Snapshot

APN Role Exists in Country Today:
Yes

Title:
Advanced Practice Nurse

Nationally Certified:
Yes

Recognize Foreign Licensure:
Yes

Treatment Authority:
Yes

Prescribing Authority:
Limited under acute care protocols

Practice Autonomously:
Varies

Contact:
Singapore Nursing Board

Role

An Advanced Practice Nurse (APN) in Singapore is recognized as an APN.  In Singapore, the title “Advanced Practice Nurse” is protected and only allowed to be used by individuals certified by the Singapore Nursing Board (Fee, 2012).  The development of the APN role in Singapore, has been a proactive response to alleviate increased workforce stress due to an aging population with greater health care needs, while also providing career advancement opportunities for nurses (Kannusamy, 2006; Premarani, n.d.).  As a result, Singapore initially developed a master of nursing program training individuals in advanced clinical skills in 2003 and had its first graduates in 2004 (Sheer and Wong, 2008).  Since the development of the APN role, Singapore plans on increasing the APN number to more than 200, approximately 1.4% of the nursing population, by 2014 (Sheer and Wong, 2008; Tan Tock Seng Hospital, 2013).  While this is the goal that has been set for Singapore, the Singapore Ministry of Health (2011) identified currently 88 APNs registered to practice in the country in 2012.

The role of the APN in Singapore is best described as a hybrid of the Clinical Nurse Specialist and the Nurse Practitioner (Fee, 2012; Bee, 2012).  APNs are trained in the advancement of the registered nurse profession to add the role skills of diagnosis and management of common ailments and chronic illnesses (Singapore Nursing Board, 2012).  The scope of practice for the APN in Singapore includes the following (Singapore Nursing Board, 2012; Tan Tock Seng Hospital, 2013):

• Advanced physical assessment
• Develop diagnosis and differential diagnoses
• Interpret laboaratory and diagnostic testing
• Management of care
• Performing procedures
• Collaboration with other healthcare professionals including doctors
• Advancement of nursing through development and implementation of Evidence Based Practice into current healthcare

APNs in Singapore work in all settings, including primary, secondary, and tertiary care as well as peer and nursing education (Singapore Nursing Board, 2012).  Pharmaceutical prescribing and management is under current investigation and standardization (Tan Tock Seng Hospital, 2013).  While prescribing is recognized to be traditionally under the medical domain, it is acknowledged that by preventing prescribing rights, this prevention would inhibit the effectiveness of the role (Tan Tock Seng Hospital, 2013).  As a result, APNs currently are allowed to provide (furnish) medication prescription privleges in certain acute care settings according to pre-identified protocols (Singapore General Hospital, 2013; Tan Tock Seng Hospital, 2013).

As APNs have only recently developed an established role in Singapore, the Singapore Nursing Board (2012) also requires the hiring institution to identify the specific scope of practice and role for the APN.

Education and Certification

Registration was first established in Singapore in 2006 (Sheer and Wong, 2008).  To be an APN in Singapore, an individual must be registered with the Singapore Nursing board and have at least 3 years of post registration experience in their specialty (Singapore Nursing Board, 2012).  There is currently one program in Singapore recognized by the Board, the Master of Nursing program at the Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine at the National University of Singapore.   Applications for registration must be made in person.  Once an individual graduates for an accredited program and has submitted for registration, they are required to perform one year of supervised clinical practice with a minimum of 1280 hours of direct patient care at an advanced level (Singapore Nursing Board, 2012).

Specialties

Currently, APNs in Singapore may be qualified as one of four specializations (Singapore Nursing Board, 2012):

• Acute Care APN
• Medical/Surgical APN
• Community Care APN
• Mental Health APN

The roles of the APN in acute care specializations includes current APNs or interns in (Singapore General Hospital, 2013; Tan Tock Seng Hospital, 2013):

• Anesthesiology
• Cardiology
• Diabetes and Endocrinology
• Family Medicine Continuing Care
• Gasteroenterology and Nutrition
• Gerentology
• Intensive Care
• Neurology
• Neurology Intensive Care
• Oncology
• Orthopedics
• Pelvic Floor Disorders
• Palliative Care
• Rehabiliation Medicine
• Renal and
• Vascular Surgery

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References:
Bee, T.S. (2012).  Advanced practice nursing in Singapore – Clinical outcomes [PowerPoint presentation].  Retrieved from: http://www.hksne.org.hk/course/DrTanSiokBeeAPNCareOutcomes.pdf

Fee, L.S. (2012).  Pioneering moments of APN in an acute tertiary hospital in Singapore [PowerPoint presentation].  Retrieved from: http://www.hksne.org.hk/course/MsLimSuFeePioneeringMomentsofAPN.pdf

Kannusamy, P. (2006).  A longitudinal study of advanced practice nursing in Singapore.  Critical Care Nursing Clinics of North America. 18,545-551.  doi:10.1016/j.ccell.2006.08.001

Premarani, K. (n.d.).  Advanced practice in Singapore [PowerPoint Presentation].  Retrieved from: https://international.aanp.org/pdf/P13.ppt

Sheer, B. & Wong, F.K. (2008).  The development of advanced nursing practice globally.  Journal of Nursing Scholarship, 40(3),204-211.

Singapore General Hospital (2013).  Advanced practice nurse.  Retrieved from: http://www.sgh.com.sg/clinical-departments-centers/nursing/nursingprofession/pages/advanced-practice-nurse.aspx

Singapore Ministry of Health (2011).  Health manpower.  Retrieved from: http://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Health_Manpower.html

Singapore Nursing Board (2012).  Advanced practice nurse.  Retrieved from: http://www.healthprofessionals.gov.sg/content/hprof/snb/en/leftnav/advanced_practice_nurse.html

Tan Tock Seng Hospital (2013).  Advanced practice nurses.  Retrieved from: http://www.ttsh.com.sg/APN/