- 2 days ago
The pressures on healthcare systems are not new but they have been intensifying, and a core pillar that has been affected is the nursing workforce. While the conversation around nursing is often framed as a shortage, the underlying issues are more complex: from remuneration and working conditions to the growing pull of overseas demand. Are current policies keeping pace with the realities facing the nursing profession today? On this episode of #ConsiderThis Melisa Idris speaks with Rajpal Singh Baldev Singh, Corporate Head of Nursing for Mayapada Healthcare Group, which is a private healthcare group based in Jakarta, Indonesia. In 2025 Rajpal received one of the world’s highest honours in nursing, the Fellowship of the Faculty of Nursing and Midwifery at the Royal College of Surgeons in Ireland.
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00:10Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show where we want
00:15you to consider and then we consider what you know of the news of the day. The pressures of
00:21the healthcare system, they're not new but they have been intensifying and a core pillar of our
00:27healthcare system is of course the nursing workforce. While the conversations around
00:33nursing is often framed as a shortage, some of the underlying issues are far more complex
00:39from remuneration to working conditions to the growing pull from overseas demand. Now tonight
00:46on the show we want to pose the question, are the current policies around nursing keeping pace
00:53with the realities facing the profession today. Joining me on the show to help me think this
00:59through is Rajpal Singh Baldiv Singh who is Corporate Head of Nursing for Mayapade Healthcare Group which
01:05is a private healthcare group based in Jakarta, Indonesia. Last year Rajpal received one of the
01:11world's highest honours in nursing, the Fellowship of the Faculty of Nursing and Midwifery at the
01:18Royal College of Surgeons in Ireland. Rajpal, it's an honour for me to have you here. Welcome to the show.
01:22So let's start broad for our conversation if I may. For the benefit of those of us who are outside
01:29of
01:29the healthcare sector, talk to me a little bit about the nursing profession. How would you describe
01:34the current state of the nursing profession in Malaysia today? Okay if you ask me the current state, I think
01:41it will be a sore truth actually. It's not easy to be said. There's a lot more can be done
01:48I would say
01:49starting off from that. Currently we have nurses working in the private and public sector in the
01:55healthcare in Malaysia. But I think one of the biggest thing is actually there is a lack in people
02:01wanting to join to become a nurse. Yeah so I think that is one of the big concerns. So that
02:06tells a lot
02:06the whole picture of the story here. Okay all right so when you know there's been a lot of coverage,
02:12a lot of
02:12national attention about the shortage of nurses and a lot of hand-wringing around it. What do you, how would
02:20you describe the current situation particularly after the pandemic? How serious is this shortage of
02:26nurses? What does it actually look like on the ground when we say a shortage of nurses? Actually the pandemic
02:33is a
02:33very important time period that actually taught us actually a lot. You know suddenly we were hit
02:37by this disease and then the hospital beds were occupied and we noticed at that point that how
02:42difficult for us to manage the situation we were having short or manpower equipment and so on.
02:48But with manpower, why nursing is very important because 24-7 the nurses spend time with the patient
02:54and during this stage of time it was understand that even the public sector strain so a lot of cases
03:01were sent off to the private. Private we had a little bit of leeway because the private mostly
03:07they do a lot of medical tourism and all that so they managed to cater with that basis some of
03:12the
03:13cases from the public side to support that. But if you look at that, nursing colleges closed down
03:18because of the pandemic and because of that the three years we didn't have a big number of nursing
03:24being graduated and the effect come right after pandemic. Suddenly we noticed that there's no nursing
03:29coming because we didn't recruit them during the pandemic period so a lot of people forget that.
03:34Yeah. Sorry, why were nursing colleges closed down during the pandemic?
03:39It came, everything came to a shutdown because they didn't want to have this disease spread around
03:43so the colleges were closed, intakes were reduced. Yeah, even SPM was delayed at that point.
03:49That's true. So now we're seeing the kind of the delayed impact of that. Exactly. So last year
03:56actually our Ministry of Health in Malaysia, they actually came up with a plan actually. They said
04:01that we have to ramp up the number of nurses intake. We were doing around thousand, five thousand,
04:06six a year. They want to ramp up to three thousand. So they actually pulled down the requirement to join
04:13for a diploma of nursing program which is from five credits to three credits. They were all uproar
04:18but at that point I think the government, I mean they examined the situation. They noticed that it was
04:24important because if not we will have a shortage because at the same time the population is increasing.
04:31Hospital beds, we want to increase but the nurses are not there. Okay. So I want to go into maybe
04:38the
04:38pipeline of nurses a bit more but since we were talking about the pandemic, I think you're right. It was
04:43such a
04:44pivotal point for us to really, all of us suddenly saw the incredible work of nurses and how we, how
04:54much
04:54we need them, how essential they are. Do you think, so what lessons do you think came out from that
04:59about
05:00particularly about the nursing profession? What did we learn about nurses and the importance of nurses
05:07from the pandemic that you think we really should pay attention to today? I think first thing is risk
05:12management. We have to be prepared no matter what and the nursing numbers is not just you must have
05:18just enough for the running of hospital. You need to have a little bit more extra. Why you need to
05:23have a
05:23little bit more extra? During the pandemic, we had to open vaccination centres. We had to have other
05:29programs, preventive programs, screening programs and so on. So these were actually the head counts that were
05:34being used to manage that. So it comes back to whatever that we do in coming time, we have to
05:41look
05:41population number increasing. There's new diseases emerging or no. How would we need and how is the
05:47manpower being planned? So it all comes down to the planning phase. That is an excellent point. You're
05:52right. We cannot just have just ngam-ngam, just enough, right? You need to have more capacity.
05:59Was there a problem of shortage of nurses even before the pandemic? And did the pandemic
06:06exacerbate the shortage, the attrition? Exactly, yeah. So there was always been a shortage of
06:11nurses. I've been in nursing, I think, 20 years already. And you come from a healthcare family as
06:15well. Yeah, I come from a healthcare family and my mother, sisters, they're all nurses actually.
06:20And one of the biggest problems in nursing is the first day when we start joining, when we start
06:24taking care of patients, when we look in our team, there is always a clause comes in. We don't have
06:28enough nurses, you need to maybe stay back and do this. Or maybe you need to take a double shift
06:33or so on. Yeah, so it has always been there. And I think the pandemic just made it, worsened it.
06:40And now we can really see the effect comes into place that we need to do even more.
06:45Right, okay. So what do you think are the drivers behind the shortage? Not just post-pandemic,
06:51but the persistent shortage that we've seen throughout the years. The one reason is actually
06:57nursing job is quite a challenging job. It's not an easy thing to do. So basically a nurse taking care
07:03of a patient, doesn't matter whether it's public or private, the expectation of the patient, family
07:08comes into place. That is the most important thing at the first level. But then also comes working on a
07:13hierarchy-based team. You have the leader there, you have the doctors, you know how to work with them,
07:20the expectation and so on, meeting that. So this makes it very challenging. And on top of that,
07:26at the end of the day, they don't get paid much. So when they think back, they think,
07:32why should I join nursing? If someone does well in the exam, even SPM or STPM or what,
07:37why should I do nursing when I have other opportunities to do? Has the role, has the profession of nursing
07:44changed over the years? I do wonder, because you said it's a tough job. It really is at the core,
07:49but it's also, you know, it's caregiving. Caregiving is always very difficult. But has the role of nurses
07:57changed over the years to maybe adapt and allow for people to grow in that profession? And you mentioned
08:04it's very hierarchy-based. Exactly. So actually, it has changed from the early days of, I would say,
08:12a few hundred years back when modern nursing came into place. It has changed from then to now,
08:17has become much more empirical and so forth. But I think the adoption is another problem.
08:21How much do people adopt and how do they see how they can improve this? So I would like to
08:27share
08:27a little bit about this country, especially America. So in 1980s, they had a shortage of nurses.
08:32Nurses were not happy at all there. And during that time, a lot of people left the profession and so
08:38on.
08:38So the American Nursing Association came up with a program, a retention program, but it's an accreditation program.
08:48So they gave these hospitals an accreditation program. If you do the program, you can somehow change
08:53the culture of nursing overall and retain them. So they came up with something called the Magnet Program.
08:58Malaysia, we don't have the Magnet Program.
09:00So was it successful, this Magnet Program? Yes. It was.
09:04But it was successful in retaining. And I think now the largest number of hospitals that have
09:10Magnet Program is in the US because it's based there. Out of the US, I think only 20 hospitals have,
09:17mostly focused on Middle East. Okay, now that's the interesting part. Where Malaysian nurses go to
09:22if they are not happy? Singapore or Middle East? And Singapore was one of the earliest adopters of the
09:28Magnet Program, Singapore GH. But eventually they dropped off and they carried on their own program.
09:33But you see, it makes a little bit different there. Yeah. Okay. How much do you, I mean based on
09:39what
09:39you've observed and you know what people are telling you, how much of it is a pull factor from
09:45overseas demand and how much of it is a push factor from the say working conditions in Malaysia? Okay.
09:51Okay. So pull factor is quite interesting because of salary. Okay. So example, if you earn here,
09:57X number of amount, you're getting three up to five times more in overseas. Because of the currency.
10:03Okay. Currency, the amount and so on. On top of it, you get to see this life balance thing. You
10:10know,
10:11they provide you with a complex for you to stay. You have sports facilities there for you to do your
10:15thing and all that. Flight ticket given through and from Malaysia. So they really take care of the whole
10:20picture. And certain positions you can even bring your family over. Yeah. Okay. So that's pull factor.
10:26Pull factor. Okay. Push factor. Malaysia, like I always share with everyone, our healthcare
10:34inflation rate is going up. So there's a lot of cost constraint. So basically, for public hospital,
10:40we look at the government expenditure. Obviously, it's increasing year by year. They're trying their
10:44best to do that. But same time, we have to look into expense. We have to manage headcount. Private,
10:50same thing. Yeah. So when you do this, there's certain roles that nurses have to uptake nursing
10:57or non-nursing roles to assist. And I think this basically can be a push factor. And also the
11:04relationship with the hospital, the expectation of patients and so on, you know. So there's a lot
11:08of other things. So this all pushing, the pulling one is the interesting thing, pulling them there.
11:12So that's how it works. So it's a confluence of factors and the timing. Is it possible to address
11:19some of these things? Remuneration is a tough one, right? Because we've heard that even with doctors
11:25and the like, it's really difficult because it's under, let's talk about public healthcare for now.
11:32It's really difficult to increase the remuneration and hard to address the pull of a triple, quadruple
11:39currency exchange. How do we think about retention of our nurses if we want to address some of the push
11:48factors?
11:49I think the main thing, one we need to look at is how we want to change it. We have
11:54to change our mindset.
11:56So a lot of time when you join in nursing, the first thing they will tell, during my days,
11:59we used to do like this, like this, like, we cannot use that. It doesn't work with nowadays
12:03generation. You can't tell, last time we used to do this, last time I used to work three shifts,
12:07I don't complain, now why you complain? It doesn't work. So that have to change the first part.
12:13And then the same thing also, to make sure that this works go forward, you have to look at other
12:18innovative
12:18ways to make it more interesting. You have to see that having some work-life balance,
12:25some sort of career development that is actively seen as the nurse that, you know, they're gaining
12:30something while I'm here, even though I'm not getting paid much, or they are looking after my
12:35career development. My bosses really care about me. Yeah, I'm doing something for nursing which
12:41I'm passionate about, and I'm getting this assistance. Yeah, I think that the sort of
12:46thing should be in picture. One of the reasons why I think it's interesting to speak to you,
12:50Rajvel, is because you have quite a regional perspective. You're based in Jakarta,
12:54Australia, but you're also looking at Southeast Asia and what's happening with the healthcare
12:58sector in the region. Compare and contrast for me, what's happening regionally? How are different
13:04countries addressing what I'm sure they're facing too, challenges with retaining their nursing staff?
13:10Yeah, it's very interesting. Maybe I just share a little bit. I'm actually in a part of team
13:17that actually we're working with the International Council of Nurses, and there is a programme that
13:22actually developed for policy makers. And I was chosen for this coming batch of programmes starting
13:29this year from Indonesia, and I was supported very heavily by the Indonesian Nursing Association.
13:34And based on that, I have the ability to see across the region for Southeast Asia. And when we look
13:41across,
13:41you can see Singapore, obviously, based on World Bank status, they are a developed country and they have
13:49their own way of doing it. They have actually put in a system where the public and private work very
13:55closely.
13:55They have multiple task force. They have a retention programme. I won't say working 100%, but they are
14:01putting in effort to make it work. So this actually brings a lot of difference because Singapore itself,
14:08they have clear shortage of nurses. And they have more than 10 countries of nurses who are
14:14practising there as a nurse. So they have to make sure these people coming from all over the world to
14:18work there, how can they retain them? And you know, they can make sure that they have enough nurses
14:23for their healthcare system there. But across, if you look at Thailand, it's a totally different story.
14:28Yeah. Thailand themselves, they train and keep. It's because one thing of their mother tongue as well.
14:33Okay. Yeah. But also, they have a focus on medical tourism where they have their locals speaking
14:38in English and so on. But they look at their internal pipeline. Yeah. So they take care of their nurses,
14:44make sure they have a retention programme, they look into remuneration packages, they look into
14:48work-life balance and so on. So Malaysia has something similar. But okay, we can do a bit more.
14:56Okay. In what way? Okay. In what way is basically, you see, currently in Malaysia, currently,
15:01we have the public and private sector. Okay. And public sector is very much represented actually
15:07wholesomely. The person who sits in public sector also sits in the nursing board. So you can make
15:15changes directly influence the public sector. Private sector is a bit left out. But basically,
15:21they are represented by some nurses in the association of private hospital group. Okay. But whatever
15:28that is focused in Malaysian nursing, basically, the public sector gets to see the whole picture first.
15:33Okay. Okay. And private sector? Secondly. Okay. Public sector nursing and private sector is
15:41different. Because public, you have the nurse, you have the medical officer, you have the specialist
15:46registrar and so on. You know, the levels are different. Private sector, you have the nurse,
15:52then the specialist doctor. So the nurses do a bit more. Yeah. And I think the role demands them to
15:57do a bit more as well.
15:58Yeah. So that's the differences between private and public. Exactly. Yeah. And then coming back to this,
16:05what things that have been put in place? I know the nursing association in Malaysia is trying to
16:09see into salary packages, how we can have more nurses in the pipeline. Like I said, they did an initiative
16:15to
16:16bring more nurses by having to drop down the qualification thing for temporary arrangement. Having
16:22foreign nurses to practice here, even though the program didn't work, but it was something started off.
16:27But there is a lot of other things like work-life balance. How do you see the career pathway,
16:33the competency way, how they can see that by staying in this group of nurses in Malaysia,
16:38one day I'll be developed. Yeah. That part, I think a lot more we can still do. Yeah.
16:42Rajabelle, would foreign nurses solve the nurse shortage in Malaysia? I think many people are saying,
16:50well, that can be a silver bullet for us. What do you think?
16:54Temporary. Temporary. The thing is very simple. So when you take a foreign nurses come in,
16:59let's say you take from India or from any other countries, first the onboarding, it will take time,
17:03three to six months. And you must remember, these people, they have family elsewhere. They would want
17:09to go back after certain. The most, maybe they stay two years, five years or so on. But after that,
17:14they will want to go back. So it's a temporary fix. And a lot of time, I see that people
17:19come in,
17:19half of them get adjusted, half no. Our culture is different. The way we speak, the way we eat,
17:26our patient expectations is different. But they can fulfill for us on a temporary basis. So I think
17:31what happened in 2023, the private sector actually worked together with the government to allow for
17:38foreign nurses to come in right after COVID because we had tough problem. I think Clang Valley had a lot
17:42of hospital, the waiting time increased, there were no nurses, the beds couldn't be filled and so on. So they
17:49need to be filled. So this is only temporary. So what, so solving the nurse shortage would mean trying
17:56as much or creating policies to retain the nurses that we have currently. But you also said a bit earlier
18:02that there's not enough coming in, there's not enough supply coming in. Can we talk a little bit about
18:08the pipeline of nurses? I'm not quite sure how the pipeline is, how long does it take to train a
18:13nurse, but
18:15have, have, have we addressed the issue of making this profession an attractive one for young people
18:22to join? I think it has been done, but can be done more. Okay. So, so, so, so basically a
18:29nurses come,
18:30a nurse come into practice at two different pathways. One is a diploma at three years, they have to study
18:35for
18:35a three years course, or if not at a degree, which is four years after their foundation or STPM or
18:41so on.
18:42And when they come into the sector, then they, they, they work through their experience and they
18:46work up, move up the bench. Yeah. So these two currently are being recruited by hospitals
18:54from post schools. That means during SPM and all that, we try to recruit them and tell them,
18:58you come to our hospital to work. I give you monthly allowance X amount. I sponsor you. Then you work
19:03with us five years. You stay with us. I was the product of the same system. So I was sponsored
19:10by a
19:10hospital right after my SPM. I was given allowance every month. And after that, I need to serve
19:17certain years with the hospital. Good system work well. Now they have challenges. People don't want
19:23to come into the system. They feel that why would I want to go and work there five years fixed
19:26in a
19:27hospital with that kind of pay. So to make it attractive, some private hospitals, even the government,
19:31they increase the allowance, but still people are not coming in. Why? Because the general understanding
19:38to be a nurse is not easy. You'll get scolding from the patient. You'll get scolding from the family.
19:42You'll get scolding from doctors. I need to clean the patient. You need to bath the patient. It's not
19:47a glamorous job. Better still become an influencer. Right. Well, that I'm sure is not just the only
19:54profession facing this challenge of attracting young people, but nursing is so important. We really
20:00need to address this. So then how would you or what would you like to see or what would you
20:07like to
20:07recommend in terms of policy changes or policy improvement, policy strengthening? And if you can
20:15tap into your experience in Indonesia, what are you seeing there that you think maybe we can hear
20:21in Malaysia learn a little bit from our neighbour? Indonesia is very interesting actually. Basically,
20:27first thing is actually the population itself. It's almost 300 million. Almost 10 times of our
20:32population in Malaysia here. And basically the hospitals that we have there are almost 3,000 hospitals.
20:37Overall in Indonesia, private and public. 3,000? 3,000. Huge, right? Mind-boggling.
20:44Yeah, exactly. So actually, has Indonesia progressed in this past 5, 10 years from the previous
20:52president, Pak Jokowi? He actually noticed that one of the most areas that has to focus on is
20:57actually healthcare. And due to that, he actually increased the ratio of number of beds to
21:02population to make sure when any disease emerges tomorrow, if the population turns old or what,
21:08there's enough number of beds. So as that thing go on, he makes sure that was a partnership between
21:12private and public to work together. Yeah. And the interesting part, in Indonesia healthcare minister,
21:21he's not from healthcare background. He's a banker. Yeah. So he sees things very differently. He sees into
21:28partnership how public can do and the private can learn. How private can do and the public can learn this
21:34cross thing, which is a plus point. Due to that, that actually makes my life easier. So me there, as
21:40the
21:40corporate head of nursing for Mayapada, we are actually a private entity. So by structure, if I'm in
21:46Malaysia, I have to follow whatever structure that has been passed around by the government and go so
21:49forth. But in Indonesia, what I can do is I can discuss. Yeah. And some of the programs that I'm
21:55doing actually, the Indonesian Nursing Association is also trying to adopt. Yeah. So there is a lot of
22:00cross things. So much collaboration between private and public. And the plus point of this as well,
22:07like I just mentioned for the International Council of Nurses Program, the Indonesian Nursing Board put me to
22:13also represent them, which I find it. Oh, this is very supportive and I couldn't let this go. Yeah.
22:20So we can see the correlation of that relationship. Yeah. Okay. Well, are you then, having said all that,
22:28hopeful for the future of nursing? I do wonder what you're most concerned about? I mean,
22:35reality check here. What are you most concerned about? What are you hopeful about in terms of the future of
22:40this profession, particularly for Malaysia? I don't know. At the end of the day, I just want that
22:46when I go around, I ask someone, tomorrow what your kids want to be or what you want to be,
22:51they will just turn around and tell me, yeah, I hope they can be nurses. You know,
22:55they make the mark to be a nurse. I would just want to hear that more people choose nursing as
23:00a
23:00profession because as we grow, as our population grow, we will need nurses. And this is something no
23:05robotics can take. No AI can take this job. Exactly. So at the end of the day, you just need
23:09them.
23:10And what I'm hopeful for, for the next stage is actually a more intense collaboration between the
23:16private and public. Yeah. But same time also how we can work together at national body like the
23:22nursing board, Malaysia Nursing Association, how we can have more intense collaboration to see things,
23:31to go through. Yeah. Rajpa, what's stopping that from happening here in Malaysia? Is there a way we can
23:36maybe help facilitate that collaboration? You paint a really nice picture. How do we make it happen?
23:42You see, the thing is actually, it's not that people don't want it to happen. It's happening up to
23:46certain level. And the main reason is very simple. Malaysia, the total number of hospitals,
23:51the biggest number of bed capacity is in private side, sorry, in public side. So the focus always will be
23:58more on the public side because they have taken the notion that I'm the training centre, I'm preparing
24:02for the country, you know, for the population and so on. So the focus has always been there.
24:06I'm not saying the private side is not important. We carry about half the total number of bids from
24:11public. But the thing is, our whole description of nursing duties, the way we work is totally different
24:18actually. People think, oh, nurse, I take care in government is same, private is same. It's different.
24:22The system is different. Like I say, in public sector, you have the MO in the ward with you,
24:27the medical officer, you have the registrar, the specialist, a whole team of them. But in private,
24:31you only have certain specialists there working with you directly. So it's much more, the task is,
24:37I think, much more focused on the overall capacity. Yeah, compared to in public side, it's much more
24:43focused. Yeah. So there's a lot of focus there because they're the biggest, but that doesn't mean
24:49that we are not important. But now I've seen that the association of the private hospital in Malaysia
24:53is trying to put that, yeah, we have around 200 hospital groups, sorry, 200 hospitals in the
24:59private sector and we cover all the major cities. So importance should be given and so on.
25:04But I still see in the association is still from, yeah, from the private, sorry, from the public side.
25:11Well, hopefully that, um, you know, things will change and improve in terms of collaboration in
25:17the future. It's been so illuminating talking to you. Thank you so much for sharing some of the
25:21insights within the nursing sector with us. I appreciate your time, Rajpal. Thank you so much.
25:26Thank you very much. That's all the time we have for you on this episode of Consider This.
25:30I'm Melissa Idris signing off for the evening. Thank you so much for watching and good night.
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