Making a difference in others' lives

​​​​​​Dr Hoi Shu Yin was one of three nurses who received the 2023 President's Award for Nurses. The chief nurse at Tan Tock Seng Hospital tells executive editor Sumiko Tan that nursing wasn't a natural career choice.

The Sunday Times (1 October 2023)

In late 2021, when the Covid-19 pandemic was still raging, Dr Hoi Shu Yin would escape to the Marina Bay waterfront on Saturday mornings to jog and clear her mind.

"It was my hideout place," says the chief nurse at Tan Tock Seng Hospital (TTSH). Each time, the beautiful city skyline, including the distinctive Marina Bay Sands (MBS) hotel, would strengthen her resolve to fight the pandemic.

"I know it sounds cliched, but the Marina Bay area is an icon of Singapore. To me, it represents what we have achieved as a nation over the years, and what it was we were trying to protect." This was the period when Singapore was bracing itself for a big increase in Covid-19 cases.

Capacity at hospitals and treatment facilities was being ramped up, and Dr Hoi's job was to find nurses, already fatigued, to man them.

"Manpower was constantly on my mind," she says. "But as I was jogging, I'd think, okay, we just need to make sure we are able to survive this as a country. We will do our best and do our part as healthcare workers."

It is for this reason that Dr Hoi has decided to meet for lunch at MBS. Her choice of restaurant, Bread Street Kitchen by Gordon Ramsay, which serves British fare, is because of her fond memories of being an undergraduate in London.

Though food was expensive in the British capital, she would occasionally treat herself to a hot meal of fish and chips. She loves the British style of chunky potato chips, and the restaurant serves these.

I suppose you'll be having the fish and chips then, I say, as we proceed to study the menu. Er... yes, I suppose, she says. You don't have to, I assure her. Yes, she repeats, setting aside the menu. She'd like that dish. I opt for a two-course set meal of salad and steak.

The 44-year-old mother of three, who's wearing her formal nursing director's uniform of pink top and navy skirt, has an unassuming demeanour that is disarming.

Ahead of the lunch, I was told by the TTSH communications executive that during Nurses' Day celebrations, the hospital's chief executive had likened Dr Hoi to Mulan, the Chinese folk heroine, for being gentle and compassionate yet making a big impact.

Her job is indeed formidable. She oversees an army of 4,000 nurses and a total of 2,000 beds at TTSH, the second-largest hospital in Singapore after Singapore General Hospital. TTSH is the flagship hospital of the National Healthcare Group (NHG), one of three healthcare clusters in the country. 

Besides the hospital, TTSH includes the National Centre for Infectious Diseases (NCID), Institute for Geriatrics and Active Ageing, NHG Eye Institute, TTSH Rehabilitation Centre, TTSH Integrated Care Hub and the Centre for Healthcare Innovation. 

In July, Dr Hoi was one of three nurses who received this year's President's Award for Nurses. She was lauded for her "relentless energy and expertise" during the pandemic. Among other things, she oversaw the conversion of two floors of TTSH into Covid-19 wards and equipped nearly 400 nurses with skills to support operations at NCID.

The award recognises nurses who have shown sustained outstanding performance and contributions to patient care delivery, education, research and administration. The other recipients this year were Dr Loh Huey Peng, director of nursing at the Singapore National Eye Centre, and Ms Pauline Tan, deputy director of nursing at the National Kidney Foundation.

Grew to love nursing

Dr Hoi didn't start off wanting to be a nurse. As a teenager, she had entertained thoughts of becoming a doctor, but the death of her father, which put a strain on the family's finances, and an offer of an overseas scholarship for a nursing degree swayed her decision.

She grew up the youngest of three children. One brother works in information technology and another runs his own company. 

Her father had an engineering business and her mother helped him with the accounts. The family lived in a condominium in the east. It was a happy childhood, with her father taking the family out for Sunday meals. "We would always go to Chinatown to have porridge." 

After work, her mother would rush to the supermarket to get groceries and cook dinner for the family. "My dad, being a traditional Chinese man, would always need two meat dishes, one veg and one soup," she recalls with a smile. 

"The other amazing thing about my mum was that she would never allow us to do any housework. She'd say, ‘your only responsibility is to study'." 

Dr Hoi attended Tampines Primary School, then Chung Cheng High School (Main), and Temasek Junior College. 

When she was in her first year in JC, her father died of liver cancer. He was just 43. 

He had been diagnosed with colorectal cancer three years earlier and had seemed to recover after an operation, she says. But he also suffered from hepatitis B and the cancer spread to his liver. "He deteriorated very fast, so his death was quite a shock to us." 

Though his illness did not overtly play a part in her decision to take up nursing, it probably influenced her attitude towards it, she reflects. 

Near the end, her father was in a lot of pain and had to be on morphine to manage it. "If I rewind what I went through and what I saw my mum go through, I saw how palliative care was very important." She was a triple science student in junior college and active in the student council. Like many of her classmates, she considered studying medicine in university. "Nursing was something that I don't think crossed anybody's mind."

After her father died, her mother worked in her paternal grandfather's engineering company. Dr Hoi didn't want to burden the family financially. "I thought that the easiest option was to get a scholarship and at the time, the only scholarship for medicine was the President's Scholarship, which I knew was too hard for me to reach."

A friend nudged her to visit a Public Service Commission (PSC) scholarship booth at the school canteen after they received their A-level results. She was offered a local teaching scholarship and a local Singapore Civil Defence Force scholarship, both of which she declined.

PSC also offered her the Overseas Specialist Award to study nursing or allied health in Britain or Australia. At that time, Singapore did not offer degree programmes for nursing. Dr Hoi chose the nursing programme at King's College London.

An aunt offered to support her study of medicine in Australia. "But I decided to just keep my life simple, and the idea of going to London was quite nice."

Her time in Britain turned out to be formative years.

Her father's early death had left her angry, Dr Hoi says. "I think I was angry with just basically everything."

It was in England that she healed. She had begun to question her Christian faith but found support in a group of like-minded Singaporeans in London. "That's where I think the healing process took place, from the grief and all."

She went on a church mission trip to an orphanage in Romania that opened her eyes. The children had been born with HIV and been abandoned. "We spent two weeks organising programmes for the kids. It was a beautiful moment for me."

She also saw the benefits of Britain's strong community nursing programme. As part of her training, she would accompany experienced nurses on visits to patients in their homes, including patients suffering from mental illnesses. She was inspired by how well the nurses knew their patients, down to whether or not they would be home at a certain time, according to their daily schedule.

"The relationship was so strong, and I realised that healthcare is beyond acute care but also in the community." Mental health patients were encouraged to be independent and to live in the community as much as possible, with support from community nurses. She remembers how one patient prepared broccoli soup for the nurse and her.

The relationship the nurse had with the patient had been formed over time. "That connection builds the relationship and the trust. Then you can work out what the person needs, and from there you plan and coordinate care for him."

Dr Hoi came to see how her choosing to be a nurse meant she could truly make a difference. "I didn't think that I would like being a nurse, but I grew to love nursing during my training," she says. "I could see how nurses impact lives."

TTSH Kampung

When she returned to Singapore after her four-year course, she was posted to TTSH, where she met her husband, Adjunct Associate Professor Chua Horng Ruey, 44, who is now head of the division of nephrology at National University Hospital.

Almost all her working life has been spent at TTSH. She calls it a close-knit community.

"We say TTSH is a kampung," she says with pride about the hospital that was built in 1844 and bills itself as "the People's Hospital".

In healthcare, relationships can be forged by fire. Dr Hoi was a junior nurse on rotation at TTSH's intensive care unit when the outbreak of severe acute respiratory syndrome (Sars) occurred in 2003.

The hospital was the main treatment facility for Sars. Working in that intense environment, she was struck by how everyone, from senior doctors to nurses, watched out for one another's safety as they tended to very sick Sars patients.

She gained her doctorate in nursing practice from Duke University School of Nursing in 2018 through a long-distance course. She also holds a master's degree in knowledge management from Nanyang Technological University. In August 2020, she was appointed chief nurse (designate) and formally assumed the position from Oct 1 that year.

Her day starts at 7.45am after she drops her 14-year-old daughter off at school. Her older son is 16 and the younger one is 12 and in his PSLE year.

Are you stressed over his exam, I ask.

She laughs and says she is more relaxed with her youngest child.

"When my first child sat his PSLE, we were anxious and helicoptering him with his studies."

RESPECT IS KEY

Respect for nurses will go a long way towards your care."

- ​ Hoi Shyu Yin, saying that nurses need a "healthy, positive connection" with patients

She has grown to believe that children need to be trusted to know what they are doing. "Of course you have to set some boundaries, but if you keep helicoptering, I feel it would add to their anxiety. I'm trying to find that balance all the time." And what is she like at work?

"I'm quite intense at work," she admits. "I don't know if it's because I took on the role during the Covid-19 period where we had to work at a certain intensity."

The pandemic, though, allowed her to get to know diverse groups of people quickly. As an administrator, she finds her time taken up by meetings, but tries to set aside Friday mornings to be in the wards. Her job is to plan for urgent situations, such as a Covid-19 surge, and to "create the environment that will help my nurses thrive". This could range from mapping out their training needs to relooking work schedules to make them more flexible.

The nursing shortage has seen her go on nine recruitment trips since April 2022. "Thankfully, we have been able to meet all our recruitment targets." At TTSH, international nurses make up 25 per cent of the nursing workforce.

They come mainly from the Philippines and India, as well as Vietnam and Myanmar.

The fight for nurses is a global one, and on her first recruitment trip to Manila after borders were open, she found herself competing with nine other countries, including Canada, Australia, New Zealand and Middle Eastern countries.

She is a big believer in empowering nurses and recently launched a scheme where new nurses can get $1,000 each to work on ideas to solve problems in the wards. "We want to create a culture where nurses are problem spotters and also problem solvers."

We've finished our dishes and round out our meal with tea. The restaurant brings us a dessert of sticky toffee pudding, on the house.

I ask her what she would say to persuade a Singaporean to become a nurse.

"If you like connecting with people and you want to use your skills and knowledge to help make another person's life better, then be a nurse," she says.

"It's important to be a compassionate and caring nurse. But more than that, it's also about the application and the practice of your knowledge and skills to complement doctors, and to give better care to patients."

And if you have a message for patients, what would that be? "Respect for nurses will go a long way towards your care," she says. "We need that healthy, positive connection with you in order to give you our best."

After we take her photos, we say our goodbyes and she strides away, briskly, back to the hospital where, I've no doubt, she gives nothing short of her best.​