When nurses are overworked, unheard or afraid to speak up, safety, dignity, learning and retention all suffer. Fernando Zhiminaicela / Pixabay

By External Source
KUALA LUMPUR, Oct 1 2026 (IPS)

Nurses are often called the backbone of the health system. We praise their compassion, commitment and resilience. On Nurses’ Day we thank them. During emergencies and crises, we call them heroes. But there is a harder question Malaysia, like most countries around the world, needs to ask more seriously: what happens when the people who care for everyone else are not safe, supported or respected at work?

This question is not only about patient safety. It is first about nurses’ own rights, dignity and wellbeing. A safe and healthy working environment is recognised by the ILO as a fundamental principle and right at work.

Nurses deserve safe workplaces not only because patients depend on them, but because no worker should be expected to absorb abuse, bullying or harassment as part of the job.

The health and care sector is highly feminised, with women making up around 70% of the global workforce. This is even more pronounced in nursing, where women account for 85% of the workforce, according to WHO’s 2025 State of the World’s Nursing report. This means workplace violence against nurses is not only an occupational safety concern. It is also a gendered issue.

As a female-dominated profession, nursing is often positioned lower in hierarchical health systems, where authority is unevenly distributed. Gendered assumptions - such as women being “naturally caring,” patient or obedient - can normalise mistreatment, silence complaints and discourage reporting

As a female-dominated profession, nursing is often positioned lower in hierarchical health systems, where authority is unevenly distributed. Gendered assumptions – such as women being “naturally caring,” patient or obedient – can normalise mistreatment, silence complaints and discourage reporting.

Because nurses are also frontline caregivers, they are exposed to aggression from patients, families and colleagues. Gender therefore shapes both how violence is experienced and how seriously it is taken.

For many nurses and frontline health workers, workplace violence extends beyond physical assault. It involves verbal abuse, bullying, humiliation, intimidation, sexual harassment, disrespectful treatment, harsh hierarchy and psychological pressure.

These forms of violence may not always leave visible injuries. But they can leave deep marks on confidence, mental health, family life, professional motivation and the decision to stay in the nursing profession.

Studies from several Malaysian healthcare settings show that workplace violence is more common than we may think across hospitals, emergency departments and primary healthcare facilities.

A study conducted among 90 nurses in Kuala Lumpur found that more than 90% had experienced verbal abuse. Similarly, a survey of 838 primary healthcare workers in Selangor reported that 68.5% had experienced workplace violence, with verbal abuse the most common form and nurses the most affected professional group. In Melaka, research among 455 female registered nurses found that 51.2% had experienced sexual harassment, most commonly verbal, but also visual, psychological, non-verbal and physical. Nearly three-quarters of those affected reported psychological effects.

Behind each of these figures is a person trying to do their job while staying calm, professional and compassionate. A nurse explaining treatment to an anxious family. A frontline worker managing a crowded clinic. A junior staff member afraid to speak up. A mother finishing a night shift and going home to another set of care responsibilities. These numbers should not be read as statistics alone. Rather, they are warning signs of workplace systems and cultures and the need for stronger prevention, reporting and response mechanisms.

Malaysia already has important foundations in place. Existing occupational safety and health obligations, together with MOH guidance on workplace violence, provide a strong basis for prevention and response. The challenge now is to build on these measures and ensure they are visible, trusted and consistently implemented in hospitals, clinics and frontline services.

This concern was clearly articulated in a focus group discussion with nurses and frontline health workers in Sabah. Participants described workplace violence and bullying as part of a wider picture of pressure: too many patients, too few staff, missed breaks, unpaid or poorly compensated overtime, limited recognition, burnout and difficulty balancing shift work with family responsibilities.

One district clinic was described as seeing around 600 to 800 patients a day, with only a small number of frontline staff managing the flow. In hospital wards, nurses described caring for 10 to 20 patients and sometimes up to 25 patients alone. Staff often missed lunch breaks, stayed beyond official hours to complete patient care and documentation and sometimes worked while sick because no one else was available to replace them. Heavy documentation and uneven digital systems added another layer of pressure.

In the same Sabah discussion, one participant described bullying as something that particularly affects newcomers and junior staff. Another explained that many young workers feel they have little choice but to endure difficult treatment because they need the job. As one participant put it, many feel they must “just bear with it” because speaking up can feel risky.

The human cost also reaches beyond the workplace. One nurse described leaving for work while her children were still sleeping and returning home when they were already asleep again. This is not only a personal story. It is a policy issue. When nurses are overworked, unheard or afraid to speak up, safety, dignity, learning and retention all suffer.

This is why workplace violence must be discussed together with Malaysia’s nursing shortages, retention concerns and migration of nurses. Nurses do not leave only because of salary, although salary and fair compensation matter greatly. They also leave when they feel unsafe, unheard, unsupported and unable to grow.

When nurses feel unable to speak up, silence becomes part of the system. When junior staff are humiliated instead of mentored, learning suffers. When bullying becomes normalised, workers may begin to see leaving as the only realistic option. For a mostly female workforce, these pressures do not affect nurses alone. They also affect families, communities and how society values care work.

Training more nurses will not solve the problem if the working environment pushes nurses away. The real question is not only how we produce more nurses, but also how we ensure that nurses can stay, work safely and be treated with dignity. A serious response to workplace violence in healthcare should include several practical steps.

First, nurses should have a stronger voice in decisions that affect their work. Frontline nurses, nursing leaders, professional bodies and unions should be meaningfully involved in shaping policies on staffing, workplace safety, reporting systems, mental health support, digitalisation and service delivery. Collective representation matters because individual nurses should not have to carry the burden of speaking up alone.

Second, trusted systems for preventing, reporting and responding to workplace violence, bullying and harassment should continue to be strengthened. Nurses need to know they can safely report any kind of violence without fear of being ignored, blamed or punished. Too often, incidents go unreported because people do not believe anything will change. A safe workplace starts with systems that people trust.

Third, addressing staffing shortages and excessive workloads is also essential. When nurses are caring for too many patients, missing breaks and regularly staying late to finish their work, everyone pays the price. Safe staffing is not a luxury. It is essential for both patient care and health worker wellbeing.

Fourth, supporting nurses also means looking beyond individual resilience. Nurses need time to rest, supportive supervisors, access to mental health support and workplaces where people treat each other with respect. Supportive mentoring and teamwork can make a real difference – especially for junior staff and newcomers.

Finally, workplace safety needs to be considered alongside career development, fair compensation and better systems. Nurses need fair recognition for overtime and workload, opportunities for specialisation and higher education, and digital systems that reduce administrative burden rather than adding to it.

Ultimately, this is about recognising that nurses are not an endless resource. They are people, often women, who care for others every day while carrying their own pressures, responsibilities and challenges. Ensuring their safety, dignity and wellbeing is not only the right thing to do. It is a smart investment in a stronger and more resilient health system.

Malaysia has an opportunity to build on the measures already in place and further strengthen workplace safety, staffing, support and working conditions. Everywhere in the world, health systems depend on nurses at every stage of life – from birth to old age, from routine check-ups to medical emergencies. Malaysia is no exception.

Safe patients need safe nurses. And safe nurses need workplaces where respect, dignity and rights are non-negotiable.

By Sergo Chikhladze, Johanna Riha, Sapna Mishra (UNU Global health) and Nicholas Hulus (Sabah Medical Services Union (SMSU))

Nurses taking to the streets demanding fair wages is now a common sight in many Indian cities. Credit: K.S. Harikrishnan/IPS

By K. S. Harikrishnan
THIRUVANANTHAPURAM, India , Jun 28 2012 (IPS)

Nurses in India are up in arms against the deterioration of the nursing profession in the country, including unfair wages and the policies of private hospital managements.

Many exploited female nurses are leaving the country in droves, migrating to countries that offer better employment prospects and working conditions.

Those that remain are taking to the streets, demanding decent pay and the enforcement of labour regulations.

For two years now, thousands of nurses working in corporate hospitals across the country have been participating in demonstrations and strikes, protesting the fact that hospital managements – often alleged to have illegal connections with politicians and bureaucrats – blatantly flout the country’s labour laws.

Nurses’ unions say that the strikes in various private hospitals are a result of long-standing grievances like poor working conditions and mistreatment of nurses in the workplace.

Jasmin Shaw, president of United Nurses Association, told IPS that threats of dismissal, disconnecting power and water connections in hostels, threats of eviction from hospital dormitories and violation of labour norms were some of the most frequent complaints to be heard as the strike spread across the country a few months ago, fanning outwards from Mumbai and New Delhi into other parts of the country.

Studies point out that working condition, though better in government hospitals, are by no means favourable to nurses, who describe their duties as “back-breaking”.

The most basic amenities – such as rooms in which nurses can rest and change their clothes – are missing in most hospitals.

A report on nurses’ working conditions in the Indian capital, published by the New Delhi-based Centre for Women’s Development Studies (CWDS), revealed that the nurse-patient ratio was generally 1:30, sometimes reaching 1:50 in general wards.

This shortage often results in nurses having to work overtime, for which there is no formal system of compensation; though the prolonged protests have prompted some hospitals to announce that they are taking measures to pay overtime wages.

The report highlighted that nurses’ hostels or other lodgings barely meet minimal standards and rarely offer any privacy

Dr. Sree Lekha Nair, researcher at CWDS, told IPS that a servant–master relation had become an established practice in the country’s nursing sector.

“Hospital managements are confiscating nursing certificates in order to restrict nurses’ professional mobility. When they start work they have to sign a “bond” that requires them to work in the hospital for two to three years.

“These measures prevent nurses from seeking job opportunities without the knowledge of the management. One of the most difficult challenges of the nursing profession in India has been in the realm of collective organising for rights,” she added.

Health activists said that senior trained nurses were being replaced by nursing aides, auxiliary nurses and untrained assistants in order to avoid paying full salaries.

Anie Mathew, a health sector activist in Jaipur, Rajasthan, said that junior nurses in the corporate sector were being treated badly and given meager salaries.

“Nursing aides and auxiliary nurses can be paid just 1,000-1,500 rupees (about 26 dollars) a month and are made to perform duties like giving injections for which they are not trained.”

“Managements do not follow regulations regarding leave packages. Maternity leave is not allowed. The moment a nurse reports her pregnancy, she can be asked to leave,” said Mathew.

Medical tourism aggravates the problem

There is a widespread feeling among nurses that medical tourism hurts the freedom of speech, which is guaranteed by the Constitution of India.

Nurses allege that sponsors of medical tourism strictly enforce the rule that nurses cannot speak in their mother tongue while on duty.

“A five-star hospital culture in New Delhi and Mumbai restricts nurses’ freedom to speak their own native language, which is unacceptable,” said Shaw.

The Indian medical tourism sector is expected to experience an annual growth rate of 30 percent, set to become a two billion-dollar industry by 2015.

An estimated 150,000 people are traveling to the country to avail themselves of low-priced healthcare every year.

Experts say that a strict hierarchy of gender and class, entrenched in Indian society, has also contributed towards the present status of the nursing profession.

Analysing contemporary concerns of status among nursing professionals, Madelaine Healey, an independent researcher from Australia, and Sri Nair, a sociology scholar in Thiruvananthapuram, explained that those in the nursing society were often looked down upon by those from a ‘domiciled European’ background, who were often the children of merchants or businessmen.

“These women nurses were considered wanting not only in their class backgrounds, but also professionally, as the training they received in India was considered inferior to that on offer in the West,” the researches found.

Taking flight

Australia, New Zealand, Canada, the U.S., the UK, Germany and Gulf countries are the main destination of Indian nurses seeking better jobs.

Experts in migration studies point out that the promise of higher income was the main reason for migration and there was no exact number on how many nurses had migrated to foreign countries.

“Now girls are showing more interest in studying nursing while looking at the lucrative salaries and other perks along with high quality of life abroad. The majority of migrant nurses are from the southern Indian state of Kerala,” Prof. Irudaya Rajan, head of the migration department at the Centre for Development Studies in Thiruvananthapuram, told IPS.

According to a recently released book, ‘Moving with the Times: Gender, Status and Migration of Nurses in India’, authored by Sree Lekha Nair, nurses from Kerala form one of the largest groups of migrant women workers in the international service sector along with Filipinos and Sri Lankans.

Comparatively better salaries, work opportunities and financial independence, along with a desire to travel across the world, are often the reasons behind this wave of migration.

Many women appear to be entering the profession with the sole intention of migrating abroad; finding employment in Delhi is intended simply as a transition to leaving the country, a trajectory that may remain unrealised, Nair’s book revealed.

A senior health official in Chennai told IPS that that the Indian health sector is facing a 50 percent shortage of nursing staff.

“The mass migration of nurses leaves already (under-staffed) hospitals with a shortage of trained nurses and exacerbates the poor nurse-patient ratio,” she added.

(END)