SINGAPORE – Tan Tock Seng Hospital (TTSH) will roll out a flexi-work arrangement for all 2,500 nurses in 27 inpatient wards by the end of 2024, making it the first public hospital to do so.

Having piloted what it calls a liquid nursing initiative in October 2023 with 52 nurses in one ward, the hospital has so far introduced the arrangement to 200 nurses in four wards.

About 90 per cent of the nurses have opted for flexi-shifts, and at any one time, about 30 per cent to 40 per cent will be on flexi-shifts. 

Typically, the nurses work three routine shifts a day, starting from 7am for the first eight-hour shift, to 8pm for the 12-hour night shift. With this initiative, they can now opt for a mix of routine and flexible shifts each week, as long as they fulfil the 80-work-hour requirement every fortnight.

There are six flexible shifts, with variable start and finish times, as well as durations, to apply for. They range from four hours with flexible timing to seven hours from noon to 7pm, and the 12-hour shift from 7am to 7pm.

TTSH chief nurse Hoi Shu Yin said during a media briefing that the nature of nursing work requires routine shifts, with handover done between each shift taking an hour or more, but this process has been shortened to around 15 minutes with the use of technology.

The hospital has also redesigned nursing, with nurses on flexi-shifts handling specific duties, while those on the routine shifts continue with the full duties.

Calling it a breakthrough for nursing, Dr Hoi said the flexi-work arrangement will help to strengthen the attractiveness of the profession, now that the attrition rate has stabilised after the Covid-19 pandemic and TTSH can focus on retaining nurses.

The nursing sector has always grappled with manpower strains, and the Government has been supporting it with various incentives. In particular, TTSH, like other hospitals here, lost a number of nurses during the pandemic.

Dr Hoi said TTSH is starting with the inpatient wards but plans to eventually scale up to all the nurses in the hospital, which now totals about 4,000.

A major challenge is the rostering of the shifts. It is done manually now, but TTSH is working with a vendor to come up with artificial intelligence-supported software that will generate the rosters.

She said this arrangement will give nurses the autonomy to continue nursing through their life stages, commitments and professional aspirations.

Several focus group discussions with nurses were held in 2023 to find out about their challenges at work, and the issues that came up included a lack of flexibility in shift start and end times. 

Dr Hoi said she has seen some nurses who are passionate about inpatient care choosing to transfer to other departments because of the daytime hours so they can spend more time with their young children.

Nurses who have opted for the flexi-shifts include new parents, those with elderly parents and even those who are newly married. One of them is senior staff nurse Tan Jia Hui, 31, who has been with TTSH for seven years.

She used to rotate among the three shifts, but has since October 2023 opted for two rotational shifts a week so she can spend more time with her two-year-old son. 

For instance, under the new flexi-shifts, in a week, she could be working from 10am to 7pm one day, followed by 7am to 7pm the next day, and 8am to 2pm on Saturdays.

Previously, she would have to do at least four night shifts a month, but she has requested not to do any night shifts for now.

Nurses need to give three weeks’ notice if they want to opt for the flexi-shift arrangement.

Ms Manjares Melody Blag, 34, a Filipino senior staff nurse with an eight-month-old son, opted for flexi-shifts when she returned to work in November 2023. 

Instead of doing two night shifts a week, she now does one night shift a week, she said.

The arrangement has enabled her to have a better quality of life, especially as her husband has resigned from his job as an airport technician when their baby arrived.

“Previously, we didn’t see each other very much because my husband used to work three shifts, but now I can take care of them,” she said.