Spark needed for change in nursing profession

I AM responding to the following three letters on nursing and nurses: “Family members doing nurses’ job” by Anne Swinitha Rajaratnam, (The Star, May 25), “Blame the system, not the nurses” by Matron Pat (May 30) and “More to nursing than meets the eye” by Professor Zahrah Saad, MAHSA University (June 14).

In her letter, Anne claimed that family members have to take leave from work to look after their relatives admitted to government hospitals. She said she was flabbergasted with the situation and questioned why nurses are not doing their nursing job.

In response, Matron Pat wrote: “I will not deny that what she has observed is true”, which in my opinion speaks volumes about the current state of affairs in nursing. As a former matron, she knows the clinical setting first hand.

The professor, however, did not seem to share the same opinion and made the following conclusion instead: “As a nurse leader who has been associated with Malaysian nursing for almost all my life, I will expose the falseness of the claim made by the writer from an academic and professional point of view... and from a legal standpoint, this is a blatant propaganda against nurses.”

The professor went on to say that “These are serious accusations and, with proper evidence, can be investigated.” She is absolutely right in saying that we need evidence.

To this end, Matron Pat blamed the system and pointed out a number of factors for this – shortage of nurses, overcrowding in wards, nurses working double shift and doing non-nursing functions, in particular filling up research questionnaires and working obsessively with computers at the expense of patient care. Evidence galore, but we need to document them.

Allow me to be the devil’s advocate here by making an attempt to view the situation from the family members’ perspectives. This is based on the belief that it would take a lot of guts and efforts on Anne’s part to make such serious accusations.

On my part, all it takes is to accept what she says as the truth as she sees it. To this end, I would pose a challenge to the professor to get answers to the following questions:

1. What if it is true that nurses want relatives/family members to stay back to take care of the patient in the hospital?

2. What if it is true that relatives are seen sleeping in the corridors because they need to be in the hospital to nurse the patient?

3. What if it is true that nurses are truly busy doing things other than nursing?

4. What if the answers to the “rhetorical questions” about the nursing profession prove to be true?

5. If I were to say that not only are the above situations possible, they could well be highly probable, what then?

I would challenge the professor in her capacity as dean and who would have the capability and expertise to conduct a study to get to the truth. The answers to the five questions could easily be obtained from former patients of government hospitals, including university hospitals, between 2017 and 2019 and the nurses who nursed them.

In her letter, Matron Pat pointed out that it is wrong for the government to appoint non-nurses to head nursing institutions. Could the non-nurse in question be a medical assistant (MA)?

If this is true, then, as a devil’s advocate, I would say that MAs are neither nurses nor allied health personnel. They are paramedics and are assistants to medical officers, hence it is not only absurd but also unprecedented that one of them is appointed to head a nursing organisation in the Health Ministry, which has more than 65,000 nurses.

The Malaysian Qualifications Agency (MQA) has identified five distinct health professions, namely medicine, nursing, allied health, dentistry and pharmacy. In this respect, under which group would MAs fall?

Even if the said MA has a PhD, he/she is still not a nurse and therefore not qualified to head a nursing institution. There are at least 80 nurses with PhD in Malaysia, and two or three of them are in the Health Ministry.

The question is why does nursing allow “the system” to be in such a “state of affairs”?

For me, the answer is very simple. Nursing in Malaysia lacks leaders with vision, courage and maturity to plan, organise and initiate change. As long as the nursing service is dominated by diploma graduates, leadership will evolve from their level, and the outcome of changes made will remain at diploma-level thinking.

Nurses in leadership positions arising from such a system may not be empowering enough to make profound and sustainable changes in the nursing culture.

The challenge is for the Health Ministry to appoint a nurse with a PhD who is currently working in the Nursing Division of the Health Ministry as the next director of Nursing. She could help to make the following changes in the system:

1. Establish an inclusive nursing service delivered by both degree and diploma nurses, thus ensuring a change from a task-oriented to patient-centred care service.

2. By 2030, to achieve a 60:40 degree-diploma nurse ratio to reduce the migration of degree nurses to Singapore and Saudi Arabia.

I would like to thank Anne for writing “such a letter” which has inspired a lot of thoughts. Hopefully, her letter will spark the profound changes that are desperately needed in nursing.

Certainly, there is more to nursing than meets the eye! As for whether “family members doing nurses’ job” is true or false, I would answer by asking “could there be smoke without fire?”

NIK SAFIAH NIK ISMAIL

Kuala Lumpur