Staff Nurse (Community Health)

The Staff Nurse (Community Health) provides professional nursing care and clinical support to clients with particular focus on post-discharge care, chronic diseases, frailty, chronicorgan failure and complex medical conditions. The role bridges hospital, primary care and community-based services through nursing assessment, care planning, monitoring, care coordination, health education, risk identification and timely escalation. The Staff Nurse also contributes professional nursing input to preventive health, ageing-in-place and integrated community care initiatives.  Responsibilities: - Clinical & Community Nursing  Conduct comprehensive nursing assessments in home, community and centre-based settings, including physical, functional, cognitive, psychosocial, caregiver and environmental needs. 

Develop, implement, review and update individualised nursing care plans within professional scope and organizational protocols. 

Support transition from hospital to home, including post-discharge assessment, monitoring, care coordination and timely escalation for clients with chronic diseases, chronic organ failure and complex medical conditions. 

Monitor chronic conditions, frailty, dementia, medication adherence and other clinical risks, and recognize early signs of deterioration. 

Provide appropriate nursing interventions, health education, self-management support and caregiver guidance within the Staff Nurse's scope of practice. 

Conduct medication reconciliation, identify medication adherence or safety concerns and escalate appropriately to the relevant healthcare professional. 

Conduct home visits where nursing assessment or clinical judgement is required, assess patient, caregiver and home risks, and initiate appropriate healthcare or social-care referrals. 

Identify clients at risk of deterioration, falls, frailty, poor disease control, caregiver stress, repeated hospital utilisation or other adverse health outcomes and facilitate appropriate intervention or escalation. 

Maintain accurate nursing assessments, care plans, clinical notes, case updates, escalation records and other documentation requiring nursing accountability. 

Clinical Capability, Governance & Quality  Provide clinical guidance and training to Community Carers, volunteers and non-clinical staff on health monitoring, warning signs, safety considerations and appropriate escalation procedures. 

Participate in multidisciplinary case discussions and case reviews where nursing input is required. 

Contribute nursing expertise to the development and review of clinical workflows, protocols and escalation procedures. 

Participate in incident reviews, clinical risk management and quality improvement activities relevant to nursing and community care. 

Maintain professional practice in accordance with Singapore Nursing Board requirements, organisational policies and applicable clinical governance standards. 

Community Health Programmes & Outreach  Provide nursing and clinical input to community health programmes, preventive health initiatives, screenings and outreach activities. 

Conduct or support health education, screening, risk identification and appropriate follow-up or referral arising from community health activities. 

Advise on clinical, health, mobility, frailty, dementia and safety considerations where programmes involve clients or other vulnerable participants. 

Support community-based activities where nursing presence or clinical expertise adds value to participant health, safety or wellbeing. 

Participate in occasional weekend or after-hours activities where nursing or clinical presence is reasonably required.  Requirements: - Minimum Diploma in Nursing from a recognised institution. 

Registered with the Singapore Nursing Board (SNB) with a valid Practising Certificate. 

At least 5 years of relevant nursing experience, preferably including medical-surgical, community nursing, home care, transitional care, primary care or eldercare experience.  Experience supporting older adults with frailty, dementia, chronic diseases, chronic organ failure, post-discharge needs and/or complex medical conditions would be advantageous.  Able to conduct home visits independently, exercise sound nursing judgement, recognise clinical deterioration and escalate appropriately.  Familiarity with community care services, care coordination and multidisciplinary working would be advantageous.  Strong communication and collaboration skills with clients, caregivers and multidisciplinary/community partners.  Able to translate clinical knowledge into practical guidance for caregivers and non-clinical staff.  Comfortable with relevant clinical documentation systems, MS365 and digital tools.