Often times, we come across international headlines underlining nursing woes in the workplace. What about the local scene? What are the challenges? How are we coping? Associate Professor Zahrah Saad, Dean of Faculty of Nursing and Midwifery at MAHSA University—alongside members of her team—enlightens MIMS with their thoughts and experiences on pertinent topics relevant to our community. We also speak to several other Malaysian nurses—discussing a day in the life of a nurse, and what it is like to work as a nurse.

Is nursing education getting the support it needs?

Many nursing education institutions have been advocating for nurses to further their education, albeit with difficulty. Professor Zahrah believes that our society does not offer enough support to those aiming to further their studies. When discussing nursing education, she expresses that the World Health Organisation (WHO) and International Council of Nurses (ICN) should be viewed as the benchmark.

“We must upgrade our nurses up to, at least, the level of a Bachelor’s degree. It has been my observation that less than 10% of nurses in Malaysia hold a degree,” remarks Prof Zahrah. In her opinion, “an overload of commitments and lack of support at the workplace are getting in the way of their studies.”

Registered Nurse (RN) at Hospital Seri Manjung, Zaid Abdul Rahman, reveals that the Health Ministry had previously planned on upgrading the nurses’ qualifications from a diploma to degree. However, there has been no news regarding the matter—“just the changes in qualifications of nurses from four to six credits for Ministry of Health colleges.”

He adds, “When students or staff graduate with a degree or Masters, the posts for the qualifications are limited. Fresh graduates will have no job; the staff will stay the same as before—unrecognised. The plans and ideas are not proportionate with the implementations.”

Programme Leader of MAHSA’s nursing department, Ashah Manghanmal, shares that most nurses desire to keep pace with global trends by upgrading themselves. She liaises with many nurses—both junior and senior—who return to the books while they work. “They face a lot of challenges, like family and financial commitments. They pay to study, and at the same time, they have to finance children who want to go to college,” elaborates Manghanmal.

A student in the Masters of nursing programme at MAHSA, Davinder (second from right) received the “Anugerah Pengajar Kategori Kepimpinan” award from the Malaysian Deputy Minister of Health. Photo credit: MAHSA University
A student in the Masters of nursing programme at MAHSA, Davinder (second from right) received the “Anugerah Pengajar Kategori Kepimpinan” award from the Malaysian Deputy Minister of Health. Photo credit: MAHSA University

To combat this major issue, the healthcare community must be revamped. “They have to create a positive environment that allows students to pursue their studies. Upon completion of their degree, appropriate positions should be available or special incentives offered,” emphasises Prof Zahrah. “Bear in mind, to pursue a degree, the students are self-sponsored and do not receive extra allowances.” In addition, nurses will be motivated and encouraged to further their education when they are rewarded with incentives.

Stressing on the flexibility in terms of class schedules, Ashah points out that it is important that “our education system and workplace are flexible and able to support them. It is not like they are neglecting their patients or escaping work. Give them a day off when they have to sit for exams, for instance,” she suggests.

On top of that, Prof Zahrah encourages nurses to specialise. But, the lack of discipline in Malaysia appears to be a drawback. “Furthermore, they are not given an opportunity to obtain sponsorship from government institutions. We prefer nurses to join the clinical field and become clinical nurse specialists – as opposed to joining the management team or becoming educators,” expresses Prof Zahrah. She then relays that there is a reasonable number of nursing educators in Malaysia—but a shortage in clinical departments.

The nursing shortage and increased workload have led many MAHSA graduates to opt for jobs overseas, shares Prof Zahrah. “These days, nurses are having to do double duty and working long shifts. Referring to the world standard set by WHO, there should be 1:200 nurses for the population. In Malaysia, nurses are taking on a larger workload with the ratio of 1:354. This number indicates that a gap is still present.”

From the educators’ regular trips to Saudi Arabia, they find that more than 10% of 3,000 Malaysian nursing graduates hail from MAHSA and have attained good jobs within their nursing system. In line with Zaid’s views, Prof Zahrah affirms that nurses with PhD and Masters qualifications find it difficult to gain advancements in terms of posts and salaries in Malaysia. “At the moment, the government still follows the old scheme,” she elaborates.

Nurses have a bigger role to play in the patient’s care, says Professor Zahrah. Photo credit: MAHSA University
Nurses have a bigger role to play in the patient’s care, says Professor Zahrah. Photo credit: MAHSA University

Large patient load; nurses step up to the plate

Nurses in Malaysia should possess larger roles within the healthcare setting, echoes Prof Zahrah. “Two years ago, we had a state educational visit to La Trobe University in Australia. We found that the nurses there play a bigger role in the specialist units; e.g. pain specialist nurses and wound care specialist nurses.

“They have autonomy,” she continues, “unless it is a very complicated and complex case. This is what we want for our nurses.” However, she believes it is still far off as there is, firstly, a gap to bridge in terms of preparing and upgrading our nurses. She also stresses on the role of policy makers and administration in addressing this subject.

“If they still believe the nurses are the subordinate to doctors, they are clearly mistaken. We must remember that doctors come and go; but nurses are constantly there with the patients. Hence, they can make the decisions. They must have a bigger role to play in patient’s care,” she emphasises.

Prof Zahrah explains that, currently, nurses can follow-up patients in government maternity clinics. They only need to refer complex cases to doctors. For example, nurses with a midwifery background, can conduct normal cases themselves without having to wait for doctors. “This is commonly seen in the UK. A total of 95% of deliveries are normal and can be handled by nurses. We need to improve on this in Malaysia,” expresses Prof Zahrah.

Farah Nasuha Ghazali, a school nurse at International Modern Islamic School (IMAS) agrees that nurses have been taking on the responsibility in government clinics. “However, we should bear in mind that this situation may increase the nursing workload. Thus, some approaches need to be taken to balance the impact of increasing patient care,” she suggests.

A bridging course for nurses to become doctors could prove advantageous for those keen and leads to a more holistic patient management. Photo credit: MAHSA University
A bridging course for nurses to become doctors could prove advantageous for those keen and leads to a more holistic patient management. Photo credit: MAHSA University

From nurses to doctors: No bridging course in Malaysia, yet

Prof Zahrah opines that nurses who are keen on the medical profession should pursue it. “If they are qualified to join the medical training programme, they can start from scratch and pursue the 5-year course. In Malaysia, we do not have an Accreditation of Prior Learning programme (as in some other countries) where they recognise your prior training.”

She believes the opposite is also true: Doctors should have the option to become nurses. For instance, in the Philippines, the lack of vacancies has rendered some medically-trained graduates opting for nursing job opportunities. In Malaysia, a similar topic was also brought to our attention. Director-General of Health Datuk Dr Noor Hisham Abdullah addressed a debate regarding the overload of medical graduates in the country and their potential nursing job prospects.

“My opinion is you can get exemption in some cases where they recognise your medical background and in some related units. However, the depth of learning would be different. They should go for it if they meet the entry qualifications and pass the interview. Furthermore, it can be an advantage for them, considering their medical background. For example, having learnt behavioural sciences, a nurse might be better at communication,” explains Prof Zahrah, reiterating Noor Hisham’s statement, in which doctors cannot become nurses unless they receive proper and adequate training in accordance with the nursing programme.

Both Farah and Zaid consider the skills learnt as a nurse are beneficial (advantageous) in the medical field. This might give nurses who become doctors some insights, which set them apart from regular doctors, explains Farah. Zaid believes this could produce “doctors with a nurse’s heart” to ensure a more holistic (patient) care management.

There has been an increasing shift in the paradigm towards more males immersing in the nursing field. Photo credit: MAHSA University
There has been an increasing shift in the paradigm towards more males immersing in the nursing field. Photo credit: MAHSA University

“Please do not call us ‘male nurses’": The perceived bias and stigma of men in nursing

Recent headlines have highlighted gender bias in nursing globally. However, the local scene has stayed mum on the topic until now. “The public demand has changed over time. In fact, in the Shariah-compliant hospitals, male nurses tend to male patients,” says Prof Zahrah.

Associate Professor Norehan binti Mohd Isa, Head of Midwifery programme at MAHSA affirms that many male nurses have been offered positions suited for them. “For example, some join cardiac catheterisation, while some join outpatient clinics or anaesthesia, operation theatres and male wards. There’re so many options, and lots of things can be done. It is an eye opener.”

There are 3,000 male nurses out of the 120,000 nurses nationwide, states Prof Zahrah. “Globally, we have 19.3 million nurses, according to the World Bank statistics. Out of these, 10% are male nurses. And, they are increasing in numbers. In MAHSA’s current nursing student group, five out of the 15 students are male. In fact, I have quite a number of outstanding male nursing graduates practising in Saudi Arabia and Singapore,” enlightens Prof Zahrah, brimming with pride.

Nevertheless, areas such as Obstetrics and Gynaecology in Malaysia still have some forms of gender bias whereby male nurses are not allowed inside the labour room; or to have physical contact with patients there. “This is not the situation in other countries. Male nurses in Malaysia cannot join the midwifery training. They are not allowed to practise; but they can observe. In female wards, they can work as usual,” elaborates Prof Zahrah.

Farah shares her thoughts stating, “There is a difference, of course. Men entering the nursing profession encounter barriers that limit their choice or preference in a specific area or task.” In her opinion, they are at risk of being labelled and stereotyped.

There should be no gender issue in the nursing career, reckons Zaid. “Whether you are a male or a female, you are still a nurse—playing the same role and working together as one,” he says. “For me, as a nurse who is a man, please do not call us male nurses.” If doctors, engineers and cleaners are not segregated by their gender, Zaid questions, “why should nurses be?” He stresses that the main agenda and focus in nursing should be the patients’ care.

Zaid reveals that he, personally, has experienced gender stigma in the workplace, especially from the patients. He attributes this to the public’s lack of awareness in the shift of the healthcare system. He also elaborates that the nursing field was traditionally a female-dominated profession. However, in this modern day and age, the lines between male and dominated fields have been blurred. “Patients’ unfamiliarity with the situation stems from an inequality in the number of job placements between male and female nurses,” claims Zaid. He explains, “most well-established hospitals in big cities recruit more male staff than hospitals in smaller cities. Due to this imbalance, people in the rural area won’t be so ‘used’ to male nurses’ existence and—also, because of this—the stigma remains.” MIMS

*Editor's note: Please note that after the initial publishing of this article, several changes were made on 14/09/2017 as per MAHSA University's request.

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