Head Nurses’ Supervision and Its Correlation with Patient Safety

in Aceh Hospital Setting, Indonesia

Yuswardi

, Delvina Julita

, Ardia Putra

, Budi Satria

, Hajjul Kamil

Department of Nursing Management, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Undergraduate Programme of Nursing Science, Faculty of Nursing Syiah Kuala University, Aceh, Indonesia

Department of Community Health Nursing, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

hajjul.kamil@unsyiah.ac.id

Keywords: Supervision, Head nurse, Patient safety

Abstract: The application of patient safety in hospital requires an active role from the head nurse in the form of

guidance or supervision. The Application of an adequate supervision of the head nurse will have an impact

on the application of optimal patient safety. This study aims to determine the relationship of head nurses’

supervision and the implementation of patient safety in hospital ward. This correlative study utilised cross

sectional design. It involved 124 nurses who work in the ward of public hospital in Banda Aceh by single

random sampling. Data was collected by a self-report questionnaires. The study shows that there was a

relationship of the head nurses’ supervision and the implementation of patient safety (p-value = 0,000). The

correlation was significant when viewed based on sub variables of 1) implementer (p-value = 0,000); 2)

target (p-value = 0,000); 3) goal (p-value = 0,000). However, the correlation was insignificant viewed based

on other sub-variables of frequency (p-value = 0,131); 2) and techniques (p-value = 0,164). The researchers

suggest that the hospital should conduct the training for the head nurses to increase the knowledge of

supervision and improve the application of patient safety in the hospital ward.

1 INTRODUCTION

Globally, healthcare systems have improved

significantly in many aspects resulting in better

patient outcomes. However, there is also a growing

recognition that patients do not always receive a

consistent and high quality of healthcare. Healthcare

services in hospitals provide hundreds of different

types of drugs, tests, many high-tech devices and

various health professions that are ready to provide

services to patients. However, the diversity of health

services might lead to ‘adverse events’ in patient

safety if not managed properly. The report from the

Institute of Medicine (IOM) in 2000 “To Err Is

Human, Building a Safer Health System” showed

that hospitals in Utah and Colorado found adverse

event in patient safety about 2.90%, which 6.60% of

them died. Adverse events in New York was 3.70%

with a 13.60% mortality rate in the hospital. The

mortality rate of adverse events in hospitalized

patients across the United States, reach to 33.60

million per year ranges from 44,000 - 98,000 per

year (IOM, 2004).

In Indonesia, patient safety is a new issue applied

in hospitals as standard for quality of delivery of

care. There are few studies regarding patient safety

focusing on the prevalence of adverse events. The

incidence of patient safety is still high. Hospital

Patient Safety Committee reported that patient safety

incidents from September 2006 to December 2007

contained 145 cases. Since 2008 - 2011 the number of

patient safety incidents is still high. In 2008 there

were 61 cases and increased to 114 cases in 2009. In

2010 decreased to 103 cases and January - April

2011 fell to 34 cases. In addition, Banten Province

found to have the highest number of patient safety

incidents in 2011 where 23.67% among the 3 other

provinces in Indonesia namely DKI Jakarta 5.15%,

Lampung 3.90%, and East Java 1.30% (Hospital

Patient Safety Committee of Indonesian, 2011).

The number of incidence during hospitalization

reflects the implication of patient safety. The

Ministry of Health of the Republic of Indonesia has

issued regulation about patient safety during

hospitalization. Based on these regulations, every

hospital is required to pursue the fulfillment of

Yuswardi, ., Julita, D., Putra, A., Satria, B. and Kamil, H.

Head Nurses’ Supervision and Its Correlation with Patient Safety in Aceh Hospital Setting, Indonesia.

DOI: 10.5220/0008395401290135

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 129-135

ISBN: 978-989-758-413-8

129

patient safety goals (Minister Health of Republic of

Indonesia, 2011). The same thing is also stated by

the Commission on Accreditation of Hospitals that

the goal of patient safety is one of the conditions that

must be applied in all accredited hospitals

(Accreditation of Hospital Committee, 2012).

The Joint Commission International (2011) has

established six areas of patient safety goals that can

be used to assess head nurses’ management towards

patient safety. These include (a) identifying patients

correctly, (b) improving effective communication,

(d) ensuring correct procedure (e) reducing the risk

of health care associated infections, and (f) reducing

the risk of patient harm resulting from falls.

Furthermore, head nurses must have the competency

to design, communicate, and apply these patient

safety goals to all nurses and other healthcare

providers under their supervision (IOM, 2004).

Head nurses are at the middle level of nursing

management system. They are working closely with

the staff nurses as well as perform day-to-day

managerial tasks (Marquis & Huston, 2015). Head

nurses perform a hierarchy of management functions

beginning with planning, organizing, staffing,

directing, and controlling. The implementation of

patient safety goals in hospital ward to all nurses

required head nurses’ supervision (Huber, 2006 in

Sugiharto, Keliat, & Tutik, 2012). According to

Mudayana (2015) explained that the implementation

of patient safety at Muhammadiyah Hospital in

Yogyakarta in the hospital ward indicated that

nurses had not been implemented the patient safety

properly (50.8%) and the collaboration between

work units was still inapropriately implemented

(65.1%).

Head nurses’ supervision considered enable to

increase patient safety goals. A study by Nur, Noor

and Irwandy (2013) in Hasanuddin University

Hospital showed that the implementation of good

supervision (59,40%) by head nurses will increase

the motivation of nurse (70,60%) increases nurse

performance in applying patient safety (73,70%).

Furthermore, according to Yuswardi, Boonyoung,

and Thiangchanya (2015) note that 14 hospitals in

Aceh against 123 head nurses stated that high head

management of patients regarding patient safety

could improve the quality of health services in order

to reduce the adverse events in patient safety, errors

and deaths in patients. With this reason, it is

challenging for the head nurses to manage their unit

to be a safety ward. To date, there is unknown study

regarding this matter. Therefore, it is substantial to

explore head nurses’ supervision and its relation

with patient safety in Aceh province.

2 METHOD

A descriptive study was conducted to examine the

head nurses’ supervision and its relation with patient

safety of Aceh province, Indonesia from Mei to July

2017. The subjects were nurses who had been

working in hospital wards who have met the

following criteria: (a) being a nurse for at least one

year and (b) holding at least diploma degree in

nursing. There were 124 nurses participated in this

study.

The instruments used for data collection was the

questionnaire designed by the reserchers. It

consisted of three parts which is the demographic

data to collect personal and work-related data

including age, gender, level of education, the

duration of working experience in current area. The

second part was the head nurses’ supervision

regarding patient safety questionnaire. The third part

was the applying patient safety. It is a 38 - item

questionnaires which consisted five dimensions

elaborating supervision of patient safety. Each

statement was rated on a three-point Likert scale,

ranging from 1 (do not perform as the item stated) to

3 (perform exactly as the item stated). The total

scores and the dimension scores were calculated and

presented as the average scores. The high scores

indicate the high level of head nurses’ supervision

regarding patient safety. This newly developed

questionnaires was content validated by experts.

Internal consistency reliability was tested, yielding

the satisfactory coefficient of .89 for the entire scale,

and .87 to .92 for the dimension scales.

3 FINDINGS

Table 1 shows that the demographic data consisted

of 124 nurses. More than half participants were at 26

- 35 years (77.42%). Most of them (79.04%) were

women, more than half head nurses (56.45%) were

had a diploma degree in nursing and most of them

(61.30%) had worked as a nurse for two to ten years.

AINC 2018 - Aceh International Nursing Conference

130

Table 1: Demographic Characteristics (n = 124).

Demographic Data

Age

17-25 year

26-35 year

36-45 year

19,35

77,42

3,23

Gender

Male

Female

20,96

79,04

Education

Diploma

Ners

56,45

43,55

Working Time

Establishment stage (< 2 years)

Advancement stage (2-10 years)

38,70

61,30

Table 2 Application of Patient Safety (n=124).

Variable

p-value

Supervision

0,000

Implementer

0,000

Target

0,000

Frequency

0,131

Aim

0,000

Technique

0,164

Table 2 shows that relationship of head nurses’

supervision and the application of patient safety. A

chi-square analysis was conducted to test whether

there is any signiﬁcant association of head nurses

supervision and applying the patient safety. The

result revealed that in general the implementation of

head nurses supervision has the relationship (p-value

= 0,000) with the application of patient safety. In

detail it can be seen that the sub variable of

implementer (p-value = 0,000), target (p-value =

0.000) and target (p-value = 0.000). Conversely, the

result of frequency (p-value = 0.131) and technique

(p-value = 0.164) have no relationship with the

application of patient safety.

4 DISCUSSION

The result of this study are described sequentially.

The finding of the study using statistical chi-square

test (= 0.05) indicated that in general the

implementation of head nurses’ supervision has a

relationship (p-value = 0.000) with the application of

patient safety. The result of this study are supported

by Rasdini, Wedri and Mega (2014) showed that

there was a relationship (p-value = 0.000) of

application of patient safety and supervision of

nursing service in inpatient ward Sanglah Denpasar.

This study indicated that the nurses have good

interaction in supervision to improve nurse

professionalism and provide safe service for patient

through active communication between nurses,

supervisors and patients.

A good relationship of the supervisor and the

nurses will improve the achievement of service

standards. Therefore, the nurses’ guidance in

providing quality of care for patient safety could

raise their awareness of supervisors to enhance the

role and responsibility of the nurses. Similarly,

Sugiharto, Keliat and Tutik (2012) mentioned that

supervision as a formal and professional process

undertaken by the supervisors or leaders to support,

guide, direct, evaluate, and develop the nurse

Head Nurses’ Supervision and Its Correlation with Patient Safety in Aceh Hospital Setting, Indonesia

131

knowledge and competence to complete the task

with full responsibility for achieving hospital and

patient safety goals.

Head nurses perform high level in management

regarding patient safety as their role of nursing

manager in managing staff, financial and any

resources to ensure safety and quality of care for

patients. The good harmony of work relationship

will grow the work environment. According to

Kerfoot (2009) that head nurses were obligated to

provide safety work environment.

The work environment has a role in improving

nurses’ performance. Conversely, less attentive work

environment will have a negative impact and reduce

nurses’ performance. This study is similar to the

research conducted by Oktariani and Murharyati

(2015) which suggests that nurses who have a poor

working environment have a risk of applying good

patient safety 2.9 times greater than those who have

a good work environment. The creation of a pleasant

work environment and meeting the needs of nurses

will provide satisfaction and increase their morale

especially in providing services that prioritize

patient safety.

Thus head nurses may realize that the

supervision of the head nurses will influenced the

application of patient safety. Supervision is carried

out to ensure the work is carried out in accordance

with the patient safety. Thus, the maximum service

could be given to the patients. A good relationship

between the head nurses and the nurses will create a

harmonious work environment that enable leading to

improve service according to work standards.

Furthermore, the common reason for the head

nurses perform the implementer has a relationship

with the application of patient safety (p-value

0,000). The result of this research is supported by

Rumampuk, Budu and Nontji (2013) which shows

that there is a relationship (p-value = 0.04) of the

role of head nurses to supervise the application of

patient safety at Gunung Maria Tomohon General

Hospital. This study shows that the head nurses in

the hospital is guiding, directing and assisting the

nurses.

A supervisor provides a way out of the problems

faced related to health services. According to

Sugiharto, Keliat and Tutik (2012) pointed out that

the supervision is not only to supervise the

performance of the nurses in accordance with the

instruction or the provisions but also to provide

solutions for things that have not been successfully

implemented. A supervisor has the advantages in the

organization because the function of supervision is

considered to be the managers’ job. But for the

success of supervision, the more priority is the

advantage in terms of knowledge and skills (Suarli

& Bahtiar, 2009).

Head nurses as the supervisor in hospital ward is

required to be able to run the supervision properly to

the nurses. Therefore, to increase the supervision

competency of the head nurse is through supervision

training. This result similar to the results of

Widiyanto, Hariyati and Handiyani (2013) showed

that the quality of supervision after the training

better than before. This result suggests that

supervision training becomes an important part of

improving the quality of the head nurses to be a

good supervisor.

The result of statistical test from the sub variable

of target is found that p-value 0,013 <0.05 meaning

there is correlation of target of supervision and

applying the patient safety. The study is similar to

Mua, Hariyati and Afifah (2011) noted that the head

nurses’ supervision significantly improves the

performance of nurses in the hospital ward in Palu;

since the head nurses of space instills a sense of

responsibility and compliance of nurse implementers

to the standard of care which has been set.

The nurses who perform their duties well and full

of responsibility certainly has a high work

discipline. According to Langingi, Kandou and

Umboh (2015) noted that the discipline of work will

affect the performance of nurses. A disciplined nurse

will follow and adhere to the application of patient

safety to the maximum and the rules set by the

organization. High discipline should always be

maintained and enhanced so that if there are nurses

who are not disciplined then the head of space can

give sanctions for him.

The result of statistical test in terms of

supervision frequency is found that p-value 0.131>

0.05, there is no correlation of supervision frequency

with applying the patient safety. This is similar to

Rozani (2009) mentioned that there is no correlation

(p-value = 0.102) of frequency factor with work

motivation of nurse executor in the hospital ward of

Dr. Zainoel Abidin Banda Aceh. The study shows

that often the head nurses to supervise when the

problem is found only and usually only conducted

on young nurses who do not have a long experience.

Thus, the nurses who have long working period in

the ward no longer need supervision since it is

considered already understood, although the fact is

the science of nursing always growing.

The researcher argued that there are no certain

guidelines regarding the number of times

supervision should be conducted. It has an impact on

some nurses who do not get supervision. In addition,

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132

the excessive workload factors will also reduce

nurses’ performance productivity. According

Astriana, Noor and Sidin (2014) explained that high

workload decreases nurses’ performance in the

implementation of patient safety programs in the

hospital ward of Haji Makassar Hospital.

In contrast, Sarwili (2015) explains that the

longer working period of a nurse, the more

experience gained in his work. Therefore, they could

reduce the caution in work. Therefore, supervision

which is not scheduled properly will have an impact

on the inability to improve the performance of

nurses in the midst of an ever-evolving environment

that will affect the implementation of patient safety.

Supervision is conducted in order to enable the

nurses always follow the development of science in

health services that prioritize patient safety. Suarli

and Bahtiar (2009) suggested that supervision

should be conducted at regular intervals. If

supervision is only conducted once, it is said as not

good supervision. This is happened since the

organization and environment is always developing.

This indicates that there are no definited guidelines

regarding the duration of the supervision should be

performed. Thus, some nurses are not supervised by

their supervisors.

The result of the aim of supervision has the

correlation (p-value 0,000) with applying patient

safety. According to Hadisah (2015) noted that there

was a relationship (p-value = 0.002) of the

supervision’s purpose and the implementation of

nursing care in the hospita; wards of Dr. Zainoel

Abidin Banda Aceh. This study shows that the

supervision performed by the head nurses to

improve the performance of nurses in providing

nursing care in order to decrease mistakes made by

the nurses.

Supervision from the head nurses could provide

continuous learning opportunities in providing

health care services to ensure patient safety at the

hospital. This is consistent with that proposed by

Arikunto (2004) mention that the implementation of

supervision is not to find fault but it contains more

coaching elements so that the work done can be

known for its shortcomings in order to be informed

of the parts that need to be improved.

Furthermore, techniques of supervision has no

correlation with applying the patient safety (p-value

= 0.164). In contrast, the study of Helendina,

Sitanggang and Rustika (2014) at Premier Jatinegara

Hospital showing a relationship (p-value = 0.015) of

supervision performed by head nurse and the

behavior of the nurses. The study shows that the

supervision has an important role in shaping the

behavior of nurses, particularly in terms of

documentation.

Several factors might be contributed to

insignificant techniques of supervision with applying

the patient safety. The supervision techniques that

include direct and indirect supervision techniques

performed by the head nurses did not affect the

application of patient safety. The knowledge of

nurses could influence in applying the patient safety.

According to Wahyuningsih, Sidin, and Noor (2014)

that there is a relationship (p-value = 0,02) of

knowledge and performance of nurses in

implementing work safety in the hospital ward of

Syekh Yusuf Hospital. Motivation is one of an

important role in the application of patient safety.

Motivation is the energy that encourages a person to

perform the job tasks to achieve the established

goals. This is inherent with the results of Nivalinda,

Hartini and Santoso (2013) research which

suggested the higher the motivation, the better the

application of patient safety culture.

5 CONCLUSION

This study has shown that there was a relationship of

supervision of the head nurses and the

implementation of patient safety. The form of sub

variables based on sub variable of implementer,

target and goal. But the correlation was insignificant

when viewed based on other sub-variables of

frequency and techniques.

ETHICS APPROVAL

This study had the ethical approved from Ethics

Committee of Faculty of Nursing, Syiah Kuala

University in Banda Aceh, Indonesia.

CONFLICT OF INTEREST

The authors state that they have no conflict of

interests.

AUTHORS’ CONTRIBUTIONS

Y and DJ conceptualizing and designing the study.

DJ conducted data collection and Y analysed the

data also prepared for the article’s first draft. All

Head Nurses’ Supervision and Its Correlation with Patient Safety in Aceh Hospital Setting, Indonesia

133

authors commented on the first draft and contributed

to the revisions of the manuscript. All authors read

and approved the final manuscript.

ACKNOWLEDGEMENTS

The authors would like to thank all nurses who have

participated in the study and the head nurses also the

stakeholders in the study setting for enabling this

research to be conducted.

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