Bullying in the Workplace: Immature Occurrence, or Symptom of Something Worse?

The noble profession of healthcare; where the work started off from compassion and spirit of alleviating others’ suffering.

It is however, very unfortunate that physicians and nurses are not spared from the issue of bullying. We tend to think that bullying only occurs in schools, and are surprised to hear that it also happens in immature settings.

Bullying is a form of directing the bullies’ dissatisfaction inward or towards each other, themselves, and towards those who are less powerful and influential than themselves.

Examples of bullying in the workplace include being spoken in a belittling manner or being lambasted by the older generation for being weak and spoilt.

Studies show that Asian healthcare workers report the largest quantity of workplace-related bullying. The study was carried out in Singapore, showing abuse by nurse managers and colleagues. It also implies that 70% of the staff choose not to report workplace incidents, suggesting that the number of bullying cases might be even higher.

Bullying cases may not be always obvious. It might not be someone yelling at a poor junior nurse in the OT in front of everyone. Shaming, spreading malicious rumors about a co-worker still is bullying, and so are refraining from promotions or the right to take leave.

Why it happens

As previously mentioned, bullying not only happens at immature settings such as in schools, but also at workplaces all the way up to the higher echelons. A stressful environment, poor working conditions and poor leadership are prime vectors for bullying cases in the workplace.

The perpetrators involved in these cases are usually the ones in power. They exercise their power over helpless individuals, humiliating and belittling them in order to make them feel superior. They are usually authoritative, and oppressive in behavior.

There is also a pattern in the victims of such bullying. Doctors and nurses below the age of 30 reported to be more likely to experience workplace bullying. This is due to their position in the workforce- they are generally the lowest tier amongst everyone else, and are prime candidates to be targeted by perpetrators wanting to flex their authority without much of a pushback.

Another study conducted in Asia showed that nurses with high levels of anxiety were almost five times more likely to experience verbal abuse. Because they are by nature unsure of themselves, they do not have the mental standing to push away from bullies’ abuse. Other personality types that are highly associated with bullying are those who are inexperienced, less assertive with their work, lower confidence, and have vulnerable personalities.

Effects

Decline in productivity and effectiveness of care

The physical and emotional health of the victims decreases, which ultimately leads to worse quality of care for patients.

Victims report headaches, sleeping disorders, and medical errors done, which in turn leads to an increase in absenteeism. An increase in absenteeism due to health issues leads to understaffing of a healthcare institution.

Incur costs

Lower morale from victims results in a higher employee turnover rate. This is costly towards the institution; it is far more expensive to constantly replace employees compared to keeping them and increasing their pay year after year. It just doesn’t make much financial sense.

Higher intetion to quit the job leads to career burnouts whuch are much earlier than normal. Impacting non-workplace relationships as well.

Death

When nurse managers or MOs abuse their co-workers by refusing their right to leave, catastrophic results follow. Malaysian newspaper “The Star” reported in May that concerns have been rising about road accidents among tired and overworked doctors. Not too long ago a houseman in Kota Bharu Hospital hit a cow on the way home and died. Nurul Huda Ahmad, a paediatrician in training, died in a motor vehicle accident after nearly 33 hours on duty.

Ways to Stop It

It is not enough to simply tell the staff to “just stop the bullying.” The superiors of the workplace have to encourage their staff to speak out and report any instances or cases immediately. In addition to promoting a safe environment where employees can do so, employers must train effective communication skills to promote reporting as being viewed as an acceptable and necessary behavior.

Moreover, the training provided must encompass business etiquette that touches upon cultural sensitivity practices, and educate the workforce on negative working behaviors. Sometimes, the bullies may not even know about what they’re doing, until pointed out to them.

In the case of management, policies set in place creates a code of conduct to stop these cases. It is important to enforce it consistently for all staff members. Document any violations. This mitigate behaviors like persistent criticism that has no basis.

The way forwards

The act of bullying in a healthcare settings must not and cannot be left to fester. It creates a lot of damage and losses for both the institution and the people working in them. Most of all, the impact on patient’s safety is hit the hardest.

Patients place their utmost trust in the medical world to help them recover and lead productive lives again. Compromised care can deal potential harm in patients; it can mean the difference between a sound mind and a vegetative state, a living patient or a dead one.

If the medical field is to become the bastion of healing and wellness, then it must address this recalcitrant issue and not let it grow like an unwanted tumor, damaging the whole system in the process.



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 Emergency Nursing 

 Emergency medicine, formerly known in some countries as accident and emergency medicine (A&E), is the medical specialty involving care for  undifferentiated and unscheduled patients with illnesses or injuries requiring immediate medical attention.  

 Overview 

 As first-line providers, emergency nurses and doctors are responsible for: 

 
	 initiating investigations and interventions to diagnose and/or treat patients in the acute phase 
	 coordinating care with doctors from other specialties 
	 making decisions regarding a patient’s need for hospital admission, observation, or discharge. 
 

 Emergency nurses generally practice in hospital emergency departments, wards, units or intensive care units. They may also be working at pre-hospital settings via emergency medical services, such as in the event of a calamity like a road accident. Moreover, emergency nurses also may work in primary care, such as urgent care clinics. 

 History 

 During the 18th century the French Revolution brought upon the development of the ambulance. After seeing the speed with which the carriages f the French flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean Larrey applied the idea for rapid transport of wounded soldiers to a central place where healthcare was accessible. 

 Emergency medicine and nursing is a relatively new field. It was only in 1979 that a vote by the American Board of Medical Specialties that emergency medicine became a recognized medical specialty in the United States. Other countries followed suit soon thereafter. 

 Scope of Work 

 Emergency nursing is a specialization based on the knowledge and skills for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders. 

 It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development. 

 Common Tasks 

 
	 Triaging of patients 
	 Suture complex lacerations 
	 reduce a fractured bone or dislocated joint 
	 treat a heart attack 
	 manage strokes 
	 stop severe nosebleeds 
	 placing a chest tube 
	 conducting emergency tracheostomy 
 

 Work location 

 Emergency nurses are tasked to provide the acute care of internal medical and surgical conditions. In many emergency departments, nurses are tasked with seeing an alarmingly large number of patients, treating their illnesses and arranging their next steps. 

 Training 

 There are a variety of models for emergency nursing training across the globe. In some countries the emergency nurse rides in the ambulance to and fro the scene of emergency. This is done to provide stabilizing care to the affected patient. 

 Nurses in emergency departments require a broad field of knowledge and advanced procedural skills of many nursing fields. They must know how to: 

 
	 Resuscitate a patient 
	 Carry out surgical procedures 
	 provide cardiac life support 
	 Manage patients’ airways 
 

 Specialization for emergency nursing often happens after a post-basic certification proceeding three years of service as a registered nurse. 

 Required skillset 

 Emergency nurses require an extensive amount of cool-headedness to handle the oncoming onslaught of daily tasks that present themselves. A great number of emergency ward cases are urgent and time-sensitive in nature, therefore the nurse needs to exercise great caution and patient, while being curt and efficient at the same time. 

 Good teamworking skills is essential. The role of an emergency nurse also involves proper triaging of patients into in- or out-patient services, and work with various specialists or fields to determine the best course of action following prognosis. A positive, proactive, and supportive nurse is beneficial in any emergency setting. 

 Clear communication skills are required in order to convey the correct information to emergency dispatchers or hospital emergency personnel. Failure in conveying correct medical info will prove to be disastrous for the patient, incur financial losses, and increase chances of litigation due to malpractice. 

 Career opportunities 

 Emergency nurses can work in a wide variety of settings, and they include: 

 
	 First aid volunteers 
	 Emergency medical services (BOMBA, paramedics) 
	 paediatric emergency medicine 
	 rescue squads 
	 emergency medical technician 
	 traumatology 
 

 It is not uncommon for nurses to leave clinical work in order to focus on research, especially at the post-graduate levels of study. 

 Search for high-paying 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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  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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 1. Midwifery 

  What : Interested in obstetrics and gynaecology? Taking up a midwifery course can land you jobs in O&G offices, clinics, or hospitals. In O&G settings, emergencies can arise at any time, so expect some pretty hectic days. You can even open up your private practice as well. 

  How : A lot of teaching institutions offer midwifery courses in Malaysia. You can check out MAHSA, IMC, UKM, and others. Course duration takes about 1-2 years. 

  Why : Nurses with Midwifery skills can earn up to 33% more than normal registered nurses. Search high-paying Midwifery jobs now. 



 2. Administrative Skills 

  What : This is a part of nursing that not many will look at. With good administrative skills, you can take on behind-the-scenes roles and oversee the “business” aspect of nursing. You can review budgets, HR functions, management, and more. 

  How : Take up administrative tasks, or courses. A lot of universities and colleges offer full- and part-time programs that you can fit in your schedule. Otherwise, online courses work as well. You can find more here. 

  Why : Nurse Administrators earn about 30% more than unspecialized nurses. 



 3. Telemetry and Informatics 

  What : As global advances in electronics become more and more sophisticated, technology companies have been producing better instruments to help healthcare workers better understand their patients. Reading these instruments require skill, training, and critical thinking in order to use the data to make decisions on treatments. 

  How : You’d need a Masters in nursing, or computer science and its equivalents. This is an emerging field, so don’t expect it to be so widespread, but you will be in high demand and paid more. 

  Why : The salary ranges from USD58,088 to USD105,034. 



 4. A different language 

  What : The advantages are numerous. You can expose yourself to new settings. New people. Take more opportunities you wouldn’t have done without that third or fourth language. Right now Mandarin is very highly prized in this side of the world. 

 What about Arabic? There’s a huge market for nurses there. Knowing Arabic would create better patient-nurse relationship that’s beneficial to treatment. 

  How : Take up language classes! Learning centers are abundant. Online classes are available here as well. 

  Why : It opens a world of job opportunities, gives your brain a boost, and develop priceless intercultural relationships. 



 5. Use MIMS Career! 

  What : MIMS Career is an effective, one-stop application platform for nurses in Malaysia, Singapore, Indonesia and Philippines. Signup today and enjoy our unique 1-click application process to countless high-paying nursing jobs. 

  How : Signup. Fill in your details and resume. Apply.  

  Why : Find high-paying nursing jobs in the comfort of your home, or wherever you are. Get connected with top healthcare employers in the country, for free, in a safe, secure manner.

5 Things Nurses Need to Know to Be Paid More

1. Midwifery What : Interested in obstetrics and gynaecology? Taking up a midwifery course can land you jobs in O&G offices, clinics, or hospitals. In O&G settings, emergencies can arise at any time, so expect some pretty...

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 For those nurses serving with  Kementrian Kesihatan Malaysia  (KKM), the start of your work life will present you with one of the toughest choices you’ll make: 

 
 EPF (Employees’ Provident Fund, also known as KWSP), or choose the pension fund? 
 

 Both are viable options in securing your financial health after you retire. Although retirement might seem like ages away, a good amount of planning and successful investments can mean the difference between being able to live comfortably in your golden years, or struggle with daily or medical expenses. 

 So which to choose? We’ll break down the points below. 

 Pension fund 

  What is it?  
It’s a monthly stipend of a set amount, provided by the Public Services Department upon your retirement. In addition to that, you also receive a  gratuity  payment, and medical/health benefits. 

  Calculation  
Here we will be assuming that you start work at 20 years old, with a starting salary of RM2,000, and continue working until you retire at 55 with a salary of RM5,600 (3% annual pay increase). 

 Your monthly pension will be your last drawn salary, divided by two. For example, if your base salary is RM5,000 when you retire, your monthly stipend will be RM2,800/mo. 

 In addition to that, you will receive gratuity payment, which is calculated as such: 

 
 gratuity = 7.5% x 35yrs x 12 months x RM5,600 (final drawn salary) 
= RM 176,400. 
 

 RM176,400 will be given as a lump sum, while RM2,800 will be given per month. Again, this is all assuming you retire at 55, with a final salary of RM5,600. 

  Benefits  

 
	 No subtraction from base pay. 
 

 Unlike EPF, as we will see later, there is no subtraction from your base salary. 

 
	 Guaranteed monthly retirement funding 
 

 Again, unlike EPF, where your money can be withdrawn for other uses, pension takers are guaranteed to have a monthly source of income. 

  Disadvantages  

 
	 You have to start and end your service in the public/government sector. It might hamper your ability to seek work overseas, better base salaries, or even some chances to study. 
 

 EPF or Employees Provident Fund (KWSP - Kumpulan Simpanan Wang Pekerja) 

  What is it?  
EPF is the accumulation of savings generated from deductions of your base salary. Currently, you can choose either 11%, or 8%, as  recently announced . 

 This accumulation of money is further grown by annual dividends. On average the dividend is around 6%, depending on the GDP (gross domestic product) of the country. 

 What makes EPF great as long term savings is due to the magic of  compound interest. . Your employer also contributes to your fund (12% of your pay). These two things make an EPF account grow substantially when properly managed. 

  2 accounts  

 Your EPF savings are divided into two accounts. 70% goes into account 1, and the rest to account 2. Account 1 is your retirement funds. Account 2 is withdrawable, under a few conditions: 

 
	 more than 50 years old 
	 Housing downpayment for your 1st house 
	 housing loan payment 
	 education 
	 medical costs 
	 Hajj pilgrimage 
 

 Upon reaching the age of 55, you will be able to withdraw from account 1. You will have to choose to withdraw one lump sum, or as a monthly stipend like a pension. 

  Calculation  

 Let’s take the same example as just now. Start work at 20, salary RM2,000, retire at 55, salary RM5,000. 

 
 Deduction from pay = 11% = RM220 
Employer contribution = 12% = RM240 
 We will assume no withdrawals are made over entire working period  
EPF annual dividend = 6% 
 

 The interest adds up year over year, and with the help of EPF’s  online calculator , 

 Total EPF savings at 55 years old = RM461,900 

 It is a marginally higher amount than RM176,400 gratuity you will receive from a pension. 

  Benefits  

 
	 Flexibility. At the age of 55, you can withdraw that money and invest in another scheme, venture, or fund that offers greater returns. 
	 Faster growth. As shown, even with a contribution of 11% of your pay, over the course of 35 years it balloons into a large amount of money. 
	 Freedom of employment. You no longer have to work within the constraints of the government or public service. You are free to pursue study or work opportunities as you wish. 
 

  Disadvantages  

 
	 Sometimes things don’t go as planned. You might hit a financial roadblock that forces you to withdraw from your EPF fund. An example of this is a medical emergency. 
	 It subtracts 11% of your base salary. 11% might not seem like much, but for people who live paycheck to paycheck, it can be a bitter pill to swallow. 
	 Annual dividend from EPF can decrease, depending on economic climate. 
 

 Making a comparison 

 Monthly funds 

 Assuming that you live until the mean life expectancy age in Malaysia, which is 76 years old. 

 
 Years to live off retirement fund (pension) = 76-55 = 21 years 
 

 To make a fair comparison, let’s subtract the gratuity amount of a pension scheme from the lump sum of EPF savings. 

 
 EPF at 55 years old - gratuity of pension at 55 years old = RM461,900 - RM176,400 = RM285,500 

 Stipend per month that EPF provides = RM285,500 / 21 years / 12 months = RM1,132.94/month 
 

 Even if we did not subtract the gratuity value, it would be: 

 
 RM461,900 / 21 years / 12 months = RM1,832.94/ month 
 

  It is far less than RM2,600/month from a pension scheme . 

 What if we invest all of EPF savings? 

 Say at the age of 55, you embark on another investment with better returns. We will assume 8%. You pile up all your savings into it. 

 Investment return x EPF savings = 8% x RM 461,900 = RM36,952/year or RM3,079.33/month. 

  It is more than what you’ll obtain from a pension.  However you’ll need to ensure that the second investment has better returns than EPF dividends. That in itself can sometimes be a challenge. 

 Conclusion 

 They both have their advantages and drawbacks. It seems like it is up to you to play it well, to ensure you can lead a comfortable life upon retirement. 

 However the main question of choosing either EPF or pension as retirement savings often boils down to your choice of employer. 

 Will you stay with the government sector for another 30+ years? You don’t want to end up with no retirement fund… No EPF or no pension. That’d be the worst. 

 If yes, go for the pension scheme. It is safe, guaranteed, and offers great peace of mind in your golden years. 

 However, with EPF, you are free to take up opportunities that come your way. Countries like Saudi Arabia, Singapore, and Australia are actively seeking out Malaysian nurses with extremely attractive pay. Opportunities for post-graduate education are more limited in the government sector; if in private, you get to choose when you want to do it. You can also fund it with your EPF savings, something you can’t do on a pension. 

 Choose the freedom of choice. Search for high-paying nursing jobs, and overseas 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. 
   

 
 Our Most Popular Articles 

  Think About These 5 Things Before You Decide On A Specialization  

  5 Things Nurses Need To Know To Be Paid More  

  10 Ways Malaysian Nurses Can Increase Their Income

EPF (KWSP), or Pension? Which to choose?

For those nurses serving with Kementrian Kesihatan Malaysia (KKM), the start of your work life will present you with one of the toughest choices you’ll make: EPF (Employees’ Provident Fund, also known as KWSP), or choose...

Read More