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When nurses are overworked, unheard or afraid to speak up, safety, dignity, learning and retention all suffer. Fernando Zhiminaicela / PixabayKUALA LUMPUR, October 1 (IPS) - Nurses are often called the backbone of the health system. We praise their compassion, commitment and resilience. On Nurses’ Day we thank them. During emergencies and crises, we call them heroes. But there is a harder question Malaysia, like most countries around the world, needs to ask more seriously: what happens when the people who care for everyone else are not safe, supported or respected at work?
This question is not only about patient safety. It is first about nurses’ own rights, dignity and wellbeing. A safe and healthy working environment is recognised by the ILO as a fundamental principle and right at work.
Nurses deserve safe workplaces not only because patients depend on them, but because no worker should be expected to absorb abuse, bullying or harassment as part of the job.
The health and care sector is highly feminised, with women making up around 70% of the global workforce. This is even more pronounced in nursing, where women account for 85% of the workforce, according to WHO’s 2025 State of the World’s Nursing report. This means workplace violence against nurses is not only an occupational safety concern. It is also a gendered issue.
As a female-dominated profession, nursing is often positioned lower in hierarchical health systems, where authority is unevenly distributed. Gendered assumptions – such as women being “naturally caring,” patient or obedient – can normalise mistreatment, silence complaints and discourage reporting.
Because nurses are also frontline caregivers, they are exposed to aggression from patients, families and colleagues. Gender therefore shapes both how violence is experienced and how seriously it is taken.
For many nurses and frontline health workers, workplace violence extends beyond physical assault. It involves verbal abuse, bullying, humiliation, intimidation, sexual harassment, disrespectful treatment, harsh hierarchy and psychological pressure.
These forms of violence may not always leave visible injuries. But they can leave deep marks on confidence, mental health, family life, professional motivation and the decision to stay in the nursing profession.
Studies from several Malaysian healthcare settings show that workplace violence is more common than we may think across hospitals, emergency departments and primary healthcare facilities.
A study conducted among 90 nurses in Kuala Lumpur found that more than 90% had experienced verbal abuse. Similarly, a survey of 838 primary healthcare workers in Selangor reported that 68.5% had experienced workplace violence, with verbal abuse the most common form and nurses the most affected professional group. In Melaka, research among 455 female registered nurses found that 51.2% had experienced sexual harassment, most commonly verbal, but also visual, psychological, non-verbal and physical. Nearly three-quarters of those affected reported psychological effects.
Behind each of these figures is a person trying to do their job while staying calm, professional and compassionate. A nurse explaining treatment to an anxious family. A frontline worker managing a crowded clinic. A junior staff member afraid to speak up. A mother finishing a night shift and going home to another set of care responsibilities. These numbers should not be read as statistics alone. Rather, they are warning signs of workplace systems and cultures and the need for stronger prevention, reporting and response mechanisms.
Malaysia already has important foundations in place. Existing occupational safety and health obligations, together with MOH guidance on workplace violence, provide a strong basis for prevention and response. The challenge now is to build on these measures and ensure they are visible, trusted and consistently implemented in hospitals, clinics and frontline services.
This concern was clearly articulated in a focus group discussion with nurses and frontline health workers in Sabah. Participants described workplace violence and bullying as part of a wider picture of pressure: too many patients, too few staff, missed breaks, unpaid or poorly compensated overtime, limited recognition, burnout and difficulty balancing shift work with family responsibilities.
One district clinic was described as seeing around 600 to 800 patients a day, with only a small number of frontline staff managing the flow. In hospital wards, nurses described caring for 10 to 20 patients and sometimes up to 25 patients alone. Staff often missed lunch breaks, stayed beyond official hours to complete patient care and documentation and sometimes worked while sick because no one else was available to replace them. Heavy documentation and uneven digital systems added another layer of pressure.
In the same Sabah discussion, one participant described bullying as something that particularly affects newcomers and junior staff. Another explained that many young workers feel they have little choice but to endure difficult treatment because they need the job. As one participant put it, many feel they must “just bear with it” because speaking up can feel risky.
The human cost also reaches beyond the workplace. One nurse described leaving for work while her children were still sleeping and returning home when they were already asleep again. This is not only a personal story. It is a policy issue. When nurses are overworked, unheard or afraid to speak up, safety, dignity, learning and retention all suffer.
This is why workplace violence must be discussed together with Malaysia’s nursing shortages, retention concerns and migration of nurses. Nurses do not leave only because of salary, although salary and fair compensation matter greatly. They also leave when they feel unsafe, unheard, unsupported and unable to grow.
When nurses feel unable to speak up, silence becomes part of the system. When junior staff are humiliated instead of mentored, learning suffers. When bullying becomes normalised, workers may begin to see leaving as the only realistic option. For a mostly female workforce, these pressures do not affect nurses alone. They also affect families, communities and how society values care work.
Training more nurses will not solve the problem if the working environment pushes nurses away. The real question is not only how we produce more nurses, but also how we ensure that nurses can stay, work safely and be treated with dignity. A serious response to workplace violence in healthcare should include several practical steps.
First, nurses should have a stronger voice in decisions that affect their work. Frontline nurses, nursing leaders, professional bodies and unions should be meaningfully involved in shaping policies on staffing, workplace safety, reporting systems, mental health support, digitalisation and service delivery. Collective representation matters because individual nurses should not have to carry the burden of speaking up alone.
Second, trusted systems for preventing, reporting and responding to workplace violence, bullying and harassment should continue to be strengthened. Nurses need to know they can safely report any kind of violence without fear of being ignored, blamed or punished. Too often, incidents go unreported because people do not believe anything will change. A safe workplace starts with systems that people trust.
Third, addressing staffing shortages and excessive workloads is also essential. When nurses are caring for too many patients, missing breaks and regularly staying late to finish their work, everyone pays the price. Safe staffing is not a luxury. It is essential for both patient care and health worker wellbeing.
Fourth, supporting nurses also means looking beyond individual resilience. Nurses need time to rest, supportive supervisors, access to mental health support and workplaces where people treat each other with respect. Supportive mentoring and teamwork can make a real difference – especially for junior staff and newcomers.
Finally, workplace safety needs to be considered alongside career development, fair compensation and better systems. Nurses need fair recognition for overtime and workload, opportunities for specialisation and higher education, and digital systems that reduce administrative burden rather than adding to it.
Ultimately, this is about recognising that nurses are not an endless resource. They are people, often women, who care for others every day while carrying their own pressures, responsibilities and challenges. Ensuring their safety, dignity and wellbeing is not only the right thing to do. It is a smart investment in a stronger and more resilient health system.
Malaysia has an opportunity to build on the measures already in place and further strengthen workplace safety, staffing, support and working conditions. Everywhere in the world, health systems depend on nurses at every stage of life – from birth to old age, from routine check-ups to medical emergencies. Malaysia is no exception.
Safe patients need safe nurses. And safe nurses need workplaces where respect, dignity and rights are non-negotiable.
By Johanna Riha, Sergo Chikhladze, Sapna Mishra (UNU Global health) and Nicholas Hulus (Sabah Medical Services Union (SMSU))
© Inter Press Service (20261001161736) — All Rights Reserved. Original source: Inter Press Service
