neurosurgery & Renal Medicine RNP

representatives

• Papua New Guinea (October): Neurology & Orthopaedic Surgery

RNP representatives

• Guwahati (November): Neurosurgery RNP representatives

Participation in Forums/ Talks

• Medical Oncology: Inaugural World Lymphoma Awareness

Day (Singapore)

• Neurology:

i) Memory Screening Day

ii) Dementia Public Forum

• Urology: Prostate Cancer Foundation of Australia, Melbourne

• Medical Oncology: Oncology Support Group

• Neurology:

i) Atypical Parkinson Support Group

ii) Brain Empowerment Support Group, Parkinson Support Group

iii) Deep Brain Stimulation Support Group

iv) Parkinson Support Group

• Orthopaedic Surgery: Amputee Support Group

Participating in Patient Support Groups

Conduct in-House Training

• Neurology, Neurosurgery & Renal: Facilitator for clinical teaching

round (CTR), journal club & induction program

• Neurosurgery: Facilitate CGH nursing clinical attachment in SGH

neurosurgery department

• Renal:

i) Collaborate with IAN to conduct peritoneal dialysis training

ii) Facilitate staff teaching for CVC dressing with TEGO

Teaching in the Region

• Jaffna (January): Orthopaedics Surgery RNP

representatives

• Cheng Du (July): Orthopaedics Surgery &

Neurology

Conduct in-House

Training

• Participate in Induction Program:

i) Colorectal Surgery

ii) Renal Medicine

iii) Urology

• Assist in competency assessment: Medical

Oncology (Administration of bolus chemotherapy)

Participate in Forums/Talks

New Services / Pathway & Initiatives

• Urology: Published ‘’A Warrior’s Diary’’ booklet for prostate

cancer patient

• Neurology: Stroke activation service & audit

• Neurology: Parkinson Public Forum

• Urology: Delivery of talks in:

i) Tian Jing First Center Hospital

ii) 14th Urology Association of Asia

(Singapore)

iii) Singapore Cancer Society

(The Walnut Warrior)

QI/Research

Projects

• QI/RIE Projects:

i) Orthopaedic Surgery

ii) Urology

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Implementation of New Services

Multidisciplinary meeting with Rehabilitation Medicine

physician for oncology patients

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Implementation of New Services

Nurse Led Assessment Clinic for patients

with Parkinson’s Disease

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September 2016

Singapore General Hospital Overview of Deep Brain Stimulation (DBS) Surgery

Coordinated Clinical Pathway (CCP)

Admit one day before DBS surgery

Patient is reviewed by Neurosurgeon and Anesthetist

PT referral

DBS surgery: Stage I Unilateral/ Bilateral Leads insertion

Post Surgery: Monitored in ICA

Rest in bed Allow feeds to diet when patient is alert

Transfer to General Ward (GW) MRI Brain post DBS (protocol)

PT review/OT/ST/ Dietitian referral Allow bedside ambulation

DBS surgery: Stage II battery insertion

. . . . . . . . . . . . . . . . . . . . . . .

> .

Back to General Ward (GW)

Rest in bed Allow feeds to diet when patient is alert

PT/OT/ST/Neurology APN or RN review Ambulate as tolerated

Aim home on the next day

One day

before DBS

Surgery

. . . . . . . . . . . . . . . . . . . . . . .

.

POD 0:

Stage I DBS

surgery

. . . . . . . . . . . . . . . . . . . . . . .

.

POD 1:

Stage I DBS

surgery

. . . . . . . . . . . . . . . . . . . . . . .

.

POD 0: Stage II DBS

surgery

POD 1: Stage II DBS

surgery

Battery insertion on the next day/ scheduled date

Development of Clinical Pathways

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Clinical Quality Improvement Projects

Reduce fall rates for patient post Total Knee Replacement Surgery

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In-House Trainings

Conducting Induction Program

for new nurses

Teaching programs

Nurses competency assessment

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Teaching in the Region

China

India Papua New Guinea

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Public Forums & Workshop

Speaker in Forum organized by

Prostate Cancer Foundation of

Australia, Melbourne

Memory Screening Day 2015

(213 Public Screened)

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• Clinical rounds with Team Doctors

• Medical interview and physical examination of patients, review post-operative patients

• Order investigations

• Perform privileged procedures

• Facilitate patient discharge

Patient Care

• Resource nurse in the specialty

• Perform specialized Patient/ Family education

• Communicate treatment plan with patient/ family

• Facilitate Clinical Teaching Rounds, conduct inservice, bedside teaching to nurses, or Nursing Journal Club

Patient Teaching/

Staff Training

• Attend teaching activities, such as, Morbidity and Mortality Round, X-ray conference, Grand Ward Round, Journal Club

• Conduct QI project or Research

• Involve in Support Group

Other

Resident Nurse: A Typical Day

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Feedback from medical and nursing team

Significantly improved quality of clinical management of

patients with greater efficiency and better

outcomes…HOD

Great resource for new doctors

and nurses …Registrar

Invaluable member in day-

to-day work …HO

Good bridge between medical

and nursing.. “always

there”…SN

Expedite care...speed up

ward processes.. …SSN Great

access…Timely provision of

updates to patient and family …NC

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1st – 3rd Intakes of Resident Nurses

(Our Beautiful Family) 20

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