KUALA LUMPUR, Jan 25 – Although the government has yet to provide data on the resignation rates of nurses in the public sector, the Ministry of Health (MOH) has internally acknowledged a dire nurses’ shortage.
Private hospitals previously cited the emigration of Malaysian nurses overseas, with a nurses’ shortage also hitting the private sector and forcing the government to allow the recruitment of foreign-trained nurses by private health care facilities last October.
Unlike doctors who have become more outspoken in recent years amid a deepening crisis of staff shortages in public health care facilities, nurses have long stayed silent due to purported threats of disciplinary action by the government and, instead, expressed their dissatisfaction by simply quitting.
But in a rare interview with CodeBlue last week, a staff nurse at a university hospital in the Klang Valley revealed in detail the reasons behind the mass resignations of nurses from the public health service.
Sarah (pseudonym) said that, in the past six months, as many as 50 nurses in her hospital resigned and relocated to countries like Singapore, Dubai, and Brunei, lured by higher pay, improved work-life balance, and better overall working conditions.
Sarah also shared that, despite 14 years of nursing experience, her basic salary remains stagnant at RM2,600. With allowances, her monthly income could reach RM3,800.
“You will laugh when you see my salary,” Sarah remarked. “Back in Doha, my basic salary was RM10,000. Despite my pleas, the university hospital refused to adjust [my salary scale] and the bank has rejected my housing loan.
“Consider also that some nurses who were not sponsored during their studies must repay their MARA (Majlis Amanah Rakyat or People’s Trust Council) or PTPTN (National Higher Education Fund Corporation) student loans.”
Sarah said that her university hospital adheres to the federal salary scale despite having the capacity to offer more. Private nurses in Malaysia typically earn a slightly higher salary range of RM2,000 to RM5,000 per month compared to nurses working in MOH hospitals, though still significantly lower than what nurses can earn abroad.
In Malaysia, a U29 grade fresh graduate nurse serving in a public or teaching hospital can earn as little as RM1,797 per month, a fraction of the SGD2,500 (approximately RM8,720) starting salary for a fresh graduate registered nurse with diploma qualifications across the Causeway.
Advancing through the ranks, nurses with a UD32 grade start with a salary of RM2,331, and at the UD36 grade, the minimum salary is RM3,590, with the maximum limit capped at RM7,605.
In comparison, mid-career registered nurses entering service through a career conversion programme in Singapore enjoy a base salary of up to SGD3,040 (RM10,603).
Singapore offers fresh graduates with degree qualifications a starting base salary of SGD3,350 to SGD3,750 (about RM11,684 to RM13,080), while mid-career entrants can earn up to SGD4,080 (RM14,233).
In Dubai, a sought-after destination for migrating nurses, the starting salary can easily reach 5,000 United Arab Emirates (UAE) dirhams, or approximately RM6,326.
Sarah, currently pursuing her bachelor’s degree, is conducting research and a pilot study on why Malaysian nurses are opting for overseas employment.
One primary factor identified by Sarah contributing to the emigration of nurses to other countries is inadequate pay. She argued that Malaysian nurses opt to work abroad due to low salary rates not aligning with Malaysia’s “economic rate” and the escalating cost of living.
Sarah notes that despite the annual increment of RM145 to the base salary of a UD29 nurse, there exists a pronounced inequality in the work-to-salary ratio. Nurses bear heavy workloads at the expense of their personal lives.
According to Sarah, nurses experience work-life imbalances due to erratic on-calls disrupting family and daily life, the extended eight-hour work shifts, and the additional pressure imposed by superiors. All of this is endured for a monthly salary that barely exceeds the minimum wage rate of RM1,500.
Sarah stressed that the increasing cost of living renders the salaries received by nurses “no longer relevant” in 2024. The unchanging salary rate, coupled with the rising cost of living, has resulted in many Malaysian nurses falling below the M40 (middle 40 per cent) income category, with some even falling below the B40 (bottom 40 per cent) income category.
University Hospitals Diverting Specialist Nurses To Wards Too
CodeBlue reported earlier this month 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 amid an acute shortage of nurses in government hospitals.
Nurses in clinics would instead be replaced by medical assistants, according to documents from Health director-general Dr Muhammad Radzi Abu Hassan’s meeting last November 27 with the MOH’s medical assistance services branch and the nursing division.
The MOH’s move to “optimise” nursing human resources in its hospitals was driven by both the nurses’ shortage — characterised by the Health DG’s meeting as currently having a “significant impact” — as well as insufficient nursing graduates from both the MOH Training Institute (ILKKM) and private nursing schools.
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.
According to Sarah, hospitals under the Ministry of Higher Education (MOHE) are also transferring specialist nurses from clinics to wards to address the shortage of nurses in university hospitals.
“So far, the transfers do not involve me. But, previously, they wanted to transfer my colleague to the neonatal intensive care unit (NICU) due to a shortage of nurses. We haven’t received any official instruction, but they will reshuffle accordingly.”
Sarah, who previously worked under the MOH before transferring to the university hospital in the Klang Valley, anticipates a more pronounced reassignment of specialist nurses from clinics as more nurses resign and leave the country.
Sarah said while the reshuffling will not have any effect on salaries, it may impact their working hours and working conditions.
“So far, our wages are still the same but it will affect our working hours. Some of us are on light duty due to medical conditions, and some who are married need to arrange for a babysitter.
“But in MOH, I heard if you are not fit for working in the ward due to light duty, they advise you to take a pension under the medical board if your service is more than 10 years. If your condition is too critical, they will force you [to take a pension].
“Many nurses get slipped disc at a young age. They have to take light duty. If they are single mothers, they need to go for an office-hour job,” Sarah said.
Sarah added that nurses frequently work double shifts, and sometimes the nurse-to-patient ratio in university hospitals is 1:4 or even up to 1:8. In acute settings, the ratio is 1:4.
In countries like Australia, nurse-to-patient ratios are legislated. According to the Queensland Government website, the minimum number of nurses to patients in a ward setting is one nurse to four patients (1:4) during morning and afternoon shifts and one nurse to seven patients (1:7) during night shifts.
Malaysia’s neighbour, Singapore, has one nurse for every four or five beds in general wards and public acute hospitals. In intensive care units (ICU), the ratio is typically one nurse to one ICU patient, but for more complex ICU cases, it could be higher, such as two nurses to a patient.
Malaysia lacks a precise figure for the nurse-to-patient ratio at hospital wards, but according to a senior MOH nurse, the maximum ratio should be 1:8, 1:6, or 1:4. However, in government or MOH hospitals currently, Malaysia has a 1:15 or 1:20 nurse-to-patient ratio. In specific wards, like dengue wards, the ratios go even higher.
Thus, while university hospitals have yet to reach the critical staffing levels of MOH hospitals (because public teaching hospitals follow standards), with nurses resigning for better opportunities, it can be expected that these hospitals will soon face the same shortage issues as MOH hospitals.
MAs Lack Skills Exclusive To Nurses
To replace specialist nurses, Sarah’s university hospital has appointed medical assistants (MAs) in their stead. Sarah said that while MAs “mostly study the same skills [as] nurses,” there are crucial skills exclusive to nurses that MAs lack, potentially jeopardising patient safety.
“Medical assistants can monitor vital signs, set lines, perform blood-taking, insert nasogastric tubes, insert urine catheters, conduct wound dressings, and administer medication.
“But they don’t know how to dilute medication, provide perineal care, clean patients, and some other nursing skills. Female nurses cannot perform catheterisation on male patients but are still involved in cleaning, whereas MAs won’t handle cleaning.
“Nurses can’t do sutures, but MAs can. However, MAs have limited skills to handle pregnant women and children. Some of them lack basic nursing knowledge to treat patients.”
Sarah disclosed that her hospital recently appointed an MA in the ophthalmology clinic, and her nurse manager was transferred out and replaced with an MA.
“So sad, my nurse manager got transferred today, and now the MA manager is in charge of my clinic. What terrible management.”
Sarah told CodeBlue that her nurse friend also resigned recently after receiving a “good offer” from Saudi Arabia.
‘We Can’t Tell The Truth’ To Visiting Ministers Or MPs
Sarah, an experienced university hospital nurse, said her managers and superiors often present a positive image to ministers and Members of Parliament visiting the hospital, concealing the fact that their staff is overworked and fatigued.
“That bloody matron will investigate who are the nurses spreading stories about their hospital.
“When any YB or minister comes to the hospital, they will say ‘everything is under control’. We cannot tell the truth.
“Last time, when the Pengarah (hospital director) did ward rounds and asked nurses, one nurse complained that she was burnt out and tired. The matron came to the ward and scolded the nurses.
“That’s why I said I don’t want an old-fashioned leader who cannot understand the younger generation.
“Balik-balik they will say, ‘When I was young like all of you, I could have been in charge of 40 patients’. Last time, where got so many charting and paperwork like nowadays?”
The secrecy surrounding issues faced by hospitals extends beyond staff matters to include hospital equipment. During her service in MOH, Sarah highlighted that equipment such as wheelchairs and machines were not well-maintained.
Despite this, hospital management often avoid addressing or advocating for the hospital’s needs. They choose instead to conceal the “real ugly truth” from visiting ministers and MPs.
“Some hospital directors are just covering for themselves. This is the ugly truth, and the most ironic part is that patients often blame nurses for these issues.
“When I was in MOH, a patient died, but I couldn’t print a straight line (asystole) as the monitoring machine was out of order. Even the ECG (electrocardiogram) machine wasn’t working. It’s frustrating.
“I suspect there’s corruption; even with changes in government, the problems persist.”
I Have To ‘Wait My Turn’ For Specialisation
Sarah concluded by asserting that nurses need new management and leaders who understand the younger generation, support them in raising issues, and do not prevent them from expressing their opinions.
“We need new management, new leaders who can understand the younger generation, can help us to raise issues, not stop us from speaking up with our opinions, not giving us pressure.
“Let us choose our own interests and specialisations, increase and study our salary scale and perks and sponsor us to further study like degree, Master’s, and PhD.
“Normally, the government sponsors for post-basic only, and we have to wait many years and follow our turn.
“Even though I want to further study using my own money, they won’t allow me as I need to wait for my turn and understand that my unit is having problems due to a shortage of staff.
“I am also thinking of working in another country after I finish my studies.”