International Medical College Head of Nursing Programmes Ng Kok Toh (centre) with students.
Some 130,000 qualified nurses needed by the year 2020.
Universiti Tunku Abdul Rahman (UTAR)’s lecturer in nursing, Sheela Devi S.
The nurse per population ratio is increasing yearly.

KUALA LUMPUR: IN 2005 to 2010, with the mushrooming of nursing schools in the country, concern was expressed over a glut of nurses being churned out in the healthcare sector, with as many as 10,000 students graduating each year.

This prompted the Malaysian Nursing Board to announce new regulations in August 2010 which increased nursing entry requirements to five credits to stem the tide of new nurses.

Ironically, the measure has been so effective that the shrinking number of candidates pursuing the vocation is a very real challenge faced by the industry today.

“Previously, when the requirements to pursue nursing were only three credits, everybody jumped on the bandwagon and we had as many as 10,000 students coming out each year. Once the number of credits was increased from three to five, there was a vast drop in intakes for nursing.

“Now, there are less than 3,000 nurses graduating yearly.

“Many colleges which offered nursing courses closed down, resulting in fewer nurses being trained,” says Ng Kok Toh, head of nursing programmes at International Medical College in Subang Jaya.

Another contributing factor is the drop in National Higher Education Fund Corporation (PTPTN) loans for students.

“In the past, the loans were worth RM60,000 but now Bantuan Rakyat 1Malaysia (BR1M) recipients are awarded a maximum of RM38,000, while those who do not fall under this category receive only about RM20,000 to RM24,000. Students cannot afford to pursue nursing courses which cost more than this.”

Budget cuts by private hospitals to support training and sponsorship of students, as well as increased student interest in other more lucrative courses are other factors she cited.

Because of the low number of nursing candidates, she believes that by 2018, with more new hospitals expected to come on line there will be a severe shortage of nurses.

“The shortage will be so severe that healthcare providers may resort to poaching nurses from each other,” says Ng, who has been in the nursing profession for 35 years.

Compounding the problem is affluent Singapore, which is actively recruiting our girls.

“Those days, they were particular about taking only experienced nurses but now they are willing to recruit anyone who is qualified, even paying off their bonds.

“But one thing they are very particular about is that the girls must be able to speak English.”

She says in the past, nurses headed to Saudi Arabia, but Singapore is emerging as their preferred destination.

MAHSA University Faculty of Nursing and Midwifery dean Professor Zahrah Saad agrees that the promise of a better salary in Singapore is attracting younger nurses there.

“There are about 2,000 nurses working in Saudi Arabia. But because the Saudis are imposing taxes on their income and have cut down on their allowances, many of them are returning to Malaysia.

“Sadly, it is just a stopover before they head to Singapore. Singapore is just waiting for them with open arms, more so if they have working experience in Saudi Arabia.”

She says there is a shortage of nurses with specialisation in the country.

“We are lacking oncology, critical care and paediatric nurses. While a detailed study needs to be done on the shortage, nurses themselves admit they have to do double duty frequently which indicates there is a shortage”.

In a short survey she conducted with nurses, they also complained of having to concentrate on non-nursing functions like documentation which impeded direct patient care.

“The new entry qualifications requiring nursing students to have five credits, including in Maths and Science, is also a stumbling block because rarely do candidates have credits in both subjects.

“They might have a credit in one and a pass in the other,” says Zahrah, who has 45 years of nursing experience under her belt.

Meanwhile, Universiti Tunku Abdul Rahman (UTAR)’s lecturer in nursing, Sheela Devi S, says the ageing baby boomer generation in the country will result in a larger proportion of elderly people.

“This will present an obvious challenge to our healthcare system, leading to the demand for more nurses.

“The demand for nurses is very high — 130,000 qualified nurses by 2020.

“The data provided in the Malaysian Human Resources for Health Country Profiles for 2014 for the number of nurses in the country showed 64,348 in the public sector and 28,333 in the private sector, totalling 92,681 nurses.

“Though the ratio of nurses to population has increased tremendously, it is still considered low than in the Organisation for Economic Cooperation and Development countries.”

“The resolution involves academic-practice partnerships among nursing academic institutions and healthcare providers that can accommodate the capacity to produce well-prepared and ‘practice-ready’ nurses.”

To better facilitate the training of students, UTAR has embarked on a plan to set up a 300-bed specialist training hospital in Kampar, Perak.

The hospital is expected to operate in 2020 as an advanced teaching-learning centre for UTAR’s medical and health science students, in addition to providing affordable medical services to the community.

Addressing the shortage

“IT is certain that in the near future, there will be a problem with the supply of nurses as a result of decreasing enrolments in nursing programmes, says Universiti Tunku Abdul Rahman’s Head of Nursing Sheela Devi S.

“In an effort to look at this issue from a different perspective, we must identify the fundamental problems that nurses face today. Shortage of nurses cannot be tackled only by churning out new graduates. With the constant change in the healthcare system and reorganisation, the aspect of nurses working conditions and career satisfaction are neglected.

“A safe and supportive work environment is important to increase nursing workforce and retain them within the Malaysian healthcare system.”

Ensuring high level of career satisfaction and organisational commitment is essential to minimise nurses’ turnover.

Among other approaches that can be engaged is to change policies on recruitment, training, selection, induction, job design and salary scale.

The support in nursing educational research is needed to build a well-qualified healthcare workforce. It can help to determine the links between education and quality patient care outcomes.

“The ultimate goal is to make significant improvements against the rising tide of nursing workforce shortage and facilitate the continued transformation of our healthcare system,” says Sheela Devi.

Other recommendations are to:

INCREASE PTPTN loan amounts, so more nurses can be trained;

THE requirements for credits in Science and Maths, which are stumbling blocks to recruitment, should be reviewed. Many fail to make the grade with only passes and not credits in Maths;

IMPROVE salary/remuneration and working conditions for nurses;

ESTABLISH better progression routes for diploma holders to pursue degrees; and

REDUCE documentation duties for nurses so that they can concentrate on patient care.