Rumah Sakit adalah suatu organisasi kompleks yang terdiri dari berbagai macam sumber daya yang mempunyai fungsi dan peranannya masing masing. Rumah sakit sebagai institusi yang mempunyai fungsi dan tugas memberikan pelayanan kesehatan kepada masyarakat secara lengkap dan menyeluruh. Seiring dengan proses pelayanan yane diberikan,kegiatan pelayanan yang dlberikan tidak saja memberikan manfaat positif bagi masyarakat berupa kesembuhan pasien namun juga mempunyal potensi menghasilkan dampak negatif dari limbah baik yang padat maupun cair yang dihasilkan dari proses pemberian layanan kesehatan tersebut. Limbah cair rumah sakit adalah limbah cair yang dihasilkan dari suatu proses kegiatan yang terjadi dalam rumah sakit Limbah Cair rumah sakit berasal dari unit rawat inap unit rawat jalan, unit laboratorium, dapur, ruang gawat darurat, ruang operasi, serta limpahan air sisa dan halaman dan kantor rumah sakit. Dari hasil penelitian yang dilakukan diketahui bahwa pcngelolaan limbah cair rumah sakit terbagi atas persiapan sistem, pengoperasian sistem dan pemeliharaan sistem. Pada evalmlsi alur' proses terlihat bahwa standar operasional prosedur yang ada masih kurang lengkap dan tidak dijalankan dengan baik. Sementara itu untuk tingkat pemahaman datl pengetahuan operator terlibat kurang yang juga didukung oleh data yang menunjukkan bahwa mereka tidak pernah mendapatkan pendidikan ataupul1 peiatihan tambahan. Selain itu berdasarkan catatan pengamatan dan telaah dokumen terlihat bahwa pengoperasian mesin ada yang tidak berjalan dengan baik dan jadwal pemeliharaan dan penggantian komponen mesin tidak dilakukan secara berkala.

The Hospital is one complex organization which divided into manykind of resources has its own function and its role. Hospital as the institution has function that its tasks is to give complete totally health services. During the services, its not only to give the positive benefits to the community by curing the patient but its also have potention to give the negatife effect from the wasted rather its solid or water wasted. Water Wasted Hospital are the water waste which come from the activity process which happening on the hospital. It may comes from the emergency unit room.daily care unit. and house hold subunit. The water wasted which comes from hospital is approximately three hundred meter cubic a day, The Research thar has been doing was the qualitative research that its goals are for analyzing water wasted hospital management. This research are using a depth interview, sekunder data exploration and by observation notes in the fields methods, From the research what we expected for were we got the whole pictures bout wasted hospital management so it can be identified what is the exactly problem which could be happens during the process and could affect the final results. From the research we could see that water wasted hospital management divided into three section which are preparing system, operating system, and maintance system. Its also seems that the standard operating procedures were not quite comp!ete and not doing well by the operator from the process evaluate procedures. The Operator seems not to quite understand the procedures and its also support from the observation that they were not get enough additional training and education. Besides that from the observation known that operating machine and its maintenance which were included replacing the component are not doing regularly.

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.

Penelitian bertujuan untuk mengetahui pengaruh perspektif pembelajaran dan pertumbuhan (sistem informasi, keselarasan, motivasi kerja, pemberdayaan karyawan tingkat pelatihan ulang karyawan, kepuasan karyawan, retensi karyawan dan produktivitas karyawan) terhadap kinerja RSUD Sawahlunto tahun 2008. Secara teoritis penelitian ini diambil dari konsep yang dikemukan oleh Kaplan dan Norton tahun 2000 tentang Balanced Score Card. Penelitian ini merupakan penelitian survei dengan pendekatan kuantitatif, dimana data yang digunukan adalah data primer dengan memakai alat bantu kuesioner. Metode penelitian menggunakan metode analisis jalur atau disebut juga dengan Path Analysis (PA) dengan menggunukan program LISREL. Sampel penelitian diambil dari karyawan RSUD Sawahlunto tahun 2008 dengan menggunakan stratified random sampling berdasarkan kelompok strata pendidikannya. Hasil penelitian ditemukan bahwa system informasi, keselarasan, pemberdayaan karyawan, kepuasan karyawan, retensikaryawan dan produktivitas karyawan mempengaruhi kinerja RSUD Sawahlunto tahun 2008 sebesar 73,79% dan 26,21% dipengaruhi oleh variabel lain. Variabel yang paling besar mempengaruhi kinerja RSUD Sawahlunto adalah kepuasan karyawan karena variabel ini berpengaruh secra langsung dan secara tidak langsung terhadap kinerja RSUD Sawahlunto yaitu sebesar 27,04% sedangkan pemberdayaan karyawan sangat berpengaruh terhadap kepuasan karyawan sebesar 17.64% Motivasi kerja dan tingkat pelatihan ulang karyawan tidak menunjukkan adanya pengaruh langsung dan tidak langsung terhadap tinggi rendahnya kinetja RSUD Sawahlunto. Ketidak sesuaian antara teori dan hasil penelitian ini mungkin disebabkan oleh keterbatasan dalam penelitian. Berdasarkan penelitian ini disarankan untuk lebih memperhatikan tingkat kepuasan karyawan hal ini dapat dilakukan dengan cara : (1) memberikan pujian atas prestasi kerja yang dicapai karyawan; (2) memberikan balas jasa sesuai dengan basil ketja: (3) Memberikan balas jasa sesuai dengan hasil kerja; (4) menempatkan karyawan sesuai dengan pendidikan, keahlian dan keterampilannya; (5) memberikan perlakuan yang adil dan layak kepada karyawan; (6) memberikan kesempatan promosi jabatan yang adil dan terbuka; (7) memberikan kesempatan yang sama bagi tiap karyawan untuk mendapatkan pelatihan; (8) menyediakan sarana dan prasarana kerja yang memadai dan (9) menciptakan suasana dan lingkungan kerja yang baik, antara lain hubungan yang harmonis antara pimpinan dengan bawahan dan antar rekan kerja.

This study has an objective to know the influence of growth-and-learning­ perspective (i.e information system, harmony, working motivation,. empowerment of the employee, refreshment training for the employee, employee's satisfaction, employee's retention and employee's productivity) to RSUD Sawahlunto's performance in 2008. Theoretically, this concept is taken from Kaplan-and-Norton's concept in 2000 about Balanced Score Card. The design in this study is a survey design with quantitative approaches. The method being used in this study is a path-analysis-method with LISREL program. The data are primer taken by the questionnaires. Samples are taken among employees at RSUD Sawahlunto in 2008 by stratified-random-sampling-method based on educational background level. The result shows that infonnation system, harmony, empowerment of the Employee, employe?s satisfaction, employeeretention and employee?s productivity has influenced RSUD Sawahlunto?s performance in 2008 as much as 73,79%, and the rest is influenced by other factor which is not included in this study. The biggest influence to RSUD Sawahlunto?s performance was caused by employee?s satisfaction variable, directly and indirectly, as much as 27,04%. Meanwhile, the employee?s satisfaction was influenced mostly by the empowerment of the employee variable. Working motivation and refreshment training for the employee do not show any influence directly, -neither directly- to the RSUD Sawahlunto's performance. This result do not appropriate with the theory, which is may caused by the limitation of this study. According to the result of this study, it is recommended to give more attention to employee's satisfaction variable. The director of RSUD Sawahlunto can do these actions : (I) to give appraisal to good performance produced by the employee, (2) to give reward to the employee as much value as the result of the job, (3) to place the employee based on his educational background, skill and competence, (4) to give equal and deserved treatment to employees, (5) to give promotion to the employee with an equal and opened chance, (6) to give equal chance to employees to follow a training, (7) to give good facility to work and (8) to create a good working- atmosphere, including good relationship between supervisor and subordinate, and among co-workers.