MEDICALLY REVIEWED

Tan Tock Seng Hospital Launches Flexi-Shifts for Nurses

Tan Tock Seng Hospital Strives To Make Work-Life Balance A Reality For Nurses With Unique Flexible Shift Scheduling

From three routine shifts, TTSH now offers six additional variable shifts for nurses.

The nature of nursing work often involves irregular hours, long shifts, and unexpected demands which hinder hospitals’ ability to attract and retain nurses. Routine work schedules can be challenging, especially as society trends towards flexible working arrangements like working from home. Yet, this structure of routine work shifts has enabled the hospital to provide round-the-clock patient care.

In October 2023, Tan Tock Seng Hospital piloted its Liquid Nursing initiative in one ward. Today, the hospital has rolled it out to three other wards and will progressively scale to more inpatient areas. The initiative offers flexible shift options and work-life balance for nurses, strengthening team-based ward care.

The Journey Towards Greater Flexibility

Nursing work is location- and time-specific, carried out onsite, during day or night shifts. Requests for flexible work arrangements are carefully studied to assess the impact on staffing levels. Focus group discussions with nurses revealed:

  • Lack of flexibility in shift start and end times, and shift durations, making it hard to juggle personal commitments
  • Inadequate break time due to workload and staffing requirements
  • Nurses leaving work later than scheduled due to lengthy handover sessions

A time-motion study in ward 11C, TTSH’s SMART ward, captured the activities of ward nurses over a 24-hour workday. It highlighted peak periods for patient care needs, enabling the modularisation of care activities and reassignment to nurses working flexible hours.

Introducing Liquid Nursing At TTSH: Flexible Nursing Schedules

Under the new initiative, ward nursing is redesigned into two broad roles – Principal Nurses (routine shifts with full duty of care) and Flexi-Nurses (flexible shifts with modularised roles and specific duty of care).

More Shift Diversity

Full-time Tan Tock Seng Hospital nurses now have a mix of routine and flexible shifts each month. They have six flexible shifts with variable start and finish times, as well as durations, to apply for. These new shifts are welcomed by nurses as they allow better planning of personal and family responsibilities around work.

Routine Shift Schedule (Principal Nurses)

  • AM: 7 am to 3 pm (8 hours)
  • PM: 1 pm to 9 pm (8 hours)
  • Night: 8 pm to 8 am (12 hours)

More Role Diversity

Flexi-Nurses support Principal Nurses by assisting with complex bedside procedures and providing auxiliary support, such as caregiver training and patient transport. Principal Nurses focus on core clinical roles, including doctor’s rounds, nursing assessment and documentation, communication with families, care coordination, and shift handovers.

The “Procedural Nurse” role was also trialled, where surgically trained nurses supported hospital-wide requests for lengthy bedside procedures, providing quality patient care and reducing the Principal Nurses’ workload. The hospital is expanding beyond the Procedural Nurse role towards a hybrid model, including Nurse specialty roles like Wound Nurse, Nurse Innovator, and Nurse Researcher to enhance staff learning and patient care outcomes.

A revised shift handover process complements the role redesign. With digitisation, nurses now save 2.5 hours per shift by efficiently retrieving and relaying essential information for continuing care across shifts. The time saved is directed towards enhancing patient interaction, allowing nurses more time for direct care. Additionally, nurses benefit from well-deserved breaks and the ability to finish their shifts on time.

Flexible Shift Schedules (Flexi-Nurses)

  • Shift 1: 8 am to 4.30 pm (8.5 hours)
  • Shift 2: 10 am to 7 pm (9 hours)
  • Shift 3: 12 pm to 7 pm (7 hours)
  • Shift 4: 2 pm to 8 pm (6 hours)
  • Shift 5: 7 am to 7 pm (12 hours)
  • Shift 6: 4-hour shift (flexible timing)

Boosting Morale and Efficiency in TTSH Hospital Wards

The Liquid Nursing initiative has saved 30 to 90 minutes of a Principal Nurse’s daily time, allowing greater focus on key tasks and sufficient break times during the shift. A post-implementation survey in November 2023 measured its effectiveness:

  • Over 60% described their new work arrangements as “flexible” (previously less than 35%)
  • 70% could leave work on time for most or all of their shifts (previously less than 30%)
  • Almost 100% reported adequate rest during shifts (previously 54%)

Ms Sui Huangbo, Project Advisor and Deputy Director of Nursing at Tan Tock Seng Hospital, shared, “Our nurses respond positively to this initiative, with a renewed drive and sense of excitement. The heightened collaboration and esprit-de-corps among nurses have resulted in greater efficiency in the ward, upholding the high standard of care they take pride in.”

Senior Staff Nurse Tan Jia Hui added, “As a flexi-nurse, assisting principal nurses in several medical procedures, which can be unpredictable and time-consuming, contributes to an overall positive and efficient environment in the ward.”

Senior Staff Nurse Manjares Melody Biag said, “With this initiative, it feels good to leave on time, allowing more quality time with my family and greater flexibility in managing personal duties around work hours.”

The initiative will extend to more inpatient wards in Tan Tock Seng Hospital. The team is developing AI-supported software to generate full shifts and rosters. 

Dr Hoi Shu Yin, Chief Nurse at TTSH, noted, “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 to nurture this aspiration by being supportive and flexible in the way they work, develop, and grow.”

References

TAN TOCK SENG HOSPITAL STRIVES TO MAKE WORK-LIFE BALANCE A REALITY FOR NURSES WITH UNIQUE FLEXIBLE SHIFT SCHEDULING. (2024, May 9). https://corp.nhg.com.sg/Media%20Releases/TAN%20TOCK%20SENG%20HOSPITAL%20STRIVES%20TO%20MAKE%20WORK-LIFE%20BALANCE%20A%20REALITY%20FOR%20NURSES%20WITH%20UNIQUE%20FLEXIBLE%20SHIFT%20SCHEDULING_For%20Immediate%20Release_FINAL.pdf

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