Against a backdrop of a gradually greying population in need of quality nursing care, Malaysia is grappling with a stark slowdown in student enrolment at nursing colleges and a marked increase in nurses moving to foreign lands where wages and work prospects look more appealing, or simply switching careers altogether.

With the World Health Organisation’s (WHO) recommended nurse-to-population ratio of 1:200, Malaysia would need 130,000 nurses in all specialisations by 2020, according to Universiti Tunku Abdul Rahman (UTAR)’s lecturer in nursing, Sheela Devi S.

“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.

The current shortfall will affect the work of doctors. WHO recommends having at least 2.5 nurses assisting one doctor at all times, but in Malaysia, this ratio is around 1:2.10.

To mitigate the problem, nurses from Philippines, Pakistan, Myanmar, India and Albania have been hired. However, though the quota for foreign nurses is filled, the staff shortage still remains.

Better career progression need for nurses

Hence, before Malaysia slips into a nation of training and exporting nurses, and leaving its own crowd competing for nursing care, strategies to promote a culture of retention and employee empowerment must be in place.

One apparent reason for the dwindling numbers in nursing colleges is the new entry requirement of five credits including Mathematics and Science. Apart from reviewing this requirement and increasing the government study (PTPTN) loans, the Health Ministry will chart better progression paths by accrediting one of its nursing colleges to university status to offer nursing degrees.

At the launch of the International Nurses Day 2016 seminar, Health Minister Datuk Seri Dr S. Subramaniam said, “"I think it's only fair that the system recognises the degree holders as we are in the process of increasing the quality of nurses and doctors in the healthcare sector.”

“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,” adds Ng.

Attrition attributed to demanding work and mindset

In a recent study published in the Journal of Human Resources Management and Labour Studies, local nurses cited the “demanding work and long hours” as the reason for their exit from the profession.

Lim Gek Mui, principal of Adventist College of Nursing & Health Sciences (ACNHS) in Penang, believes that better pay and positions are needed to entice nurses who return.

Also, she feels that the mindset plays a decisive role. “Preparation is crucial. Even before they enter nursing and up till they are finished with their studies, we have to tell them the reality,” Lim added.

One nursing student in a public teaching hospital, Hamizah, shared, “I have been rethinking my decision about nursing. So many patients but so few nurses. Too little time for quality care.”

State health director of Kuching, Datuk Dr Zulkifli Jantan, had expressed concern over the nurse-patient ratio. He said that the ratio in the state was currently one nurse to 250 people.

“We would like to achieve a ratio of one nurse to 150 people. Every year we take in 500 to 600 nurses while some leave the service or retire, so the net gain is about 500 new nurses.”

However, despite the discouraging attrition figures, it is reassuring that there are still many modern Florence Nightingales who persist to stay and keep their lamps aglow.

As nurse Kamarul Fitri Bin Mohd Isa puts it, “You need lots of patience if you are planning to be a nurse. If not, please consider other options. Not everybody can be a nurse and you should be proud that you are one!" MIMS

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