Development of Nursing Education in Malaysia Towards the Year 2020

4/ Vision 2020 for Nursing

Strategies
1. The Ministry of Higher Education will include a plan to reorganize the conduct of

nursing programmes in the following manner:

(a) By 2012, all public and private universities must cease to conduct diploma
programmes and concentrate their efforts on increasing student enrolment into
the bachelor of nursing programme.

(b) By 2012, the entry requirements into the diploma programme must be a pass
in SPM with five credits in Biology, Chemistry or Physics, Mathematics,
Bahasa Malaysia and Bahasa Inggeris to ensure the probability of the graduates
continuing into the degree programme as part of lifelong learning strategy; in
addition, only colleges with hospitals or affiliate hospitals be allowed to conduct
diploma programmes, to ensure that only colleges with specified capabilities do
so at a controlled student enrolment rate.

(c) By 2015, only qualified teachers in nursing be allowed to teach in private colleges
and universities. Qualified teachers would include meeting the following
criteria:

i. For diploma in nursing programme: only those with the Bachelor
of Nursing and a clinical specialty (postbasic course or postgraduate
certificate or diploma in nursing) plus a certificate or equivalent in
education technology (as required by the Nursing Board of Malaysia);

ii. For Bachelor of Nursing Programme: only those with a Master of
Nursing in a clinical specialty (eg. Master of Nursing (critical care) to teach
critical care nursing) and in due course to continue for doctoral studies,
plus a certificate or equivalent in education technology (as required by the
Nursing Board of Malaysia). By 2020, a Doctorate in Nursing will be the
minimum qualification for a lecturer.

2. The Ministry of Higher Education to develop a viable mechanism for admission of
students, similar to Unit Pusat Universiti (UPU) for public institutions of higher
learning, to ensure all private colleges and universities admit only candidates that meet
the stipulated entry requirements. The presence of such a mechanism will address not
only issues of the number of candidates to be admitted but also the expected quality
of candidates.

3. Nursing organizations, namely, the Nursing Board of Malaysia, the Malaysian
Academy of Nursing, the Task Force for Nursing Education, Ministry of Higher
Education and the Jemaah Kejururawatan IPTA must play a role in enforcing and
monitoring high standards of nursing education in Malaysia.

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Nursing Education in Malaysia

4. A Nursing Database is a necessary tool to ensure current demographic profile of
practicing and non-practicing nurses in the country, and since the Ministry of Health
has easy access to such profile, the Ministry’s Nursing Division should be entrusted
with initiating and maintaining the database.

Agenda Six

By 2020, the composition of the nursing profesion in Malaysia be shared between
registered nurses of two levels: Level 1 comprising nurses with Bachelor of Nursing to be
known as Professional Nurses; and Level 2 comprising nurses with Diploma in Nursing
to be known as Diploma Nurses. The roles of both levels will differ in both functions and
responsibilities.

Strategies
1. The Ministry of Health and all relevant nursing service organizations must include a

plan to ensure that the highest quality of care be provided to meet consumer needs,
advances in medicine, nursing and education, and to ensure nursing’s participation in
the growth of the Malaysian economy, and to do so in the following manner:

(a) All priority areas of patient care which require collaborative and independent
decision making must be staffed by professional nurses. These areas include:
all critical care services (Intensive Care Unit (ICU), Critical Care Unit (CCU),
Psychiatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit (NICU),
Burn Centre, Emergency Room, Trauma Centre and Delivery suite); extended
programmes requiring independent decision making such as Home Care
Services, Day Care Surgery, Infection Control and Prevention Programme, Pain
Management Programme and all Community Health Programmes.

(b) Less priority areas ie. Areas that can tolerate a “staff mix” of degree and diploma
nurses with or without specialization must be staffed by both professional and
diplomas nurses. These areas include: Adult general care (medical, surgical,
obstetrics and gynaecology) and paediatric services.

(c) All non-patient care areas must be adequately staffed by registered nurses
prepared at minimum the diploma level. These areas include: Specialist Centre
Services, Operating Rooms and Centralized Sterile Supply Unit (CSSU).

2. Nursing service organizations must define nursing practice standards to include the
following definitions:

(a) Patient care areas are those areas that admit and discharge patients where
needs must be assessed, problems identified and whose care must be planned,

44

4/ Vision 2020 for Nursing

implemented and evaluated collaboratively or independently. The degree of
patient contact may affect the quality of care.

(b) Non-patient care areas are those areas that provide direct or indirect services
which can be described as nursing and non-nursing. The absence of registered
nurses may or may not affect the quality of services.

3. Nursing service organizations must also define nurses’ extended role which must be
regarded as part of routine professional nursing activities and these include: providing
information to clients, giving health education to patients and families, counseling of
patients and families, planning for discharge and follow-up care and participating in
research.

Agenda Seven

Nursing’s future plan must include the positioning of degree nurses at the bedside i.e,
in the clinical setting providing direct high quality care to clients. To retain degree nurses in
the clinical setting, there must exist a clinical structure (similar to medicine), where nurses
can rise both in pay and power while remaining in the clinical setting and a conducive
environment that makes it possible for them to make bedside nursing a “destination
career”. The clinical ladder will provide a new focus for the nursing profession where
nurses do not have to change direction, either towards management or teaching in order to
gain profesional recognition.

Strategies
1. By 2012, the Malaysian Academy of Nursing with the support of the Ministry of

Higher Education and the Ministry of Health will make a proposal to the Public
Services Department (JPA) on the need for a Clinical Service Structure as a justifiable
means to make bedside nursing a “destination career” for the bachelor of nursing
graduates. The Clinical Service Structure should enable the professional nurse to rise
from a starting salary of U41 to U52 with only an additional postgraduate certificate
or diploma in nursing (in a specialty area). Within the same structure, the professional
nurse could aim at gaining a salary beyond U52 by completing a Master’s degree in
Nursing (in a specialty area) to occupy the position of a Clinical Nurse Specialist and
later the position of Clinical Nurse Consultant, with a Doctorate in Nursing (Please
see Figure 2).

2. The Ministry of Health and Ministry of Higher Education at the earliest possible time
must ensure that only nurses with a Master’s degree in Nursing (in a clinical specialty)
occupy the position of the Clinical Nurse Specialist whose responsibilities include the
provision of leadership in patient care, research and teaching in the clinical setting.

45

Nursing Education in Malaysia

3. The Malaysian Academy of Nursing with the support of both the Ministry of Health
and Ministry of Higher Education, plans at the earliest possible time, to make a
proposal to the government for a five day week work system for shift duty nurses, as
a means to promote a more attractive working life.

Agenda Eight

Graduate education in nursing must necessarily be in clinical nursing specialties to
enable the nursing profession to develop its capacity in achieving its professional status
and professional autonomy as well as to ensure only “content experts” teach nursing in
colleges and universities.

Strategies
1. The Ministry of Higher Education to ensure that all newly proposed graduate education

programmes are clinical-based programmes, specifically graduate education leading
to Masters in Nursing, Doctoral degree and postgraduate certificate/diploma in
nursing.

The clinical specialty may cover a broad array of areas to include midwifery, mental
health, oncology, community health, critical care, emergency care, orthopedics and
traumatology, renal, burns care, paediatrics or even medical-surgical nursing.

2. It would be in the best interest of the nursing profession to also expect a clinical
qualification at doctoral level. In line with the latest development in the US, the
Ministry of Higher Education will recommend the universities to offer doctoral
programmes leading to Doctor of Nursing Practice (DNP) to ensure continuing
research activities in clinical nursing.

3. The MalaysianAcademy of Nursing will recommend to the Nursing Board of Malaysia
that teachers of nursing be active in clinical practice as a condition for renewing the
annual practice certificate (APC). This is to ensure that what is taught to students is
current and relevant.

4. On the basis that clinical specialization requires extensive and intensive clinical
practice, only universities with hospitals or affiliate hospitals will be given the mandate
to conduct graduate education programmes by the Ministry of Higher Education.

5. The Ministry of Higher Education and the Malaysian Academy of Nursing must
ensure that Graduate Education Database be initiated and updated to enforce and
monitor a system that only content experts are appointed as teachers of nursing.

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4/ Vision 2020 for Nursing

Agenda Nine

By 2020, the nursing profession would have built an effective research enterprise
in nursing through a planned research capacity building which takes into consideration
quality educational programmes, sound research infrastructure and sufficient funding for
essential research.

Strategies
1. The Ministry of Higher Education must continue to ensure that only candidates with

pure science and mathematics be admitted into nursing programmes at both diploma
and degree levels, as a basis for building a sound background in critical thinking and
problem solving.

2. On the basis that research is a process similar to problem solving and nursing process,
all colleges and universities are encouraged to include as early as possible in the
curriculum the application of nursing process and problem solving process (such
as problem-based learning-PBL) to facilitate better understanding of the research
process.

3. Knowledge and skills of research process in all academic programmes (Bachelor’s
, Masters’ and Doctorate) must focus on the development of a scientific knowledge
base that enables graduates to implement evidence-based practice. Doctorate nurses
will provide leadership in the implementation of such initiatives to ensure the most
comprehensive approach taken to solve a research problem.

4. The creation of a research culture in all nursing service areas (acute care facilities and
the community) is through the presence of the Clinical Nurse Specialist whose major
function, among other major functions, is to provide leadership in research activities
in respective specialty areas. Within a conducive research culture, a Clinical Nurse
Consultant (a Clinical Nurse Specialists with a Doctorate in Nursing Practice) will
emerge to further strengthen research activities in service organizations.

5. On the basis that healthcare is costly, and that nursing should be held responsible for
quality and effectiveness of nursing care and patient outcomes, both the Ministry of
Higher Education and the Ministry of Health must encourage the implementation
of outcomes research and intervention research methodologies incorporating both
quantitative and qualitative research. Graduates grown out of such an environment
would be ready to implement an evidence-based practice.

6. By 2020, nursing organization with the support of the Malaysian Academy of Nursing
and the Ministry of Higher Education, a Centre for Nursing Research (CNR) will be
established to secure funds. A Nursing Research Journal is expected to be initiated
before 2020.

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Nursing Education in Malaysia

Agenda Ten

By 2011, the Malaysian Academy of Nursing shall be established as an independent
professional institution as well as a leading institution of nursing devoted to upgrading and
maintaining quantity care to clients via high standards in nursing education .

Strategies
1. The Ministry of Higher Education is to endorse and support the establishment of the

Malaysian Academy of Nursing to be done through the following mechanisms:

(a) Formation of a PROTEM COMMITTEE

(b) Drawing up of the CONSTITUTION of the Academy

(c) Making formal APPLICATION TO THE REGISTRAR OF SOCIETIES for the
establishment of the Academy.

(d) RECRUITMENT OF FELLOWS on approval of the establishment of the
Academy.

2. The provision of financial support will have to come from the Ministry of Higher
Education to facilitate the establishment of the Academy in the initial stages.

3. The Academy to be named as the MALAYSIAN ACADEMY OF NURSING will
admit nursing leaders from education, management, research and clinical practice
with minimum qualification of a Master’s degree in Nursing.

Agenda Eleven

By 2015, the Nursing Board of Malaysia shall become Nursing Council of Malaysia
whose chairman shall be a Nurse selected by the Minister of Health from a group of highly
qualified nurses in the country and who, in addition, has extraordinary leadership qualities
that makes it possible for the council to function independently of the Ministry of Health.

Strategies
1. A working paper shall be prepared to outline the critical issues underlying the need

for change from a Nursing Board of the Ministry of Health headed by a medical
doctor to a Nursing Council, independent of the Ministry of Health headed by a nurse.
The Malaysian Academy of Nursing, with the support of the Ministry of Health, shall
be responsible for initiating the change process.

2. On the basis that the council must serve the interest of the nursing profession and
legal aspects of nursing practice and that its autonomy depends almost entirely on

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4/ Vision 2020 for Nursing

its effectiveness at governance, the Chairman of the Council must be qualified at a
doctoral level (at minimum a PhD level) and its membership at a level of expertise in
education, management and clinical practice.

PROPOSED PLAN OF ACTION

The following plan of action is seen as a necessary sequence of events from now till 2020
in an attempt to address the most basic needs in nursing.

Nursing’s Agenda Expected Activities
1. 2010-2011 Nov/Dec 2010: Appointment of Protem Committee
by JPT to draw up Academy’s Constitution; make
The establishment of the Malaysian application to Registrar of Societies by DHE; to identify
Academy of Nursing (MAN). “Headquarters”
March 2011 : Recruit Fellows
June 2011 : Firstst AGM to elect main Committee; pass
constitution; Fully functioning as an Academy.

2. 2010-2012 1st 6 months of 2011: On DHE’s request, MQA
Establishment of one-system nursing appoints a Panel of Assessors (who are non-Nursing
education through accreditation process Board members) to accredit the following programmes
of the Ministry of Health Diploma in (secondnd six months 2011 to firstst six months of 2012)
Nursing Postbasic courses Top-up Diploma in Nursing
degree in private institutions. Postbasic courses in Nursing
Top-up degree programmes in five private colleges/
universities.

3. 010-2020 By June 2011 (with the aid of Nursing Database)
Ensuring a 60:40% ratio o degree to A WORKING COMMITTEE to be set up by DHE to
diploma nurse population by 2020 undertake situational analysis on nursing staffing and
through the following initiatives: projection for 2020-to plan for 60:40 degree-diploma
ratio.
3.1 2010/2011 Centralization of scheduling of clinical posting by JPT
A NURSING DATABASEA is to be through MOU/MQA with affiliate hospitals to ensure
initiated by Nursing Division, Ministry of only colleges with hospitals or affiliate hospitals be
Health OR by the Malaysian Academy allowed to conduct nursing programmes. By 2015,
of Nursing with support of the MOH. only colleges with hospital will be allowed to conduct
diploma programmes.
3.2 2011/2012 By 2012 all universities to cease conducting diploma
Activation of national plan for stoppage programmes and start/increase enrolment of students
or reduction of diploma graduates and into the four-year degree programme.
increase in BN enrolment.

3.3 2012
A “Nursing expert” Database to be
initiated by DHE/MAN to ensure only
content-experts teach in nursing
colleges and universities. By 2015 only
qualified teachers will be allowed to
teach.

49

3.4 2012/2013 By mid-to end of 2012
Full enforcement of MOHE revised A mechanism to centralize student enrolment into
entry requirements into the diploma diploma programmes by MOHE to ensure only qualified
programme ie. SPM with five credits candidates will be admitted within a stipulated number
in Biology, Chemistry/Physics, by 2013 – full enforcement should by ensured.
Mathematics, BM, English.

3.5 A mechanism to be in place to hire all By 2011- all four year degree nursing graduates should
four-year degree graduates as staff be employed by government hospitals to work as staff
nurses into the government service nurses on U41 salary scale. Provision must be made
system on U41 salary. for this.

4. 2012-2015 By 2012
Planning and implementation of clinical A concept/working paper will be forwarded to MOHE
graduate programmes by universities by Jemaah Kejururawatan IPTA/Nursing Education
and by 2015 enforcement of policy to Taskforce or the Malaysian Academy of Nursing to
take only “qualified” teachers. justify the need for clinical nurse experts from Masters
to Doctorate level.
By 2015 a plan to have terminal degree By 2015: At lease 50% of Nurse Teachers employed
for nurses as Doctorate in Nursing are clinical experts (Masters in clinical nursing).
Practice (DNP) (instead of PhD). By By 2020: At least 50% of Nurse Experts teaching in
2020 only DNP graduates will teach universities are holders of DNP.
in universities and Head the Nursing By 2011: Clinical practice to be made a condition for
Council/Board. renewing of APC by all lecturers.

5. 2012/2013 By 2011/2012, the Academy will prepare a proposal
A proposal for a Clinical Service paper to be sent to JPA through MOHE and with the
Structure will be forwarded to JPA as support of Nursing Division, MOH.
a means to retain degree-prepared By 2012/2013, the Academy will also help to make a
nurses at the bedside, making clinical proposal for a five-day week work system for shift duty
practice their career destination. nurses.

6. 2015 By 2011: All nursing education programmes will include
The Nursing Practice Standard will the teaching and practice of Nursing Process.
include the Nursing Process Model. All teachers must be well versed and qualified to teach
(four years to prepare nurses and practice the Nursing Process Model.
conceptually and structurally, by which By 2013: Discussion between nursing colleges/
time more degree nurses would be universities and nursing service departments will be
employed as Staff Nurses) held to discuss the possibility of implementing the
Model through trials and pilot projects. Plans and
In 2013 KPI for new graduates should formats to be ready for implementation in 2015.
include the Nursing Process Model.

7. 2013-2015 By 2013/2014: The Academy will be held responsible
The establishment of the Nursing for accomplishing the task (considered as both political
Council to replace the Nursing Board. and profesional).
The Chairman shall be a Nurse Preparation of legal and professional document;
with a Doctorate in Nursing Practice
(DNP), or at minimum a PhD. Nursing Gaining acceptance from the Minister of Health and
membership will comprise nurse Director General of Health;
experts in various specialties.
Presentation and approval by parliament.

8. 2010-202 From 2010-2020
The establishment of a research enterprise All colleges and universities to ensure:
through @a planned research capacity Admission of suitable candidates – those with
building; (b) sound research infra-structure; pure science and Mathematics;
and (c) sufficient funding. Nursing Process Model be applied in theory

2012/2013 – appointment of Clinical Nurse and practice;
Specialist – a Masters prepared nurse in Research Process be taught to enable
clinical practice. application of EBP;
All teachers are clinical experts and active in
clinical research.
2018/2020 – appointment of Clinical Nurse
Consultant – a Doctorate (Doctor of Nursing
Practice) nurse to head research activities Nursing practice areas to develop research
for nursing. culture through the appointment of Clinical
Nurse Specialists who are adept at research
process.

By 2020, a centre for Nursing Research will be
established to ensure financial security.

Research activities will be focussed on
Outcomes Research and Intervention
Research based on Nursing Process Model.

9. 2015-2020 By 2015
The establishment of two levels of The Ministry of Health, universities and private
Registered Nurses: hospitals will plan to have nursing service
Level 1: The Professional Nurse (nurses delivery in the following manner:
with Bachelor of Nursing).
Level 2: Diploma Nurse (nurses with
Diploma in Nursing ) – both having different Profesional Nurses to be in priority areas
functions and responsibilities. of patient care (all critical care services,
extended programmes, as well in less priority
areas requiring a staff mix of BN and Diploma
nurses.

The Diploma Nurses to be in less priority areas
as well as non-patient care areas.

The Nursing Database will be made available
to help the organizations to balance the 60:40%
need ratio of profession and diploma nurses.

In the Community Health Centres, a plan
should include preparing degree nurses to
lead nursing teams in health centres and rural
areas.

The team could have a staff mix of Professional
and Diploma nurses.

10. 2010-2020 From 2010 onwards: Hospitals must plan to
The recognition of nursing service as place degree nurses at the bedside mainly in
a Professional Service and nurses as acute care facilities, in the community and in
Professional Staff to replace support service rural setting.
and support staff status, respectively.
By 2020: At least 60% of nurses providing
care will be degree nurses.

From now on: The Bachelor of Nursing
degree will be the most basic qualification for
promotional posts in nursing.

Chapter 5

Conclusion

Nursing has some major issues to address and multiple basic needs to fulfill, some of which
are so extremely basic akin to Maslow’s physiological needs for air, water and food which
must be partially satisfied before higher order needs (such as social needs) can be fulfilled.
For example, the low entry requirement into nursing (ie. SPM three credits) which has
not changed for the last 25 years, and now that it has (to five credits in 2010), instead
of rejoicing for the profession, serious objections have been made; nursing care is task
oriented based almost entirely on doctor’s orders; more than 99% of nurses are diploma
holders (receiving a starting salary of U29 and retiring at below U36) placing nursing
within the support service category within the government service structure, awaiting
CUEPAC (Kongres Kesatuan Pekerja-pekerja Di dalam Perkhidmatan Awam) to improve
its fate; nursing DATABASE is almost nonexistent despite advances in computer and
communication technology: registration exam for thousands of candidates three times a
year remain at paper-and-pencil exam; Nursing Process Model and problem-based learning
(PBL) cannot be implemented because of the weakness in the system. More importantly,
despite the improvement in nursing education system, weak leadership is felt at every level
of the system. Nursing leadership, on the whole, lacks vision, maturity and intellectual
presence.

The above mentioned needs are mostly “physiological” which must be partially
fulfilled before issues of professional autonomy, one-system education, research-enterprise,
nursing expertise and professional status and many more, could be satisfactorily achieved.
For example, it would take a tremendous amount of commitment and sense of accountability
for the Ministry of Health to even accept the idea of the 60:40 degree diploma nurse ratio
because of what it implies, or to agree with the idea of one-system nursing education. A
failed attempt at addressing these two issues alone, would result in non-application of the
Nursing Process Model, a strategy so needed in gaining professionalism and autonomy.

The concerted efforts of all concerned – the Ministry of Health, the Ministry of Higher
Education, Nursing Board of Malaysia, Jemaah Kejururawatan IPTA, Nursing Education
Task Force and the Malaysian Academy of Nursing – can make it all possible for some, if
not all, of the issues to be resolved.

Nursing Education in Malaysia

The Malaysian Academy of Nursing is seen as the NERVE-CENTRE for a significant
number of professional activities including the request for a Clinical Ladder Scheme for
degree nurses, the establishment of the Nursing Council, creation of nursing database,
strengthening research initiatives, and leadership in heightening visibility of nursing through
its active efforts in political, professional and financial issues affecting healthcare and
nursing profession. Hence, its establishment is to be regarded as the MOST IMPORTANT
event in Nursing Agenda towards 2020. Accordingly, the choice of its members to lead in
its development must be based on their vision, maturity and intellectual presence.

It is envisioned that the intake of STPM/Matriculation students into nursing will
revolutionize nursing as a profession in Malaysia. There is a steady rise in the choices
made by these students to make nursing as their first choice. In UKM for example,
evidents has shown that male students with 4.00 CGPA have chosen nursing as their firstst
choice. There is also evidence to show that these nursing students are “communicating”
with medical students in the clinical setting, possibly because they were, at one time,
classmates in STPM/Matriculation program. These same students are put together as part
of interprofessional learning in research projects and primary care activities. They are also
sharing the same nursing skills lab and faculty computer lab. The synergistic effect of
putting the two types of students together will go far beyond social interaction.

This development is encouraging. There is hope yet for collaborative problem solving
and decision making for both nursing and medicine. Unfortunately, on graduation, the
graduates of the four-year Bachelor of Nursing, with the exception of Department of Public
Service (DPS) scholars, are offered position as Staff Nurses with diploma salary of U29.
The current scenario shows a gradual trend of migration of degree nurses to Singapore.
UNIMAS and UKM have participated in making this trend a reality. Visionary leadership
can stop this exodus and nip the problem in the bud. This trend must not be allowed to
proliferate if the 60:40 ratio of professional and diploma target is to materialize.

Indeed Nursing is not short of opportunities to develop and needs to fulfill. But these
needs cannot be fulfilled until nurses, particularly those in leadership positions by changing
what they are. For them to change what they are, they must change the way they think, the
way they feel and the way they act.

Prepared by:
Task Force Committee for Nursing Education
Department of Higher Education
Ministry of Higher Education Malaysia

11th October, 2010

54

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