Dire cost of longer hours for nurses
NURSES are the backbone of healthcare worldwide and Malaysia is no exception. They serve on the frontlines in hospitals, clinics and community care settings, often working long hours to ensure patients receive timely and compassionate care.
Their importance was highlighted during the Covid-19 pandemic when Malaysian nurses risked their health to care for thousands of patients.
Despite their indispensable role, the government is considering increasing nurses' weekly work hours to 45 hours. This policy aims to address workforce shortages and meet rising healthcare demands but has met with widespread concern.
While the intent is commendable, increasing work hours without increasing support risks harming nurses' welfare, patient safety and healthcare quality.
Nurses' work hours in other countries
Globally, healthcare systems that prioritise strong protections for nurses typically maintain workweeks between 36 and 40 hours – striking a crucial balance between service demands and staff well-being.
0 The United Kingdom: Nurses work around 37.5 hours weekly, with regulations limiting overtime and mandating rest breaks to prevent fatigue. The Royal College of Nursing advocates for safe working hours to uphold care quality.
0 Australia: Nurses typically work 38 hours per week, with industrial awards ensuring fair shifts and rest. The Australian Nursing and Midwifery Federation warns that long shifts can compromise patients' safety as well as nurses.
0 Singapore: Nurses generally have a 40-hour work week, with carefully managed shifts designed to minimise fatigue.
0 The United States: Despite the prevalence of 12-hour shifts, total weekly hours generally remain between 36 and 40. The American Nurses Association highlights that exceeding these hours increases errors and dissatisfaction.
In comparison, Malaysia's proposed 45-hour work week exceeds these standards, raising valid concerns.
Real cost and implications
Burnout among nurses has been recognised by the World Health Organisation as an occupational phenomenon linked to chronic workplace stress.
It manifests as emotional exhaustion, cynicism and reduced personal accomplishment. For nurses, this translates to diminished empathy, increased absenteeism and lower quality of care.
Research confirms that extended shifts and work weeks correlate with higher burnout. A study across 12 countries found that nurses working over 12-hour shifts reported significantly higher burnout levels and poorer care quality.
Another study showed nurses working more than 40 hours per week faced increased risks of depression and anxiety.
Prolonged work hours can also endanger nurses physically. Fatigue impairs cognitive function, increasing the chance of errors and accidents. Nurses working longer shifts experience higher rates of musculoskeletal injuries and needle-stick incidents.
Additionally, it causes chronic sleep deprivation, a frequent outcome associated with cardiovascular disease, obesity and a weakened immune system.
Multifaceted problem
Malaysia is grappling with a severe nursing shortage, with over 12,000 vacancies in public healthcare reported by the Health Ministry.
This shortage forces existing nurses to work longer hours and manage heavier patient loads. Simply increasing work hours without hiring more staff only shifts the burden onto nurses, accelerating burnout and turnover.
Research shows poor working conditions and excessive workloads are key reasons nurses quit. Turnover is costly, including recruitment and training expenses. It also disrupts patient care continuity and weakens institutional knowledge.
Patients' safety at risk
Patient safety is closely tied to nurses' working hours and staffing levels. Nurses working beyond 12-hour shifts are twice as likely to make errors.
Each additional hour over 40 per week increases the risk of adverse events. Fatigue impairs decision-making, vigilance and reaction times critical to safe care.
Low nurse-to-patient ratios increase mortality, complications and hospital stay lengths. Increasing work hours without improving staffing ratios dilutes nurses' ability to provide quality care.
Professional development
Over 90% of nurses in Malaysia are women, many of whom juggle demanding professional roles with unpaid caregiving at home. This 'double burden' is only intensified by extended work hours.
This imbalance increases stress and work-family conflict, especially among younger nurses and mothers, contributing to higher attrition rates.
Longer work hours also reduce time for continuing professional development (CPD), which is highly required for all nurses.
CPD is essential for maintaining clinical skills and improving patient outcomes.
Without adequate time for learning, nurses face professional stagnation, which risks the quality of healthcare delivery.
Ethical and legal considerations
Malaysia upholds international labour standards that emphasise fair working conditions, reasonable work hours and the protection of workers' rights.
Implementing a 45-hour work week for nurses could contradict these principles, potentially breaching ethical obligations and legal commitments. Such a policy not only risks compromising nurses' well-being but also undermines their professional dignity, equity and the broader values of social justice in the healthcare workforce.
Alternatives solutions
To improve healthcare sustainably, Malaysia should:
0 Maintain a 40-hour work week in line with international norms.
0 Enhance recruitment and retention by improving pay, benefits and working conditions.
0 Adopt flexible shift scheduling to reduce fatigue and burnout.
0 Provide comprehensive mental health support and burnout prevention programmes.
0 Ensure nurses have protected time for CPD and career development.
Supporting healthcare quality
Nurses are the lifeblood of Malaysia's healthcare system. Extending their work week to 45 hours will threaten their health, patient safety and the overall quality of care.
Rather than imposing longer hours, Malaysia should invest in sustainable workforce solutions that respect nurses' welfare and dignity. Only by doing so can we build a resilient healthcare system capable of delivering safe, compassionate care to all Malaysians.
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