KUALA LUMPUR: When Matron Asiah Suppaat recalls the day she was slapped by a patient, she does so with unexpected calm and a touch of humour.
The 71-year-old former nurse, who retired in 2015, was then serving at a public hospital psychiatric ward in Kuala Terengganu when the incident took place.
Despite years of experience handling patients with mental health conditions, she said the sudden attack still caught her off guard.
"When I asked, 'Why did you slap me?', the patient replied, 'Because you're too pretty.' How could I stay angry after that?" she said with a laugh during a Google Meet interview with Bernama.
But Asiah said her experience was relatively mild compared with what some colleagues had endured.
In another incident, a patient grabbed a nurse's necklace and attempted to strangle her with it.
"I had to slip my hand between the necklace and her neck to stop her from choking," she recalled, adding that staff managed to calm the patient and prevent further harm.
While such incidents are often associated with psychiatric wards, violence against nurses is not confined to specialised units. Verbal abuse, intimidation and physical assaults have increasingly become part of working life for many nurses – from patients, as well as their relatives and visitors.
A 2022 Universiti Kebangsaan Malaysia (UKM) study on workplace violence in Penang Hospital found that 43.9 per cent of nurses surveyed had experienced some form of abuse.
Of these, 82.2 per cent involved verbal abuse, 8.9 per cent psychological abuse and 8.3 per cent physical assaults.
The study also stated that workplace violence against nurses was a global issue, with prevalence rates of 51.3 per cent in Asia, 61.3 per cent in the Middle East and 38.8 per cent in Europe.
However, experts and nursing bodies believe the true figures are likely higher due to widespread underreporting.
"In reality, many cases go unreported. The actual numbers are higher," said Malaysian Nurses Association (MNA) president and former nurse Safiah Sutan Taharudin.
This week, Malaysia marks International Nurses Day. While discussions often focus on pay and long working hours, less attention is given to workplace safety – despite its significant impact on nurses' wellbeing.
NOT BUSINESS AS USUAL
This year's theme, "Our Nurses. Our Future. Empowered Nurses Save Lives", highlights the importance of nurse empowerment as the foundation of quality healthcare.
Universiti Putra Malaysia nursing lecturer Dr Azura Abdul Halain said empowerment must go beyond recognition and include safeguarding nurses' mental and emotional wellbeing.
"Nurses face heavy workloads, manpower shortages and prolonged emotional stress. Empowerment is not only about individuals, but also systems – safe workplaces, supportive leadership and protective policies," she said.
Although all healthcare workers face risks, nurses bear a disproportionate burden as the largest workforce group with the most direct patient contact.
Most violent incidents occur in emergency departments and psychiatric wards, a trend also seen in Malaysia.
"My staff have been punched, had their spectacles broken, even had cough medicine poured on them. We've seen it all," said Kuala Lumpur Hospital (HKL) Emergency Department head Datuk Dr Alzamani Mohammad Idrose.
Bernama also spoke to nurses attending a recent conference, many of whom admitted experiencing or witnessing verbal and physical abuse. Most, however, regarded it as part of the job unless it escalated.
MNA's Safiah said many nurses had been conditioned to remain composed regardless of circumstances.
"We go through everything, but we cannot show it. We were trained not to display anger – even if we are hurt, we still smile," she said.
She added that while counselling support existed, some nurses avoid reporting abuse for fear of being seen as weak.
VICIOUS CIRCLE
Healthcare experts attribute much of the aggression in emergency departments to overcrowding, long waiting times and poor public understanding of triage systems.
Occupational and public health specialist Professor Dr Victor Hoe Abdullah described emergency departments as "high tension, high needs" environments.
"Each patient or family member believes their case is the most urgent, and frustration builds when they are not treated immediately," he said.
He added that lack of understanding of triage – which prioritises life-threatening cases such as chest pain, breathing difficulties and severe trauma – often fuels conflict.
Former HKL emergency matron Noorliana Noordin said overcrowding worsened when non-critical cases sought treatment at emergency departments instead of clinics.
"Minor illnesses could be treated at clinics, but patients often expect immediate attention at HKL," she said.
HKL's emergency department handles between 500 and 700 cases daily, according to Dr Alzamani.
A nationwide nursing shortage has further strained the system.
The World Health Organisation recommends six nurses per 1,000 population for adequate coverage. Malaysia currently has about 4.1 per 1,000, according to World Bank data.
The shortage, worsened after the Covid-19 pandemic, has increased workload and burnout, while relatively low pay continues to drive dissatisfaction.
Although nurses officially work 42 hours a week, many regularly perform overtime due to staffing gaps.
Health Minister Datuk Seri Dr Dzulkefly Ahmad has warned Parliament that Malaysia could face a 60 per cent nursing shortfall by 2030 if the issue persists.
Dr Alzamani described the situation as a "vicious circle", adding that HKL's emergency department was operating at about 60 per cent efficiency due to manpower constraints.
He said incoming graduates might help ease pressure, but numbers remained insufficient.
INVESTING IN MALAYSIA'S HEALTH
Malaysia continues to face an exodus of nurses seeking better pay and conditions abroad.
In 2024, a total of 3,021 nurses left the country, according to the Malaysian Nursing Board. Of these, 84.5 per cent were from the private sector, 11.7 per cent from Health Ministry facilities and 3.8 per cent from other public institutions.
Nursing leaders say improving pay and benefits remains key to retention.
"In Malaysia, starting salaries are around RM3,000. In Singapore, it can be about S$3,500 – roughly three times higher. In some Gulf countries, salaries can reach RM10,000 to RM12,000," said Safiah.
While Malaysia may not match overseas pay, experts say better structured allowances and incentives could help retain talent.
Public sector nurses currently receive about RM100 monthly for sub-specialty allowances, compared with RM300 to RM700 in private hospitals.
Dr Alzamani described nurses as the "backbone of the healthcare system", saying their contribution was often undervalued.
"They are highly trained professionals, but often not seen as such. Nurses handle medication, patient monitoring and care delivery with precision. They deserve far greater recognition," he said. - NST
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