KUALA LUMPUR, Jan 29 — Nurses in the Ministry of Health (MOH) are compelled to specialise in fields aligned with the MOH’s vision, while options outside this scope are denied, a nurse complained.
Ariana (pseudonym), a nurse at a government hospital in the Klang Valley, revealed that nurses assigned to hospital wards are pressured to specialise or pursue a post-basic qualification related to their ward duties.
For instance, those working in the intensive care unit (ICU) are expected to undertake a post-basic programme that enhances their knowledge in ICU practices. Similarly, nurses in public health are encouraged to pursue post-basic training in midwifery and public health.
“The [issue arises] when some nurses who want to specialise [in a] different [field] than what is prescribed. As you know, everyone wants to gain knowledge in different areas of expertise for the future.
“Their (MOH’s) directives and the way they tell us sometimes [come across] as threatening. If we refuse to take the [specified] post-basic requirements, we will be transferred or given a negative view from the management.
“That is wrong. This pressure on nurses needs to be minimised,” Ariana said in a written response to CodeBlue.
According to Ariana, the public health nursing field operates under a rigid hierarchy, where superiors dictate nurses’ roles, limitations, and promotions. Superiors oversee their staff and decide which areas nurses are permitted to pursue for their post-basic or specialisation.
“Seniority takes precedence in nursing. The hierarchy controls who can [or] who cannot [get promoted]. We cannot choose what we love to study. They will manage that for you. While it can be beneficial to some extent, not giving a chance for us to choose can also be cruel.”
Ariana said nurses who aspire for career advancement must specialise or have a post-basic qualification as this will prioritise them over other nurses.
“If you want promotion, rise up the ranks, those with post-basic are preferred over those without. To be promoted or [considered for promotion] in the future, of course, are those with expertise compared [to those] who do not have expertise.”
However, Ariana said additional qualifications alone do not solely determine promotions. Favouritism, Ariana claimed, plays a role in decision-making.
“Those favoured by the higher-ups are promoted first. There is a guideline for promotion, but, well, this is Malaysia, and personal relationships tend to come into play, isn’t it?”
While ethics and guidelines exist for promotions, Ariana said that “today’s nurses” find it hard to accept the terms laid down by the MOH, as they have their “own way of thinking.”
“What they propose is mostly from what they see and know from experience, but for new nurses, it seems like [undue] pressure. The issue does not lie with superiors, management, or seniority, but the basic thinking of a nurse to increase their own proactivity and become a recognised and qualified nurse.”
Apply for Transfer to Specialise in a Different Field
Providing further insights into the limited choices in specialisation is Rekha (pseudonym), a clinic nurse serving in a Selangor government hospital.
According to Rekha, nurses can choose their specialisation if they are already working in the desired field. However, if a nurse wishes to specialise in a different field, they must apply for a transfer.
“The inability to choose your specialisation isn’t a strict rule. It depends on the management of the government health facility. If you work in nephrology but want to study oncology, the department loses out because they lose a staff member while you’re away. When you return, you will go to the oncology department.
“The nephrology department can’t send someone else to specialise in the field because they’ve used up their quota so it’s not fair to the other staff; the department is short-staffed, and when you return, you can’t stay in that ward. You end up being like a burden to other people,” Rekha explained in an interview with CodeBlue.
Rekha suggested that if a nurse wants to specialise in a different department, they should request a transfer early. However, transferring is challenging, as it requires the nurse to start from the bottom in the new department before they can become familiar with its operations, treatments, and skills.
“If you want to study, you can pursue post-basic, meaning advanced studies in that area. It means you must know that thing before you continue your studies,” Rekha said.
“The transfer is really not easy to get,” Rekha added. While nurses may resist initially, they must eventually accept the constraints on choosing their path.
When it comes to promotion, Rekha said that nurses are promoted based on time spent in service, not specialisation. Specialisation is about self-improvement rather than a tool for climbing the hospital ladder, Rekha said.
“In reality, it’s hard to get promotions. You may have a degree, but obtaining a promotion is time-based and influenced by politics. If you want to request a transfer, it involves politics and can be fast, but we are not allowed to use political connections. If you do, action will be taken against you. But if you don’t, it will be late. Very late.”
“One of my friends wanted to go back because her mother was sick. Until her mother passed away, she couldn’t go back. It’s the norm.
“We prioritise the welfare of patients but neglect our own families. It’s a dilemma – ‘You are our mother, but you distraught us,’ say their children.”
