Malaysia's Nursing Shortage Drives Calls for Better Pay and Flexible Hours

Low Pay and Heavy Workloads Put Public Nursing Under Pressure

Malaysia's public healthcare system faces a projected nursing shortfall of nearly 60% by 2030 if current trends continue, as low pay, rigid working hours and heavy workloads make it harder to recruit and retain staff. Between 2020 and 2024, 2,141 nurses were among 6,919 healthcare workers who left the Health Ministry for the private sector.

As of July 12, 2025, the Malayan Nurses Union and independent health advocates are calling for better incentives and more flexible schedules to address a shortage that threatens the quality and sustainability of care for millions of people. Hospitals and clinics struggling to fill vacancies must also manage rising patient numbers with fewer staff.

The financial pressures begin at recruitment. A nurse entering Malaysia's public sector earns an average starting salary of around RM1,800, about US$380. For a nurse with a diploma appointed at grade U29, the starting salary is RM1,797. Specialist nurses with advanced qualifications receive a post-basic incentive allowance of just RM100.

New recruits also enter the Employees Provident Fund (EPF) scheme rather than the more generous civil service pension. The EPF is a retirement savings arrangement, so the choice between these benefits affects how nurses prepare financially for life after work.

Pay is only part of the problem. Nurses also face administrative duties, inflexible schedules and limited opportunities for career advancement. The pressure to keep services running can leave little room for family responsibilities, further education or recovery between demanding shifts.

Why Nurses Are Choosing Other Employers

Saaidah Athman, president of the Malayan Nurses Union, says public sector conditions are failing to attract and retain young talent. Many new graduates prefer private hospitals or opportunities abroad, where pay and the balance between work and personal life are more appealing.

Singapore, Australia and the United Kingdom offer Malaysian nurses the chance to earn several times their local salaries, often with better benefits and less administrative work. Private sector employment also offers higher pay and, in many cases, more flexible working hours.

The 2,141 nurses who left the Health Ministry for private employment between 2020 and 2024 accounted for about 31% of the 6,919 healthcare workers recorded as making that move. The figures show how much nursing contributed to the ministry's loss of staff during that period.

Experienced nurses take practical knowledge and continuity of care with them when they leave. Replacing a vacant position requires more than recruiting someone new: the incoming nurse must learn the workplace, its routines and the needs of the patients it serves.

The Pressure Behind the 45-Hour Working Week

Public hospital nurses are responsible for patient care alongside paperwork, inventory management and other logistical duties. These tasks compete for time during shifts, adding to exhaustion and burnout as patient numbers increase and staffing levels fall.

The recent shift to a working week of 45 hours was intended to standardize working hours. In an already strained healthcare system, however, it has increased pressure on staff, prompting calls for greater flexibility.

Senator Dr RA Lingeshwaran warned that continuing the schedule could accelerate resignations. He criticized the Public Service Department's handling of working hours:

Continuing the 45-hour work week in an already strained healthcare system will lead to more resignations. The Public Service Department's insensitivity and rigidity are making matters worse.

For nurses, the concern is the combination of hours, workload and control over their schedules. Rigid arrangements and mandatory overtime make it difficult to meet family commitments or pursue further education while continuing to work in public healthcare.

Training Is Struggling to Keep Pace

Malaysia is also facing a decline in the number of institutions offering nursing courses. With fewer colleges providing training, the pipeline of qualified nurses entering the workforce is shrinking just as hospitals and clinics need more staff.

Health Minister Datuk Seri Dr Dzulkefly Ahmad has acknowledged the problem. Efforts to increase the number of trainees to 1,000 have still been insufficient to meet demand.

A smaller training pipeline makes recruitment harder even when employers have vacancies to fill. Training new nurses takes time, while public hospitals must continue providing care and replacing staff who move to other employers.

An aging population and rising rates of chronic disease are increasing the need for skilled nursing care. Chronic diseases are conditions that require care over an extended period, so patients may need repeated appointments, monitoring and support rather than a single visit.

The main dates and workforce figures frame the challenge:

• 2020 to 2024: 6,919 healthcare workers left the Health Ministry for the private sector, including 2,141 nurses.
• July 12, 2025: Calls for better incentives, flexible hours and expanded training form part of the response to the public sector shortage.
• 2030: The nursing shortfall is projected to reach nearly 60% if current trends persist.

A Large Gap in Specialist Incentives

Malaysia's RM100 post-basic incentive allowance is another concern for retaining nurses with advanced qualifications. This allowance recognizes additional training undertaken after a nurse's basic qualification, including preparation for specialist work.

Comparable incentives in countries such as Singapore or Australia can reach RM3,000 or more. Against Malaysia's RM100, that is a difference of at least 30 times, giving nurses a strong financial reason to consider taking their skills abroad.

Dr Sean Thum, an independent health advocate, argues that public healthcare needs more competitive remuneration to retain staff. He links nurses' decisions to leave with the value employers place on their skills and commitment:

If we want to keep our best nurses in the public sector, we need to offer salaries and benefits that reflect their skills and dedication. Otherwise, we will continue to lose them to other countries.

Better starting salaries would address recruitment, while stronger specialist incentives and clear routes to promotion would support retention. Both matter because the public sector needs new graduates as well as experienced nurses who can take on more demanding clinical responsibilities.

What Fewer Nurses Mean for Patients

Patients feel the staffing shortage through the amount of time nurses can spend with them. When fewer nurses are on duty, each must care for more people, increasing the risk of errors and reducing the time available for individual attention.

Studies have linked nurse-to-patient ratios with infection rates, recovery times and patient satisfaction. The ratio describes how many patients a nurse is responsible for, making it a practical measure of how thinly staff are spread across a ward or service.

Paperwork and inventory duties add another demand on the same limited time. Reducing these tasks would allow nurses to focus more closely on clinical care, even as wider recruitment and training measures work toward increasing staff numbers.

The World Health Organization recommends a minimum nurse-to-population ratio to support safe and effective care. Malaysia risks falling below that threshold as demand grows. A persistent shortage could weaken progress in healthcare delivery and make it harder for the public system to meet patients' needs over the longer term.

Rural Communities Face Added Strain

Rural hospitals and clinics are often among the facilities hardest hit by staffing shortages. Limited resources and fewer incentives to attract nurses make it difficult to recruit enough staff to provide even basic services.

For people in rural and underserved communities, the consequences can include longer waits, reduced access to care and poorer health outcomes. Vulnerable patients face particular difficulties when local services are already stretched.

Population aging and the growing burden of chronic disease add to these pressures. More people need skilled care over time, increasing the importance of a nursing workforce that can provide dependable services in places with fewer resources.

Retention measures therefore need to address where nurses work as well as how many enter the profession. Better conditions in public healthcare are especially consequential for facilities that already struggle to attract staff.

The Changes Advocates Want

Nursing representatives and health advocates are calling for a coordinated response covering pay, working conditions, training and career development. Their recommendations address both the immediate reasons nurses leave and the shortage of replacements entering the workforce.

The proposed measures include:

• Raise starting salaries and specialist allowances to make public employment more competitive with private hospitals and overseas opportunities.
• Introduce flexible working hours, including options to work part time or choose shift schedules that better accommodate personal responsibilities.
• Invest in more nursing colleges and scholarships to increase the number of qualified graduates.
• Reduce administrative and other duties outside clinical care so nurses can spend more time with patients.
• Provide clearer routes to promotion, professional development and specialization.

The Health Ministry has pledged to review the incentive structure and explore ways to make nursing more attractive. Some measures are under discussion, but no implementation date has been given. Putting them into effect will require political commitment and sustained investment.

Recruitment and retention are connected. More training places can bring additional nurses into the workforce, while better employment conditions can help keep those graduates, and their more experienced colleagues, in public service.

What Malaysia Could Adapt from Abroad

The United Kingdom has introduced return to practice programs for former nurses. These programs help people who have left nursing prepare to resume professional work, creating another route into the workforce alongside training new graduates.

Australia offers incentives for rural placements and flexible contracts. Such arrangements respond to two problems also facing Malaysia: attracting staff to areas with fewer resources and making nursing compatible with responsibilities outside work.

Many developed countries allow nurses to choose part time work or shift arrangements that offer a better balance between employment and personal life. Malaysia could adapt these approaches to local needs, alongside changes to salaries and specialist allowances.

Professional associations, unions and educational institutions would need to work with policymakers on those changes. Involving nurses in decisions would help ensure that reforms address the pressures they face at work, from excessive paperwork to scheduling difficulties and limited career opportunities.

Malaysia's challenge is to expand the supply of nurses while making public healthcare a place where they can build lasting careers. The figures on departures, starting pay and specialist incentives show why training alone will be insufficient without changes to working conditions.

Key Points

• Malaysia faces a projected nursing shortfall of nearly 60% by 2030 if current trends continue.
• Between 2020 and 2024, 2,141 nurses were among 6,919 healthcare workers who left the Health Ministry for private employment.
• A diploma nurse at grade U29 starts at RM1,797, while the specialist post-basic incentive allowance is RM100.
• Heavy workloads, rigid schedules and the working week of 45 hours are central concerns for retaining staff.
• Fewer nursing course providers and insufficient trainee numbers are limiting the supply of new nurses.
• Advocates want better pay, flexible hours, expanded education, less administrative work and clearer career routes.
• The Health Ministry has pledged an incentive review, while rural services and patient care remain under pressure.