MOH: Nurses’ Relocation To Hospital Wards ‘Strategic Mobilisation’ With ‘Skill-Matched Staffing’

MOH’s statement on nurses’ transfer from specialist clinics to wards in government hospitals, where nurses in clinics are replaced by MAs, describes it as “optimising” the healthcare workforce with “skill-matched staffing”, without mentioning nurses’ “shortage”.

KUALA LUMPUR, Jan 9 – The Ministry of Health (MOH) has simply described the reassignment of nearly all nurses from specialist clinics to wards in government hospitals as a “strategic mobilisation” or workforce optimisation exercise.

The ministry said health care personnel, including both nurses and medical assistants, would be “trained and privileged accordingly”, before they are assigned with specific clinical tasks and procedures.

“In response to the article published by CodeBlue on 8 January and the ongoing discussion about the strategic mobilisation of nurses in hospitals, we would like to emphasise that patient well-being and safety will be the utmost priority of the Ministry of Health (MOH) and will not be compromised,” the MOH said in a statement to CodeBlue today that was not attributed to the health minister or a specific MOH official.

“To ensure the best quality of nursing care provided to patients, it is important to strategically station nurses at sites that require specific nursing skills, particularly in wards.

“MOH continues to prioritise the well-being of nurses who have always been committed to providing the best health care services to Malaysians.”

CodeBlue reported yesterday 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, due to a severe shortage of nurses in public hospitals and insufficient nursing graduates.

Nurses in specialist clinics would be substituted with medical assistants, according to documents sighted from Health director-general Dr Muhammad Radzi Abu Hassan’s November 27 meeting with MOH’s medical assistance services branch and the nursing division.

Although the MOH’s plan was to complete diverting nearly all nurses from specialist clinics to wards in government hospitals by last January 1, the reassignment exercise — which began in July 2023 in several states like Penang, Sabah, Perlis, Kuala Lumpur and Putrajaya, and Perak — is still reportedly ongoing.

The MOH said today that nurses and medical assistants would be placed “according to their core competency, complementing each other”, in a “meticulously” planned and executed strategic mobilisation of the health care workforce without compromising clinical services and patient safety.

“This is pertinent in ensuring adequate and skill-matched staffing aligns with the commitment to enhance patient care and safety, contributing to the overall effectiveness of health care services.”

Use of the phrase “skill-matched staffing” indicates the MOH’s apparent belief that nursing capacity can be filled by medical assistants from allied health care, even though these are two different job roles.

CodeBlue reported earlier today a senior nurse as saying that nurses and medical assistants undergo different training. Medical assistants are primarily tasked to assist, while nurses have a variety of duties, including preparing patients’ documents, attending to bedridden patients, conducting immunisations, administering medication, and being involved in school programmes like dental clinics.

The MOH’s three-page statement to CodeBlue also did not make a single mention of the word “shortage”, even though an internal memo and minutes of the Health DG’s November 27 meeting described the current “nurses’ shortage” as having a “significant impact”.

Despite internal documents from Dr Radzi’s meeting last November noting the insufficiency of nursing graduates from both the MOH Training Institute (ILKKM) and private nursing schools, the MOH’s media statement today simply said the ministry has established 13 colleges nationwide with diploma and advanced diploma programmes.

“These initiatives aim to produce skilled health care personnel, including nurses and paramedics. MOH not only supports nurses in advancing their education but also allocates resources for in-house training programmes, aligning with guidelines to credential and privilege nurses.

“This comprehensive approach aims to capitalise on human resources, increasing skilled nurses in multiple disciplines and enhancing patient outcomes.”

Besides exploring “workflow reorganisation” to “optimise the existing workforce”, the MOH also described investments in digitalisation as a “crucial measure to reduce dependency on human resources”.

The ministry added that while it welcomes constructive feedback from every segment of the society in its bid to further improve the health services delivery system, it strongly believes that freedom of expression should be exercised in a responsible manner and in ways that “do not spread hatred, negativity, and fake news” regarding public health care.

The MOH’s statement did not state if it would consider recruiting foreign-trained nurses, like what was approved for private hospitals last year, to tackle the dire nursing shortage in the public health service that was not acknowledged either.

A senior nurse, commenting on the nurses’ reassignment exercise in MOH hospitals, suggested the hiring of foreign-trained nurses from Commonwealth countries, as has been done previously in the mid-90s.

While exact figures are not available, the nursing shortage at MOH can be estimated by considering that ideally, the nurse-to-patient ratio at hospital wards should be around 1:8. The common ratio in government hospitals now is 1:15, 1:20, or even more, according to the senior nurse, especially in some wards like dengue wards, leaving room for substandard patient care.

Double shifts for nurses in MOH hospitals are also very common.

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