KUALA LUMPUR, Jan 8 – An acute shortage of nurses has forced the Ministry of Health (MOH) to reassign nearly all nurses from specialist clinics to wards in government hospitals.
An internal memo on the outcome of Health director-general Dr Muhammad Radzi Abu Hassan’s meeting with MOH’s medical assistance services branch and the nursing division on November 27 last year revealed the MOH’s goal to relocate “100 per cent” of nurses from specialist clinics – excluding those in clinical areas like obstetrics and gynaecology (O&G) and paediatrics – to wards by last January 1.
The memo stated that vacancies left by nurses in specialist clinics at MOH hospitals can be filled by assistant medical officers (PPP), health care assistants (PPK), administrative assistants (PT), or MySTEP personnel instead, after identifying clinical and administrative tasks; these replacements need not be one-to-one.
MySTEP is a government initiative that provides contract jobs in ministries, government agencies, and government-linked companies.
“In view of the shortage of nurses and the insufficient production of such personnel from ILKKM (MOH Training Institute), KPK (Health DG) proposes the optimisation of nurses in the field, especially in hospitals,” stated the November 27 memo, as sighted by CodeBlue.
The minutes of the Health DG’s meeting on November 27 last year, as sighted by CodeBlue, noted that the production of nursing graduates from private educational institutions was also limited, driving the MOH’s “desperate need” to optimise nursing human resources in government hospitals.
CodeBlue understands that despite the MOH’s goal of completing the reassignment exercise by January 1 this year, the reshuffling of nurses and medical assistants in public hospitals is still ongoing.
Nurses returning to the ward after an extended period in clinics, who have lost their skills, must undergo mentoring programmes. The nursing division should monitor nurses’ transitions from clinics to wards, submitting reports every three months.
The MOH’s November 27 memo stated that specialist nurses with post-basic qualification in diabetes management do not necessarily need to be placed in clinics.
“Many patients who need treatment or specialist care in wards are the same [like those for] other post-basic qualification holders, such as palliative, wound care, HIV, and others,” said the memo.
The MOH added that such specialist nurses could be placed in wards and help on a scheduled basis in clinic sessions if needed.
Nurses facing health issues or are on light duty may not necessarily be assigned to clinics; they can still perform duties in wards, adjusting tasks to their health conditions, the memo stated. Referral to a counsellor and a medical board proposal is required for cases with no hope of recovery.
Nurses accepting offers must understand their fundamental role, with the scope of work unchanged despite promotions. Clinical tasks take precedence over administrative duties, except for those in management positions like the hospital chief supervisor nurse (KPJH) and hospital assistant medical officer chief (KPPPH).
Interfacility transfer tasks fall under the responsibility of medical assistants in pre-hospital care, except for O&G or paediatrics cases, enabling nurses to concentrate on ward care.
All heads of department (HODs) and health supervisor nurses (PJK) are part of the ward roster. HODs work in shifts as team leaders, and PJK as the ward manager handles clinical and management duties.
Ophthalmology and otorhinolaryngology nurses can be included in the operating theatre (OT) pool for scheduling based on OT sessions/ specific department procedures.
“The MOH aims to remove OPD (outpatient) services from hospitals and go towards a shift system, including clinic services,” said the MOH memo.
Nurses’ Reassignment To Wards Ongoing Since July 2023: Penang, Sabah, Perlis, KL & Putrajaya, Perak
A seven-page minute of the Health DG’s November 27 meeting revealed that the reassignment of nurses from specialist clinics to wards has been ongoing in several states since as early as July last year.
In Penang, the implementation of Phase 1 of the reassignment involves 20 nurses, aligning with the Penang state health department receiving 20 additional medical assistants. Penang is also conducting a review of the administrative tasks performed by nurses to be transferred to clerical/ MyStep personnel at Bukit Mertajam Hospital.
In Sabah, reassignments began in July last year, involving a total of 612 nurses. As of November last year, 175 nurses (28.6 per cent) have been reassigned to carry out clinical duties in wards. The reassignments also included 64 medical assistants.
This initiative has covered Queen Elizabeth I Hospital, Queen Elizabeth II Hospital, and Likas Women and Children Hospital, all located in Kota Kinabalu, Sabah. Future phases will involve other hospitals in Sabah.
The Sabah state health department highlighted a need for 300 additional MyStep personnel as replacements, contingent upon financial allocations for MyStep.
Perlis has completed over 50 per cent of its nursing optimisation plan and has replaced administrative duties with appropriate staff.
However, some issues that the Perlis state health department has identified include nurses with chronic diseases who are tasked with light duties, nurses nearing retirement, nurses who have served in clinics for an extended period that resulted in a decline in clinical skills, and nurses who have pursued an advanced diploma/ degree in patient safety and management.
The reassignment of MOH specialist nurses in Kuala Lumpur and Putrajaya is reportedly progressing slowly, as there are no immediate replacements for medical assistant duties.
In Perak, the state health department has initiated a phased one-on-one transfer of specialist nurses with medical assistants in Raja Permaisuri Bainun Hospital, Taiping Hospital, Teluk Intan Hospital, and Slim River Hospital.
Perak faces implementation constraints for district hospitals, especially at eight district hospitals with outpatient departments, since nurses have been assigned to these departments.
Health DG: Prioritise Wards for Nurses Due to ‘Significant Impact’ of Shortage, Consider Shift System for All Staff Across Hospital Departments
The meeting minutes highlighted Dr Radzi’s emphasis on nurses to “carry out their fundamental duties” in clinical areas such as wards. The placement of nurses in specialist clinics will be overhauled and redirected to wards. Strong justifications are required if nurses are needed in other locations, such as clinics.
“In the current situation where the shortage of nurses has a significant impact, priority in nurse placement should be given to wards to reduce the workload of nurses currently on duty in the wards,” as noted in the meeting minutes.
The Health DG’s meeting also highlighted the shortage of human resources for nursing positions, particularly involving new and additional facilities in hospital operations. Therefore, nursing appointments need to be “optimised” to ensure smooth service operations.
It was also emphasised in the meeting that the primary duties of medical assistants include pre-hospital services such as ambulance calls, interfacility transfers, and disaster management coordination.
There are also medical assistants assigned to registration counters at emergency departments or units after office hours. It was noted: “This needs to be examined by management to ensure that these tasks are given to qualified personnel.”
It was also noted in the meeting minutes that Dr Radzi urged all MOH health care facilities to examine the feasibility of implementing a shift system across all departments. This would enable the existing workforce to be pooled and strategically placed in respective departments.
“Such an approach could also help control financial expenses related to overtime demands, among other benefits. Implementing a shift system could also ensure fairness for all hospital staff, whether in wards or clinics,” said the meeting minutes.
The MOH has told CodeBlue that it will provide a response to questions about the nurses’ reassignment exercise.
Dr Zaliha Mustafa — who was replaced by Dzulkefly Ahmad as health minister in a Cabinet reshuffle last December 12 — did not mention the reassignment exercise of nurses from specialist clinics to wards in public hospitals that had begun since July 2023 in her September 18 statement on the MOH’s approval of foreign-trained nurses for private hospitals.
Instead, Dr Zaliha had simply said the MOH would recruit nursing graduates on a permanent basis in phases from 2024 to 2025 to fill vacancies in MOH facilities — without mentioning that nursing graduates are actually now insufficient, as per Health DG Dr Muhammad Radzi’s meeting last November 27.
