GROWING up with an elderly grandmother at home, Madam Jamie Lim discovered her natural knack for tending to the weak and frail.

She dreamed of becoming a doctor, but those hopes were dashed when she was forced to give up a pure science course in secondary school.

“I transferred to another school but there was no space in the popular triple science stream even though I qualified,” recalls Madam Lim. She settled for a commerce course instead.

Disappointed yet undeterred, she attended a Ministry of Health job fair in 1988 seeking alternative routes into the health-care profession.

She signed up to become a nurse, uncertain where it would take her but excited about the chance to make a difference in people’s lives.

Today, after two decades of experience pounding the wards as a staff nurse and intense specialised training, the cheerful 41-year-old can proudly say she has earned the credentials to take on tasks once reserved for medical doctors as well.

As an Advanced Practice Nurse (APN) with Tan Tock Seng Hospital, Madam Lim also assumes daily duties such as working on simple diagnosis and problem lists, interpreting test results and conducting physical examinations, which in turn free doctors to take up more complex cases.

For instance, she can see up to 20 patients daily during her rounds at the hospital’s cardiology ward and reviews each case in detail.

She also runs a Heart Failure Clinic once a week, where she checks on patients’ hearts and lungs and monitors their blood test results.

But there are clear limits to what such specialised nurses can do. Prescribing medication, for example, remains a doctor’s job.

And while APNs can see patients on their own, they have to consult a doctor for more complex cases or to get a prescription approved.

Now regarded as the pinnacle in the clinical track of nursing, APNs had originated in rural communities in the United States during the 1960s.

Troubled by poor access to hospitals and a dire shortage of physicians, local nurses volunteered to step up and play a bigger role in diagnosing and treating patients.

Since then, much has been done to raise professional standards.

In Singapore, APNs first have to undergo an 18-month — it will be a two-year stint from August — Master of Nursing Programme at the National University of Singapore.

They then do a one-year hospital internship and finally have to attend an exit interview with the Singapore Nursing Board before they are given their accreditation badges.

For those who pass the stringent requirements, the rewards are aplenty. Apart from gaining the ability to provide advanced health care even in complex fields such as neurology and diabetic care, they can explore academic or clinical research roles as well.

The medical industry on the whole also gains from having more APN practitioners, says Tan Tock Seng Hospital’s Deputy Director of Nursing Lee Leng Noey.

“Doctors and their medical expertise can be intimidating to the nurses, especially the junior ones. So if they need to clarify or get more information about certain illnesses, they will approach the APNs, who share their background and hence understand their concerns,” Madam Lee says.

The important role that specialised nurses can play in complementing the routine duties of doctors has been recognised on a national scale. The Ministry of Health recently announced expansion plans for the programme, with a target of developing 200 APNs by 2014.

Despite the hectic workload and challenging job demands, Madam Lim, whose husband is a neurologist at the same hospital, said being an APN makes for a uniquely rewarding experience.

“You get to develop closer friendships with patients, and they learn to trust your opinion,” she says. “It’s really heartwarming.”

When asked if she still harbours her dream of becoming a doctor one day, Madam Lim replies with a smile: “This job allows me to stay by the bedside and grow together with my patients, and that, I feel, is my true calling. If I had to do everything again, I wouldn’t change a thing.”