Advanced Practice Nurses

When you are ready, you can pursue your Masters Degree in Nursing to develop your expertise for extended practice as an Advanced Practice Nurse (APN).

Registered Nurses who have an inclination to stay in the clinical track and pursue clinical excellence may find the path of becoming an Advanced Practice Nurses (APNs) inspiring. It is no mean feat to become an APN but it is a truly rewarding journey if one makes it to the end.

APN Interns are Registered Nurses (RN), upon graduating from the two-year Master of Nursing Course, these APN Interns return to their individual sponsoring institution and begin their one-year internship. A provisional license will be provided by Singapore Nursing Board (SNB) for practice during internship.

Some of the key APNs’ roles include:

  • To provide clinical leadership and consults
  • To provide patient care in collaboration with the medical team
  • History taking, physical examinations
  • Provide clinical/differential diagnosis and order basis laboratory testsInterpret basic laboratory and diagnostic results
  • Update patients and families of clinical conditions and management
  • To provide clinical consults for ward nurses and other allied health professionals

APNs also conduct clinic sessions in the outpatient settings either independently or in conjunction with a medical doctor. An APN can review and mange patients with stable chronic conditions. Examples of existing APN-led clinic are heart failure clinic, diabetic clinic, stroke clinic, hip care clinic and mental health clinic etc.

How are the APNs prepared to take on these roles?

After graduating with a Master in clinical nursing, the APN-Intern works and learns under the supervision and mentorship of a Medical Consultant/team. . The APN Intern will be assessed formatively periodically to ensure that he or she is clinically competent accordingly to the developmental milestones set by Ministry of Health. At the end of the internship, the APN Intern will undergo a high stake OSCE examination in order to obtain a full APN certification.

More information can be obtained from Singapore Nursing Board website.

In TTSH, which clinical specialties are the APNs practising in? 

  • Cardiology Medicine
  • Diabetic Medicine
  • Geriatrics Medicine
  • Intensive Care Unit (NICU and CCU)
  • Palliative Medicine
  • Orthopaedic Medicine
  • Respiratory Medicine
  • General Medicine
  • Renal Medicine
  • Rheumatology, Allergy and Immunology Medicine

The future of APN in Singapore

Ministry of Health (MOH)’s vision to develop more APNs is both ambitious and exciting! Besides numbers, other avenues are also currently explored to increase the scope of APN practice.

One key area under the lime light is prescriptiverights. Prescribing medications are traditionally only done by the physicians... However, internationally, prescription rights for Nurse Practitioners and/or APNs ranged from limited formulary to full prescriptive authority which includes controlled substances.

In 2014, National Nursing Taskforce (MOH) recommended for the hospitals to operationalise a prescription framework for APNs to prescribe medicines based on drug formulary. Since then, TTSH and other NHG institutions have been working with IHIS to develop electronic work processes to allow non-physicians to prescribe medications approved by Clinical Board.

In preparation for the upcoming Novena Health City and the services which are rendered being predominantly intermittent to long term based, the projection of APNs to be trained are hence demographic and service driven to serve the chronic and elderly populations.