KUALA LUMPUR, Jan 26 — Nurses in government hospitals are allegedly silenced through threats of transfers and blacklisting when they speak up about workplace issues.
Rekha (pseudonym), a nurse at a government hospital in Selangor, accused the Ministry of Health (MOH) of persecuting nurses for raising concerns, despite claiming to prioritise their welfare.
Backlash occurs whether complaints are made internally or publicly, Rekha said.
“The hospital management has never looked after our (nurses) welfare. They would say all kinds of things like, ‘We look after our nurses. We give this, we give that.’ When we speak out, they fight and blacklist our names. So, that thing (the welfare of nurses) is not there.
“It’s not fair for someone who wants to speak out. If we speak out, the management will not accept our views or our problems; they will not accept anything. All they know is, ‘Okay, that thing is settled, done, and gone.’
“If you speak out, your name will get blacklisted. You will be transferred out to a different department,” Rekha said in a recent interview with CodeBlue on condition of anonymity as civil servants are not authorised to speak to the press.
Rekha explained that nurses, unlike doctors, face “bans” or transfers for speaking up. She said that doctors are able to protect themselves and can “stand up”, while nurses have to keep their heads bowed down if they don’t want to face the retaliation that comes from speaking out.
The “ban” often involves distressing departmental transfers.
“Okay, let me ask you, how would you feel if you got transferred to a different department? Surely, someone will make a story about you, right? Will you feel comfortable going to someone else’s place? No. Will you feel safe?
“You can get depressed. Look at how they make people depressed with this community, by making these things viral.
“You want to lower suicide levels, you want to lower depression levels, but you are the ones causing it. Do you think there would still be people who would want to speak out? None. People are afraid it will go viral, and they are afraid of disciplinary action,” Rekha said.
“We can’t speak. We can’t feel anything.”
While there is a hard crackdown on posting comments and statements on social media platforms and doing media interviews, management in MOH hospitals allegedly shows little interest in listening to staff opinions and feedback during staff meetings.
Rekha claimed that superiors often dismiss staff comments, having “prepared” answers that render meetings ineffective.
“If you enter a meeting, even if you say anything, they would already have an answer. So, what else is there to say? So, no point if you want to speak out at the meeting; you are only wasting your time.
“When you enter a meeting for discussion, you hope for something, right? But they already have an answer for everything you will say, and they will also repeat their answer, and they will also repeat whatever goals they have. So no point lah for the meeting.
“Tak ada function. You are nothing. Your voice tak akan didengar (Your voice will not be heard).”
For Rekha, meetings are purely for record-keeping purposes. If a nurse wanted something in black and white, they would need to attend the meetings. For example, if the nurse needs to give an apology, she would do it in a meeting as there will be a record of her giving an apology. Whether she truly meant that apology though is another matter altogether.
When asked about the effectiveness of MOH’s Public Complaints Management System (SISPAA), Rekha said that the system is ineffective as bosses will be able to use “cables” and find out who made the complaint against them.
The only method for nurses to launch a successful complaint without repercussions is by complaining in a group.
“If your community has many people, like 13 to 14 people, or if one whole ward or a department complains, it’s okay. You are safe. But if you are the only person complaining, you are not safe. You will be mentally tortured.
“Unless you feel you have strong support, that’s okay. But if you feel you are just one person, you cannot bear hearing what other people say, you have to ignore a lot if not, you cannot work at all. People bully you or whatever, you ignore them.”
MOH Allegedly Tells Staff: ‘Your Problem is Not My Problem’
The transfer of nurses from specialist clinics to wards in MOH hospitals nationwide, amid a dire shortage of nurses in the public health service, has and will impact the lives of many nurses, Rekha said.
The senior nurse expressed sympathy for nurses who have families and have to rearrange their lives to fit the new working schedules.
Rekha claimed that MOH is not accepting any appeals among nurses affected by the transfers and that all clinics are supposed to be empty of nurses by June.
“Appeals are not entertained. Even if you face certain problems, they will still transfer you to the wards. If you have a slipped disc, you can work in the normal places, so you don’t have to carry patients. Daily treatment but still have shifts.
“If you have a personal problem, you have to handle it yourself. That is not management’s problem. This is your personal problem. That is why MOH will say, ‘We have given you the letter early. We have informed you early, so you arrange lah yourself.”
Even when nurses argue during meetings that they are needed by their doctors and patients in the clinics, they are told that the MOH can train someone else to replace them.
Nurses’ Transfers from Specialist Clinics to Wards May Hamper Training
Rekha said people have to change their mentality about the amount of work a nurse has to do when they work in the clinic. Many people assume that nurses don’t do much work in the clinics, have plenty of days off, and do not improve their skills, unlike the impression of doing ward work, which has nurses working all year round.
However, the reality is the opposite, and the transfer of nurses to hospital wards could very much hamper the training of nurses. Rekha, who has worked in a ward and is now serving at a clinic, said that nurses learn from the vast number of cases that come through the clinic doors as not all patients get admitted into the ward.
“You can learn how to perform procedures. If you have a post-basic, definitely you are more advanced, you will have more knowledge, but like you will learn more from the doctor.
“Once you are attached to a doctor it’s easy. It’s better if you ask someone who is a specialist. It’s not like asking your friends when you don’t understand. This is learning from a specialist about a medical procedure, for example. It can add to your knowledge.”
The issue with transfers goes beyond a reduction in learning opportunities. The absence of a fixed schedule in wards encroaches on weekends, posing challenges for studying nurses to maintain a consistent study routine.
Contrary to misconceptions, clinic nurses have fixed working hours and a stable staff. Unlike in wards with passovers, clinic nurses complete all tasks on the same day. They handle patient files and receive instructions from doctors, and the smooth functioning of the clinic relies on their presence.
MAs Replacing Nurses in Specialist Clinics Akin to Men’s ‘Messy’ Handling of a Household
Nurses are crucial in clinics, and reshuffling them without considering their roles can disrupt operations. Rekha expressed concern about potential disorder if medical assistants (MAs) replace nurses, likening it to men’s “messy” handling of a household.
“I don’t know what it will be like. You know if men handle the house, how it will be. Like it will become in the ward, messy or what, like that. Like their organising is not as good,” Rekha said.
Most MAs in government hospitals are men, while most nurses are women. The MOH’s reassignment of nurses from specialist clinics to wards involves replacing nurses in those clinics with MAs.
While Rekha acknowledges MAs can perform clinical duties, she doubts their proficiency compared to nurses. Despite this, she believes MAs will not compromise patient safety, but she anticipates feedback from patients may reveal any shortcomings.
“We will wait for a complaint from the patient. If a patient complains that the clinic is not organised, people cannot do this or that, then they may need us (nurses) to come back.
“If a patient complains, the issue will get addressed faster. If doctors complain, or whatever staff complain, it will be faster. But if a nurse complains, they won’t entertain it.”