Mahasiswa Residen
I. Identitas Pengisi
Jabatan : …………………………………………………………..
Ruangan : …………………………………………………………..
1. Perencanaan (Planning)
a. Visi, Misi, Rumah Sakit
1) Apakah ruangan memiliki visi, misi, rumah sakit? Jika ada apakah sudah
disosialisasikan kepada staff di ruangan?
Visi
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Misi
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2. Organizing
a. Struktur Organisasi
1) Apakah ruangan memiliki struktur organisasi dan jelaskan metode
penugasan?
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2) Apakah jumlah tersebut sudah sesuai dengan kebutuhan yang ada diruangan?
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b. Sistem Rekruitmen
1) Apakah kepala ruangan mengetahui tentang sistem rekrukmen pegawai
rumah sakit?
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2) Bagaimanakah sistem pengusulan rekruitmen penambahan tenaga perawat
baru di ruangan?
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3) Apakah kepala ruangan ikut serta menentukan kriteria atau ketentuan syarat-
syarat tenaga perawat yang ditempatkan di ruangan?
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2) Apakah orientasi dilaksanakan mencakup seluruh unsur yang ada di ruangan?
Apakah unsur-unsur tersebut?
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3) Berapa lamakah proses orientasi dilaksanakan di ruangan?
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d. Penjadwalan
1) Bagaimanakah proses pengaturan jadwal dinas/ shift pengelolaan tenaga
keperawatan yang diterapkan di ruangan?
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2) Berapakah jumlah rata-rata jam kerja per minggu atau hari kerja per bulan
perawat di Ruang Rawat Inap dan Rawat Jalan?
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3) Apakah ada penanggung jawab setiap jadwal shift dinas perawat di ruangan?
Dan bagaimana dengan pergantian dinas di ruangan?
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2) Apakah ada perawat diruangan yang mengikuti proses tugas belajar atau
melanjutkan pendidikan?
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3) Apakah ada syarat/ kriteria perawat yang diberikan izin untuk mendapatkan
tugas belajar maupun pendidikan atau pelatihan dalam pengembangan ilmu
keperawatan?
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4) Apakah ada subsidi atau bantuan yang diberikan oleh rumah sakit/
pemerintah dalam upaya pengembangan staf/ perawat?
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f. Metode penugasan
1) Metode penugasan apa yang diterapkan di ruangan( struktur organisasi)?
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2) Apakah metode penugasan tersebut sesuai dengan jumlah perawat yang ada
di ruangan?
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4. Actuating
a. Kepemimpinan
1) Apakah jenis gaya kepemimpinan yang diterapkan dalam proses tata kelola
praktik keperawatan di ruangan?
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b. Pendelegasian
1) Apakah ada teknik pendelegasian atau tugas limpah yang diterapkan di
Ruang Rawat Inap dan Rawat Jalan?
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3) Apa sajakah bentuk-bentuk kegiatan yang didelegasikan dan yang tidak
didelegasikan dan adakah uraian tugasnya dengan jelas?
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c. Manajemen Konflik
1) Apakah teknik manajemen konflik yang diterapkan dalam menyelesaikan
masalah-masalah yang terjadi di ruangan Ruang Rawat Inap dan Rawat
Jalan?
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1) Apakah alasan kepala ruangan menggunakan teknik manajamen konflik
tersebut?
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d) Motivasi
1) Bagaimanakah tingkat kepuasaan perawat pelaksana di ruangan dalam
melaksanakan tugas dan wewenangnya?
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2) Apakah ada system penghargaan dan reward yang diberikan bagi perawat
yang berprestasi? Apakah jenis penghargaan atau reward tersebut?
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5. Controlling
a. Indikator Mutu
1) Bagaimanakah system indikator mutu yang dilaksanakan di ruangan?
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b. Penilaian Kinerja
1) Bagaimanakah system penilaian kinerja perawat di Ruang Rawat Inap dan
Rawat Jalan? Menggunakan metode apakah?
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2) Apakah ada proses penilaian kinerja dari bawahan ke atasan, penilaian
teman sejawat, dan penilaian sendiri oleh perawat?
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d. Audit Keperawatan
1) Apakah saudara tahu tentang audit keperawatan?
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c. Kebutuhan SDM
1) Apakah kepala rungan merasa kekurangan tenaga perawat diruangan?
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3) Apakah kendala yang dirasakan dalam proses identifikasi pasien?
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4) Apakah perawat selalu melakukan hand higiene dengan 6 langkah dan five
moment?
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