NS (Nursing Service) for Women

The Nursing Careers page on the Ministry of Health's website (retr. 1 May 2011) acknowledges both the key frontline role of nurses and our acute shortage of nurses in Singapore. To rattle off a quick statistic, the proportion of those aged 65 and above will double to 20% in 2020. Allegedly, this is a problem because of the decline in the proportion of people who are economically productive, but that is a separate issue. Given the status quo, potential healthcare costs are set to rise and our already stretched healthcare system will be stretched ever more severely.

My proposal is the conscription of women to be trained and to serve as nurses in rather the same fashion as men are currently conscripted into the military. Nursing Service (NS) for women. This idea may be, at the outset, distasteful to young ladies and their parents. Let me attempt to convey the national and personal advantages of such a scheme.

The national advantages are obvious. All women will be trained as nurses and nursing professionals will be able to take on more specialist tasks as more basic administration and treatment is handled by NSF (Nursing Service: Full time) nurses. This would be a boon to the health service.

Another major benefit to the nation is the boost in our health risk hedge. A major element of Goh Keng Swee's design of the national service system was the intent to be able to field, in an event of military need, a large number of troops after some years of the system's operation. Hence the NSF and Reservist systems. Similarly, in the event of a healthcare incident (such as the SARS and H1N1 outbreaks) there would be, at all times, a large group of people with the basic skills necessary to support the medical profession in addressing the problem.

The female "NSFs" would spend a year or so training up to at least some subset of the National ITE Certificate (NITEC) in Nursing curriculum, which qualifies one as an Enrolled Nurse. To give a greater sense of nursing careers, let us revisit the Major Nursing Appointments section of the Nursing Careers page on the Ministry of Health's website (retr. 1 May 2011):

Major nursing appointments The following are major nursing appointments, a person may undertake in the course of a nursing career in Singapore.

Enrolled Nurse Administers treatments, medications, medical procedures and monitors patients' progress under the direction and supervision of a registered nurse.

Registered Nurse (RN) Assesses plans, and provides and evaluates preventive, curative and rehabilitative care for patients in a wide variety of settings. These include public and private hospitals, nursing homes, home-based services and other healthcare settings. RNs also supervise the enrolled nurses and patient-care assistants.

Specialised Nurse Requires patient care and medical knowledge, skills in equipment and facilities management as well as ward management.

I am not suggesting that this be the basis for a rank structure. The NITEC in Nursing is a 3 year course, so it would be tough to even be considered an Enrolled Nurse for all but the brightest girls. What I would like to see is most girls progressing (over their NSF and Reservist terms) to the standard of Enrolled Nurses, with some progressing to some intermediate standard between Enrolled Nurse and Registered Nurse. (It is notable, that the core non-ambulance courses comprise about half of the NITEC in Nursing curriculum, which should be easily completable over a year of full-time training.)

Nursing is a worthwhile skill of unquestioned value. Such training would equip girls with real and practical skills and enable them to take better care of their families, ushering in an age of excellent preventive care. This would be a huge self-esteem boost likely to be greater than the one associated with being "a defender of the nation" for men (which has faded in the past decades). In addition to improving the overall quality of life, this would also drastically lower national healthcare costs.

NSF nurses might be deployed to hospitals, polyclinics, and even retirement villages. (I have other ideas about state sponsored retirement villages that any Singapore citizen 70 and over is entitled to stay in with free food and board. More on this when I have time.)

The big question is: Who loses and who gains? I would say that the winners are the nation, most families and most girls. Some families do not need the additional healthcare benefits of having a nurse in the house. Some girls who plan to go on to lucrative careers unrelated to nursing will see their career progression retarded a little. The nursing profession will benefit as well. The larger base of Enrolled Nurses and "pre-Enrolled Nurses" will free up capacity for professional nurses to focus on more high value nursing tasks. Furthermore, the NS period for nurses would be a useful to girls planning to move into the nursing and medical fields.

Phase in can be done slowly to build the necessary infrastructure. Experienced instructors have to be appointed from the nursing and medical professions. This would reduce immediate treatment capacity. This problem may be less difficult than the introduction of the program. Whether to begin with an initial voluntary phase for 3 years with a very generous lifetime tax relief, and tapering it down to the target tax relief level as partial compensation for economic losses.

Clearly there are implementation issues, but the big picture view is: this is good, serving national needs and upgrading national resilience, providing families and communities with valuable skills, teaching young ladies practical and useful skills that will also add to their standing socially. Let's do this.