Implementation of The Tiered Supervision as a Supervision Function


 

 
Corresponding author: 
Retno Wahyu Nugrahini 
retnowahyu2408@gmail.com  
South East Asia Nursing Research, Vol 2 No 1, March 2020 
ISSN:2685-032X 
DOI: https://doi.org/10.26714/seanr.2.1.2020.33-39  

 
 

 
 
 
 
 

 

Case Study 
 

Implementation of The Tiered Supervision as a Supervision Function  
 
Retno Wahyu Nugrahini1,2, Vivi Yosafianti Pohan2 

1 Rumah Sakit Islam Sultan Agung Semarang, Indonesia 
2 Universitas Muhammadiyah Semarang, Indonesia 

 
Article Info  Abstract 

Article History: 
Accepted March 4th, 2020 
 
Keywords:  
Nursing Supervision; 
Nursing Management; 
Supervision Function 

 Tiered supervision that supports improving the quality of nursing services 
in the field of nursing at Sultan Agung Islamic Hospital has not been carried 
out in a structured and documented manner. Baitul Izzah 1 room as a disease 
treatment room in class III, the head of the room has not yet supervised the 
Person in Charge of Care (PPJA) and so on PPJA to the Associate Nurse (PP). 
The supervision that has been carried out so far is only to ask directly about 
existing problems to the head of the room and directly observe the activities 
of implementing nursing care by PPJA and PP. Tiered supervision does not 
go well, because there are no references and standards for its 
implementation. The purpose of this study was to determine 
Implementation of The Tiered Supervision as a Supervision Function. It was 
found that the implementation of tiered supervision instruments improved 
the performance of the head of the room, PPJA and PP, then the patient's 
medical record document increases in completeness chargingespecially the 
patient's Islamic education document. In conclusion, tiered supervision 
instruments are very helpful in the implementation of the supervisory 
function as well as monitoring and evaluation in nursing management in the 
implementation of nursing care in the inpatient room. The recommendation 
for the role of the nursing field that is most important in controlling the 
quality of nursing care is to actively involve staff to jointly ensure the 
continuity of the implementation of tiered nursing supervision. 

 

INTRODUCTION  

Nursing management is a process of 
planning, organizing, managing staff, 
directing, supervising and controlling each 
other. The role of the nursing manager 
cannot be separated from the management 
process carried out, including applying 
attention to material resources and nursing 
human resources. The role of the manager 
that is actually applied is able to bring 
transformation for other nursing staff to 
apply nursing quality standards. Standards 

are set to measure the performance of 
objective, measurable and achievable 
nursing care and services.1  

The nursing management process is carried 
out with an open systems approach, where 
each component is interconnected, which 
includes input, process, output, control and 
feedback. Nursing managers are required to 
plan (plan), organize (organize), lead and 
evaluate (evaluate) the facilities and 
infrastructure available to be able to 
provide nursing care that is as effective and 

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Retno Wahyu Nugrahini / Implementation of The Tiered Supervision as a Supervision Function 

efficient as possible for individuals, families 
and communities.2 

Supervision or controling is the application 
of methods and tools to ensure that the plan 
has been implemented according to what 
has been determined. Supervision through 
communication, namely supervising and 
communicating directly with the team 
leader and executor regarding the nursing 
care provided to patients. Supervision in 
nursing management through supervision 
with direct and indirect supervision. 

Nursing supervision is a supervision and 
guidance activity carried out continuously 
by supervisors covering nursing service 
problems, manpower and equipment 
problems so that patients receive quality 
service at all times.3 Supervision or 
controling is the application of methods and 
tools to ensure that the plan has been 
implemented according to what has been 
determined. Supervision through 
communication, namely supervising and 
communicating directly with the team 
leader and executor regarding the nursing 
care provided to patients. Supervision in 
nursing management through supervision 
with direct and indirect supervision. 

Tiered nursing supervision at Sultan Agung 
Islamic Hospital in Semarang has not been 
implemented. The head of the nursing 
department carries out supervision of the 
head of the room in completing his duties, 
only asking things that have problems in the 
treatment room. The head of the room in 
monitoring and evaluating PPJA's duties in 
providing nursing care to patients does not 
have standardized tools or references, as 
well as PPJA evaluating PPJA is not well 
documented. The absence of supervision 
through supervision from nursing 
management, the head of the room and PPJA 
in a documented and structured manner so 
that the evaluation cannot be carried out 
continuously because there are no records 
used as evaluation material. 

The supervision instrument as a reference 
in the implementation of tiered supervision 
as a form of supervision activities, if it is 
carried out and documented in a structured 
manner and there is a clear supervision 
assessment format, the supervisory 
function will run smoothly. 

The assessment format is the nurse's 
performance record for further 
improvement and the supervised nurse will 
also have a performance record as material 
for self-evaluation. Thus it will be easy to 
make improvement efforts in nursing 
services. However, if the supervision 
activities are not carried out in a structured 
and well-documented manner and there is 
no evaluation format for standard 
supervision, then the form of evaluation 
that is carried out cannot be carried out 
continuously because there are no notes 
used as material for a structured 
evaluation.4  

The purpose of this research is to find out 
the extent of the supervisory function of 
nursing management through tiered 
supervision, providing solutions by making 
supervision instruments and evaluating the 
implementation of supervision instruments 
at Sultan Agung Islamic Hospital Semarang. 

Increased supervision by the head of the 
room, the nursing committee, and the 
nursing department needs to be improved, 
by means of an organizational structure 
approach in order to motivate the 
performance of the nurse executing.5 The 
importance of clinical supervision apart 
from managerial supervision is therefore, 
that an effective clinical surveillance 
support system is strengthened to support 
managerial supervision.6 

The purpose of this study was to determine 
Implementation of The Tiered Supervision 
as a Supervision Function. 

METHODS 



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Retno Wahyu Nugrahini / Implementation of The Tiered Supervision as a Supervision Function 

The research design uses descriptive 
qualitative methods, namely the research 
method is basically a scientific way to obtain 
data with specific purposes and uses as well 
as to determine how to find, collect, process 
and analyze research data.7  The method 
was chosen to obtain natural data about the 
understanding of the supervisory function 
through tiered supervision and its 
implementation using the supervision 
instrument through interviews. 

RESULTS 

Assessment according to the priority of the 
problem in the Baitu Izzah 1 room obtained 
2 (two) problems, namely: the frequency of 
Islamic education with the number of 96, 
and the number of 256 tiered nursing 
supervision activities that have not been 
implemented. tiered. Tiered supervision 
activities have not been carried out because 
there is no reference for implementation, so 
that the completion of routine work has no 
target. Supervision is a coaching activity 
that is planned to assist nursing personnel 
in doing their job effectively.8  

The intervention was carried out by 
conducting socialization on nursing 
supervision, making supervision 
instruments, and making supervision of 
Standard Operating Procedures (SOP). 
Socialization about supervision material 
with Focus Group Discussion (FGD), 
Socialization carried out directly to the 
Head of Nursing, Head of Department of 
Education, PPJA and PP continued with the 
implementation of supervision instruments 
on December 9, 2020. Tiered supervision 
instruments can be implemented properly 
from the field of nursing, Head of 
Department and PPJA well .. Group clinical 
supervision as an intervention to support 
nurse resilience in the hospital as a 
recommendation for practice, to improve 
development through clinical supervision.9 

 Evaluation of the implementation of tiered 
supervision instruments by conducting 
interviews and observations to three 

participants, namely the Head of Nursing, 
the Head of the Room and the PPJA.  

…. With the supervision instrument it makes 
it easier for me to monitor the memnitor of 
the head of the room… ”(P1) 

…. This supervision instrument turned out to 
make it easier to complete supervisory tasks 
for PPJA and my duties as head of the room .. 
(P2) 

… .After there are supervision instruments, all 
of which become my job as PPJA to monitor 
and evaluate PP in providing nursing care to 
be better and more directed… .. (P3) 

Observations are made by looking at the 
filling of the supervsisi instrument. The 
supervision instruments are well 
implemented and fully stocked. Clinical 
nursing supervision has an influence on 
nurses' experiences of well-being and in 
relation to their psychosocial work 
environment. Nurses attending clinical 
nursing supervision reported increased 
satisfaction with their psychosocial work 
environment.10 

DISCUSSION 

The supervisory function will run well with 
the implementation of supervision. Tiered 
supervision is carried out as an effort to 
observe and monitor the implementation of 
nursing management or the provision of 
nursing care on an ongoing basis including 
nursing service problems, workforce 
problems, and care so that patients receive 
quality service at all times.2Based on the 
evaluation of the implementation of tiered 
supervision through the supervsisi 
instrument, the performance of the head of 
the room, PPJA and PP is different from the 
previous one which was seen only providing 
routine nursing care. Supervision of the 
head of the room has a positive and 
significant effect on nurse performance. 
This means that the better the supervision 
of the head of the room, the nurse's 
performance will increase. Conversely, the 



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Retno Wahyu Nugrahini / Implementation of The Tiered Supervision as a Supervision Function 

less good the supervision of the head of the 
room, the lower the performance of the 
nurse. Supervision of the head of the room, 
workload, and motivation simultaneously 
(together) have a significant effect on the 
performance of nurses. This means that the 
better the supervision of the head of the 
room, workload, and motivation together, 
the nurse's performance will increase. On 
the other hand, the supervision of the head 
of the room is not good.11 

Completeness of the documentation found 
in the second priority problem is the Islamic 
education medical record document, with 
the implementation of supervision, it is 
hoped that it can be completely 
filled.Existencesupervision by documenting 
nursing care indicates that the need for 
supervision action for hospitals that have 
not implemented supervision and for 
hospitals that have implemented 
supervision is expected to further improve 
the implementation of the supervision. 
Because with this supervision, a nurse will 
feel that someone is accompanying her and 
this will have a positive impact on the 
nurse's own performance.12 

The description of the supervision of the 
head of the room that is perceived by the 
nurse states and the description of how 
53% of the nursing care documents are 
completely filled. A good head of the room 
increases the documentation of nursing 
care so that the head of the room should 
carry out the supervision properly and 
schedule to continue to improve the quality 
of nursing care documents.13  

In Asmawati's research, Yuanita Ananda, 
Alkafi (2018), in her research it can be 
concluded that from 12 nurse respondents 
before being given supervision, the average 
development of nursing care 
documentation was 34.56 with a standard 
deviation of 4,912. Furthermore, it appears 
that the minimum value of 20 is classified as 
incomplete documentation and the 
maximum value of 32 is classified as 
complete documentation. Of the 12 nurse 

respondents after being given supervision, 
the average development of documentation 
of nursing care was 28.38 with a standard 
deviation of 4.773. Furthermore, it can be 
seen that the minimum value of 21 is 
classified as complete documentation and 
the maximum value of 38 is classified as 
complete documentation. There is a 
difference in documenting nursing care 
before and after being given supervision 
with a P value of 0,000.14 

Supervision or supervision material is 
adjusted to the job descriptions of each 
supervised nursing staff. For the head of the 
room, supervision material includes 
managerial skills and nursing care. The 
team leader is supervised regarding team 
management skills and the ability to 
provide nursing care. Implementing nurses 
undergo supervision related to the ability of 
nursing care carried out. 

Some of the activities that can be supervised 
by the person in charge of the room / head 
of the room for the orphans are: 

a. Conducting pre conference and post 
conference 

b. Implementation of patient 
consideration 

c. Implementation of nursing 
assessments 

d. Implementation of nursing diagnoses 
e. Implementation of nursing plans 
f. Implementation of nursing 

implementation 
g. Implementation of nursing evaluation 
h. Implementation of nursing care 

documentation 
i. Implementation of universal 

precautions 
j. Implementation of patient safety 
k. Implementation of case reflection 

discussions 
l. Implementation of discharge planning 
m. Compliance with SPO 
n. Implementation of the nursing round 



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Retno Wahyu Nugrahini / Implementation of The Tiered Supervision as a Supervision Function 

Some of the activities that can be supervised 
by the orphan of the implementing nurses 
are: 

a. Implementation of nursing care for 
patients 

b. Implementation of nursing care 
documentation 

c. Compliance with SPO 
d. Implementation of universal 

precautions 
e. Implementation of patient safety 

Nursing interventions are oriented towards 
14 (fourteen) basic nursing components 
including: 

a. Meet the needs of oxygen. 
b. Meet the needs of nutrition, fluid and 

electrolyte balance 
c. Meet the needs of elimination. 
d. Meet security needs. 
e. Meet the needs of cleanliness and 

physical comfort. 
f. Meet the needs of rest and sleep. 
g. Meet the needs of movement and 

physical activity. 
h. Meet spiritual needs. 
i. Meet emotional needs. 
j. Meet communication needs 
k. Prevent and overcome physiological 

reactions. 
l. Meet medical needs and help the 

healing process. 
m. Meet extension needs. 
n. Meet rehabilitation needs 

Supervision in hospital hospital 
accreditation is also an element in the 
assessment, as a basis for monitoring 
evidence of implementation, namely at 

Access to Hospitals and Service 
Continuity (AHSC) 

In Access to Hospitals and Service 
Continuity (AHSC) 3.3, it is stated "If the 
patient is in the management of the patient 
service manager (MPS), the continuity of 
the above process is monitored, followed, 

and the transfer is supervised by the patient 
service manager (MPS)". 

 

Competence and Authority of Staff (CAS) 

In Staff Competency and Authority (CAS) 5, 
it is stated that "All staff are supervised and 
evaluated periodically to ensure continuity 
of competence in their position". 

Hospital Governance (HG). 

a. In Hospital Governance (HG) 8.6. stated 
"The organizational structure can 
support the control process on the 
quality of clinical services". 

b. In Hospital Governance (HG) 11, it is 
stated that "the head of the service unit 
improves the quality and safety of 
patients by participating in the quality 
improvement and patient safety 
program of the hospital, monitoring, 
and improving specific patient care in 
his unit. The head of the service unit 
involves all his staff in quality 
improvement and patient safety 
activities that reflect the overall 
priorities of the hospital and conducts 
monitoring of clinical and non-clinical 
activities specific to the service unit ”.15 

Theory Conformity: Supervision is a 
professional process carried out by 
supervisors through a continuous process 
of direction, guidance and evaluation to 
supervisees (supervisory participants) to 
increase the ability of supervisees in 
carrying out their work in order to achieve 
professional service quality and protection 
of patient safety. 

Nursing management activities will run well 
and improve service quality by approaching 
management functions must always be 
carried out optimally, including planning, 
organizing, directing, and controlling 
(monitoring and evaluation). Nursing 
service management focuses on the 5 M 
components (Man, Money, Material, 



South East Asia Nursing Research, Vol 2 No 1, March 2020/ page 33-39 38 

 

Retno Wahyu Nugrahini / Implementation of The Tiered Supervision as a Supervision Function 

Method, Machine). In every management 
activity, it always begins with planning and 
ends with control which is a recurring cycle. 

 

CONCLUSION 

The results of the evaluation of the 
implementation of the supervision 
instrument are very helpful in the 
implementation of tiered supervision in the 
nursing management of Sultan Agung 
Islamic Hospital Semarang. The 
implementation of nursing leveled 
supervision is quite effective in increasing 
the insight in the field of nursing, the Head 
of Runag, PPJA and PP. A good perception 
from the Head of the Room about the 
importance of nursing clinical supervision 
is a good initial capital to make changes and 
improvements in carrying out its functions. 
This supervisory function requires hospital 
support in its implementation. 

The recommended suggestion is that the 
role of nursing is most important in 
controlling the quality of nursing care is to 
actively involve staff to jointly ensure the 
continuity of the application of nursing 
leveled supervision. Development into an 
online application is the task of the nursing 
field. 

ACKNOWLEDGMENTS 

Special thanks to Dr. Ms. Vivi Yosafianti 
Pohan, M.Kep for their guidance and 
motivation in completing this task. may 
Allah bestow good deeds and blessings. 

CONFLICTS OF INTEREST 

Neither of the authors has any conflicts of 
interest that would bias the findings 
presented here. 

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