HISTORICAL DEVELOPMENT OF NURSING IN MALAYSIA

The history of nursing in Malaysia began from the year 1800, with the formation of the East
India Company when hospitals for the sick were established in Penang and Singapore.
Nursing of the sick was carried out by catholic nuns and later by English nurses from
England.

At this time, every state in Malaysia established and organized its own “on-the-job
training” for nurses. Lectures in theory and practice were given by the English matrons or
assistant matrons, sister and doctors at the hospital level. They sat for their own state
examination and the standards varied from one state to another. Upon completion of
training, they were promoted to Staff Nurses and later, if considered suitable, would become
Senior Staff Nurses.

The emphasis of nursing practice then was on patient care in hospital which was
mainly on the curative aspects.

In 1923, legislation for the control of the Practice of Midwifery and the training of
midwives were established. This was followed by the established of the Midwives Act and
the development of the Midwifery Board, which regulated the practice of midwifery requiring
the registration of all nurse midwives in the country in 1966.

In 1950, the Nurses Act was enacted which provided for the establishment of the
Nursing Board, with the power to control the training and registration of nurses in the
practice of nursing. The included the power to control the development of the curriculum for
Basic Nurse Training, regulation for the conduct of final examination, issuing of Nurse
Training Certificate and the Regulation to control the practice of nursing through registration,
issuing of Nurse Registration Certificate and Registration Badge.

In 1969, the Nurse Act 1950 was extended to Sarawak and in 1978 to Sabah. In
1985, the Nurses Act remains in use today.
1959 marked the beginning of the development of health service throughout the country.
Health service became mainly the responsibility of the central government with delegation of
service delivery through state and district health administrations.

Within this period, the maternal and child health service came to the forefront as an
essential part of the National Rural Health Institute, Kuala Lumpur.

In response to this development, Public Health Nurse programme was started in

Penang using the British Society for Health Programme curriculum, By early 1960s this
programme was rightly placed in the Public Health Institute, Kuala Lumpur.

The early 1970s saw the integration of Family Planning Service and School Health
Programme into the healthcare system. By 1978, there was a relatively well developed
public sector health service consisting of rural health network with urban-based district
hospitals (150-400 beds), general hospitals (500-2000 beds), general outpatient department
care, inpatient care specialist service which served as referral centres.

Nursing education in Malaysia progressed in tandem with the development of the

country’s health service. Before the enactment of the Nurses Act (1950), three regional
school of nursing were established: School of Nursing, Hospital Johor Baharu (1946), School
of Nursing, Hospital Pulau Pinang (1947), School of Nursing Kuala Lumpur (1948). All the
three schools were headed by English tutors. At this time, education of nurses was based on
“on-the-job training” approach where lectures were given by the matrons or assistant
matrons, sisters and doctors.

In 1952, the training became more formalized using a curriculum based on

the General Nursing Council (GCN) of the United Kingdom. The block system curriculum
was adopted comprising 20% theory and 80% practice for the education of three years and
four months. The ultimate aim of the training at this point in time was to obtain reciprocity
with hospitals in England and Wales, to enable Malaysian nurses to continue their studies in
countries abroad that have reciprocity with England and Wales. During this period, many
nurses were sent for nurse tutor courses (including midwifery tutor course) in Great Britain,
Australia, New Zealand (Nursing Board of Malaysia).

The first private school of nursing was the Tun Tan Cheng Lock School of
Nursing, established in1967 at the Assunta Hospital, Petaling Jaya. In the 1968, the
University Nursing School of Nursing Kuala Lumpur was set up. Both school were subjected
to the 1950 Nurses Act regulations and procedures.
 Up until 1992, the graduates of nursing programmes, on passing the Final
Nursing Board Examination, received a Certificate in General Nursing. By late 1992, the
certificate curriculum was upgraded with more theoretic input (up to 50%), to becomes a
diploma curriculum.

While the ministry of Health remained the biggest producer of diploma

graduates at the time, the number of private institutions began to multiply. Currently, there
are 70 private college, 17 Ministry of Health college and three public universities that
produce approximately 12,000 diploma graduates annually. To date, the Ministry of Health
colleges remain the major institutions to conduct post basic course in clinical nursing.

Year 1993 marked the beginning of tertiary education for nursing. The first
university programme started in 1993 at the University of Malaya, admitting diploma
graduates to prepare them to become nurse education and nurse administrators. It was a
three-year programme awarding a Bachelor of Nursing Science (BNSc) with honours. In
2003, the Quality Assurance Division, Department of Higher Education, Ministry of Higher
Education through a high level committee including a member of the Nursing Board of
Malaysia, developed guidelines in curriculum design for a four-year Bachelor of Nursing
(Honours). Currently, at least eight universities are conducting the four-year curriculum, six
in the public sector – University Malaysia Sarawak (UNIMAS), University Kebangsaan
Malaysia (UKM), University Science Malaysia (USM), University Putra Malaysia (UPM),
International Islamic University Malaysia (IIUM), University Teknologi Mara (UITM) and two
in the private sector (International Medical University(IMU) and University College Sedaya
International (UCSI).

With the introduction of the four-year degree programme, the three-year

degree programme of the University of Malaya ceased to exist.

The proposed curriculum is comprehensive yet balanced proportionately between

three major sciences: Basic Medical Science, Core Nursing Science, Humanities and Social
Science. They entry requirement include pure science at Sijil Tinggi Pelajaran Malaysia
(STPM) or matriculation level, Mathematics and Bahasa Malaysia at Sijil Tinggi Pelajaran
(SPM) level and Malaysian University English Test (MUET).
 These standards and criteria mark the beginning of a true upgrading of nursing
education in Malaysia. The entry requirements have placed nursing at par with other
professional programme such as Medicine, Dentistry, Pharmacy or Engineering where the
pure science subject become the main criteria for admission. The current scenario in Faculty
of Medicine where both nursing and medical students coexist and where sharing of
resources in inevitable, the outcome is not only competitive but also synergistic in nature.

The 21th century also mark the beginning of the establishment of post graduates
programme in clinical nursing at various public institutions, namely University of Malaya,
UITM and UKM. The emphasis on post graduate education in nursing must be clinical to
enable the graduates to use the content and experience as experts in order to teach at the
bachelor degree level or to manage an acute care institution.

This clinical post graduate nursing education is seen as another positive milestone
for nursing. Being a practice profession, nursing must be practiced by nurses at all levels.
(The 3 public universities offer Masters of Nursing degrees in: Clinical care and Women’s
Health (UITM); Clinical Speciality (UM); Midwifery, Mental Health, Community Health and
Orthopedics and Traumatology (UKM).

Several private institutions of higher learning, namely MAHSA University College and
Open University (OUM) offer nursing-related course at Master level.

While nursing education has made an impression in the Malaysian education system,
its nursing service, however, remain static. In hospital, across the board, the nursing method
used had always been the functional method (evolved from World War, to overcome nursing
shortage). The method is based on identified functions such as, an injection nurse, a
dressing or medication nurse and so on. Although it is economical, it could lead to
fragmented care and possibility of overlooking priority patient needs, for example, patients’
need for counselling, health education, passive exercises, extra fluids, etc, which are outside
of their functional responsibilities, maybe missed.

In general, of the four fundamental responsibilities identified within the International

Council of Nurses (ICN) Code of Ethics, only aspects of “restoration of health” and
“’alleviation of suffering” might have been covered if only unconsciously; the other two
aspects: “Health promotion” and “Illness prevention” hardly receive much attention, if any,
within hospital nursing.
 On the whole, nurses working in the community, in particular Public Health Nurses
are able to cover the four aspect (if only unconsciously) within the scope of maternal and
child health.

The latest development in nursing records the following events:

1. At the end 2008, there were about 70,000 nurses registered with the Nursing Board.
The nurse-patient ratio was 1:375 where the target by 2015 should be at 1:200 to
meet the standards set by World Health (WHO). There was 17 public college of
nursing, 10 public universities and 54 private colleges. Together, they produced
6,000 diploma graduates (2,500 from Ministry of Health and 3,500 from private
college)(New Sunday Times, 9 November 2008). Six months later in 2009, the
number of graduated produced has been doubled (12,162 including community
nurses who are not registered nurses). Currently, there are 109 private and public
institutions offering nursing programme and among them, 88 offer diploma
programme. By December 2009, there were 83,302 nurses in the country (New
Sunday Time, 216th June, 2010).

For many years now, the production of nurses has become a competitive
venture among businessman. The nursing shortage is being seen as a number
game. To win the game, with its current rules, the more the nurses they can produce,
the closer they will be to winning the game. The fastest way is to take in as many
students as the colleges can possibly take. As crudely put by FORD (2009), nurses
are “being pumped into the healthcare system as water might be pumped into the
fire”. The question is, will these numbers put out the fire, that is, fix the shortage? .
Temporarily, more importantly, will these numbers add to the improvement of
healthcare, or the caring that nurses have been entrusted by society to provide.

In response to all of these, the Minister of Higher Education in April 2010

stated that “the mushrooming of private nursing colleges will soon be a thing of the
past. Application to set up new institutions will not be accepted from July”. He
continued to say that institutions of higher learning should concentrate more on
degree courses.

Around the same time in April 2010, the Minister of Health Education in April
2010 stated that “Medical services in Malaysia are heading for major improvement
with better service, particularly at the clinical wards, as more graduate nurses are
roped in to serve at these facilities”. According to him, public universities currently are
 producing 415 graduates yearly and 1760 graduates by private universities (The Sun,
April 2010).

2. In June 2010 (New Sunday Time, 26 th June 2010) the minister of Health announced
“a temporary freeze of nursing courses by July… to cap the number of diploma
courses offered by private and public institution”. Accordingly, the Minister stated:
”The Cabinet has agreed that a moratorium be placed on new nursing courses and
institutions. This is to make sure the current institutions place importance on the
quality of the course and the performance of student”.

The Minister further affirmed that the next aim was to focus on degree nurses
because “We want to improve the quality of nurses in the country”. But what the
Minister is not aware of is that some graduates of public universities, with the
exception of JPA scholars, are not hired by government hospitals. These graduate
are now looking at other avenues including the private sector and foreign countries.
Currently, UIA, UNIMAS, and UKM graduates are employed by Prince Court Medical
Centre Kuala Lumpur and hospitals in Singapore. A private organization in Singapore
is now seeking to hire degree holder Malaysian nurses to serve Singapore hospitals.