Creating safer workplaces to retain Malaysia's nurses

LETTERS: It is no secret that Malaysia's healthcare sector has faced increasingly serious talent-retention challenges, especially in recent years, both in the private and public sectors. On Aug 15, the Health Minister said that 10,557 of the 73,281 nurse positions in health facilities were vacant. At the same time, the Health Ministry's nursing workforce fell by about 1,200 between 2022 and 2024, from 71,434 to 70,234. Malaysian nurses are also being recruited for overseas positions, particularly in Singapore and the Gulf, while countries such as the United Kingdom and Australia provide attractive pathways for internationally trained nurses, offering substantially higher remuneration and, in some cases, stronger benefits, work-life balance, and career opportunities. In my four decades of practice, having worked alongside hundreds of nurses and doctors, I can say with great confidence that a majority of Malaysian healthcare professionals are not in this profession simply for the money. Many, if not most, are driven by a deep sense of duty, a desire to serve their country, and a genuine passion for caring for others. With this in mind, I believe that retaining our nurses is crucial, and one of the most important things we can do to retain them is to ensure the well-being of nurses so that they feel safe, supported, and valued at their places of work in private or public hospitals. Building a formal nurses-safety framework Malaysia has spent considerable effort building a formal patient-safety framework, the Malaysian Patient Safety Goals (MPSG), to address key patient-safety priorities. But healthcare staff safety, especially that of nurses, has not, from my observation, enjoyed the same degree of institutionalisation or visibility as patient safety. Nurses face daily exposure to infectious diseases and, in a lot of cases, physical and verbal abuse, harassment, and bullying from colleagues, patients, and patients' families. While hospitals have a responsibility to provide a safe working environment, patients, their families and the wider public also have a role to play in treating nurses with respect. Nurses are trained healthcare professionals. They should not be expected to perform every non-clinical task simply because they are available, nor should they be subjected to shouting, verbal abuse, or intimidation. Such incidents are far too common in Malaysia. When nurses are repeatedly exposed to stress, hostility, and abuse, it can take a toll on their mental and emotional well-being, and ultimately, affect the quality of the care they provide. This is true for any profession, in fact. Everyone deserves to be treated with dignity in performing their duties. The cost of retention and turnover A longstanding issue that needs greater attention in nurse retention is whether Malaysians fully recognise the true cost of healthcare. Yes, medicines, equipment, hospital buildings and medical technology contribute to healthcare costs, and the increase of it, but we must also factor in the people who deliver care. Nurses make up the largest group of healthcare professionals in Malaysia, with 141,255 nurses recorded across the public and private sectors in 2024, an increase of 2.3 per cent from the previous year. In the race to "reduce healthcare costs", we cannot do so by undervaluing the people who deliver care. If we do not adequately remunerate and retain nurses, our healthcare system will inevitably struggle to maintain the quality and standard of care that Malaysians deserve. Nurse turnover can be costly. While Malaysia-specific figures are not currently available, US data can provide a helpful benchmark. A 2026 US report covering 527 hospitals estimated that replacing one bedside registered nurse costs about USD 60,090, with the average hospital spending between USD 4.2 million and USD 6.2 million a year on nurse turnover. The report also found that every 1 per cent increase or decrease in nurse turnover could cost or save a hospital about USD 295,000 annually. Another US study found that hospitals spent about USD16,736 per nurse each year on turnover linked to burnout, compared with USD 11,592 at hospitals that introduced programmes to reduce burnout. Nurses in hospitals with such programmes also stayed for about 3.5 years, compared with 2.9 years without them, suggesting that reducing burnout could lower turnover-related costs by about 30%. The takeaway from this is not that Malaysia will incur the same costs as the United States. It is that staff turnover has a substantial economic cost. Nurses wellbeing and safety programmes A well-designed staff-wellbeing programme could potentially be a worthwhile investment when compared with the costs associated with having to repeatedly recruit and onboard. This raises the question of what can be done to safeguard nurses' workplace safety and mental and emotional well-being while making employment in Malaysian hospitals a sustainable career. The Health Ministry's own Nursing Strategic Plan 2026–2036, launched on June 9, recognises much of this. It sets out 17 strategies and 44 initiatives, and names burnout and the migration of skilled staff among the challenges it is designed to confront. The Health Minister was right to say the ministry can no longer rely on cosmetic approaches or temporary fixes. The next step now is implementation. Since the plan identifies burnout as a core challenge, what is needed is effective commitments on workplace-violence reporting, mental-health support and roster design. Confidential mental-health support that nurses will actually use needs to be in place. That said, support also must be accessible and designed around the reality of what nurses are facing in their workplace, rather than as an administrative programme for staff. In addition, the Healthy Ministry may consider whether existing systems can be strengthened to provide staff-safety reporting with greater national visibility and standardisation, while ensuring that reporting is confidential and non-punitive for victims. Some private hospitals are already giving nurses more say in how they are rostered. This is an approach that deserves wider consideration because having greater control and predictability over work schedules can help reduce fatigue and stress and give nurses a more sustainable work-life balance. The World Health Organisation's Global Patient Safety Action Plan 2021–2030 recognises that patient safety depends in part on creating safe working environments for health workers. Occupational safety and healthcare organisations internationally have similarly emphasised the importance of protecting healthcare workers from violence, burnout and other workplace risks. At some point, every one of us will be a patient, and we will depend on nurses to provide safe, professional and compassionate care when we are most vulnerable. Protecting nurses and their wellbeing is therefore also about protecting the quality and safety of care we can all expect to receive. As such, I urge all Malaysian hospitals to take the wellbeing and safety of nurses seriously, and for all Malaysians to treat nurses with dignity. We have a responsibility to protect and support our nurses, especially those who choose to stay and serve despite the "greener grass" abroad. Datuk Dr Kuljit Singh President of the Association of Private Hospitals Malaysia (APHM) The views expressed in this article are the author's own and do not necessarily reflect those of the New Straits Times