Analysis on Leadership, Budget Allocation and Disposition of Management Policy at Nursing Department of Kudus District General Hospital

Abstract

Kegiatan perawatan yang dilakukan oleh perawat berada di tatanan pelayanan kesehatan terdepan dengan kontak pertama dan terlama dengan pasien. Terjadi penurunan jumlah kunjungan pasien pribadi/umum/bayar (28,33%) di RSUD Kabupaten Kudus dalam 5 tahun terakhir. Hasil Indeks Kepuasan Masyarakat untuk keperawatan kurang baik, sehingga pengelolaan keperawatan perlu perhatian dari manajer. Tujuan penelitian adalah menjelaskan kepemimpinan, alokasi dana dan disposisi pengambil kebijakan di bidang keperawatan RSUD Kabupaten Kudus. Penelitian ini adalah penelitian observasional kualitatif. Subjek penelitian adalah 3 orang pengambil kebijakan bidang keperawatan sebagai informan utama dan 3 orang perawat pelaksana kebijakan sebagai informan triangulasi. Analisis data dengan content analysis yaitu pengumpulan data, reduksi data, menyajikan data dan menarik kesimpulan. Hasil penelitian menunjukkan kepemimpinan telah dilakukan pengambil kebijakan dalam bimbingan dan hubungan antar perawat namun belum menjelaskan motivasi yang ada dalam sebuah reward & support system. Pengambil kebijakan telah mengalokasikan dana untuk pemenuhan SDM, infrastruktur dan peralatan penunjang keperawatan namun anggaran yang ada dan sedang berproses belum menyentuh peningkatan SDM keperawatan dari jalur pendidikan formal. Disposisi pengambil kebijakan telah memberdayakan perawat sebagai pelaksana kebijakan yang berkaitan dengan pembuatan keputusan dan pembuatan SOP, tetapi belum menyentuh pada instrumen evaluasi terstruktur pelayanan keperawatan. Disimpulkan bahwa bimbingan kepada pegawai hanya melibatkan pejabat struktural dan fungsional, peningkatan motivasi sudah dilakukan, anggaran belum menyentuh jalur pendidikan formal dan belum ada evaluasi yang terstruktur.

Nursing activities conducted by nurses were at the first line in the health service; and it was the first and the longest duration of contact with patients. The number of private/ public/paying patients (28.33%) in Kudus district general hospital (RSUD) decreased in the last five years. Result from community satisfaction index was not good. Therefore, nursing management needed to get attention from the manager. Objective of this study was to explain leadership, budget allocation, and delegation of policy makers in the nursing section of Kudus district general hospital. This was an observational-qualitative study. Study subjects were three policy makers in the nursing section as main informants, and three policy-executor nurses as triangulation informants. Content analysis method was applied in the data analysis; this method consisted of data collection, data reduction, data presentation, and conclusion drawing. Results of the study showed that leadership had been done by policy makers in the supervision and in relationship among nurses; however, policy makers had not explained motivation that was in the reward and support system. Policy makers had allocated budget for human resource completion, infrastructure, and supporting instrument for nursing. However, the existing budget had not been used to increase nursing human resource that originated from a formal education path. Policy makers had delegated formulation of decisions and SOP to the nurses who implemented the policies; however this delegation did not include structured evaluation instruments on nursing service. In conclusion, supervision to workers involved only structural and functional authorities; motivation improvement had been done; budgeting had not included a formal education path; structured evaluation was not done.