SINGAPORE - Ms Nan Hnin Ei Phyu, 38, an assistant nurse clinician with the Singapore General Hospital (SGH), left Myanmar to come to Singapore in 2000 to study nursing.
Her aunt, who was working here as a nurse, had encouraged her to do so, and Ms Nan, a Singapore permanent resident, was recently one of the 125 nurses presented with the Nurses' Merit Award.
Foreign nurses like her are needed because of Singapore's manpower shortage.
But their numbers could take a hit after the Philippines recently temporarily barred nurses from working overseas as it sought to beef up its own nursing workforce to help fight Covid-19.
Since the pandemic hit, Ms Nan has not been home, which she typically visits every one to two years, to see her parents and two younger siblings.
She said work has become more challenging as nurses have been given added responsibilities, which demand more of their time and energy.
She said: "The Covid-19 pandemic has really tested our ability to adapt and learn, to cope with constant changes, in both processes and patient care.
"It also tested our competency in providing consistent care to patients regardless of these changes, and I am glad we have fared well."
The Philippine suspension of overseas permits for nurses last month has highlighted Singapore's dependence on foreign nurses. And the Republic is not alone. Globally, the world is also short of nurses.
To cope with demand that is expected to rise with an ageing population, Singapore's Ministry of Health (MOH) said it will continue to grow the local workforce and boost productivity via ways such as the use of automation and technology.
And private healthcare group IHH Healthcare Singapore is also sourcing nurses from places like Australia, Hong Kong and Britain, as it said there is still a huge shortage of nurses.
Foreign nurses make up about one-third of the overall nursing workforce here, with Philippine nurses forming the biggest pool.
The Philippines is known as the world's biggest supplier of nurses, and Philippine nurses are a common sight in the United States and Britain.
While the Philippines has since raised the quota of overseas permits for nurses, nursing aides and nursing assistants by 1,500 to 6,500 for this year, there is also the quotas on foreign workers that healthcare institutions have to contend with.
IHH Healthcare Singapore said the limit placed on S Passes, a mid-tier work pass for those earning at least $2,500 a month, has been its biggest hurdle in filling its nursing ranks.
In 2019, about 58 per cent of the 2,804 new nurses here were foreigners. To meet its nursing needs, Singapore recruited nurses from Malaysia and the Philippines in the 1980s. Then, nurses from China, India and Myanmar arrived.
Meanwhile, the Government here has focused on growing the local workforce.
It has announced 5 per cent to 14 per cent salary hikes for nurses from July. And, last week, Health Minister Ong Ye Kung said the plan is for Singapore to have up to 700 Advanced Practice Nurses who can prescribe medication for patients by 2030. Currently, just 57 of 294 of such highly skilled nurses have prescribing rights.
An MOH spokesman told The Sunday Times: "The Ministry of Health continues to build up a local core of nursing workforce to meet our future needs by growing the local nursing training pipelines for both fresh graduates and mid-career entrants.
"At the same time, we are committed to supporting nursing productivity through automation and technology adoption, streamlining of work processes, and upskilling our nurses to better meet changing healthcare needs.
"These efforts help to keep the growing demand for nursing manpower sustainable, even whilst we continue to grow the local supply."
Nurses form the largest professional group of Singapore's healthcare workforce. As at end-2020, there were more than 42,000 nurses registered with the Singapore Nursing Board, an increase from 36,000 in 2013.
The MOH spokesman said this translates to a ratio of around 7.4 nurses registered per 1,000 population, which is comparable with Asia's developed economies like Hong Kong and higher than Taiwan.
Ms Nan, the Myanmar-born nurse, said while she would like to be with her family in a pandemic, she has a duty to support her parents and siblings financially.
She added: "I also have a duty to my 'adopted' SGH family here as well... This is my calling as a nurse which I know I need to fulfil."
In 2007, while working at SGH, she completed a bachelor's in Health Science (Nursing), then did an advanced diploma in Neuroscience Nursing. In 2019, she finished her specialist diploma in Clinical Education.
At IHH Healthcare Singapore, half of its nursing workforce are foreign nurses. Its director of nursing Josephine Ong said there is a unique sense of camaraderie among its diverse workforce and its nurses have helped one another whenever there was a crunch.
She added: "There is still, however, a huge shortage of nurses. The workload has remained high even when hospitals see a smaller number of inpatients because nurses are redeployed to support other areas."
She cited the example of ward nurses helping to set up quarantine and community care facilities. And being deployed to support swabbing exercises and vaccination projects.
To combat fatigue and stress, they provide appropriate training and support. And where possible, they will get locum nurses, ancillary and support staff, and resident physicians to help out.
Ms Ong said they also constantly leverage technology and incorporate it into nursing care to lighten the workload.
"Still, a more long-term solution would, of course, be to recruit more nurses," she said.
To help staff, the National University Hospital (NUH) provides alternative short-term accommodation for those who prefer not to go home during the pandemic to minimise risk exposure to family members, said its spokesman.
It has relied on locum nurses in the pandemic, and six of 18 locum nurses who worked at the Tuas South Community Care Facility have joined them as permanent staff at NUH, after the facility closed in July last year.
NUH recruits about 200 nurses annually and expects to continue to do so this year. Its spokesman added that they partner local educational institutions to attract local nurses and offer sponsorships to local talent.
IHH's Ms Ong said they have been offering sponsorships to nursing students at Nanyang Polytechnic, Ngee Ann Polytechnic and National University of Singapore.
She added: "We are always in need of local nurses and would be keen to consider any suitable candidate."