FRAMEWORK &

ELEMEN MANAJEMEN
KETENAGAAN
KEPERAWATAN DAN
PERENCANAAN
KETENAGAAN
1
Disajikan oleh: Dra. Junaiti Sahar, PhD
FIK UI

Sumber: Hamid, AY, Guru Besar Keperawatan

FIK UI, 2010.
 SUB-POKOK BAHASAN:
 Perkembangan Kondisi Kesehatan/ Keperawatan
secara Nasional dan Global
 Framework Manajemen Ketenagaan
Keperawatan
 Elemen-elemen Manajemen Ketenagaan
Keperawatan yang Efektif
 Research Protocol

 Perencanaan Kebutuhan Ketenagaan

 Kebijakan Perencanaan Tenaga Keperawatan

dan Dampaknya terhadap Keperawatan
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 PERKEMBANGAN KONDISI KESEHATAN
DAN KEPERAWATAN DI ERA GLOBAL

 Challengos to the health system system

 Global health care versus domestic health
care
 Opportunities and challenges of
technology
 Situation analysis of SEAR countries,
including Indonesia
 Situation analysis of Nursing and
nationally
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 CHALLENGES TO THE HEALTH SYSTEM

 Global health workforce crises

 Lack of appropriate timely evidence

 Lack of financial resources

 Stewardship challenges of implement pro-

equity health policies in a pluralistic
environment

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 GLOBAL HEALTHCARE DIFFERS FROM
DOMESTIC HEALTHCARE IN 3 WAYS:

 Structurally :
1. how care is veliverd;
2. the people
3. the organizations, and
4. the processes

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 GLOBAL HEALTHCARE DIFFERS FROM
DOMESTIC HEALTHCARE IN 3 WAYS:

 Culturally :
1. ethnicities
2. languages
3. socio-political environment
 Clinically :
1. new types of diseases
2. new types of curing and caring

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 TECHNOLOGY
Opportunity:
 Global communication network

 Clinical data warehouses & decision support

systems
Challenges:
 Loss of the human element in care

 Increased dependence on systems

 The digital divide

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 TANTANGAN UTAMA UNTUK MENCAPAI SASARAN
KESEHATAN DI NEGERA ASIA TENGGARA, TERMASUK
INDONESIA:

Tantangan yang dihadapi pemerintah:

 Ketidakmampuan untuk menjamin mutu
pemberi pelayanan dan pelayanan kesehatan
 Ketidakseimbangan SDM

 Terpilahnya pelayanan dan rendahnya cakupan

 Terbatasnya alokasi dan manajemen sumber

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SDM KESEHATAN SEDUNIA

70%- 80% total SDM

Kesehatan adalah Perawat

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 WHY NURSING WORKFORCE ??

Contributing factors to:

 Cost containment

 Quality improvement

 Community satisfaction

 Competent and motivated nurses, and

 Strategic investment of the highest important

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The forcefield for nursing practice

Sumber Ekonomi Faktor Politik, Sosial

• Cross Netkonal Product (GNP) dan Budaya
• % of GNP to health
• Total flemencial resources to health

- Status dan pendidikan

- Komitmen praktek
Kondisi
Kepemimpinan - Kepedulian etik
Kerja
& Menajemen

SDM Kesehatan
Praktik
Sistem Yankes Keperawatan
- Organisasi - Divisi Ketenagaan
- Kruanga
- Teknologi

Undang2 &
Regulasi
Pendidikan
Riset

Demografi &
Epidemiologi Lingkungan 11
 KEPERAWATAN PERLU > 40 THN UNTUK
MASUK AGENDA WHO

WHA Resolution (2001)

Strengthening Nursing Services

 Melibatkan perawat dalam pengembangan

kebijakan kesehatan, perencanaan, dan
implementasinya pada semua tingkat
 Menata program pengembangan SDM
komprehensif yang mendorong rekrutmen dan
retensi Tenaga Keperawatan

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 WHA RESOLUTION (2001)
STRENGTHENING NURSING SERVICES

 Mengembangkan dan mengimplementasikan

kebijakan dan program yang menjamin tempat
kerja yang sehat dan lingkungan kerja yang
berkualitas bagi perawat.
 Mengembangkan dan menghasilkan evidence
base bagi keperawatan

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 Indonesian’s Global Health Problems
Health Problems

Millennium Development (Goals (MIX/Gs) 2015

National
Health System WHA Resolution (2001):
(SKN) Strengthening Nursing & Midwifery Services

Strategic Direction for Ng &

National Stretegic Mw Services 2002 2008
Direction for Ng Dev’t

Framework in-depih country assessment, guidelines

Evidence
For Ng & Mw Workforce Management
WHO SEAPO

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 Kesepakatan WHO framework, Elemen
efeltif dan
Protokol Riset untuk Pengembangan SDM
Keperawatan se Asia Tenggara (termasuk
Indonesia)

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Negara Asia Tenggara
(SEAR Countries):
• Bangladesh
• Bhutan

• DPR Korea

• India

• Indonesia

• Maldives

• Myamar

• Nepal

• Sri Lanka
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• Thailand
Nursing Workforce Management

Framework

Elemen Tindakan Manajemen Efektif

Research Protocol/Instrument

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18
 KEBIJAKAN DAN PERENCANAAN
 Keterlibatan perawat dalam perumusan
kebijakan dan perencanaan program
 Rencana strategik keperawatan (dokumen
kebijakan) sebagai bagian integral dari
sistem pengembangan pelayanan
kesehatan
 Rencana dan kebijakan terkait dengan
sumber & finansial

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 WHY???
KETERLIBATAN PERAWAT DALAM PERUMUSAN
KEBIJAKAN DAN PERENCANAAN PROGRAM

 Semua kebijakan kesehatan dan program

mempengaruhi perawat
 Perawat secara langsung dipengaruhi oleh
perubahan pada kebijakan kesehatan
 Keterlibatan perawat membantu percepatan
perkembangan profesi
 Keperawatan, termasuk kapasitas dalam
bekerjasama secara konstruktif dalam sistem
kesehatan

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 WHY???
RENCANA STRATEGIK KEPERAWATAN (DOKUMEN
KEBIJAKAN) SEBAGAI BAGIAN INTEGRAL DARI SISTEM
PENGEMBANGAN PELAYANAN KESEHATAN

 Memberikan arah yang jelas untuk perkembangan SDM

Keperawatan dengan pendekatan terstruktur dan POA
yang spesifik serta kerjasama lintas sektor, lintas profesi
dsb
 Mekanisme utama untuk pengembangan keperawatan
pada suatu negara melalui pembentukan focal point…
keperawatan), Badan Regulatori/ Konsil
 Keterpaduan upaya pengembangan SDM (keterpaduan
perencanaan SDM dengan pelayanan, perencanaan untuk
SDM terintegrasi misal tim multidisiplin, keterpaduan
proses perencanaan lintas disiplin, wilayah dan sektor)
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 WHY???
RENCANA DAN KEBIJAKAN TERKAIT DENGAN
SUMBER & FINANSIAL

 Meningkatkan efisiensi sumber dan cost

containment
 SDM merupakan investment
 Pengembangan investment memerlukan
penanaman/ penggunaan finansial awal yang
memadai

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 PENDIDIKAN, PELATIHAN &
PENGEMBANGAN

 Koordinasi antara pendidikan dan

pelayanan
 Rekrutmen calon mahasiswa
Keperawatan
 Pendidikan berdasarkan kompetensi

 Pembelajaran multidisiplin

 Budaya belajar sepanjang hayat

 Sistem pendidikan berkelanjutan

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 PENEMPATAN DAN UTILISASI
 Keterampilan dan kompetensi komplementer
 Infrastruktur keperawatan yang relevan

 Manajemen dan kepemimpinan yang efektif

 Kondisi kerja yang memadai dan pekerjaan yang

terorganisasi secara efisien
 Sistem supervisi teknis

 Kesempatan pengembangan karir

 Sistem insentif

 Kepuasan kerja

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 PROCESS

* Formation of WHO-SEARO
Advisory Group

• Framework (2001), Elements,

Protocols
• In-depth country assessments
(SEAR Countries, 2001-2002)
• Analysis (2002)
•Guidelines (2003)
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Lihat Referensi :

 Essential actions/elements for effective

management of nursing workforce
 Protocols for in-depth country assessment
of nursing workforce management

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In-depth country assessments

 Conducted in 2001-2002 in 10 SEAR

countries
 Using protocols for in-depth country
assessment based on framework
 Analysis of country assessments

GUIDELINES

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 MANFAAT PENGKAJIAN:
 Panduan pengembangan keperawatan pada tiap
negara
 Panduan WHO untuk mendukung upaya
pengembangan keperawatan di Asia Tenggara
 Masukan untuk penyempurnaan guidelines for
effective management of nursing workforce di
Asia Tenggara
 Masukan untuk penyiapan laporan implementasi
Resolusi WHA 53.12

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 METHODS OF DATA COLLECTION:

 Interviews
 Document search and review

 Focus group discussions

 Multidiciplinary discussions

 Nurse-specific focus group discussions

 Surveys

 Observation

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ANALYSIS OF COUNTRY ASSESSMENT: BRIEF
SUMMARY OF FINDINGS……..

Planning and policy:

 Inadequate involvement of nurses in the

formulation of health policy and planning
 Inadequate capacity and capability of nurses to
effectively contribute
 Limited strategies and opportunities to develop
capacity and capability

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ANALYSIS OF COUNTRY ASSESSMENT: BRIEF
SUMMARY OF FINDINGS……..
Education, training and development:

 Absent or weak linkages and interdependency between the

education and service sectors
 Few current problems with the number of students being
recruited but there are issues with the quality and
professional potential of those recruited
 Achieving competency-based education and modern
teaching methodology and skill requires considerable effort
 There are few multidisciplinary learning opportunities for
nurses
 Difficulty in encouraging, promoting and achieving a
culture of lifelong learning
 Continuing education other than Thailand, is ad hoc and 31
inadequate
 ANALYSIS OF COUNTRY ASSESSMENT:
BRIEF SUMMARY OF FINDINGS……..

 Shortage and maldistribution of nursing personnel

along with and inappropriate professional skill mix
 Few initiatives to strengthen the flexibility of nursing
workforce
 Rosters are not evidence based and are in need of
revision
 Basic equipment is lacking
 Sustainable funding is problematic and inequitably
distributed particularly between urban, rural and
remote areas
 Nursing professional associations are essential but
need to be strengthened as do leadership and
management 32
ANALYSIS OF COUNTRY ASSESSMENT: BRIEF
SUMMARY OF FINDINGS……..

Deployment and utilization …..:

 Working conditions need improving: salaries are

low, health facilities are poor and unsafe for staff,
inappropriate nurse: patient ratios, nurses are
subject to physical and verbal abuse, housing and
transport are often unsatisfactory, incentives are
poor, mutual respect between nurses and with
other members of the health team need
strengthening.

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ANALYSIS OF COUNTRY ASSESSMENT: BRIEF
SUMMARY OF FINDINGS……..

 Technical supervision is poor overall and the

approach to continuous quality improvement and
encouraging motivation is weak
 There are few developmental opportunities for
nurses to improve technical supervision skills
 Career advancement opportunities are few and
higher level nurse clinical practitioner training is
largely absent
 Evidence base is inadequate to accurately assess
job satisfaction
 In Bangladesh, DFID survey showed that 90% of
nurses were dissatisfied 34
ANALYSIS OF COUNTRY ASSESSMENT: BRIEF
SUMMARY OF FINDINGS……..

Regulation:

 Most countries have nursing or health council or

other regulatory mechanisms in place
 Robustness of regulation for nurses is uneven
across SEAR, despite the extensive evidence
bases now available on the impact of
strengthened regulation, and best practice
approaches to regulation.

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ANALYSIS OF COUNTRY ASSESSMENT: BRIEF
SUMMARY OF FINDINGS……..

Evidence base for decisions:

 Limited information systems available

 Limited local research

 Limited access to evidence bases being developed

in other countries, with financial constraints
cited as the most common reason for the
weaknesses
 A center for evidence-based best practice in
nursing has been established in Thailand
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 GUIDELINES
for Member Countries

 Lihat referensi WHO

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 PENTINGKAH RASIO
PERAWAT: DOKTER?

 Biaya
 Asuhan yang tepat

 Mutu

 Downward substitution: dokter mengerjakan

tugas yang dapat dikerjakan perawat
 Upward substitution: perawat mengerjakan
pekerjaan dengan tingkat yang lebih tinggi

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 PERENCANAAN SDM:

 Pengintegrasian perencanaan SDM dengan

perencanaan pelayanan kesehatan

 Perencanaan untuk SDM yang terintegrasi: tim

multidisiplin

 Pengintegrasian proses perencanaan- sepanjang

disiplin, region dan sektor

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 LESSON LEARNED FROM CANADIAN
GOVERNMENT

 8 years 8 million Canadian dollars strategy to

strengthen nursing quality of care

 Formula: substitution equation is : cost + quality

= substitution decision

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 SARAN RASIO DOKTER: PERAWAT
MEMPERTIMBANGKAN:

 Efisiensi maksimal dalam utilisasi dan

penyebaran perawat dan dokter

 Mereka mempunyai kompetensi, pengetahuan

dan keterampilan yang memadai untuk
memberikan asuhan yang bermutu

 Bahwa infrastruktur kesehatan, meliputi

peralatan, sesuai dengan tingkat pelayanan
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PENGUKURAN BEBAN KERJA ???

Right numbers of nurses with the

right knowledge, skills and attitudes

at the right location

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PERENCANAAN KETENAGAAN KEPERAWATAN

Pastikan keselamatan,
Keseimbangan Berapa Minimalkan risiko,
anggaran orang? Tingkatkan mutu asuhan

Pastikan kehidupan kerja yang baik

Menarik dan mempertahankan staf yang baik

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METODE TELAAH STAFFING LEVELS

 Outcome measure

 Benchmarking

 Consultative methods

 Workload measurement tools

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 WHY MEASURE NURSING WORKLOAD?

 To assess the client’s status determine nursing

need a professional interest of nurses

 To determine and manage staffing levels,

working conditions, quality of care

 To determine and manage caste, adequate

allocation of resources

 To measure the outcome of nursing interventions

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 COMPLEX DIMENSIONS FOR NURSING
WORKLOAD

Patient/client
dependency: Therapeutic,
intervention severity of
illness,
Nursing dependency :
Basic care requirements, manual
handling, infection control measures,
support of relatives, safety of
confuses or dressing change nursing
escort for transfer
Nursing workload:
Research and development ,
coordination of multidisciplinary
team, teach/supervise
inexperienced staff, multiple
admissions/ discharges 46
 CATEGORIES OF MEASUREMENT METHODS:

 Dependency level approach: systems measuring the

process of patient care, categorizing the patients into
groups according to the amount of nursing care
received or required, allocating either standard times
for nursing care according to dependency groups or
standard time for each activity, which is the summed
 Task-oriented approach: systems analysis and
summing up nursing activities required
 Care-plan driven approach: systems producing a
nursing care plan and using this to predict workload
 Ward-based approach: systems concentrating on
patient through put and BOR, deriving staffing
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requirements per ward
 INSTRUMENTS:

Dependency Based Measures:

 Resident Assessment Instrument (RAI)

 Functional Independence Measure (FIM)

 Criteria for care

Activity Based Methods:

 Workload Indicators of Staffing Need (WISN)

 Nursing Hours per Patient Day (NHPPD)

 Nursing Minimum Data Set (NMDS)

 Leistungserfassung in Der Pflege (LEP)/Nursing

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Performance Recorded
 INSTRUMENTS :

 Soins Infirmiers Individualises A La Personne

Soignee (SIIPS)

Care plan Driven Methods

 Projet De Recherche En Nursing

 Planification Informatisee Des Soins Infirmiers

Requis (PLAISIR)

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