Kesenjangan pengembangan karir perawat klinik dalam jenjang jabatan struktural di RS Mohamad Ridwan Meuraksa, merupakan sesuatu yang kurang sesuai dengan konsep pembinaan karir. Kesempatan pengembangan karir perawat klinik PNS terbatas bila dibandingkan dengan perawat klinik militer. Disisi Iain pengembangan karir melalui jalur karir fungsional belum jelas, yang diperlukan dalam pengembangan karir terutama perawat klinik PNS, karena dengan adanya jalur karir fungsional akan menempatkan perawat klinik sesuai dengan peran dan fungsinya di rumah sakit, dengan harapan akan meningkatkan kinerja dan mute pelayanan. Penelitian dilaksanakan di Rumah Sakit Mohamad Ridwan Meuraksa Jakarta dengan metode penelitian kualitatif. Data sekunder diperoleh dan telaah dokumen serta data primer diperoleh melalui wawancara mendalam terhadap pimpinan Rumah Sakit dan suprasistem sampai dengan perawat pelaksana dilapangan. Adapun tujuan penelitian adalah untuk mengetahui gambaran pola karir yang efektif untuk pengembangan karir perawat klinik di Rumah Sakit Mohamad Ridwan Meuraksa. Rumah Sakit Mohamad Ridwan Meuraksa memiliki tenaga keperawatan berjumlah 189, yang berstatus perawat klinik berjumlah 178 orang yang terdiri dan perawat klinik militer 50 orang, perawat klinik PNS 84 orang dan perawat klinik sukarelawan 44 orang. Karakteristik dari masing-masing personil tersebut adalah Perawat Klinik militer mempunyai umur sebagian besar antara 31 - 40 tahun berjumlah 39 orang (78%), pendidikan sebagian besar SPK/bidan/SPRG berjumlah 39 orang (78%), masa kerja sebagian besar antara 6 - 10 tahun berjumlah 22 orang (44%), dan sebagian besar berpangkat Bintara berjumlah 39 orang (78%). Perawat klinik PNS mempunyai umur sebagian besar antara 31 - 40 tahun berjurnlah 29 orang ( 33,3%), pendidikan sebagian besar SPK/bidan/SPRG berjumlah 70 orang (80,5%), masa kerja sebagian besar antara 16 - 20 tahun berjumlah 29 orang (33,3%), pangkat sebagian besar golongan II berjumlah 72 orang (82,8%). Perawat klinik Sukarelawan mempunyai umur sebagian besar antara 20 - 30 tahun berjurnlah 39 orang (88,6%), pendidikan sebagian besar D3 keperawatan berjumlah 29 orang (65,9%). Pengembangan tenaga keperawatan di Rumah Sakit Mohamad Ridwan Meuraksa melalui pendidikan dan pelatihan, hampir seluruh program berasal Bari supra sistem. Rumah sakit sendiri hanya mempunyai program pelatihan, tetapi belum menjadi program yang tersistem dengan baik. Pengalaman kerja yang diperoleh oleh tenaga perawat dalam pengembangan karirnya adalah melalui riwayat jabatan dan kepangkatan, program mutasi dan promosi, pendidikan dan pelatihan yang mereka peroleh, bimbingan para perawat senior dan pimpinan, dan khusus perawat milker penugasan lapangan dari supra sistem. Kebijakan dan peraturan tentang pengembangan karir perawat klinik di Rumah Sakit Mohamad Ridwan Meuraksa tergantung dari supra sistem terutama dari Kesdam Jaya, karena rumah sakit merupakan badan pelaksana dari Kesdam Jaya. Disamping itu Ditkesad sebagai pembina teknis dari kecabangan kesehatan secara tidak Iangsung juga ikut mempengaruhi keputusan rumah sakit. Pala karir yang berlaku saat ini hanya pola karir struktural sesuai dengan struktur organisasi dan tugas Rumah Sakit Moh. Ridwan Meuraksa. Berdasarkan wawancara mendalam sebagian besar informan menyatakan bahwa, pola karir fungsional sudah seharusnya dibuat agar pengembangan karir perawat klinik sesuai dengan pola karir profesional yang sesuai dengan konsep teori tentang pola karir perawat yaitu perawat klinik I, Perawat klinik II, Perawat klinik III, perawat klinik IV, dan perawat klinik V. Pada akhir penelitian ini dapat diambil suatu kesimpulan bahwa untuk peningkatan kualitas pelayanan, maka perawat klinik hares ditempatkan sesuai dengan peran dan fungsinya.

Regarding to the concept of career development, there is a disparity on career development of structural function level of clinic's nurses at MRM hospital, which is considered inequitable. Because, clinic's nurses that having the status of civil government officer (PNS) has more limited opportunity in developing their career, comparing to their colleagues at military clinic. Moreover, the developing career through functional career route is still unclear. Suppose that career route is very important to PNS clinic's nurses, as they can develop and improve their career in suitable roles and functions. Therefore, they can implement their tasks and duties at the hospital in proper way, and it is expected that their performance and their quality services will be increased. Based on the thought above, this study has an aim on describing an effective career pattern on career development of clinic's nurses at MRM hospital. The study is carried out at the MRM Hospital in Jakarta, using qualitative research method. Two types data will be perform, i.e. the primary data attained from in-depth interview of hospital top director until program implemented nurses in the field, and the secondary data that obtained from documents review. The MRM hospital has 189 nurses, which 178 of them are clinic's nurses. Of 178 clinic's nurses, 50 of them are military clinic's nurses, 84 are PNS clinic's nurses, and 44 are voluntary clinic's nurses. To describe each personnel characteristics: there are 39 (78%) of military clinic's nurses are mostly on the range of age 31 to 40 years old; 39 (78%) are graduated from SPKJBidanISPRG; 22 (44%) of them have working period on the range of 6 to 10 years; and most of them 39 person (78%) are in lowest grades of military rank, called Bintara. From 84 PNS clinic's nurses, there arc 29 (33.3%) in the range of age 31 to 40 years old; 70 (80.5%) are graduated from SPK/Bidan/SPRG; 29 (33.3%) of them have working period from 16 to 20 years; and 72 (82.8%) of them are in the rank of grade II PNS. Of the 44 voluntary clinic's nurses, mostly or 39 (88.6%) of them are in the range of age 20 to 30 years old; 29 (65%) person have graduate from nurses diploma (D3). At MRM hospital, the development of nurse personnel is trough education and trainings. Almost all of training programs at the hospital are part of the supra system program, as the hospital only have a limited training program and have not yet arrange as a systematically usefulness program. Working experience as part of career development is mostly achieved due to experience on function and rank of their employment grade, mutation and promotion program, education and training, guidance from their seniors, and particular from military nurses are supra system of field duty. The policy and regulation on clinic's nurses career development at MRM hospital is depend on its supra system of Kesdam Jaya, as because the hospital is part of implementation unit (badan pelaksana) of Kesdam Jaya. Moreover, the Ditkesad, as the technical assistant from health subdivision, is also indirectly influence the decision making on the hospital management. The pattern of career development that legitimately valid up to now is a structural career pattern appropriate with the organizational structure and the duty on the MRM hospital. As the in-depth interview, almost all informants stated that a functional career development is should be determined in order to support the career development of clinic's nurses. Therefore, it will be suitable to its professional career development and it's also concurred with the theory of career pattern concept of the nurse, i.e. clinic's nurse I, clinic's nurse II, clinic's nurse III, clinic's nurse IV, and clinic's nurse V. To increasing the quality on hospital services, it is needed to arrange the clinic's nurses on regards to their roles and function with considerable on their education, working experiences, and competency.

Perawat sebagai tenaga keschatan mayoritas di tempat pelayanan kesehatan, tcrmasuk rumah sakit, mempunyai posisi kunci dalam pelayanan kesehatan karena hakikat dari asuhan keperawatan yang bersifat kontinyu, konstan, koordinatii dan advokatitl sehingga pcxsiapan, pendayagumaaxm, distribusidan retensi tenaga perawat memplmyai implikasi penting untuk kesinambungan dan tercapainya tujuan pelayanan kesehatan. Penelitian dilaksanakan di RSUD Tarakan karena pengembangan karir tenaga keperawatan yang dilaksanakan di RSUD Tamkan belum sesuai dengan fungsi dan peran perawat. Penelitian dilaksanakan dengan menggunakan metode penelitian kualitatif dengan melakukan wawancara mendalam terhadap jajaran direksi, Jajaran kepala bidang, kcpala scksi, dan kepala subbag serta Foccus Group Discussion (FGD) untuk kepala ruang dan perawat ldinik Juga dilakukan telaah dokumen yang berhubungan dengan pengernbangan pola karir perawat klinik untuk memperlcuat metode tersebut. RSUD Tarakan memiliki tenaga kepemawatan sebanyak 245 orang dengan karakteristik (1) mayoritas tenaga kepcrawatan bemda pada kelornpok umur 25-44 tahun (77,96%), (2) memiliki mass kelja terbesar pada kelompok >3 tahun (61,22 %), (3) dcngan latar belakang pendidikan D III Keperawatan sebanyak 72,24 %, Mekanisme pengembangan tenaga kcpezawatan yang saat ini diterapkan di RSUD Tarakan dimulai dengan kegiaian rekruitmen pegawai bam, dilanjulkan dengan seleksi, kemudian dilaksanakan orientasi selama 30-70 hari. Selain itu juga meliputi kegiatan mutasi, promosi dan pendidikan dan pelatihan. Berdasarkan hasil wawancara mendalam dan FGD diperoleh gambaran pola jalur karir tenaga kepcrawatan di RSUD Tarakan yang sesuai dengan pemn dan iimgsinya yang dapat diterapkan di RSUD Tarakan yaitu sebagai perawai klinik (enam level) dan perawat menejer (empat level). Pada akhir penelitian ini direkomendasikan bagi RSUD Tarakan untuk dilaksanakan advokasi kepada pihak direksi rumah sakit untuk menetapkan peraturan nunah sakit tcntang sistem remunerasi terhadap jenjang karir keperawatan dan mengopllmalisasi iimgsi dad komite keperawatan untuk menyusun insuumen uji kompetensi yang bqrhubungan dengan pengembangan karir tenaga keperawatan.

The nurse as a majority health worker in the health care place including hospital has a significant position in health care. The value of nursing care that is continuous, constant, coordinative, and advocative so the preparation, usage, distribution, and retention of nurse, has an important implication to the continuity and to obtain the objectives of health care. The study was conducted in the Tarakan General Hospital (RSUD Tarakan) because its nursing career development was not appropriate yet with the function and role of the nurse. This study was conducted using qualitative research method by doing the in depth interview toward the directors, head of divisions, head of units, and head of sub units, and doing focus group discussion (FGD) toward the head of rooms and clinical nurses. Document review related to career pattem development of clinical nurse was also conducted in the study to enhance the method. RSUD Tarakan had 245 nurses with characteristics as follow: 77.96% of nurses has the age range of 25 - 44 years old, 61.22% of nurses had working period > 3 years, 72.24% of nurses had nursing diploma educational background, and 4ll2% of nurses was governmental officer. At present, the mechanism of career development of nurse that implemented in RSUD Tarakan is started from recruitment of new nurses followed by selection, orientation for 30-70 days. Beside that, mutation, promotion, and training and education were also conducted. According to the in depth interview and FGD was resulted the description of nursing career path pattem in RSUD Tarakan that suitable to the function and role and could be implemented in the hospital, were the clinical nurse (six levels) and manager nurse (four levels) career path. The study recommended RSUD Tarakan to conduct advocacy toward the hospital director board to determine the regulation of remuneration system of nursing career path in the hospital and to make the function of nursing committee optimally in formulating the instrument of competency test related to the nursing career development.

Sistem pengembangan karir perawat melalui jenjang karir struktural maupun timgsional berperan penting dalam meningkarkan kualitas tenaga keperawatan yang akan mempengaruhi kualitas pelayanan Rumah Sakit secara keseluruhan. Saat ini pengembangan karir untuk perawat pelaksana yang sudah dijalankan di RS MH Thamrin Salemba baru berdasarkan jenjang karir struktural. Diharapkan dari penelitian ini dapat menghasilkan rancangan pola pengembangan karir perawat pelaksana yang sesuai dengan kondisi dan kebutuhan RS MH Thamrin Salemba. Penelitian dilaksanakan di RS MH Thamrin Salemba bulan Oktober- November 2011 dengan pendekatan analisis lcualitatiff Data primer diperoleh melalui wawancara mendalam dengan beberapa infonnan berdasarkan prinsip kesesuaian dan kecukupan. Data sekunder diperoleh melalui telaah dokumen Rumah Sakit, kajian literatur maupun hasil penelitian terdahulu dengan topik serupa di Rumah Sakit lain. Untuk menjaga validitas data dilakukan triangulasi sumber dan metode. Jumlah tenaga perawat di RS MH Thamrin Salemba sebanyak 189 orang dengan karakteriétik sebagian besar di antaranya: tingkat pendidikan D3 Keperawatan (63,1%), sudah ada pengalaman sebelum masuk ke unit kexja saat ini (51,9%) dan memiliki masa kexja 1 sampai 3 tahun (24,3%). Rumah Sakit beium memiliki pola pengembangan karir perawat pelaksana yang terstmkmr dan sistematis berdasarkan sistem kompetensi. Oleh karena itu dibuatlah suatu rancangan pola pengembangan karir bagi perawat pelaksana di RS MH Thamrin Salemba yang terdiri dari 6 level karir (NO sampai dengan N6) berdasarkan persyaratan tingkat pendidikan, pengalaman dan masa kerja, waktu berlaku suatu level karir, dan kompetensi yang hams dimiliki perawat pada setiap level karir tersebut. Persyaratan minimal pendidikan tenaga perawat yang baru masuk adalah D3 Keperawatan. Sedangkan bagi perawat lama lulusan SPK, selama masa peralihan akan dilakukan penyesuaian berdasarkan pengalaman dan masa kerja.

 The nurse's career development system through structural and functional level of career has very important role ?in increasing the quality of nursing staff which will also affect the quality of hospital service. At this time, MH Thamrin Salemba Hospital has only implementing the structural level of career for nursing staff and the functional level of career has not implemented yet. Therefore, the purpose of this research is to design the clinical nurse's career development pattern at MH Thamrin Salemba Hospital according to the hospital's condition and needs. The research is implemented at MH Thamrin Salemba Hospital in October-November 2011 using qualitative analysis approach. The primary data is obtained from the selected informants based on appropriate and adequacy principles using in-depth interview method. The secondary datas are obtained from hospital's document review, literature review and also the results of previous similar studies at other hospitals. The source and method triangulation are done as well to maintain data's validation. MH Thamrin Salemba Hospital has 189 total number of its nursing staff which majority of them have the characteristics: Nursing Diploma education level (63,1%), already have the experience before entering current unit of work (5 l,9%) and period of employment between 1 to 3 years (24,3%). Hospital does not have the structured and systematic clinical nurse?s career development pattern. Therefore the researcher formulated the design of clinical nurse's career development pattem at MH Thamrin Salemba Hospital which consists of 6 level of careers (NO to N6) based on education level, work experience, period of employment, temr of level and nursing competency requirements for each level. The minimal qualification for new nursing staffs education level is Nursing Diploma. But there is special provision for the longtime nursing staff with level of education SPK, during the transition time, they still can be accomodated in the career development pattern based on their work experience and period of employment.