There have been conversations surrounding the starting salaries of nurses in Singapore in recent days.

This in particular re-emerged as a topic after a recruitment advertisement for temporary Covid-19 test swabbers was put out by e2i on May 14. According to the poster, swabbers will be paid a monthly salary of S$3,800 while swab assistants will earn S$3,400 monthly.

In response, one nurse, who has 11 years experience in the field, wrote a viral Facebook post (that she later on took down) that highlighted the lower wages nurses get, despite having far more qualifications and experience than these temporary positions would require.

This sparked significant discussion online. Some who were in favour of the high swabber pay argued that the salaries offered for temporary swabbers and swab assistants were a result of supply and demand.

 

Others spotlighted the salaries of nurses in Singapore.

MOH: entry-level registered nurses earn S$3,300 - S$5,200

Last week, the Ministry of Health responded to media queries on the matter and said the “average gross monthly salary, after adding in allowances and bonuses, for entry-level registered nurses ranges from S$3,300 to S$5,200 depending on their qualifications”.

But here's the thing: registered nurses are but a subset of all nurses who work in Singapore.

So who are registered nurses?

According to MOH’s website, nurses are classified as "Enrolled Nurse" and "Registered Nurse".

Registered nurses can specialise their nursing skills in different practices, and can further their career as a Nurse Clinician, Nurse Educator, and Nurse Manager.

To be classified as a registered nurse, one must have attained at least one of the following qualifications from MOH-recognised institutions:

• Diploma in Nursing / Diploma in Health Sciences (Nursing)
• Accelerated Diploma in Nursing
• Degree in Nursing

To enrol in the courses to get these qualifications, applicants need O-Levels, A-Levels, or diploma and degree qualifications.

And who are Enrolled Nurses?

Enrolled nurses "assist the Registered Nurses to provide holistic nursing care for patients" and "can progress to be a Senior Enrolled Nurse to take on higher nursing responsibilities". They may also become a registered nurse by obtaining the relevant qualifications stipulated for registered nurses.

For enrolled nurses, the minimum entry requirement for course qualification is an N-Level certificate. They must also have acquired a Nitec in nursing.

The minimum requirement of N-Levels for enrolled nurses is similar to that for temporary swabbers and swab assistants.

As listed in the job application form, the requirements for temporary swabbers and swab assistants are:

• Minimum N-Level/ WPLN5
• Medically fit with no history of chronic diseases
• Proficient in English and Mother Tongue (Chinese, Malay and/or Tamil), fluency in dialect is a bonus

It is not specified that temporary swabbers and swab assistants require nursing qualifications.

We know the salary ranges for registered nurses. So how much do enrolled and other nurses start with?

The Healthcare Services Employees’ Union (HSEU) makes agreements for the salary ranges of nurses in different healthcare clusters and institutions, including the National University Health System (NUHS), SingHealth, National Healthcare Group (NHG), and NTUC Health Co-Operative.

The salary ranges referred to below are based on HSEU's agreements with NUHS, SingHealth, NHG, and NTUC Health Co-Operative.

The agreements with NUHS, SingHealth, and NHG were effective April 1, 2018 till March 31, 2020 while the agreement with NTUC Health Co-Operative is effective January 1, 2020 till December 31, 2022.

These documents do not include the salary ranges for "Registered Nurse". This could be due to the different classifications used by healthcare clusters and institutions.

Salary range for NUHS nurses

The basic salary range for “Enrolled Nurse II” for NUHS is S$1,700 to S$2,800.

The list of salary ranges for other classifications of NUHS nurses can be found below:

Salary range for SingHealth nurses

The base salary range comprising Monthly Variable Payment (MVP) for “Enrolled Nurse II” for SingHealth is also S$1,700 to S$2,800.

The list of salary ranges for other classifications of SingHealth nurses can be found below:

Salary range for NHG nurses

The NHG does not use "Enrolled Nurse" as a job title, but here's their list of base salary ranges that includes MVP for the different classifications of nurses:

Salary range for NTUC Health Co-Operative nurses

NTUC Health Co-Operative uses a job grade system.

The salary ranges for NTUC Health Co-Operative nurses are below:

So why are these entry-level nurses being paid so much less than swabbers?

Some commenters in the discussion thus far have pointed out the temporary nature of the latter.

Temasek CEO Ho Ching herself waded into the debate as well, remarking that people who think the pay being offered to swabbers is unfair should "stop whining" and go take on the job.

Ho wrote that we should not take for granted the "kindness and public spirit in volunteering" of those applying to be swabbers and swab assistants, and that they should be paid properly and higher than for "easier and safer jobs".

But is it that straightforward? Some questions do arise from assertions like these, though.

For one,

1) Are nurses really at lower risk than swabbers in the work they're doing in this pandemic?

The application form for the swabber and swab assistant positions states that possible deployment sites include community recovery facilities, government quarantine facilities, and nursing homes.

This certainly puts them on the frontlines of Covid-19 operations and makes them susceptible to contracting the virus.

While not all nurses are deployed at the frontlines of Covid-19 operations, their involvement in Covid-19 operations is doubtless extensive.

Nurses work in isolation wards, community recovery facilities, and, of course, the Accident and Emergency departments of all our hospitals — these are just some of the many locations nurses could be, and are, deployed.

Earlier on May 4, Health Minister Gan Kim Yong announced in Parliament that as of April 26, there were 66 cases of confirmed Covid-19 infections among healthcare workers and support staff.

46 of these cases were from healthcare workers whose work involved direct contact with patients.

Based on investigations then, there were no established epidemiological links showing that these healthcare workers were infected in the line of duty. However, a possible link between the doctor and a Covid-19 patient was not ruled out for one case in a private healthcare institution.

Since then, there have been other cases of nurses being diagnosed with Covid-19.

Though the specific types of nurses (e.g. enrolled or registered) deployed in Covid-19 operations is unclear, a call for former healthcare professionals by MOH's SG Healthcare Corps indicates that both "Enrolled Nurses" and "Registered Nurses" are being called upon in support of ongoing Covid-19 operations.

2) How do the terms for nurses and swabbers compare?

For swabbers:

According to the application form, the term of contract for swabbers and swab assistants is six months, with the option to extend for another three.

Working hours are specified as "rotating 6 working days per week", and applicants can indicate their interest in the part-time (four hours) or full-time (eight hours) shift.

Applicants can also indicate their interest in shift work.

For nurses:

Based on HSEU's agreements with NUHS, SingHealth, and NHG, the maximum working hours per week for nurses is 42 hours for regular shift, 40 hours for a rotating shift, and 38 or 40 hours (depending on hospitals) for permanent night shift.

The detailed breakdowns of maximum working hours per week for the different healthcare clusters are below:

NUHS

• Regular shift: 42 hours per week
• Permanent night shift: 40 hours / 38 hours per week (depending on hospital)
• Rotating shifts: 40 hours per week (averaged over a two- or three-week cycle)

SingHealth

• Regular shift: 42 hours per week
• Permanent night shift: 38 hours per week
• Rotating shifts: 40 hours per week (averaged over a two- or three-week roster)

NHG

• Regular shift: 42 hours per week
• Permanent night shift: 38 hours per week
• Rotating shifts: 40 hours per week (averaged over a two- or three-week roster)

Rest days and leaves

Nurses are entitled to one rest day per week, while their annual leave ranges between 15 and 24 days depending on their job grading.

There are also annual childcare leave of up to six days, and family leave of up to three days for nurses.

Other monetary incentives

Nurses under the different healthcare institutions are also entitled to other monetary incentives such as Annual Wage Supplement (AWS), annual increments, performance bonuses, and shift allowances.

These vary across the different healthcare clusters and institutions.

Govt efforts to support healthcare workers: counselling, helplines, peer support, care packages, transport, shift & overtime allowance

At a May 4 parliament sitting, Gan said healthcare workers are "at the core of our fight against this Covid-19 outbreak" and the government is committed to "taking care of them in every way".

This includes ensuring an adequate supply of Personal Protective Equipment and proper training on its use.

In the event healthcare workers are infected, Gan said the government will ensure they are well taken care of. MOH institutions would also check on the general well-being of infected healthcare workers.

Mental well-being

Before the Covid-19 pandemic, healthcare clusters already had "counselling clinics, helplines and peer support programmes".

Gan said the government has since stepped up its efforts. Healthcare institutions "have rostered breaks and staff rotations to ensure that frontline workers have sufficient rest periods in between work days".

Healthcare clusters are also working closely with HSEU on initiatives such as the care packages distribution, the GrabCare programme to provide transport for frontline workers, and a collaboration with Mindfi, a mindfulness app.

Gan: Compensation is "another important area", but "no monetary compensation is ever enough"

Gan also acknowledged that "compensation is another important area".

Gan said Deputy Prime Minister Heng Swee Keat had "previously announced a special bonus for our public healthcare workers working on the frontline".

In February, DPM Heng announced an up to one-month bonus for frontliners including healthcare workers. 

Gan also said there are shift and overtime allowances for healthcare workers if they take on longer or more shifts during this period.

However, Gan also noted that "no monetary compensation is ever enough" and thanked healthcare workers for their hard work and dedication.

The conversation continues

We have taken some of these questions to the Ministry of Health in the hopes of gaining a better understanding into their use of registered nurses' starting salary ranges to compare against that of the temporary swabber positions, as well as a comprehensive view into how nurses are compensated.

We will update this article with their responses when we receive them.

But the topic of whether nurses are being compensated fairly or sufficiently for the work they do is one that has emerged time and again in these years, and will continue to be subject to ongoing discussion.

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Mothership Explains is a series where we dig deep into the important, interesting, and confusing going-ons in our world and try to, well, explain them.

This series aims to provide in-depth, easy-to-understand explanations to keep our readers up to date on not just what is going on in the world, but also the “why’s”.

Top photo via TTSH Facebook page.