Malaysia is grappling with a deepening crisis in its public healthcare system as a critical shortage of nurses threatens to undermine the nation’s ability to deliver essential care. With starting salaries as low as RM1,797 (~US$380) per month for entry-level nurses and a grueling workload exacerbated by a recent shift to a 45-hour work week, many healthcare workers are leaving for better opportunities in the private sector or abroad. As the government struggles to address a projected shortfall of nearly 60% by 2030, calls for urgent reform—ranging from better incentives to flexible hours—are growing louder.
A System Under Strain
The challenges facing Malaysia’s nursing workforce are stark. According to Malayan Nurses Union president Saaidah Athman, the current conditions are driving nurses away from public hospitals at an alarming rate. With a starting salary of just RM1,797 (~US$380) for a U29 grade nurse with a diploma, and new recruits placed under the Employees Provident Fund scheme rather than the more secure civil service pension, the financial incentives to stay are minimal. Specialist nurses with advanced qualifications receive a mere RM100 (~US$21) monthly allowance, a figure Saaidah describes as woefully inadequate compared to international standards. “Nurses are paid RM3,000 and above for post-basic allowance overseas, and in private practice in Asia, it’s about RM500,” she said, as reported by local sources on July 3, 2025.
Beyond low pay, the workload in Malaysia’s public hospitals is relentless. Nurses often perform double duty, handling not only patient care but also administrative tasks, moving patients between units, and even transporting medicine trolleys to pharmacies. “One can imagine how exhausted nurses here are compared to overseas, where nurses only focus on their respective nursing care duties,” Saaidah emphasized. The recent transition to a 45-hour work week, intended to streamline operations, has instead added to the burden, with little to no flexibility in scheduling to accommodate personal needs or recovery time. 
The numbers paint a grim picture. Between 2020 and 2024, a total of 6,919 healthcare workers under the Health Ministry left for the private sector, including 2,141 nurses—1,754 permanent and 387 contract appointees. Health Minister Datuk Seri Dr Dzulkefly Ahmad acknowledged the severity of the issue, noting on June 29, 2025, that the country faces a critical shortage of nurses. “We have also taken various approaches, including increasing the number of trainees to 1,000, but it still does not meet the shortfall,” he was quoted as saying.
Seeking Greener Pastures
The allure of better pay and working conditions abroad is a significant factor in the exodus of Malaysian nurses. Independent health advocate Dr Sean Thum pointed out that the promise of a more balanced life overseas is a powerful draw. “We don’t pay well enough. Indeed, we are lacking in staff, so the existing staff will have to shoulder more work,” he said on July 3, 2025. In countries across Asia and beyond, nurses often earn significantly higher salaries and benefit from clearer boundaries in their roles, focusing solely on patient care rather than juggling multiple responsibilities.
Within Malaysia, the private sector also offers a more attractive alternative. While public sector nurses struggle with low pay and long hours, private hospitals provide better remuneration and, in some cases, more manageable workloads. This disparity creates a vicious cycle: as more nurses leave public service, the remaining staff face even greater pressure, further fueling resignations.
Adding to the problem is the declining number of new entrants into the profession. Saaidah highlighted that fewer colleges in Malaysia are offering nursing courses, directly impacting the pipeline of prospective nurses joining the workforce. Without a robust supply of trained professionals, the shortage is set to worsen, with projections estimating a deficit of nearly 60% by 2030 if current trends persist.
Policy Missteps and Calls for Accountability
The government’s response to the crisis has drawn sharp criticism from healthcare advocates and political figures alike. Senator Dr RA Lingeshwaran, a former director of Hospital Sungai Bakap in Penang, warned that the decision by the Public Service Department (JPA) to enforce a 45-hour work week within an “already crippled” healthcare system could push more workers to quit. “JPA has to bear responsibility if this fails,” he stated on July 3, 2025, describing the policy as insensitive and highly risky.
Lingeshwaran’s concerns are echoed by many within the nursing community. “I have engaged with many nursing associations and unions within the Health Ministry, and the majority have expressed that they will not be able to endure it if the workload continues to increase without any form of compensation or resolution to their welfare,” he added. With morale among healthcare workers at its lowest point, he urged the government to prioritize support, incentives, and recognition for their sacrifices rather than imposing additional burdens. “Don’t wait until public hospitals collapse before pointing fingers. If JPA continues to be rigid, then they will be the ones held accountable by the people,” he warned.
The senator’s critique underscores a broader frustration with the lack of meaningful reform. While the Health Ministry has attempted to address the shortage by increasing trainee numbers, these efforts fall short of meeting demand. Critics argue that without systemic changes—such as competitive salaries, improved working conditions, and a reevaluation of allowances like the RM100 (~US$21) post-basic incentive—the government risks losing even more nurses to attrition.
A Path Forward: Incentives and Flexibility
Amid the mounting challenges, stakeholders are united in their call for urgent action. Saaidah Athman has urged the Health Ministry to overhaul the nursing system by offering attractive incentives and flexible working hours. “All these will not attract the younger generation to nursing. They would definitely choose to go to the private sector or overseas, where the salaries are better and there is some flexibility in working hours,” she said. A review of the post-basic incentive allowance, currently set at a meager RM100 (~US$21), is also seen as a critical step to retain specialized talent.
Dr Thum similarly emphasized the importance of raising remuneration to ensure adequate staffing levels in public healthcare. Competitive pay, he argued, is not just a matter of fairness but a necessity to prevent the system from buckling under the strain of understaffing. Beyond financial incentives, advocates are pushing for policies that prioritize work-life balance, such as shorter or more flexible shifts, to make nursing in the public sector a viable long-term career choice.
For now, the government faces a delicate balancing act. On one hand, budget constraints and bureaucratic inertia may limit the scope of immediate reforms. On the other, the risk of a collapsing healthcare system—already strained by an aging population and rising patient numbers—demands bold action. The Health Ministry’s acknowledgment of the crisis is a start, but without concrete measures to address nurses’ grievances, the shortfall will only grow more acute.
Regional Implications and Global Context
Malaysia’s nursing shortage is not an isolated issue but part of a broader regional and global trend. Across Southeast Asia, countries like Thailand and the Philippines are also grappling with healthcare worker shortages as nurses and doctors seek opportunities in wealthier nations with better pay and conditions. The Philippines, for instance, has long been a major exporter of nursing talent to the United States and Europe, a trend that has depleted its domestic workforce. Malaysia, while not historically a primary source of migrant nurses, is increasingly seeing its professionals follow a similar path.
This brain drain has significant implications for public health in the region. As middle-income countries like Malaysia struggle to retain skilled workers, the quality and accessibility of healthcare for ordinary citizens are at risk. Rural areas, where medical facilities are already scarce, are often the hardest hit, with patients forced to travel long distances for basic care. The ripple effects extend beyond health, impacting economic productivity and social stability as families bear the burden of inadequate medical services.
Globally, the demand for nurses is projected to rise sharply in the coming decades, driven by aging populations in developed countries and the lingering effects of pandemics like Covid-19. For Malaysia, this presents both a challenge and an opportunity. While the pull of international opportunities may exacerbate domestic shortages, it also underscores the need to invest in training and retention strategies that can position the country as a regional leader in healthcare education and employment standards.
Looking Ahead: A Test of Resolve
As Malaysia navigates this critical juncture, the stakes could not be higher. A healthcare system without enough nurses is a system on the brink, unable to meet the needs of a growing and aging population. The government’s response in the coming months—whether through increased funding, policy reform, or dialogue with nursing unions—will signal its commitment to safeguarding public health.
For the nurses on the front lines, the struggle is deeply personal. They are not just fighting for better pay or shorter hours but for recognition of their indispensable role in society. As Saaidah Athman and others continue to advocate for change, the question remains: will Malaysia rise to the challenge before the crisis becomes a catastrophe?
