Nurses’ Safety Crucial To Ensuring Patient Care
When Matron Asiah Suppaat recalls the day she was slapped by a patient, she does so with surprising calmness and humour.
The 71-year-old former nurse, who retired in 2015, was serving at a public hospital’s psychiatric ward in Kuala Terengganu when the unexpected incident occurred.Despite being accustomed to dealing with patients with mental health conditions, the sudden attack still caught her off guard.
“When I asked, ‘Why did you slap me?’, the patient simply replied, ‘Because you’re too pretty.’ So how could I even stay angry when she was complimenting me?” Asiah said with a laugh during a Google Meet interview with Bernama.
Yet, she admitted that her experience was mild compared to what some of her colleagues had endured.
In another incident, a patient suddenly grabbed a nurse’s necklace and attempted to strangle her with it.
“I had to put my hand between the necklace and my colleague’s neck to stop her from choking,” she recalled, adding that the nurses had to calmly persuade the patient to release her grip.
While physical aggression is often associated with psychiatric wards, violence against nurses is by no means confined to such settings.For many nurses, verbal abuse, intimidation and occasional physical assaults have become an unfortunate part of daily working life, coming not only from patients but also from family members and visitors.
A 2022 study titled Workplace Violence Among Nurses in Penang Hospital: Prevalence and Risk Factors by Universiti Kebangsaan Malaysia (UKM) researcher Dr Halim Ismail and his team found that 43.9 percent of nurses surveyed had experienced workplace abuse.
Of the reported incidents, 82.2 percent involved verbal abuse, while 8.9 percent were psychological in nature and 8.3 percent physical assaults.The study also highlighted that workplace violence against nurses is a global issue, with prevalence rates reaching 51.3 percent in Asia, 61.3 percent in the Middle East and 38.8 percent in Europe.
However, health authorities, nursing associations and researchers believe the actual figures may be significantly higher due to widespread underreporting.
“In reality, it is difficult to obtain the true data because many nurses do not report these incidents. It is underreported,” said Malaysian Nurses Association (MNA) president and former nurse Safiah Sutan Taharudin.
Along with the rest of the world, Malaysia celebrates International Nurses Day this week. While discussions on the profession have largely focused on low pay and long working hours, less attention, however, has been given to workplace safety despite its profound impact on nurses’ wellbeing and the work environment.
NOT BUSINESS AS USUAL
The theme for this year’s International Nurses Day celebration, ‘Our Nurses. Our Future. Empowered Nurses Save Lives’, places strong emphasis on the wellbeing and empowerment of nurses as a cornerstone of quality healthcare.
In conjunction with the May 12 celebration, Universiti Putra Malaysia nursing lecturer Dr. Azura Abdul Halain said empowering nurses goes beyond professional recognition and must include safeguarding their mental and emotional wellbeing.
“Nurses also face multiple challenges of high workload, workforce shortages, and prolonged emotional stress. Therefore, nurse empowerment is not just about the individual, but also about the systems that support them – a safe work environment, understanding leadership, and policies that look after their well-being,” she said in a statement.
While all healthcare workers face various forms of violence at the workplace, nurses often bear the brunt of it as they form the largest workforce in the healthcare sector and spend the most time interacting with patients and their families.
Research worldwide has found that most of the violent incidents affecting nurses occur in emergency departments and psychiatric wards, a trend similarly observed in Malaysia.
“My staff have been punched, their spectacles broken, cough medicine poured on their head – we’ve had our share of bad experiences,” said Datuk Dr.Alzamani Mohammad Idrose, head of the Emergency Department at Kuala Lumpur Hospital (HKL). He spoke to Bernama after delivering the keynote address at the National Nursing Conference in Putrajaya.
Bernama also spoke to several nurses attending the conference, many of whom admitted to either experiencing or witnessing verbal and physical aggression at the workplace. Yet, most appeared to regard such incidents as part and parcel of the profession, often brushing them aside unless the abuse escalated into physical violence.
Safiah from MNA acknowledged that such reactions are common among nurses, many of whom have been conditioned to maintain a cheerful facade and professionalism at all times.
“We go through all kinds of emotions, but we still have to hide them. We were trained never to show anger in front of patients no matter what happens — even if your heart is breaking, you must still smile,” she said with a light laugh.
She added that while counselling services are available to alleviate healthcare workers’ mental stress, some nurses prefer not to report verbal attacks or seek psychological support for fear of being perceived as weak.
VICIOUS CIRCLE
Healthcare experts largely attribute violent outbursts against nurses to long waiting times and overcrowding at emergency departments, where most aggressive incidents tend to occur, compounded by poor public understanding of how emergency care operates.
Occupational and public health specialist Prof Dr. Victor Hoe Abdullah said these are areas of "high tension, high needs."
“(Patients and their family members) are coming in an alert state, and each of them that comes into ED or emergency department thinks that their issue or their problem that they face are more important than the next person, are more urgent than the next person. And that is where the violence (happens) because if you're a patient, if you are relatives of a patient and you bring, let's say your kids … you want them to be treated immediately,” he told Bernama.
Dr Hoe, who also heads the Department of Social and Preventive Medicine at University Malaya, said conflicts often arise when members of the public fail to understand the triage system practised in emergency departments.Under the system, doctors and nurses are required to prioritise patients with the most critical conditions first, including those suffering from chest pain, breathing difficulties, serious falls among the elderly, dengue complications and high fevers in infants and young children.
Former HKL emergency department matron Noorliana Noordin agreed that overcrowding becomes worse when patients with non-critical conditions seek treatment at emergency units instead of visiting health clinics.
This, she said, contributes to longer waiting times and rising frustration among patients and family members.
“We advise them that minor illnesses, such as mild fever, can be treated at clinics, but sometimes people become upset. Once they come to the HKL emergency department, they expect to receive treatment immediately,” she said.
HKL’s emergency department is currently the busiest in the country, handling between 500 and 700 cases daily, according to Dr.Alzamani.
The nationwide nursing shortage has only intensified the pressure faced by healthcare workers.
According to the World Health Organisation (WHO), a ratio of six nurses per 1,000 people is needed to achieve universal healthcare coverage. However, the latest World Bank data from 2023 showed Malaysia had only 4.1 nurses per 1,000 population.
The shortage, which worsened following the COVID-19 pandemic, has significantly increased nurses’ physical and emotional workload while job dissatisfaction continues to grow amid relatively low wages.
Although nurses in Malaysia officially work 42 hours a week, many are forced to put in overtime to compensate for manpower shortages.Two years ago, Health Minister Datuk Seri Dr Dzulkefly Ahmad told Parliament that Malaysia could face a 60 percent nursing shortfall by 2030 if the issue remains unresolved.
The mounting pressures have prompted many nurses to leave the profession altogether or seek better opportunities in the private sector and overseas, further deepening the staffing crisis.
Dr.Alzamani described the situation at HKL’s emergency department as a “vicious circle,” revealing that the department is currently operating at only about 60 percent efficiency due to workforce constraints.
He expressed hope that the arrival of newly graduated nurses in July would help ease the burden on existing staff and improve morale, although he acknowledged the numbers would still fall short of what is needed.
INVESTING IN MALAYSIA’S HEALTH
Malaysia’s nursing shortage has become increasingly alarming, with thousands of trained nurses leaving the country each year in search of better opportunities abroad.
According to the Health Ministry, a total of 3,021 nurses left Malaysia to work overseas in 2024, based on figures from the Malaysian Nursing Board.
Of the total, 2,554 nurses or 84.5 percent came from the private sector, while 353 nurses (11.7 percent) were from Health Ministry institutions and another 114 (3.8 percent) from other public healthcare providers.
Healthcare experts and nursing leaders interviewed by Bernama agreed that improving salaries, allowances and benefits remains one of the most effective ways to retain skilled nursing talent in the country.
“In Malaysia, a nurse’s starting salary is around RM3,000. In Singapore, it can reach about S$3,500, which is roughly three times higher. In Arab countries, it is also similar, salaries can range between RM10,000 and RM12,000,” said Safiah.
Although Malaysia may not be able to fully match the salaries offered overseas, experts believe the country can still create more attractive employment packages to encourage nurses to remain in the local healthcare system.
Among the proposals raised is increasing allowances for nurses with sub-specialty qualifications so that they are more comparable to those offered in the private sector.
According to nursing sources, nurses in the public healthcare sector currently receive a monthly sub-specialty allowance of only RM100, compared to between RM300 and RM700 offered by private hospitals depending on the institution.
Dr. Alzamani described nurses as “the backbone of the national healthcare system,” stressing that their contributions are often overlooked and undervalued.
“A lot of times (nurses) are … not seen as professionals, but merely as workers performing menial jobs. The public tend to look at them lower than their(true) value,” he said.
“But (nurses) are (highly) trained … with medical, physiological understanding, calculating the medications, giving the fluids, monitoring and executing patient care well. They deserve (far greater recognition),” he added.
