Still think a nurse is someone who just feeds patients and changes their dressings? You ought to speak to Associate Professor Lim Swee Hia.
Prof Lim, who has been in the nursing profession for over 40 years, thinks there’s nothing these women (and men) in white can’t do. From completing PhDs to writing research papers, nurses today can and have done it all. They can even become the CEO of a hospital, the 63-year-old insists.
“Why not? I think they can do it,” she tells me at her office at the Singapore General Hospital (SGH). “They have experience working in a hospital and will understand the issues on the ground.”
She adds that some nurses are now heading small private hospitals. She’s waiting for the day when one will helm a large public healthcare group like SingHealth, where she led close to 7,000 nurses as group director of nursing between 2008 and 2012.
She stresses: “We must dare to dream.”
It’s a future she has worked hard to secure. When this year’s Population White Paper referred to nursing as a low-skill job in a footnote, she wrote to Deputy Prime Minister Teo Chee Hean and Health Minister Gan Kim Yong expressing her objections—and no wonder. In the last few decades, Prof Lim has been the unseen force behind a spate of initiatives to elevate the profession.
In the early noughties, she introduced programmes to equip unemployed workers with nursing skills so they could join the healthcare sector. In 2003, she launched what local newspapers called a “quiet revolution” in SingHealth by training nurses to take on tasks formerly done by doctors, such as drawing blood. This expanded the job scope of nurses and made hospitals more efficient.
She later led SGH to become the first and only hospital in Asia to receive the Magnet accreditation in 2010, an achievement akin to an Olympic gold in nursing. Conferred by the American Nurses Credentialing Center, it recognises hospitals that show, among other things, excellent nursing leadership.
She took a step back last year when she retired as group director of nursing to become the director of special projects at SGH and the National Heart Centre Singapore (NHCS). But she has left a legacy.
Under her watch, SGH hasn’t had to place a job ad for nurses in eight years. It has a low attrition rate of 5 per cent, with most of its nurses being local.
As a point of comparison: The combined attrition rate for public hospitals in 2010, according to the Ministry of Health, was 9 per cent.
And though SGH has walk-in interviews every Thursday, they can’t hire everyone. They don’t need to.
Nurses there, it seems, don’t want to leave.
ALL IN THE FAMILY
Much of her success boils down to her management style. Some bosses have a hands-off approach, preferring to direct from the boardroom, but Prof Lim is decidedly hands-on, her fingers pressed on the pulse of hospital life.
It’s easy to forget that she left bedside care years ago – she can still rattle off, in detail, the many inventions her nurses have come up with to help patients – from an armrest for mothers to use while breastfeeding to an elevated rest that supports the leg casts of wheelchair-bound patients. “I don’t like to do ‘remote control’ planning from the office. I like to be on the ground, listening to my staff.”
It’s an extension of her “servant leadership” philosophy: being humble, going down to the wards and serving the people under her. Prof Lim, who goes to work in blouses and slacks, reluctantly gave up her nurse’s uniform when she retired as group director of nursing last year. “The uniform made me feel like I was one with my nurses,” she says.
The idea of leading to serve has its roots in Prof Lim’s childhood. The eldest of six children, including brother Lim Swee Say, a Minister in the Prime Minister’s Office, Prof Lim learnt the meaning of selflessness at a young age. Her father was a sales assistant and her mother a housewife, and the family lived in a one-room rental flat.
While her parents were making ends meet, the precocious child took it upon herself to be the mother hen of the brood, mopping the floor and cooking meals.
“She was the quintessential big sister who took care of us,” recalls sister Sok Hia, 57, a banker. “I remember running around, playing with our neighbours, while Swee Hia stayed home doing all the housework.”
She could be bossy. Once, while still in primary school, she searched the neighbourhood for her twin brother, Swee Piow, who had got lost. “She found me and said: ‘Whenever you leave the house, you have to hold my hand!’” recalls Swee Piow, a retired pilot. The twins were born just minutes apart, but it was clear who was in charge.
Being the oldest, however, didn’t mean that her siblings deferred to her. Prof Lim laughingly recalls being at the beck and call of her youngest sibling Nam Say, who is 10 years younger. He was a playful child who disliked school, so Prof Lim, who attended the afternoon school session, accompanied him to kindergarten every morning for several years and sat in class to keep an eye on him.
“Some nights, I would fan him to sleep and get so tired that I’d doze off. He’d wake up and complain that I’d stopped!” she chuckles.
Her selfless nature extended beyond the home. As a teenager, Prof Lim joined her school’s Red Cross society and volunteered for two years at SGH.
Every fortnight, she read to and kept patients company.
It seems natural that her nurturing personality drew her to nursing. She became a nurse at 17 after her O levels, to supplement her family’s income.
Prof Lim quickly fell in love with her job. She was inspired by the dedication of her supervisors, whom the student nurses called “sisters”. “They were our role models. When we saw that they came to work half an hour before their shifts, we came in earlier too,” she says.
She eventually made the leap into management, taking on concurrent directorial positions—nursing director at NHCS in 2000, then at SGH in 2004, and finally group director of nursing at SingHealth. The soft touch that worked with her patients she now used to win over her staff.
“The first time I went on an overseas work trip with her, she bought chicken and vegetables from the supermarket and started cooking for all of us,” recalls Dr Tracy Carol Ayre, 46, who succeeded Prof Lim as group director of nursing at SingHealth and director of nursing at SGH. “She’s like a mother to her nurses.”
One of Prof Lim’s priorities when she took the helm at SGH was to foster a more supportive working culture. She noticed how the nurses were reluctant to report lapses in service, such as if a patient fell, as they feared being punished.
Keen to move away from a “blame culture”, she urged SGH’s nurse managers to adopt servant leadership too. These senior nurses swop their white uniforms for pastel green ones upon becoming supervisors. “I told them: ‘The minute you get your new uniform, you’ve lost your power. You now have to work with your staff. They are your bosses.’”
She recalls an incident years ago when a nurse had a near miss and almost administered the wrong medication to a patient. The girl was so shaken that she wrote a resignation letter. “I had a talk with her and her supervisors immediately,” Prof Lim says. “I assured her no one would be punished and persuaded her to tell us what went wrong.”
Prof Lim discovered that someone had interrupted the nurse while she was preparing the medicine—a serious problem, as nurses are frequently approached by patients, visitors and doctors. This led the nurses to design a “Do Not Disturb” vest they could wear while preparing medication. Incidences like this built up the staff’s trust in the management and encouraged them to speak up. In this way, a near miss ended up paving the way for change.
SOFT HEART, HARD HEAD
But don’t think she’s a softie. Talk to Prof Lim’s staff and you’ll hear them describe her as a visionary with the grit to see things through.
“She pushes for advances in nursing and isn’t afraid to take on new challenges,” says Dr Tracy. “All of us had to work extra hard to achieve what she wanted, but it was well worth it.”
Some of the changes Prof Lim pushed for included expanding the role of enrolled nurses—nurses with ITE qualifications who assist the staff nurses, who hold diplomas or degrees. Enrolled nurses lamented that, despite their years of experience, their qualifications limited them to basic tasks like bathing and feeding patients.
In response, Prof Lim introduced skills upgrading programmes in 2005, enabling experienced enrolled nurses to assist doctors and take on tasks such as conducting ultrasound scans. The following year, Prof Lim co-founded the Tan Chin Tuan Nursing Award, a national award for outstanding enrolled nurses.
“I like Prof Lim a lot, and I’ll do anything for her,” declares principal enrolled nurse Alice Ang. The 46-year-old, who was among the first enrolled nurses to benefit from Prof Lim’s schemes, won the Tan Chin Tuan Nursing Award in 2010.
“She once popped in during a training workshop just to ask how us junior nurses were doing. How often do you see someone at her level doing something like that?” says Alice. “When you work with Prof Lim, you’ll never think of going anywhere else.”
One of Prof Lim’s biggest coups was pushing for SGH to obtain the Magnet accreditation, which only 5 per cent of hospitals in the world have managed to obtain. Hospitals must meet a 14-point criteria, which includes strong nursing leadership and quality patient care.
She rallied a team of nurses who toiled for six months to put together SGH’s application. Led by Prof Lim, who edited every single page (“I felt like a teacher marking exam scripts!”), the team produced several tomes of evidence to support the application, which collectively measured 15 inches in thickness.
It was enough for the Magnet surveyors to fly down to inspect the hospital—a shock for Prof Lim, as she’d heard that only a handful of hospitals ever make it to this stage.
On the day the surveyors were supposed to call Prof Lim with the results, she booked one of the largest auditoriums in the hospital and invited SGH’s senior management, doctors and nurses. “I wanted to thank everyone for their hard work and to celebrate, regardless of the result.”
As a hush fell over the room, she stood on a stage with a phone, waiting for it to ring. “You made it,” the caller said simply. The room broke into chaos as the staff cheered.
Achievements like this boosted morale and further convinced the nurses that they were in the right profession. With obvious pride, Prof Lim says: “If you ask them, you will find they are proud to say: ‘I am a nurse.’”
Prof Lim’s daughter Serene, 26, is a doctor at the National University Hospital. She jokingly says of her mum: “She’s the worst kind of patient because she always downplays her symptoms! She worries about everyone more than she worries about herself.”
It begs the question: With a lifetime spent caring for others, what of Prof Lim’s own needs and wants?
There have been sacrifices, she admits. Nursing’s irregular hours stole away time with her husband and two children, Serene and Tze Chin, 34. “When they were young, my children would say: ‘Mummy is a workaholic’,” she reveals. “Sometimes, I wouldn’t notice when they called me ‘Mummy’. But if they called me ‘Madam Lim’, the name I go by at work, I’d look up immediately!”
But she did her best to juggle work and family, always consulting her husband and children before accepting promotions. If she worked through weekends, she used free weekdays to send her kids to school, and she boiled soup every night so they could have it the next day.
One weekend at her twin brother’s home, I watch the tight-knit Lim clan gather for one of their regular meals. I spy Prof Lim’s 85-year-old mother, her siblings, Serene, and Tze Chin and his one-year-old daughter.
Just like she did as a girl, Prof Lim takes charge, cooking and directing her family to cut fruits for me, their guest.
With her siblings and children all grown up, cooking is no longer a necessary chore, but a hobby she’s grown to love. “You have to try this,” urges Tze Chin, as he serves me Prof Lim’s signature vegetarian bee hoon.
As someone who demonstrates her love through acts of care, it’s no wonder she appreciates it when others do the same for her.
For when I ask about the most poignant moments in her career, she tells me about her morning rounds in SGH’s wards. “The nurses would approach me, saying: ‘We’ve prepared some tea and kueh for you. We know you have a busy day.’” she says smiling.
“It humbles you … that people appreciate you. And this is very important to me.”