THE nursing shortage in Malaysia has become a critical issue, with projections indicating that by 2030, the deficit could reach nearly 60%, as highlighted by Datuk Seri Dr Dzulkefly Ahmad in May 2024.
This shortfall presents serious challenges to the healthcare system, affecting patient care quality, increasing workloads for existing staff and potentially hindering the country’s ability to meet growing healthcare demands.
Despite various efforts to expand the nursing workforce, Malaysia continues to struggle with high resignation rates and inability to retain experienced nurses.
To understand the severity of this crisis, we need to examine the historical context, root causes, impact and potential solutions.
Historical context
Malaysia has been struggling with nursing shortages for decades. In the early 2000s, the government took significant steps to increase the nursing workforce, largely by boosting the number of nursing graduates.
According to a review by T. Barnett (2010), Malaysia more than doubled its nursing workforce over the past decade through an increase in domestic graduates. However, despite these efforts, the problem persists due to rising demands in healthcare services and workforce attrition.
The country currently has a nurse-to-population ratio of only 3.6 per 1,000 people, far below the Organisation for Economic Cooperation and Development (OECD) average of 9.2 per 1,000. This puts Malaysia at a significant disadvantage compared with its regional neighbours, with nursing staff strength estimated to be 2.5 times lower.
The Malaysian Health Ministry has struggled to fill these vacancies, leading to increased workloads for remaining staff, burnout and further resignations. The situation has been exacerbated by a mass exodus of nurses from public healthcare institutions as many leave in search of better opportunities abroad.
Root causes
Several key factors contribute to the ongoing nursing shortage in Malaysia:
Migration for better pay and conditions
One of the primary causes is the migration of nurses to countries that offer better salaries and working conditions. For example, Singapore offers salaries that are nearly double that of Malaysia, along with housing allowances and career advancement opportunities. Similarly, nurses in Saudi Arabia and Dubai earn significantly more, which are often tax-free.
In Malaysia, a nurse with over 10 years of experience earns an average basic salary of RM2,600, with total monthly earnings including allowances reaching around RM3,800. In contrast, nurses in Saudi Arabia with similar experiences earn between RM10,000 and RM16,000 per month tax-free. This stark pay disparity makes migration an attractive option for many nurses seeking financial stability.
Poor working conditions and high workloads
Public hospitals in Malaysia are frequently overcrowded, placing immense pressure on nurses. Many are required to work long hours, including night shifts, weekends and public holidays, without adequate compensation or rest. The shortage of staff further increases the burden on the workforce, leading to high levels of burnout and job dissatisfaction.
Additionally, nurses often lack access to modern medical equipment and adequate support staff. They are frequently expected to handle administrative duties alongside their clinical responsibilities, further increasing their workload.
The recent introduction of a 45-hour work week has not significantly alleviated the pressure on nurses, as understaffing continues to be a major issue.
Limited career growth and professional development
Another significant factor is the lack of career advancement opportunities within Malaysia’s healthcare system. Many nurses feel that promotion prospects are limited, and that specialisation or further education does not lead to substantial salary increases or improved working conditions. This lack of professional growth discourages nurses from remaining in the public sector, prompting them to seek opportunities elsewhere.
Rising resignation rates and job insecurity
The number of nursing vacancies has steadily increased over the past five years, from 2,106 in 2020 to 6,896 in 2023 (OECD).
Many nurses were initially hired on short-term contracts during the Covid-19 pandemic but as the crisis subsided, contract renewals were reduced.
Without permanent positions, these nurses lack job security, structured career progression and benefits such as pensions and housing allowances.
The uncertainty of their employment status led many to resign and seek better opportunities in private hospitals or overseas.
Impact on healthcare
The consequences of Malaysia’s nursing shortage are severe and far-reaching:
Decline in patient-care quality
With fewer nurses available, the quality of patient care is significantly compromised. Overworked nurses have less time to attend to each patient, leading to delays in treatment, increased medical errors and reduced patient satisfaction. In critical care settings, such shortages can result in life-threatening situations.
Increased workload and burnout
As resignations continue, the remaining workforce is forced to take on additional responsibilities. This results in high levels of exhaustion, stress and burnout, which further contribute to resignation rates.
Nurses working overtime without adequate rest experience declining job performance and morale.
Longer waiting times and overcrowding
Staff shortages has led to longer patient waiting times and overcrowded emergency departments. Hospitals struggle to manage admissions efficiently, impacting the overall healthcare delivery system and placing additional strain on medical personnel.
Urgent solutions
To prevent further deterioration of Malaysia’s healthcare system, immediate interventions are necessary:
Increasing salaries and benefits
To retain nurses and reduce migration, the government must offer competitive salaries and additional benefits. Salary adjustments should reflect the rising cost of living, and incentives such as housing allowances, transport subsidies and overtime pay should be provided.
Improving working conditions
Hospitals must invest in better infrastructure, ensure access to modern medical equipment and reduce administrative burdens on nurses. Staffing levels should be optimised to prevent overworking and mandated rest periods should be enforced.
Expanding training and career development opportunities
The government should allocate more resources for nursing education and create clear career advancement pathways. Specialisation opportunities should be incentivised, with higher salaries and improved working conditions to encourage nurses to pursue professional development.
Strengthening retention strategies
The Health Ministry should implement policies that encourage nurses to stay in the public sector, such as offering long-term contracts, structured career progression plans and mentorship programmes. A supportive work environment that prioritises staff well-being is essential for retaining skilled nurses.
Enhancing public-private partnerships
Collaboration between the public and private healthcare sectors is crucial in addressing the nursing shortage.
The private sector can contribute by funding nursing education while public hospitals can focus on structured career pathways to retain experienced nurses.
Malaysia’s nursing shortage is a crisis that demands immediate and sustained action. Rising resignation rates, high vacancies and deteriorating working conditions are putting immense strain on the healthcare system. Without urgent interventions, Malaysia will continue to lose its skilled nursing workforce.
As the foundation of the healthcare system, nurses play a crucial role in ensuring quality patient care. Their well-being directly impacts healthcare outcomes, making it imperative for policymakers, healthcare institutions and the government to implement sustainable solutions.
Addressing this crisis now is not just necessary, it is an urgent responsibility.
Ensuring that Malaysia’s nurses are valued, supported and retained is the only way to secure the future of the nation’s healthcare system before it is too late.
Zainudin Rozali is the dean at the Faculty of Nursing, IJN College, Kuala Lumpur. Comments: [email protected]
