Malaysia’s Nursing Shortage: A Growing Crisis
Malaysia is facing a critical shortage of nurses, a problem that threatens the stability and quality of its public healthcare system. Despite the essential role nurses play in patient care, the profession is struggling to attract and retain talent. The reasons are complex, but at the heart of the issue are inadequate incentives, inflexible working hours, and rising workloads. If left unaddressed, the shortage could reach nearly 60% by 2030, with dire consequences for patient care and the nation’s health infrastructure.
Understanding the Scope: How Bad Is the Shortage?
Recent data from the Ministry of Health (MOH) paints a stark picture. Between 2020 and 2024, 6,919 healthcare workers left the public sector, including 2,141 nurses. In 2023 alone, over 2,400 nurses from both public and private sectors applied to work overseas, lured by better pay and working conditions. The MOH estimates that by the end of 2025, more than 6,000 additional nurses will be needed just to fill existing vacancies and new positions in upgraded facilities.
This exodus is not unique to Malaysia. The World Health Organization (WHO) has warned of a global nursing shortage, with countries like Singapore, Australia, and the Middle East actively recruiting Malaysian nurses for their skills, work ethic, and multilingual abilities. However, the impact is particularly acute in Malaysia’s public sector, where the loss of experienced nurses is compounded by a declining number of new entrants into the profession.
Why Are Nurses Leaving? The Role of Pay, Workload, and Work-Life Balance
At the core of the crisis are issues of pay, workload, and work-life balance. The average starting salary for a nurse in Malaysia’s public sector is around RM1,800 (about USD 380), with new recruits placed under the Employees Provident Fund (EPF) scheme rather than the more attractive civil service pension scheme. Specialist nurses with advanced qualifications receive a post-basic incentive allowance of just RM100—a figure that pales in comparison to the RM3,000 or more offered overseas, or even RM500 in private practice within Asia.
Malayan Nurses Union president Saaidah Athman has been vocal about the inadequacy of these incentives. She notes that the younger generation is unlikely to be attracted to nursing under current conditions, especially when private sector and overseas opportunities offer better pay and more flexible working hours. The workload in public hospitals is also rising, with nurses often required to perform administrative tasks, move patients, and handle logistics in addition to their core nursing duties. This multitasking leads to exhaustion and burnout, making the profession even less appealing.
The 45-Hour Work Week: A Controversial Policy
In 2024, the Public Service Department (JPA) implemented a standardized 45-hour work week for all civil servants, including nurses. Previously, nurses worked 42 hours per week. While the intention was to address workforce shortages and meet rising healthcare demands, the policy has been widely criticized for failing to account for the unique challenges of shift-based clinical work.
Experts and nursing advocates argue that longer hours without corresponding increases in support or compensation only worsen morale and drive more nurses to resign. Senator Dr. RA Lingeshwaran warned that the move is “insensitive and highly risky,” and could lead to further resignations in an already strained system. The Galen Centre for Health and Social Policy echoed these concerns, emphasizing that nurse welfare is essential for delivering safe, high-quality patient care.
Global Comparisons: How Does Malaysia Stack Up?
Globally, countries that prioritize nurse welfare typically maintain workweeks between 36 and 40 hours. For example:
- United Kingdom: Nurses work around 37.5 hours weekly, with strict regulations on overtime and mandatory rest breaks.
- Australia: Standard workweek is 38 hours, with protections against excessive shifts.
- Singapore: Nurses generally have a 40-hour workweek, with flexible scheduling to minimize fatigue.
- United States: While 12-hour shifts are common, total weekly hours usually remain between 36 and 40.
Malaysia’s 45-hour workweek exceeds these standards, raising concerns about burnout, patient safety, and the ability to attract and retain talent. Research consistently shows that extended shifts and long workweeks are linked to higher rates of burnout, errors, and job dissatisfaction among nurses.
The Impact of Burnout: Risks to Nurses and Patients
Burnout is recognized by the WHO as an occupational phenomenon resulting from chronic workplace stress. For nurses, it manifests as emotional exhaustion, cynicism, and reduced personal accomplishment. The consequences are serious: diminished empathy, increased absenteeism, and lower quality of care. Studies have found that nurses working more than 40 hours per week face higher risks of depression, anxiety, and physical injuries.
Patient safety is also at risk. Fatigue impairs cognitive function, increasing the likelihood of errors and accidents. Low nurse-to-patient ratios are associated with higher mortality rates, more complications, and longer hospital stays. In short, overworked nurses cannot provide the level of care that patients need and deserve.
Why Flexible Working Hours and Better Incentives Matter
Research and expert opinion converge on a clear solution: improving pay, offering flexible working hours, and creating supportive work environments are essential to retaining nurses. A 2022 study on employee retention in Malaysia’s service industry found that reward and compensation are the strongest predictors of retention, followed by work-life balance and work environment. When nurses feel valued and fairly compensated, they are more likely to stay in the profession.
Flexible scheduling options—such as self-scheduling, shift-swapping, and part-time positions—help nurses manage their time and reduce burnout. These arrangements are especially important for women, who make up over 90% of Malaysia’s nursing workforce and often juggle professional and family responsibilities. Policies that support work-life balance, such as weekend leave and childcare support, can make a significant difference in job satisfaction and retention.
Lessons from the Region: Singapore’s Angel Scheme
Regional examples offer valuable lessons. In Singapore, the government introduced the Angels Scheme in 2024, providing structured financial incentives to attract and retain nurses in the public sector. Nurses receive payouts of $20,000 to $30,000 every four to six years, with the potential to earn up to $100,000 over 20 years. The scheme also includes non-monetary incentives like flexible work arrangements and career development opportunities. Early results suggest that such holistic approaches can stabilize the workforce and improve healthcare delivery outcomes.
Addressing the Root Causes: Beyond Entry Requirements
In response to the shortage, Malaysia’s Health Ministry has considered relaxing entry requirements for nursing programs. While this may increase the number of new nurses in the short term, experts warn that it risks lowering professional standards and does not address the root causes of attrition. The Malaysian Medical Association (MMA) argues that the focus should be on improving pay, working conditions, and career development opportunities, rather than simply making it easier to enter the profession.
Efforts are also underway to increase the intake of nursing students and lift the moratorium on new private nursing colleges. However, without meaningful improvements in incentives and work-life balance, these measures may not be enough to stem the tide of resignations and outward migration.
Broader Implications: Economic and Social Impact
The nursing shortage is not just a healthcare issue—it has broader economic and social implications. The International Council of Nurses (ICN) has highlighted the link between the well-being of nurses and the stability of national economies. Investing in the nursing workforce is a strategic imperative for Malaysia’s future. Failure to act decisively will compromise patient care, deepen inequality between those who can afford private care and those who rely on overstretched public services, and undermine the nation’s resilience in the face of public health crises.
What Needs to Change?
- Competitive Compensation: Salary scales should reward experience and qualifications, with regular adjustments for inflation and cost of living.
- Flexible Work Arrangements: Policies should allow for self-scheduling, part-time work, and adequate rest periods.
- Supportive Work Environments: Investments in mental health services, professional development, and career progression are essential.
- Strategic Workforce Planning: Recruitment and retention strategies must be tailored to the unique challenges of nursing, including gender diversity and the needs of an aging population.
Collaboration between government agencies, healthcare institutions, and professional associations is crucial for implementing these reforms. The creation of a dedicated Health Services Commission, independent from the broader civil service, has been proposed as a way to develop sector-appropriate policies on work hours, remuneration, and career pathways.
In Summary
- Malaysia faces a critical nursing shortage, with projections of a 60% shortfall by 2030 if current trends continue.
- Poor pay, inflexible working hours, and rising workloads are driving nurses to leave for better opportunities abroad and in the private sector.
- The recent move to a 45-hour workweek has been widely criticized for exacerbating burnout and attrition.
- Global best practices suggest that flexible working hours, competitive compensation, and supportive work environments are key to retaining nurses.
- Regional examples, such as Singapore’s Angels Scheme, demonstrate the effectiveness of holistic retention strategies.
- Addressing the shortage requires systemic reforms, including better incentives, flexible scheduling, and strategic workforce planning.
- Investing in nurses is essential for the health, resilience, and economic stability of Malaysia.
