Against the global shortage of health workers, among whom nurses and midwives account for half the number, there is an urgent need to ensure such resources are used well. The largest needs-based shortages are in Southeast Asia (as well as Africa), according to the World Health Organisation (WHO). Thus, Singapore needs to bear in mind that it will not be easy to recruit from the region to meet shortfalls as the population ages and spurs greater healthcare demands. Given the supply-side challenges, it's important to examine whether healthcare systems are functioning properly so that nurses are able to use their patient-care skills effectively.

Nurses play multiple roles in delivering primary, acute and community care; managing and preventing the spread of disease and infection; and promoting public health. Often they are the first point of contact when a health assessment is required, and sometimes the only healthcare professional seen when low-key treatment is in order. As such, they are very much "part of their local community... and can shape and deliver effective interventions to meet the needs of patients, families and communities", says WHO.

Despite their obvious potential value, many nurses in Singapore are spending two-thirds of their time on tasks like paperwork and replenishing supplies, rather than on patient care, according to a 2016 study by Tan Tock Seng Hospital. Naturally, one can expect the abundance of such administrative duties to "erode their desire to remain in the nursing profession for the long term", as the Health Ministry noted. Research done elsewhere shows that nurses do seek opportunities to develop professionally, gain a degree of autonomy and take part in the decision-making process, as observed in an International Council of Nurses publication.

There are already efforts here to broaden the clinical scope of senior nurses. At the National Heart Centre, they conduct consultations and do follow-up work like monitoring the use of warfarin, which helps to reduce the risk of clots that can cause strokes or heart attacks. Certain clinics are operated and managed by advanced practice nurses, who typically have master's degrees in nursing and are also trained to prescribe medicines and order certain tests. Nursing competencies at lower levels too are being improved via on-the-job and speciality clinical skills training, as part of the push towards the healthcare transformation that planners have in their sights.

Enhancing the scope of nurses can help to sustain this valuable pool of workers and keep them in the front line of healthcare. Apart from the human touch, patients will also benefit from shorter waiting times and lower costs when nurses play bigger roles - both vital outcomes to ensure universal healthcare is meaningfully realised.