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Full-time TTSH nurses can now have a mix of routine and flexible shifts each month.
Tan Tock Seng Hospital (TTSH) has rolled flexible work arrangements for its nurses.
Having started its Liquid Nursing initiative in October 2023 for one of its wards, the hospital has since extended the initiative to three other wards, with plans of progressively scaling it to more inpatient areas.
Announcing this on Thursday (9 May 2024), at an event attended by HRO, the hospital acknowledged that the nature of nursing work often involves irregular hours, long shifts and unexpected demands which have been hindering hospitals’ ability to attract and retain nurses. With this, adhering to routine work schedules can be challenging for nurses — especially as society shifts towards flexible working arrangements such as working from home and flexible hours.
Yet, this structure of routine work shifts has enabled the hospital to provide care for patients around the clock.
Against this backdrop, TTSH's new arrangement accords a good level of flexible shift options and by extension, work-life balance for nurses, while also strengthening the way the ward nurses deliver care as a team.
The journey towards greater flexibility
Traditionally, nursing work is admittedly location- and time-specific — duties are carried out onsite, during day or night shifts. Any requests for flexible work arrangements would have to be studied carefully by the ward team to assess the impact on operational staffing levels, and the entire team of nurses would typically have to readjust their schedules to accommodate the request. The challenge here lies in accommodating flexi-work arrangements in nursing.
Under the new flexible nursing schedule, ward nursing is redesigned into two broad roles:
- Principal Nurses (i.e., Nurses on routine shifts with full duty of care)
- Flexi-Nurses (i.e., Nurses on flexible shifts with modularised roles and specific duty of care).
Traditional shifts were limited to three options. Six new flexible time slots have since been introduced. Full-time TTSH nurses can now have a mix of routine and flexible shifts each month.
The six flexible shifts have variable start and finish times, as well as durations, to apply for, to allow nurses to better plan their personal and family time. Full-time TTSH nurses can now have a mix of routine and flexible shifts each month.
TTSH said prior to rolling out this initiative, focus group discussions were conducted with nurses, which uncovered:
- Lack of flexibility in shift start and end times, and duration of shifts, resulting in challenges in juggling personal commitments;
- Lack of adequate break time due to workload and manpower requirements;
- Nurses leaving work later than official shift end time, due to activities such as handover, sessions that typically take much time on each shift.
A time-motion study was conducted in ward 11C – TTSH’s SMART ward for advancing workforce innovations of which the pilot started with, to capture what ward nurses do in the three shifts over a 24-hour workday. The study shed light on the peak time periods where patient care needs are the highest and nursing time is most needed. Hence, care activities can be modularised and reassigned to nurses working flexible shift hours.
The nurses then started working on Liquid Nursing to deliver on the better future of care envisioned. This initiative is now transforming the nature of TTSH nursing.
More role diversity
As TTSH affirms, flexi-nurses support the principal nurses by assisting with complex bedside procedures such as wound dressings, and providing auxiliary support such as caregiver training, and transporting patients to and from their venues of treatment. Meanwhile, principal nurses focus on their clinical core roles, such as participating in doctor’s rounds, nursing assessment and documentation, communication with family, care coordination and shift handovers.
Complementing the flexible arrangement, the role of “procedural nurse” was also trialed, where a group of surgically trained nurses supported hospital-wide requests for assistance with lengthy bedside procedures. Procedural nurses help provide quality patient care and lighten principal nurses’ workload.
The hospital is now expanding beyond the procedural nurse role towards the hybrid model, including taking on various nurse specialty roles such as wound nurse, nurse innovator, nurse researcher to enhance staff learning experiences and patients’ care outcomes.
The role redesign is facilitated by a revised shift handover process — with digitisation, nurses now save 2.5 hours per shift by efficiently retrieving and relaying important information required for continuing care across shifts. The time saved is instead directed towards enhancing patient interaction, allowing nurses more time for direct care. Additionally, nurses benefit from breaks and the ability to finish their shifts on time.
Boosting morale and efficiency in the hospital wards
The implementation of the Liquid Nursing initiative has saved some 30 to 90 minutes of a Principal Nurse’s daily time, which in turns allow greater focus on their key tasks and sufficient break times.
Following the two-month-long trial, a post-implementation survey was conducted in November 2023 with the participating nurses to measure its effectiveness:
- Over 60% described their new work arrangements as “flexible” [prior to pilot: less than 35%]
- 70% recorded that they were able to leave work on time for most or all of their shifts [pre-pilot: less than 30%]
- Almost 100% of nurses reported that they were able to rest adequately during a shift [pre-pilot: 54%]
Sui Huangbo, Project Advisor and Deputy Director of Nursing at TTSH shared: “It is encouraging to see our nurses respond positively to this initiative, with a visibly renewed drive and sense of excitement. The heightened collaboration and esprit-de-corps among the nurses have resulted in greater efficiency in the ward, while still upholding the high standard of care that they have always taken pride in.”
Tan Jia Hui, Senior Staff Nurse, TTSH added: “With the new arrangement, most of the nurses on shift have sufficient breaks, and are taking significantly less time for our handovers. As a flexi-nurse, it gives me great satisfaction to know that I am able to assist the principal nurses in several medical procedures, which can be unpredictable and time-consuming. This has contributed to an overall positive and efficient environment in the ward."
Dr Hoi Shu Yin, Chief Nurse at TTSH highlighted that the nursing sector has always grappled with manpower strains. As such, there is a need to strengthen the attractiveness of the nursing profession in a holistic approach that includes incentives such as flexibility at work, aside from the monetary incentives provided by the ministry.
"The Liquid Nursing initiative will give our nurses the option and autonomy to align with their life stages, commitments, and professional aspirations. Our nurses aspire to go beyond to care for patients and it is important that this aspiration is always nurtured, starting from being supportive and flexible in the way they work, develop, and grow."
In terms of next steps, the initiative will be extended to more inpatient wards in TTSH. The team is also developing an artificial intelligence-supported software which allows the generation of full shifts and rosters.
Lead image / Tan Tock Seng Hospital
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