2.3. Findings
The introduction of the modified policy appears to have satisfied many of the nurses. Meanwhile, to attract new recruits for the nursing staff, the entry salary for nurses was raised from the original 340 points to 430 points on the salary scale, and the salary increase for each rank would range from 23 to 42% under the bill of the Rank and Grade System [21]. Starting in May 2012, one point equals MOP$66 (US$1.00 = MOP$8.00). Therefore, a newly recruited nurse would be paid at least US$3,359.37 (equivalent to MOP$26,875) monthly, with the potential for additional types of allowances (Detail in Table 2). This salary is more than one and half times the median monthly earnings of the employed population in Macao (4th quarter/2011), which was US$1,250.05 per month on average [22]. The increased salary was large for all of the nursing staff, even the experienced nurses who also had benefits based on their number of working years. In addition, the salary for shift duty, such as afternoon or night shifts, were increased, and overtime now provides up to double pay (after 22:00 and at least 0.75 times the basic salary (for weekday regular office hours). Some nurses did not mind working on shift duty, holidays or weekends, which is likely due to the sharp changes in salary, which is the most common important element responsible for the nursing shortage [9-10]. This basic salary excludes employment benefits, such as on-shift allowance and family subsidies. As a result, the total salary for one month will increase by more than US$1,000 compared with the previous salary rank and grade scheme. In addition, there are more positions for promotions among the nursing staff, such as ranks for specialists, ward nurse managers and supervisors. In addition, the preliminary training course has been adapted to train the newly graduated nurses for six months to work in the medical and surgical wards, with a few additional hours devoted to theoretical knowledge.
The allowance for working experience after five and 10 years has also been adjusted, increasing by 194.4% and 177.8%, respectively. The most noticeable changes involve overtime pay and on-shift allowances, with the percentage of salary and employee benefits being increased more than expected. Overall, these increases are larger than those provided in a report from the USA that stated that wages will have to increase by at least 50% of the present wages by 2016 [23] to retain RNs. The concept of allowance in this modification is expected to increase the time spent working with a consequent increase in salary. One category of rank scheme, the senior specialist nurse, was added to the previous five categories of nurse, senior nurse, specialist nurse, ward manager and supervisor. In addition, two more positions have been added to the old policy. A summary of the old and new policies is shown in Table 2