Making The Case For Longer Studies

Recently there’s been talk about the Malaysian Nursing Board phasing out the Diploma in Nursing programme. As a result, soon all future nursing students that want to practice the profession in the country has to complete a four-year degree (Bachelor of Science in Nursing).

Many parties have been very vocal about this, citing that many nurses cannot afford the extra costs it takes to study for four years instead of the usual two for a diploma. Some students get into nursing for that reason; it offers a quick pathway to work in a respectable profession, without the added burden of a pre-university programme after completion of secondary school.

While I understand that some nurses have to support their families ASAP, I’m here to argue that there is a hidden benefit to all nurses being required to do their degree in order to be registered practitioners.

That benefit is the extra 2-4 years of age that nurses have upon graduation.

Older… Wiser?

A few days ago there was news of a 19-year old girl who will become the youngest medical doctor in Malaysia this year. The prodigy completed her secondary education at the age of 14, enrolling straight into an Australian pre-U programme, followed by medical school.

While I applaud her achievements (it is nothing to make light of), for the rest of us entering the healthcare workforce at 19 is not the best of ideas.

A doctor fresh out of medical school at the age of 25 is six years older than 19, and will have six years of extra life experiences that will make him or her relate better to patients.

The healthcare line, as we all know, is riddled with a lot of challenges and difficulties that are difficult to teach in training colleges. There are unexpected obstacles from patients, their relatives, and colleagues that are difficult to circumnavigate without emotional maturity. When these are not handled well they lead to burnouts and depression.

Forcing the degree programme for nurses rather than diploma grants student nurses extra time to prepare themselves. Most of the time, maturity comes with age. Being a nurse (or a doctor for that matter) is an arduous endeavor in itself. There will be times when you have to react to difficult situations requiring you to make a choice. Maturity grants the wisdom to make the right ones.

The healthcare line, as we all know, is riddled with a lot of challenges and difficulties that are difficult to teach in training colleges.

Being sure about oneself

As a patient, you would want nurses or doctors who are sure of themselves for your treatment. You want those who believe in what they do and believe in the importance of their work. Not the reluctant ones.

It is common for healthcare practitioners to leave the profession within the first 5 years of working. An extra few years of study provides the extra time to contemplate on whether this career path is really for them or not. This creates better rounded nurses and doctors.

Better clinicians

Better rounded nurses and doctors, who can find the balance between their personal growth and career, make for better clinicians. They are more likely to innovate and push medicine forward. This is why countries like the US and Sweden require prospective medical school students to have a Bachelor’s degree beforehand. These countries have the most number of medical innovations in history.

Removal of bad habits

Better rounded nurses and doctors make for better clinicians.

For nurses, making BSN degrees mandatory in order to be registered means an addition 4-5 years of study; 1-2 years for a pre-university course (like STPM) and another 4 years for the degree. Contrast this with immediately hopping on the diploma programme for two years after school.

The work involved to obtain a degree is very hard. It can only be done by being mentally sound, organized, and effective. These habits are not necessarily attained in school.

An older nursing graduate has more time to become a better, organized person; to know her strong points, faults, breaking points, things she cannot do, and learn how to deal with them knowing that a harder road lies ahead.



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 Nephrology/Renal Nursing 

 Nephrology is a specialty of medicine and pediatrics that concerns itself with the kidneys:  the study of normal kidney function, kidney problems, kidney health, and the treatment of kidney problems.  It encompasses dietary and medication to replacement forms of treatments. Systemic conditions that affect the kidneys and systemic problems that occur as a result of kidney problems are also studied in nephrology. A physician who has undertaken additional training to become an expert in nephrology may call themselves a nephrologist or a renal physician. 

 A nephrology nurse (or renal nurse - those two terms are used interchangeably) is a nursing practitioner that focuses on kidney health. They treat and care for patients that are suffering from those suffering from kidney problems as well as those that are at risk of developing them. 

 As a renal nurse, one must be prepared to stay on top of current developments, as treatments in this field are accelerating their development at a very rapid pace. This is possible to be done by regular consumption of renal-related literary content such as medical journals. Attending seminars and conference is also a possible method. 
   

 Scope 

 Renal nursing concerns the  diagnosis and treatment of kidney diseases , including electrolyte disturbances and hypertension, and the care of those needing replacement therapy, including dialysis and transplant patients. 

 Many diseases affecting the kidney are systemic disorders not limited to the organ itself. Examples include acquired conditions such as systemic vasculitides and autoimmune diseases, as well as congenital or generic conditions such as polycystic kidney disease. 

 Methodology of nursing 

  History and physical examinations are central to the diagnostic workup in nephrology or renal nursing.   

 This may include inquires regarding family history, general medical history, diet, medication use, drug use and occupation. Examination typically includes an assessment of volume state, blood pressure, skin, joints, abdomen, and flank. 

 Urinary analysis (urinalysis) is an instrumental method in assessing possible kidney problems. Nurses in this specialization are trained to notice the appearance of blood in the urine, protein, pus cells or cancer cells in the urine, often with the help of a urologist or nephrology physician. 

 Basic blood tests can be used to check the concentration of hemoglobin, platelets, sodium, potassium, chloride, or phosphate in the blood. All of these may be affected by kidney problems, and renal nurses are supposed to be well-versed in this area. 

 Under certain circumstances, an invasive test is required for diagnosis. A biopsy of the kidney may be performed. This typically involves the insertion, under local anesthetic and ultrasound or CT guidance, of a core biopsy needle into the kidney to obtain a small sample of kidney tissue. Kidney biopsy is also used to monitor response to treatment and identify early relapse. 

 Training 

 The process differs across countries, but the outcome is indefinitely similar. Nephrology is a subspecialty of general medicine. A nephrology/renal nurse will have to complete nursing school, a minimum of three years of practice as a general nurse, and a BSN (Bachelor’s of Science in Nursing) or post-basic course in renal subjects. Typically this training lasts 1-2 years. 

 Nurses in training for renal nursing often continue in the world of academia to obtain research degrees, putting a temporary halt to their clinical practice. Some also sub-specialize in dialysis, kidney transplantation, CKD, cancer-related kidney diseases, procedural nephrology or other non-nephrology areas. 

 However, only pediatric-trained nurses are allowed to train in pediatric nephrology, due to differences in physiology. 

 Work environment 

 A major task and responsibility for renal nurses are  administering treatments to patients.  Treatments can include medications, blood products, surgical interventions, renal replacement therapy and plasma exchange. Kidney problems can have a significant impact on quality and length of life, and so psychological support, health education and advanced care planning play key roles in nephrology. 

 Renal nurses often find themselves having a better work setting compared to their non-specialized counterparts. Schedules are less erratic, especially for nurses working in dialysis support roles. 

 On average, renal nurses with post basic certification get  about 10% more pay.  

 Career opportunities 

 
	 Dialysis centers (out- and in-patient) 
	 Nephrology wards 
	 Transplant units 
	 Home care 
	 Medical device industry 
	 Pharmaceutical industry 
	 Government and nonprofit healthcare settings (eg:  NKF ) 
	 Community clinics 
 

 There is a severe shortage of nephrology nurses in Malaysia. 

 Search for high-paying job in renal nursing at  MIMS Career . MIMS Career is a premier, healthcare-focused job portal site for Malaysia, Singapore, the Philippines and Indonesia. Our simple sign-up process allows you to easily apply for jobs you might be interested in with a single click. Job locations include hospitals, nursing homes, and private practices. It’s free, easy to use, and safe. 

 Can’t find what you’re looking for? Set up a job alert and we’ll notify you by email whenever positions that suit your preferences are available. All of our pages are mobile-responsive, so you can take your applications with you on the go. 
   

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  Photo cr: Unsplash  

 Mental Health 

 Mental health is a level of psychological well-being, or an absence of mental illness. It is the “ psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment” . From the perspective of positive psychology or holism, mental health may include an individual’s ability to enjoy life, and create a balance between life activities and efforts to achieve  psychological resilience . 

 According to the World Health Organization (WHO), mental health includes “ subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one’s intellectual and emotional potential, among others.”  Cultural differences, subjective assessments, and competing professional theories all affect how mental health is defined. 

 Mental health nurses play and important part in helping patients lead a positive life. It is not uncommon for physical disorders to arise from mental issues. It is a field that is growing in awareness. It is estimated that  40% of Malaysians will suffer from mental health issues in their lifetime . 

 Specialization tasks 

 Maintaining good mental health is crucial to living a long and healthy life. Mental health nurses are required to show a considerable amount of empathy towards their patients in assisting them to make a full recovery. Research has shown that there is stigma attached to mental illness. Therefore, it is extremely important that mental health nurses develop excellent observational skills in the treatment of the patient. 

 Activity therapies 

 Activity therapies, also called recreation therapy and occupational therapy, promote healing through active engagement. Making crafts can be a part of occupational therapy. It is very common for nurses to take patients on walks as part of this type of therapy. 

 Psychotherapy 

 Psychotherapy is the general term for scientific based treatment of mental health issues based on modern medicine. It includes a number of schools, such as  gestalt therapy ,  psychoanalysis ,  cognitive behavioral therapy  and  dialectical behavior therapy . 

 Legal requirements 

 Mental health nurses assist in the legal requirements for the patient. Requirements encompass the setting of the patient or a group of patients. 

 Progress monitoring 

 Mental health nurses may have roles that include visiting patients in their home to monitor their progress and carry out risk assessments. While carrying out this task, nurses assess the risks involved to the patients’ safety, health, and welfare. 

 Pathway 

 In order to specialize as a mental health nurse, you must be a registered nurse, practicing for a minimum of three years. A Bachelor’s of Science in Nursing is an advantage. You must take up a psychiatry-based training course with practical hands-on experience. For those courses, you may be able to get accreditation if you have a degree in psychology, or social work. 

 Required skills 

 You will need to display: 

 
	 
	 Exceptional observational skills. You will be required to assess patients and look out for signs of tension or anxiety, which sometimes are not that obvious. 
	 
	 
	 Physical fitness, especially when working in a hospital. Increased stamina and strength is an added bonus. 
	 
	 
	 Emotionally and spiritually resilient to work in a challenging environment. 
	 
 

 Job prospects 

 While a lot of work for mental health nurses is done in the hospital, the majority is community-based in a wide variety of settings. Some of them include community mental health centers, nursing homes for the elderly, rehab units, and private clinics. 

 Working conditions 

 Salaries for mental health nurses will depend on the level of education that they possess. Those with a BSN or MSN will earn more. The type of institution and experience that you have will also factor in your earnings. 

 It is important to have a calm demeanor and able to handle stress well as you will be working with many difficult patients with psychotic episodes. It can be rather jarring to those who are not used to it. However, when approaching these situations without judgement, many mental health nurses manage to overcome these issues and help the patients with their treatment. 

 Career opportunities 

 Search for high-paying mental health nursing jobs on  MIMS Career . Browse, save, and apply for nursing jobs, all in one-click. Take the opportunity for higher pay and better work locations. Our pages are all mobile-responsive, allowing you to take that leap for a better job whenever, wherever you are. All our job postings are heavily screened to  prevent scams and mistrustful behavior . 

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 Gynaecology is the medical practice of dealing with the health of the female reproductive system and the breasts. Literally the term gynaecology means “the study of women.” The opposite of gynaecology is andrology, which deals in male-specific medical issues. 

  Almost all modern gynaecologists are obstetricians : physicians who deal in the branch of medicine and surgery of childbirth and labor. These two fields overlap in many areas, therefore in many institutions Obstetrics and Gynaecology are lumped together as O&G. 

 Gynaecology is concerned with the health of the female reproductive organs and the ability to reproduce. It also encompasses paediatric and adolescent problems to post-menopausal ages. 

 History 

 From ancient Egypt circa 1800 BC, the Kahun Gynaecological Papyrus is the oldest known medical text of any kind. It writes about women’s complaints; gynaecological diseases, fertility, pregnancy, contraception, etc. In the 4th century BC Hippocrates wrote texts about gynaecological diseases that were common afflictions to Greek women at the time. 

 J Marion Sims is widely considered to be the father of gynaecology. He operated during the 19th century at Jefferson Medical College, New York. However the title is now being scrutinized due to his unethical development of his surgical techniques. He operated a lot on slaves, many of whom were not given anaesthesia. 

 Training 

 Post-basic courses on midwifery, gynaecology, and obstetrics are considered to be part of gynaecological training. If desired, a nurse can opt to pursue a Masters in order to carry out research work in the field, and proceed to doctorate studies. 

 Training is given out to encourage the study and advancement of the practice of gynaecology. It is also done by the publication of clinical guidelines and reports on aspects of the specialty and service provision. 

 Gynaecology is a vast field. Nurses who work in this area have sub-specialties in high-risk obstetrics, fertility care, or minimal access surgery. The job most deals with healthy women, where unexpected challenges can present themselves on a daily basis. Work includes a large number of hands-on procedures, and training reflects that. 

 Common Cases 

 Patients range from those who have chronic disorders which are not life threatening, to those who require immediate acute emergency treatment. 

 Nurses in this field are often required to provide assistance during operative procedures. Some of the common procedures a gynaecological nurse with oversee include: 

 
	 dilation and curettage 
	 Oophorectomy 
	 Exploratory laparotomy 
	 Treatments for urinary incontinence 
	 Cervical excision procedures 
	 treatment of polyps 
	 surgery for cancers 
 

 A major part of a gynaecology nurse is the delivery of infants. Their work includes: 

 
	 assist delivery using instruments (forceps or vacuum) 
	 C-sections 
	 Foetal health 
 

 Career Opportunities 

 
	 Independent Nurse Consultant 
	 Educator 
	 Training programme director for gynaecology nursing 
	 
	 Research in public and private sectors 
	 
	 - 
 
   

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  1. Specialization tasks  
 2. Pathway  
 3. Common job scopes  
 4. Common terms  
 5. Career opportunities  

 Cardiology 

 Cardiology is a branch of medicine dealing with disorders of the heart as well as parts of the circulatory system the field includes medical diagnosis and treatment of  congenital heart defects ,  coronary artery disease ,  heart failure ,  valvular heart disease  and  electrophysiology . Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons. The supporting role of the surgeons and physicians are  cardiology nurses . 

 Although the cardiovascular system is inextricably linked to blood, cardiology is relatively unconcerned with hematology and its diseases. Some obvious exceptions that affect the function of the heart would be blood tests, decreased oxygen carrying capacity, and  coagulopathies . 

   

  source: Resus.me  

 Specialization Tasks 

 All cardiologists study the disorders of the heart and all cardiology nurses are trained to take care of either adult or children conditions. This is due to differing aspects of training for adult and paediatric physiology. Surgical aspects are not included in cardiology and are in the domain of cardiothoracic surgery. 

 For example, coronary artery bypass surgery and cardiopulmonary bypass are both surgical procedures performed by surgeons, and not cardiologists. As a nurse, your task will be that of assisting the cardiologists in this matter. A properly-trained cardiology nurse would have the necessary critical thinking in order to draw conclusions to make meaningful impact of treatment. 

 Common tasks in the wards that you might have to do include the insertion of stents, pacemakers, and valves. 

 Pathway 

   

  source: verywell  

 Cardiology is a specialty of internal medicine. To be a cardiology nurse, a three-year work experience followed by a post-basic or relevant course is required. It is possible to sub-specialize in Malaysia. Recognized sub-specialties in cardiology for Malaysia are cardiac  electrophysiology ,  echocardiography,  interventional cardiology, and  nuclear cardiology . 

 Currently there is insufficient data for Malaysia, for salary, but it is guaranteed to be higher or on par with other similar nursing specialists. 

 Common job scopes 

 Cardiology is a vast field. Not only does it involve the heart and its systems, it also involves supporting systems such as haematology and its diseases. It is important to know and train for this when pursuing this specialization. 

 Cardiac electrophysiology 

   

  An example of echocardiography  

 This is the science of elucidating, diagnosing, and treating the electrical activities of the heart. The term is usually used to desccribe studies of such phenomena by  invasive catheter recording  of spontaneous activity as well as of cardiac responses to programmed electrical stimulations. These studies are performed to assess complex arrythmias, relieve symptoms, evauate abnormal ECGs, assess risk of developing arrhythmias in the future, and to design treatment. 

 Cardiac examination 

 The cardiology nurse is able to carry out cardiac examinations of patients. It is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination. Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation, and auscultation. 

 Paediatric cardiology 

   

  source  

 Paediatric cardiology is a specialty of paediatrics. To be a paediatric cardiology nurse, one must complete at least three years of registered working experience and pass all the required courses. Adult cardiology certifications are not valid due to differences in physiology in children. 

 Common complications that you will see as a nurse practicing paediatric cardiology are  paediatric hypertension ,  paediatric hyperlipidemia , heart palpitations and arryhthmias. 

 Diagnostic tests 

 Diagnostic tests in cardiology are the methods of identifying heart conditions associated with healthy vs. unhealthy pathology heart function. It is commonly started by obtaining a medical history, followed by auscultation. Blood tests soon precede after, and imaging can be done on a need-to-do basis. 

 Common terms 

 1. Tetralogy of Fallot 

 It is the most common congenital ehart disease arising in 1-3 cases per 1000 births. The cause of this defect is a ventricular septal defect and an overriding aorta. These two defects combined causes deoxygenated blood to bypass the lungs and going right back into the circulatory system. The modified  Blalock-Taussig  is used as a treatment for this condition. 

 2. Pulmonary atresia 

 This happens in 7-8 births per 100,000 and is characterized by the aorta brancing out of the right ventricle. It causes deoxygenated blood to bypass the lungs and enter the circulatory system. Fixing it can by done by a team of cardiologists and nurses by redirecting the aorta and fixing the right ventricle-pulmonary artery connection in surgeries. 

 3. Double Outlet Right Ventricle 

 Double outlet right ventricle is when both great arteries, the pulmonary artery and the aorta, are connected to the right ventricle. There is usually a ventricle in different particular places depending on the variations of DORV, typically 50% are subaortic. A VSD closure is the most common form of treatment for this condition. 

 Career opportunities 

 Search for  high-paying cardiology nursing jobs  on  MIMS Career . Browse, save, and apply for nursing jobs, all in one-click. Take the opportunity for higher pay and better work locations. Our pages are all mobile-responsive, allowing you to take that leap for a better job whenever, wherever you are. All our job postings are heavily screened to  prevent scams and mistrustful behavior . 
   

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1. Specialization tasks 2. Pathway 3. Common job scopes 4. Common terms 5. Career opportunities Cardiology Cardiology is a branch of medicine dealing with disorders of the heart as well as parts of the...

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