School of Health Sciences Jenderal Achmad Yani Page 246 Jenderal Sudirman Canal Road – Cimahi 40533 Phone: +62-22-6631622 - 6631624
EXPLORING THE IMPLEMENTATION OF CAREER DEVELOPMENT FOR CLINICAL NURSE AT THE INPATIENT WARD OF TK II 03.05.01 DUSTIRA HOSPITAL; A
PHENOMENOLOGY STUDY
Oyoh*, Lilis Rohayani [email protected]
Department of Nursing, School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia ABSTRACT
In providing nursing care, a nurse has the responsibility to be professional with the appropriate knowledge, skill, and authority to provide the care to patients based on the knowledge and the authority given based on their level. In response to the statement, the Health Ministry made a regulation system to regulate the professionalism in career development of clinical nurses via Regulation of the Health Ministry No. 40 year 2017. In reality, its implementation varies despite a guideline was nationally put into effect in 2017. This research aims to explore the implementation experiences of the clinical nurses in the inpatient ward of the TK.
II 03.05.01 Dustira Hospital.
The method employed is that of qualitative with the phenomenology approach. The data was collected from an indepth interview method supplemented with field notes. Participation selection used the purposive sampling method. Five respondents were selected through data saturation. The analysis employed the Colaizzi method with the following stages: listening to recorded verbal interviews with the respondents prior to making, accumulating, and reading several times the transcript from all participants to arrive to significant statements and their summary, theme cluster, theme, flawless description, description validation with the participants, a combined data in a final description, and the integration of the theme in a narrative description. The discovery of the research was the identification of four themes, namely: 1) Support in career development implementation, 2) the perception of the nurses about the program, 3) commitments of the parties involved, and 4) the expectations of the nurses.
Summary: The results showed that its implementation is still lacking due to various obstacles, such as: a lack of common perception among the parties in the implementation, as well as the commitment and support of the management. Recommendations: for the hospital, the research may be used as a basis for implementing the career development program stipulated by PMK No.40 year 2017, a perception reconciliation, and improvements in support and mutual commitment to establish professional nurses profession . As for future research, there is a need to discover the factors that affect such implementation.
Keywords: Phenomenology, clinical nurses, career development.
INTRODUCTION
The quality of healthcare services must be continually improved, as it is with nursing services in hospitals (Kuntoro, 2010; Depkes RI, 2012;
Nursalam 2016). Every effort in improving the service quality in a hospital should also be congruent with its nursing services (Mulyono, et al, 2013). In providing such services, the nurses must have the compentence and authority as and individual, part of a group, or collaborative partner with other healthcare professionals (Azwir, Azwir, Ayuningtyas D, Riastuti KW, 2010). In providing such care, the nurses are required to be professional by having the knowledge, the skills, and the authority to carry out their duties based on the science and the extent of such authority (Nursalam, 2016; Manurung, 2011). The American Nurse
Association (2015) in Sulistiawati (2016) stipulates that a professional nurse functions within the perimeter of practice standards based on their competencies and capacity. Suroso (2011) stated that through their competency increase a nurse may be a ble to save the life of a patient.
Thus, PPNI (2016) issued a system that regulates the professionalism of the nurses, one of them being their career development program, in line with the decree of the Ministry of Health No.
40 year 2017 (Kemenkes 2017). It was expected that the program spurred on the nurses to be competitive and functional according to their competencies. Its implementation followed after the issuance of the regulation which controlled career development of the nurses in Indonesia. However, its effectiveness varies across the nation. Wijaya (2015) in
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Medianers (2015) stated in a seminar that the increase of competenceand professionalism of nurses can be achieved through career development, credentials, and bills. Its monitoring system is also considered not optimal, since there are nurses with lower capacities executing higher- level tasks and vice versa. Almost a hundred percent of the seminar attendance from various regions have yet to participate in career development and remuneritation rewards as the Health Ministry imposed. Zakaria A, (2010) and istiawati (2016) showed in their research that its implementation is effective in enhancing the work performance of the nurses. Suroso (2011) also proved that career development can improve professionalism, work performance, and achievements of the nurses of their respective capacity through competence increase. Sulistiawati further conveyed that career development had a positive effect on discharge planning. It also increases patient satisfaction.
At Rumah Sakit TK. II 03.05.01 Dustira which is an Indonesian military-owned establishment and has undergone KARS accreditation processes. The KARS accreditation standards for KPS 12 set the fundamental for obtaining credentials in hospitals so that the nurses provide services in a professional and safe manner. The results of the nurses’credential mapping provide a guideline for their career development and the dispatch of clinical authority. Preliminary research showed that the nurses did not have full comprehension about the career development implementation. Furthermore, they were not satisfied with the rewards related to their career advancement. Also, they did not execute nursing services based on their clinical competencies. Furthermore, they were only aware that career development was one of the requirements for accreditation, and some of them had no knowledge of what their clinical authority was. The implementation of career development should encompass the nurses to work according to the authority they have. In turn, it should have impact on the quality of services and patient safety because the providers are competent workers.
Therefore, there is a need to investigate the experience of career development implementation for clinical nurses at the inpatient ward at Rumah Sakit TK. II 03.05.01 Dustira.
OBJECTIVES
This research aims to explore the experiences of clinical nurses in their participation in a career development scheme at
the inpatient ward of Rumah Sakit TK II 03.05.01 Dustira.
METHODS
The design of the research is that of qualitative descriptive through the phenomenology approach (Anselm, and Juliet C, 2009; Streubert &
Carpenter, 2011; Creswell, 2013). The study explored the implementation of career development for clinical nurses at the inpatient ward of Rumah Sakit TK. II 03.05.01 Dustira. The main instrument of this qualitative research comprises data collection tool in the form of an interview guideline, notebooks, and a camera (Maleong, 2012; Creswell, 2013). Its technique involved in-depth interviews to allow respondents to describe their experiences during the implementation. while being recorded with a voice recorder (Creswell, 2014; Sugiono 2014). Five participants who are nurses working at the hospital took part. and they were chosen using the purposive sampling technique with the following inclusive criteria: the participants agreed to take part in the study; they worked at the hospital for more than a year; and, they are able to describe their experiences with the implementation (Streubert & Carpenter, 2011). The data analysis employed that of Colaizzi in the following stages: listening to recorded verbal interviews with the respondents prior to making, accumulating, and reading several times the transcript from all participants to arrive to significant statements and their summary, theme cluster, theme, flawless description, description validation with the participants, a combined data in a final description, and the integration of the theme in a narrative description (Colaizzi in Polit & Beck 2010).
The results were presented in a descriptive narrative (Maleong, 2011; Creswell, 2013)..
RESULT
The results of the research derived from an inductive process through in-depth interviews and notes which produced essential themes and eventually a narrative presentation. It is divided into two parts, namely the narrative of the participants’
characteristics and the themes gained from the interview. There were five respondents who participated. Data analysis results yielded four themes that underlied the research question. The themes are discussed in whole in the following parts. They were: 1) Support in career development implementation, 2) the perception of the nurses
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about the program, 3) commitments of the parties involved, and 4) the expectations of the nurses.
Meaning description or the themes are as follows:
Theme 1, which is the support in implementing the clinical nurse career development, 03. showed its lacking from the management as expressed by the participants like the following:
“hmmm…it’s like this, ma’am…it seems the management has not provided its full support in the implementation of career development which leads to inconsistencies in PK to date.” (P1)
Participants 3,4, and 5 also expressed the same concern and they felt that the decision makers regarded the implementation as a low priority, giving the impression that they less supported it, reflected in the following responses:
“…look…I feel that the decision makers pay less attention or provide less support…in regards to the career development…” (P5)
“…It is not fully supported; that’s why its implementation is not consistent with PK…the career development has not been implemented satisfactorily…”(P3)
“haha…(smilingly) when making a policy, they should prioritize fully on supporting the
implementation of career development to make it happen…” (P4)
Theme 2, which was the perception of clinical nurses on
their career development, varied as reflected in the following responses:
“…that’s they way it is, ma’am…we don’t have the same perception on executing the PK; we implement them to patients together with the head of the team and the members…” (P2)
“…it’s like this, ma’am…(seemed confused) sometimes the ward head says one thing, and the head of the team says another thing, so I’m usually confused…I also have my own opinion
(smiling)…”(P5)
“…It should be that we agree on a common perception first, and then the career development can take place…”(P1)
Theme 3, which is the commitment of all parties involved in the implementation, showed that in reality there was still a need of commitment with good intent from all of them as conveyed in the following excerpt:
“…in fact, there is already a regulation made by the Ministry of Health about implementing career development for nurses…if I’m not mistaken, it’s the PMK no. 40 year 2017, right, ma’am?...(while smiling)…we only need to refer to the regulation…it seems we need to re-strengthen the commitment, ma’am…” (P4)
“…if the commitment from all parties are well…the implementation of the clinical nurse career development can be realized, ma’am…” (P5)
“…it seems that we need a strong commitment to realise it, ma’am…” (P1)
Theme 4, which was the expectations of the nurses in the implementation, The participants expected rewards equal to their work performance and career level, as mentioned
in the following responses:
“…my real hopes are (while smiling) that the reward is equal to our work performance…” (P1)
“…I hope that there is a reward appropriate with our career level…” (P3)
“…the higher the level of our career, the heavier the work load and responsibilities, so I hope that the reward is equivalent to the work performance and the level…” (P5)
DISCUSSIONS
This segment presents the interpretation of the research results, the underlying theories that relate to the context of the study, journal reviews, discussions and opinions of the researchers, and other literary sources. The results are presented in the order of the themes as follows:
1. Support in implementing the clinical nurse career development,
There was still low support in the implementation. There was a need for a policy from the management of the hospital in line with that of the government as a guideline and regulation in the implementation, since it could also be used for processing rotation, promotion,
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and mutation, so that it would have an impact on the work performance and the satisfaction of the nurses, and in turn, the satisfaction of the patients. The support from the hospital was evident from the issuance of a decree from the director regarding the implementation which was in line with the ministry’s regulation no.40 year 2017.
Success in career development is was influenced by various factors such as support from the hospital top management, the nurse manager, and colleagues, as well as the dedication and enthusiasm of the nurses (Burket, et al. 2010; Afriani, Hariyati, Gayatri, 2017).
Additionally, there was a need for support from adequate human and financial resources. Both resources need to have enough focus in implementing the program or policy, and the absence of a competent implementator would lead to the less dynamic and slow policy, while the lack of financial support would also lead to ineffective implementation (Han & Kim, 2014;
Marquis & Huston 2010). The success was also related to the support from various stakeholders involved in the existing policy (Indiahono, 2009).
2. The perception of clinical nurses on their career development
The results exhibited a difference in perception among the nurses. If there was no immediate action taken to solve the problem, it would have adverse effects on the implementation. Correct and accurate information about career development for clinical nurses needed to be comprehended by all parties in its implementation.
Nurses in applying the services within their competence based on their career development should be balanced with positive intellectual values so that such services could be scientifically accounted for as they should be according to the knowledge and practices, and the nurses could professionally function in their work (Haryati, 2014). Professionalism in nursing is based on comprehension and the skills to carry out the nursing practices with scientific bases for the good of the humankind (Marquis & Huston, 2010; Fowler, 2014). An essential factor in accurately and positively molding the behavior of a person is the effect of knowledge or cognition. Knowledge-based behavior will be better than otherwise (Notoatmodjo, 2010;
Sarudin & Hariyati, 2014). Nurse compentence in carrying out their duty or actions related to nursing services are affected by their education, skills, knowledge, and experience. Should the experience or the cognition of the nurse is less than desirable in implementing the nursing services, the evaluation suggested that it gave a negative effect on fulfilling the needs of the client or patient (Zakaria, 2010; Abdullah, Sidin
& Pasinringi, 2014). An increase in achievements or performance through the increase of knowledge, skills, and work ethics are necessary for all employees/nurses to be able to adjust with changes and demands from time and technological advancement (Suroso, 2011).
3. The commitment of all parties involved in the implementation
The next finding of the study is the commitment of all parties involved in the implementation of career development of the clinical nurses. The lack of strong commitment from the parties involved may cause negative impact on the implementation of the career development for clinical nurses in the hospital.
Commitment, according to Kreitner and Kinicki (2014), is an agreement to do something for the sake oneself, other individuals or organisations.
Ivancecich, Konopaske, and Matteson (2008) stated that commitment is an emotion of identification, involvement, and loyalty conveyed by employees to the hiring company.
Therefore, it relates to three things: The emotion of identifying with the cause of the organisation, being involved in the duties of the organisation, and being loyal towards the organisation.
An organisational commitment directly has an impact on the performance of the workers.
Leadership in employee performance with consideration in organisational commitment shows a positive and significant impact.
Therefore, improving leadershiip will increase the performance and content of the employees if it is simultaneously done with the increase in organisational commitment (Murtie, 2012;
Yunus, Hamid, Yusuf, 2018).
Improving a career development is better than increasing work performance of clinical nurses if it is simultaneously done with the enhancement of organisational commitments.
According to Kornela, Hariyanto, and Pusparahaju (2014) as well as Priansa (2014), it is important to consider such commitments in
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efforts for career developments for clinical nurses towards their work performance
4. The expectations of the nurses in the implementation.
Another finding of the research is the expectations of the nurses in the implementation.
An expectation, according to Gottschalk and Stotland (in Lopez, (2009:487) is a longing for achieving something. Gottschalk described it as a positif energy that drives a person to navigate around difficult circumstances, while Stotland emphasized that it is an important part in fulfilling an objective. The participants aspired that the implementation led to a financial reward that is equal to their career level.
A reward is a crucial factor that affects the interest of an individual in working for an organisation. According to Wibowo (2011), it is a level of performance that has manisfested from a certain effort. Individuals are motivated by hope of what is to come, so some of them do their best in their work. This result is also advocated by a study by Fitria and Sawitri (2017) that shows how a reward, when it is equal to the work performance, can inrease the satisfcation of the nurses and drive hem to optimize their roles.
Royani, Junaiti Sahar and Mustikasari (2012) concluded from their study that a reward equivalent to work performance has a positive impact on how they provide nursing services. A well-planned and well-implemented reward can instigate enthusiasm and a sense of responsibility on the employees and their work.
Therefore, the hospital management should already have implemented a reward scheme for well-performing employees.
CONCLUSION
The results indicated that the implementation of career development for clinical nurses has not been carried out as well as it should due to various obstacles such as the lack of support, different perceptions, the lack of commitment of the stakeholders, and the lack of satisfaction in the implementation on the part of the nurses. The results of the study can be used as information and evaluation material and fundamental data in developing a policy in the implementation of career development for clinical nurses at Rumah Sakit TK II 03.05.01 Dustira, the importance of rewards, commitment, and comprehension about the career
development from all parties involved in the implementation.
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