ARTICLES (1)

STANDARDS OF NURSING PRACTICE

A. Definition
The standard is a descriptive statement outlining job performance can be measured
by the quality of structure, process and outcome (Gillies, 1989, h.121).
Standards are statements that include the activities of care that leads to
professional nursing practice (ANA, 1992, H.1).
Nursing is a professional services form an integral part of health care, based on
science and troubleshooting, servicing shaped bio-psycho-socio-spiritual
comprehensive, addressed to individuals, families, and society, both sick and
healthy which includes human life (workshop national 1983).
Standards of nursing practice is a statement that describes a desired quality of the
nursing pelyanan given to the client (Gillies, 1989h. 121). The main focus is the
client's nursing practice standards. Used to determine the process and outcomes of
nursing care provided in order to achieve the nursing service. Through practice
standards can be known whether the intervention atan nursing actions that have
been given in accordance with the plan and whether the client can achieve the
desired objectives.
B. Type of nursing practice standards
Some of the standard type has been used for a landing and control the practice of
nursing. Standards can be shaped 'normative' which outlines the ideal nursing
practice that describes the appearance of high-quality nurses, standard also shaped
'empirical' that describe nursing practice is based on the observation on a large part
of nursing care facilities (Gillies 1989, h.125).
C. Objective Standard
In general standards of nursing practice is set to improve care or nursing services
by focusing on the business process activities or services to meet the criteria of
service expected.
Preparation of nursing practice standards are useful for nurses, hospital / institution
clients, the profession of nursing and other health professionals.

a. Nurse.
Nursing practice standards are used as a guideline to guide nurses in determining
nursing actions to be performed teradap kien and protection from neglect in nursing
action to guide nurses in nursing action is right and true.
b. hospital
By using standard nursing practice will improve the efficiency and effectiveness of
nursing care can be decreased with the curing short time in the hospital.
c. client
With care not long then the cost to the client and family to be mild.
d. profession
As a planning tool to achieve the target and as a measure to evaluate the
performance, where the standard as a means of controlling.
e. Other health professionals
To determine the limits of authority with other professions so as to respect and work
together well.
D. Benefits Standards of Nursing Practice
a. Clinical practice
Provide a series of conditions to evaluate the quality Askep and is a tool to measure
the quality of work performance nurses to provide feeedbeck for improvement.
b. Nursing Services Administration
Providing information to administrators who are very important in planning the
pattern of staff, staff development programs and identify the contents of the
orientation program.
c. Nursing Education
Helps role in planning the curriculum and evaluating student work performance.
d. Nursing research
The results of the evaluation process is the meeting penilitian can improve and
enhance the quality Askep.
e. Health Care System
Standard implementation can improve the functioning of the health team work in
developing Askep quality and the role of nurses in the health care team that built up
a good working relationship and give satisfaction to the members of the health
team.
Know Standards of Nursing Practice in Indonesia

1. YEAR 1963
Nurses are executing commands physicians in the treatment of patients (Law No: 6
of 1963 on Health Workers).
2. 1979
Distribution of medical and health personnel be divided into two paramedics
paramedis.Paramedis nurses (nurses and midwives) and non-nurse. Permenkes No:
262 / Per / VII / 1979.
3. YEAR 1980
Midwives are allowed to do private practice (Labor and KB) .Permenkes No: 363 /
Menkes / XX / 1980.
4. 1992 - Present
Nursing as a profession with a certain authority:
a. Law 23 Th. 1992 on Health
b. PP 32 Th. 1996 tentnag Health Workers
c. Kepmenkes 1239 Th. 2001 concerning the Registration and Practice Nurses
d. Kepmenkes 900 Th. 2002 concerning the Registration and Practice Midwife.
a. The importance of the Nursing Practice Act
There are several reasons why the Nursing Practice Act is required. namely:
1. Reasons philosophy. Nurses have given a great contribution in improving health.
Nurses play a role in providing health services ranging from government and private
services, from urban to remote rural corners and borders. But such devotion in fact
has not been matched with the provision of legal protection, even tend to be the
object of the law. Nurses also have a scientific competence, attitude rational, ethical
and professional, high spirit of dedication, disciplined, creative, skillful, virtuous and
able to uphold professional ethics. In addition, this Act has a purpose, a clear scope
of the profession, the profession absoluteness, common interests of various parties
(communities, professions, government and other stakeholders), a balanced
representation, optimization of the profession, flexibility, efficiency and harmony,
universal, justice , as well as equality and suitability interprofesional (WHO, 2002).
2. juridical reasons. 1945, Article 5, states that the President holds the power to
make law with the approval of the House of Representatives. Also Thus Act No. 23 of
1992, Article 32, explicitly states that the implementation of treatment and care
based on science or medicine or nursing, can only be carried out by health workers

who have the expertise and authority to itu.Sedang article 53, states that health
workers the right to obtain legal protection in carrying out duties in accordance with
the profession. Moreover, article 53 that health workers in performing their duties
are obliged to adhere to professional standards and respect the rights of patients.
On the other hand technically enacted Decree of the Minister of Health Nomor1239 /
Menkes / SK / XI / 2001 concerning the Registration and Practice Nurses.
3. sociological reasons. Community needs for health services, especially nursing
services is increasing.
This is due to the paradigm shift in the delivery of health services, from the medical
model of care focused on the diagnosis and treatment of disease, health paradigm
to a more holistic view of disease and symptoms as information and not as the
focus of service (Cohen, 1996). Besides, people need nursing services that are
accessible, quality nursing care as an integral part of health care, and obtain legal
certainty to the granting and administration of nursing services.
b. The concept of nursing standards in Indonesia
Nursing Professional Standards are guides to be used as guidance in performing the
profession as well. (Nomor1239 / Menkes / SK / XI / 2001 on nursing standards)

1. Nurses can carry out the practice of nursing in health care facilities,
praktekperorangan / atauberkelompok.
2. Nurses who carry out the practice of nursing in health care facilities should
have SIK.
3. Nurses who practice individual / group must have a SIPP.
Article 9 Paragraph 1
SIK as referred to in Article 8, paragraph 2 is obtained by submitting an
application to the head of the health districts / local town.
Article 10
SIK only applies to one (1) health care facilities.
Article 12
(1) SIPP as referred to in Article 8 paragraph (3) is obtained by applying to the
Chief Medical Officer of the District / Municipality. Nurse Practice License
hereinafter referred SIPP is given written proof of nurses to practice nurses
(2) SIPP is only given to nurses who have a graduate of diploma nursing

education or nursing education with a higher level of competence.

Article 13
Recommendations for SIK and / or SIPP done through assessment of scientific
capabilities and skills in nursing, adherence to a code of professional conduct
and ability to practice nursing.
Article 15
Nurses in performing nursing practice is authorized to:
a. Implement nursing care includes assessment, nursing diagnosis
determination, planning, implementing and evaluating nursing nursing
actions.
b. Nursing actions referred to in item a cover: nursing interventions, nursing
observations, health education and counseling.
c. In performing nursing care as dmaksud letters a and b must be in
accordance with specified standards of nursing care professional
organizations.
d. Service medical action can only be done by a written request from a
doctor.
The exception is Article 20 Article 15
(1) In a life-threatening emergency patient / individual, the nurse is
authorized to conduct health services outside of the authority referred to in
Article 15.

ARTICLES ARRANGEMENT NURSING PRACTICE (2)

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ARTICLE (3)

Nursing practice is set at the state and federal level. Regulation of Nursing began a
very simple process to protect the title registry and public nursing (Flook 2003). The
main purpose of nursing regulation today is not only to protect the public through
nursing practice but also regulate and supervise nursing education nursing
competencies through licensing and disciplinary rules. The authority to license and
discipline of the nursing profession is given to each state board of nursing, often
referred to the board of examiners nurses through state legislation creating the
practice of nursing actions and mechanisms for licensing.
Advancement of Nursing Practice
According to the definition of an advanced practice nurse is a registered
professional nurse who is ready for nursing practice based on the knowledge and
skills acquired through continuing education programs of study, act independently
or in collaboration with other health care professionals in the delivery of health care
services.
Nursing Practice Settings
Advanced nursing practice governed and constructed in accordance with standards
of nursing for registered nurses, nursing actions identified in the practice of each
country.
Prior to 1997, most states make it illegal for any nurse who perform diagnosis or
prescription medication. Regulations and programs for their preparation
by the board of nursing varies from country to country. Fenton and Thomas (1998)
reported that the arrangement has the authority only to regulate the practice
progress through: the recognition of APN and set the standards and scope of
practice. Fenton noted the lack of a consistent standard of education and
experience and recognition criteria APN problem at the level of accreditation,
certification, and regulation. As a result, Texas Board of Nursing
Examiners develop a model that is designed to ensure the education and
recognition APN, emphasizing both professionalism and public safety
(Fenton & Thomas, 1998). For example, APN practice through protocol or
written authorization lainnya.Untuk this protocol definition and other written
authorization
under the Nursing Practice Act of Texas. Roemer (1977) reported that more and
more countries liberalize the scope of nursing functions, making it possible for the
APN to assume the functions previously not within the scope of clinical practice

nurse. In some countries, some functions of advanced practice allowed by physician

supervision. In other countries, especially in rural areas, APN can function
independently. The action was independent, but as dispensing, may be limited to a
series of treatments. Midwives tend to function independently. According to Roemer
(1977), the nurse has a rare medical facilities, generally authorized to provide
prenatal and postnatal care, handle normal labor, and do the work of family
planning, including the diaphragm and insert and remove the IUD. In addition,
courses for nurse practitioner in family planning established throughout the United
States. Roemer (1977) also reported the California program of both registered and
unregistered nurses trained as a specialist in women's health, which makes
inspection to give advice to family planning. Family planning non-specialist trained
RN including (1) a licensed vocational nurse, (2) the holder of a bachelor's degree in
a non-nursing field, and (3) those who qualify with less formal education. This 24week course at the official under the California State Department of Health.
According to Roemer, use APN will (1) help make family planning and good service
baby more commonly available and (2) to save time for cases that require greater
skill and training. As nursing care standards vary from country to country, as well as
APN settings. Fitzgerald and Wilson reported that many other countries of advanced
nursing practice nursing checking to determine a process to identify and regulate
the practice and finally uniformity for the purpose of nursing law. For example, in
1999, redesigned Minnesota state law to define and provide protection for the
practice of registered nurses. Minnesota Board of Nursing was held to develop (1)
recommendations on issues of certification, (2) the criteria for determining
acceptable certification organization, (3) the procedure in case of failure of the
examination, and (4) a process for communicating this information to the
community nursing (Ponto et al., 2002).
Scope of Practice Clinical Nurse Specialist
A clinical nurse specialist is APN that has the education and specialized training in a
clinical one. For example, psychiatric CNS focuses on treating patients in the clinical
area through patient or staff, in consultation with psychiatric nursing or other staff,
and patient treatment arrangement. to the scope of practice for the APN.
Heitkemper and Bond (2004) believe that the CNS is essential to provide leadership
to improve patient care, advance nursing practice, and strengthen the health care

delivery system. The scope of nursing practice has expanded to include nursing
through various technologies. For example, with the advent telenursing, the state
should expand the scope of practice across the country. Influence telenursing After
the expansion of nursing practice act story developed by individuals who had
arranged that the practice of nursing in the state.
Telenursing is the electronic transfer of data of nursing, nursing information, and
nursing expertise. Because nurses are now able to practice outside their country
without actually, telenursing has had quite an impact on the expansion of nursing
practice act. Hutcherson (. 2001, p 4) argues: During the last century the world
increasingly rely on various technologies to manage information needs. Escalation
in the remote deployment
technology to improve health care, along with expanded public and private
reimbursement for remote maintenance, showing an increase penerimaanteknologi.
However, many questions of law and regulations concerning the provision of health
services use this technology. Age informatics has opened a new era for nursing
practice, taking advantage of advances in telecommunications technology that has
allowed nurses to provide patients perawatankepada different locations across the
country (Hardin & Langford, 2001).
DISCIPLINE AND REHABILITATION
Regulation of nursing have the power to take disciplinary action against the license
that has been violated. Typically, the license suspension penalties. examples of
violations of the act and the reasons for disciplinary action, disciplinary action in
most countries is a function of the state board of nursing. But also promoting their
rehabilitation nurse while back competence. Lewallen and McMullan (2001) reported
that as part of the disciplinary process, the state board of nursing may require a
license to take a course in ethical decision-making-law or pharmacology. They
showed that a form of discipline rehabilitative nursing competencies as follows: (1)
during the course, the license holder must recognize their specific violations and
explore the reasons for the occurrence and strategies for prevention and (2) upon
completion of the course, instructors deliver the required subject matter used for
the consideration of the decision.

MEASUREMENT OF COMPETENCE IN CLINICAL PRACTICE

Staff development and continuing education instructor profisional always associated
with maintaining continued competence of practitioners in clinical nursing practice.
Waddell (2001) reported that the competence issue reached a new level of
significance.

ARTICLE (4)
Nurse Practice Settings According Permenkes
No. 148 of 2010
We all know that the nursing profession is part of a health care profession which in all activities
of his ministry has been regulated in Law Number 36 year on Health and the division of power
also provided for in Regulation Number 32 of health workers and the newest PERMENKES
Number 148 of 2010 concerning license and implementation practice nurse.
In the case of nursing practice settings set forth in article 2, 8, 9,11 and 12, PERMENKES 148 of
2010 which reads:
Article 2
(1) The nurse can run practice in health care facilities.
(2) health care facilities as referred to in paragraph (1) shall include health care facilities outside
independent practice and / or independent practice.

(3) The nurse who runs an independent practice as referred to in paragraph (2) perpendidikan
least a Diploma III (DIII) nursing.
In this article the nurse is authorized to carry out independent practice at home in addition to
working on other health care institutions, this is an award for the nursing profession which in the
old PERMENKES not regulate it.
Article 6
"In carrying out independent practice, nurses must install signboard nursing practice".
In the application of this Article occur anbivalensi or mistrust themselves to nurses, especially in
the area of local government / regent no attention at the nursing profession, especially in Gresik.
Other things in the district nurse. Kebumen all nurses who practice independently in the
compulsory putting signs, aligned with the chairman's speech PPNI districts. Kebumen in a panel
discussion of legal practice nurse according to the latest laws in Indonesia, the discussion was to
coincide with the International Nurses Day is celebrated every year on May 12. Discussions were
held in the hall of the building STIKES Muhammadiyah Gombong on May 12, 2010, attended
by district government officials, heads of municipal police officers penertipan PP as violators
PERMENKES, health law practitioners and members of the District Council. Kebumen.
Chairman PPNI Kab. Kebumen H. Trinity Eco Sapto, SKM, MPH asserts that:
independent nursing practice concepts that have a license, understanding of human rights and
the rights of patients, understand the ethical and legal system in force, speaking carefully,
understand the informed consent procedure, understand the secret of the patient as well as the
need to understand the standard of nursing care. "Follow-up of these 148 Permenkes there should
be regulation / Perbup to organize independent nursing practice. For colleagues who already
have a SIPP must install signboard practice (signpost) in accordance with Permenkes 148,
"added H. Trinity Eco Sapto, SKM, MPH. [1]
Article 8
(1) The practice of nursing in health care facilities implemented the first level, second level and
third level.
(2) The practice of nursing as referred to in paragraph (1) is aimed at, families, groups and
communities.

(3) The practice of nursing as referred to in paragraph (1) shall be implemented through the
following activities:
a. Implementation of nursing care
b. Implementation of promotive, preventive, recovery and community empowerment.
c. Implementation of nursing actions complementary.
(4) Nursing care as prescribed in paragraph (3) letter a covering assessment, nursing diagnosis
determination, implementation of nursing actions.
(5) The implementation of nursing as referred to in paragraph (4) covers the implementation of
the planning and implementation of nursing actions.
(6) nursing actions referred to in paragraph (5) includes the implementation of nursing
procedures, observation, nursing, health education and counseling.
(7) The nurse in performing nursing care as referred to in paragraph (4) may provide a drug-free
and / or free 0bat limited.
In this article focuses on the authority, duties and functions of nurses especially in kolaboratip
services in hospitals and in the workplace or overall responsibility but not the only nurse health
care team, except in paragraph (4) and (7) that provide authority is independent.
Article 9
"Nurses in practice must be in accordance with the authority."
Nurses in practice, nurses are required to adhere to ethical and stantar standard operating
procedures in order to avoid legal problems, and to improve service quality as expected by both
parties both patients and nurses.
Article 11 and 12 which contains the rights and obligations of nurses as well as the rights and
obligations of patients who have the writer explained on the page above.

ARTICLE (5)
1. Setting the Nursing Act
Nursing as a profession in the health sector has the most amount of power that can
determine the quality of health care. The number of nurses each year continues to
increase along with graduates from nursing education institutions that are not
controlled so that the necessary development of professionalism and a strong legal
framework for nurses to compete and achieve domestic and foreign employment
opportunities in the global competition. Nurses are the largest health workers in
Indonesia with 60% (sixty percent) of all existing health workers. [24] This condition
is reinforced by the results of the interviews showed that nurses in hospitals
Labuang wedge has a percentage of about 49% (forty-nine percent ) of all
employees of the hospital, amounting to 787 (seven hundred and eighty-seven).
[25] the potential is not used optimally. In addition, many nurses working in the
gray area. Nurses often acted outside its control of nursing care and perform the
work under the authority of a doctor. It happened because of the vagueness of

authority for nurses and delegation of authority from medical personnel (doctors).
Nurse jobs in the gray area covers a diagnosis, prescribe medications, treatment
action inside and outside the health services, antenatal care, perform delivery
assistance, invasion action (such as an IV drip, put a catheter, and inject), execute
hygiene tasks, and perform administrative tasks. [26] this is due to the lack of a
clear job decriptions. The consequences of work in the gray areas include nurses
work not in accordance with the competence and the scientific and the work that is
not under its control. It is feared could cause harm to the user community nursing
services. Grey areas arise due to lack of harmony in the relationship between nurse
partnership with other health professionals with non-medical personnel. This
partnership relationship be created and not given, so sue liveliness of nurses but
may not exceed the authority of care in performing nursing care. [27] The results
showed that the partnership between the nurses with other health professionals,
especially doctors need to get a balanced regulatory framework, that in the
implementation of nursing care services are not overshadowed by other
professions.
Utilization of nurses is more so in rural / remote areas or in emergency conditions.
When people need medical intervention to resolve health problems are often
hampered by the nurse competence and limited space so that public health issues
are not resolved, improve community health status is hampered, and raises legal
issues. This means that the presence of nurses is very important to realize that
public health covers all aspects of the lives of both individuals, social, psychological,
spiritual, and mental, but the implementation of nursing care by nurses did not rule
out a conflict because the nurse's legal position is still very weak in the absence of
legislation -undang that specifically protect nurses and people who receive health
care services by nurses.
Other causes for nomenclature mention education graduates and nurses,
educational institutions are still a variety of settings (Ministry of National Education,
Ministry of Health, and Local Government), the strengthening of nursing care in the
curriculum teaching materials, built to user communication and other professional
services, rights nurses, including nurses in exchange for services, as well as the
competence of nurses and education in accordance with the standards. The low

recognition of nurses and the lack of protection and legal certainty to the nurse
related to competency and education in the possession of a nurse. The results
showed that educational qualifications held by nurses still vary with education
background School of Nursing Education (SPK), Diploma in Nursing, Diploma IV in
Nursing, Bachelor of Nursing, Bachelor of Nursing & Professions (nurses), Graduate
Nursing, Doctor of Nursing. In addition to the diversity of nursing education, there
are many nurses who have to test its competence and has not been registered as a
registered nurse (RN).
The nursing profession in Indonesia is also influenced by globalization in health
services. Globalization is a challenge and a serious threat to Indonesia, including the
existence and quality of Indonesian nurses. Globalization in health opportunities for
health workers from overseas into Indonesia and Indonesian health personnel can
also work abroad. However, this condition is not balanced for the profession of
nursing. Interviews showed that in one sisiperawat in Indonesia has not received
international recognition, because Indonesia has not recognized the competence of
nurses internationally and has not been registered as an RN. [28] On the other hand
has a lot of foreign nurses who enter and work in Indonesia because Indonesia has
signed the MRA . Nursing Indonesia is still lagging at the ASEAN level, because of
weak regulation of nursing, there is no regulatory body / counsil, and does not have
a register nurse system. [29] This means that Indonesia has not fully run because
MRA MRA requires signatory countries have the same system in recognized
competence and act together, including nursing regulatory body / counsil.
MRA is an agreement in the field of services in a professional manner, including the
field of Health. Under the MRA, services should be based on recognized professional
standards, such as standards of education, professional quality, and others. MRA on
nursing service is essentially intended to facilitate the mobility of nursing
professionals for the signatory countries, as well as the standards and qualifications
of professional practice and nursing services. The consequences are very favorable
for foreign nurses, because the foreign nurse goes to Indonesia as employment by
obtaining exclusive rights and ease. On that basis, stakeholders argued that foreign
nurses in Indonesia needs to be given to the mandatory limits through a process of
adaptation, competence, registration, licensing, and the Indonesian language.

This condition is different from the situation faced by Indonesian nurse abroad.
Indonesian nurses abroad is reflected from Indonesian nurses who work in Japan of
more than 1000 (one thousand), but is not recognized as a nurse for 50% (fifty
percent) as a candidate nurse dan50% remaining as care workers [30] and does not
have RN thus decreasing competence (deskilling). Indonesian nurses are not
allowed to participate in the MRA in the region even though Indonesia has signed
the MRA because Indonesia does not have legislation nursing, does not have the
council, limited foreign language skills possessed by nurses in Indonesia, Indonesia
has not been admitted as an RN nurse (no system registers nurse), there is no
standardization of competence of nurses nationwide, and nursing in Indonesia is still
lagging behind compared with the countries in ASEAN especially weak regulation of
nursing. These data supported the results of discussions with PPNI Center stating
that Indonesian nurses working overseas will need to register to get an RN in the
destination country and not automatically RN Indonesia can apply abroad.
Indonesian nurses abroad is considered an assistant nurse, because it is not
recognized his ability as a result has no legal proof in black and white. [31]