Breaking barriers: How a nurse rose through the ranks to become Alexandra Hospital’s new deputy CEO

SINGAPORE: Nursing was never a profession she considered or wanted, but when Ms Margaret Lee received her GCE O-Level results – about 30 years ago – it was one of the only few options she was offered.
“I was interested in drawing, still life, graphic design … but I didn’t do well in school and in my O-Levels so I couldn’t qualify for a lot of things. I think nursing was my ninth choice,” she said. 
Left with few options, she decided to take up a diploma in nursing at Nanyang Polytechnic. 
Though a bitter pill to swallow, Ms Lee said the experience had been a huge wake-up call and drove her to work harder.  
“I told myself that I couldn’t fail again … or let my parents down. So, since I ended up in nursing, I told myself that I’d better make good use of this opportunity.” 
Last month, the 48-year-old was promoted from chief nurse to Alexandra Hospital’s deputy chief executive officer, making her one of the rare few nurses to take up a C-suite position.
Yishun Community Hospital’s CEO Pauline Tan was reported to be the first nurse to have attained the position in 2015.
Ms Lee’s climb to the top was not without its challenges. 
Recalling her early days as a young nurse at the National University Hospital (NUH), she had problems with her then-supervisor which led her to quit her job.
“I was still serving my (nursing sponsorship) bond, but it was quite hellish going to work every day because I felt very picked on. I didn’t feel that I could escalate (the issue) … so I decided to just break my bond and leave,” she said. 
It was her parents who paid the S$20,000 to release her from the bond. She took up a job selling dialysis machines for a medical equipment supplier but after two months, she realised that she was not suited to the private sector.
“I felt terrible and had a lot of self-doubt and guilt … because obviously I didn’t learn my lesson the first time round from my O-Levels, set my parents back by S$20,000 only to come back to nursing again.
“But I was really affected by the markup (in the prices of the machines) because … this cost would be transferred to patients and if patients didn’t pay, the government would need to pay, which means it’s taxpayers’ money.
“That was really a turning point, because it made me realise that … I could not survive in this kind of environment,” she said. “It validated where my calling was.”
Ms Lee decided she needed to prove that she could “make good” on her parents’ investments and to stop finding excuses for herself. She returned to NUH shortly after.
Back in familiar territory, Ms Lee was determined to succeed in her nursing career, taking on new challenges and working harder than before. 
She had been hired as a dialysis coordinator at NUH to provide clinical care for liver patients. It was a steep learning curve for her as the role also came with many other responsibilities including procuring equipment and supplies. 
“Typically, nurses wouldn’t be exposed to this aspect of work if they are purely providing direct care, but I had to do all of these,” she said. 
“So I had to turn to different people to guide me on how to get things done, how to budget for equipment, how to design processes.”
She kept at her job until her supervisor left for private practice five years later. Remembering her experience in the private sector, Ms Lee decided against leaving and returned to the ICU’s nursing unit in February 2006. 
Over the next 12 years, she worked steadily in the ICU and nursing wards, where she was promoted every two years. 
During this time, she worked on numerous projects including leading nurse quality training as well as the implementation of shared governance for nursing in the university’s medicine cluster. 
In 2016, when the National University Health System (NUHS) started planning for a new Alexandra campus, she was appointed the nursing lead to oversee the planning and preparation of the nursing team. 
Ms Lee was appointed chief nurse of Alexandra Hospital in July 2019 – just six months before Singapore reported its first COVID-19 case. 
As the rapidly spreading coronavirus placed increasing stress on the country’s healthcare resources, she focused on pivoting her nurses so that they could readily fill gaps. 
This included implementing crash course training of nurses to prepare them for a surge in ICU cases, deploying nurses to workers’ dormitories as well as setting up community care and treatment facilities for stable COVID-19 patients who did not require ICU. 
Her contributions to the nursing profession, which include starting a system that allows nurses – instead of doctors – to take the lead in caring for certain groups of patients, won her the President’s Award for Nurses in 2021. The award is the highest accolade in Singapore’s nursing profession.
Reflecting on her appointment as the hospital’s deputy CEO, Ms Lee said she felt her appointment was a signal of trust from the hospital that she could take on bigger responsibilities and have a larger impact.  
Her nursing background also brings diversity and balance to the team, she added. 
We can actually be … more all-rounded in the decisions that we make because we are all innately more intuitive towards a specific group,” Ms Lee said.
“For instance, doctors will definitely gravitate towards knowing doctors’ needs a lot more than everyone else, while I obviously will be more in tune with nursing needs. So, we really need a diverse group to form the leadership team.”
Her appointment comes as the 300-bed Alexandra Hospital prepares to serve more patients. By 2028, the hospital will be redeveloped into a 1,300-bed integrated general hospital. 
Although the hospital is already stepping up on recruitment, Ms Lee said it has to be more agile, given the manpower crunch and increasing healthcare needs. 
“If we continue to do things the same way, we will never have enough nurses. We know that the outcome is just going to be very dismal, but we have a runway so that nurses can rethink how they want to practise,” she said. 
Alexandra Hospital has 700 nurses now in a 1,650-strong workforce. It will have to boost its headcount by 82 per cent to meet the increased bed capacity in four years.
To boost capabilities, the hospital has been rotating nurses between disciplines so that they can gain more experience in different fields. 
“If we just let nurses continue to hone their skills within a specific discipline, it will take time for them to grow. We find that given the opportunities that’s on offer today for nurses, which is a lot, most people don’t know what they don’t know unless they have a chance to experience it,” she said.
“So, we are very intentional about rotating our nurses so that they have a flavour of different disciplines, even practising in different settings, so that they can also reflect and learn … where their passion lies.”
Nurses who decide to deepen their expertise in a certain area can then undergo relevant courses.
The hospital has also been sending its nurses to work outside the hospital, said Ms Lee. 
She added that Queenstown – where the hospital is located – has seen a rapid transformation with the proportion of residents aged 65 and above rising from 20 per cent to over 30 per cent in under five years.
“If we are truly person-centred in our care, we must see the person as a whole, not just the condition, not just the body organ, and think about what this means when the patient is out of the hospital space,” she said. 
“Because the hospital … is a very artificial environment that is catered to look after acute medical needs.
“So, this is how we have been rotating our nurses, giving them opportunities to go out into the community, so that they are more discerning as nurses, and they can actually take more ownership to redesign their practice.”
When the redevelopment is completed, a new, integrated model of care will also be implemented on a full-scale basis.
Under this model, patients can remain in the same bed after their conditions improve, instead of transferring to a community hospital. They will receive acute and subsequently step-down care tailored to their needs from the same clinical team in the same location.