I REFER to the Spotlight on healthcare, “Sounding the alarm on shortage of nurses” and the need for 130,000 more qualified nurses by 2020 (New Sunday Times, Jan 1).
It was reported that private institutions of higher learning are not getting the number of nursing students that they used to. Two major reasons were cited: the increase in the entry requirements from Sijil Pelajaran Malaysia from three credits to five and the drop in the National Higher Education Fund loan. Those interviewed felt certain that “in the near future, there will be a problem with the supply of nurses” and that “we must identify the fundamental problems that nurses face today”.
Let’s look at some episodes in the development of nursing from 2008 to date.
In 2008, the number of nurses was about 70,000. There were 17 Health Ministry colleges of nursing, 10 public universities and 54 private colleges.
Together, they produced 6,000 diploma nurses (NST, Nov 9, 2008). Six months later in 2009, the number of private colleges increased to 70, or 16 more in a matter of months. The number of graduates produced doubled. At this time, there were 109 ministry, private and public institutions offering nursing programmes, and among them, 88 offered diploma programmes. By December 2009, there were 82,302 nurses in the country (NST, June 20, 2010). In 2011, Malaysia recorded the highest number of diploma graduates, 8,000 of whom were unemployed.
For many years, nursing education has become a competitive business. The shortage of nurses is being seen as a numbers game.
The fastest way to win the game is to take in as many students as the colleges can possibly take. Any deviation from normal practice, for example, a change in admission criteria, will be seen as an interference in the supply of nurses, causing severe shortage.
The question is, will the desired number fix the shortage but, more importantly, will it add to the improvement of healthcare or the care that nurses have been entrusted to provide?
In response to all of these, the higher education minister, in April 2010, stated that “the mushrooming of private nursing colleges will soon be a thing of the past. Applications to set up new institutions will not be accepted from July”.
He added that institutions of higher learning should concentrate more on degree courses.
In June 2010 (NST, June 26), the Health Ministry announced a temporary freeze on nursing courses by July 1 to cap the number of diploma courses offered by private and public institutions.
In 2010, the Nursing Board Malaysia announced a change in entry requirements into the diploma programme from three SPM credits to five, including credits in General Science and Maths.
The desire “to improve the quality of nursing in this country” is clear. But what the government is not aware of is that degree graduates of public universities, with the exception of Public Service Department sponsored graduates, are not hired by government hospitals.
Some are being hired by private organisations in Singapore to serve the country’s hospitals. The rest are hired by private hospitals in Malaysia on a diploma salary (U29) for two years in preparation for employment in Saudi Arabia.
In other words, Malaysia, through public universities, is preparing degree nurses for other countries, and the private hospitals serve as transit to further their career and enable them to earn a decent salary.
In essence, contrary to what was reported on Jan 1, private colleges are not losing their diploma graduates to Saudi Arabia because, for many years now, the country only accepts degree nurses.
If, by this very act, Malaysia faces a shortage, then it is safe to say that if these degree nurses are not hired as staff nurses, Malaysia will not only face a shortage in the near future but will also suffer from the lack of professional care needed in its healthcare system.
The shortage is in the number of degree nurses working in hospitals and the community, not diploma nurses. Currently, there are more than 100,000 diploma nurses and more than 85 per cent are on a U29 salary scale.
It can be concluded that nursing in Malaysia is a diploma-dominated service and the reason why nursing is acknowledged as a support service.
DR NIK SAFIAH NIK ISMAIL,
Taman Melawati, Kuala Lumpur