International Journal of Health and Pharmaceutical The Relationship Between Clinical Nurse Career Path and The Implementation of Public Service Interaction Behavior at Dr.
Rehatta Hospital.
Central Java Province Buchori Setyoaji Prayodya1*.
Indanah2.
Sri Siska Mardiana3.
Andy Sofyan Prasetyo4
1,2,3,4
Fakultas Ilmu Kesehatan.
Universitas Muhammadiyah Kudus.
Indonesia Corresponding Author:
Email: ajisaka.
aji77@gmail.
Abstract.
The quality of nursing services in hospitals is a crucial factor that affects public satisfaction and Issues related to service complaints in Jepara underline the importance of nurse professionalism, one of which is developed through a career level system.
This study aims to analyze the relationship between the career path of clinical nurses and the implementation of public service interaction behavior at dr.
Rehatta Hospital.
Central Java Province.
This quantitative research uses a correlation design with a cross-sectional approach.
The study population was 106 clinical nurses, with a sample of 84 nurses selected through stratified random sampling techniques.
Data was collected using a questionnaire referring to Permenkes No.
33 of 2019, then analyzed univariately to describe the characteristics of respondents and bivariate with the Spearman Rank Correlation Test.
The results of the study showed that the majority of respondents had public service interaction behavior in the "Good" category .
2%).
The correlation test showed a correlation coefficient value .
638 with a p-value of 0.
These results prove that there is a very significant, strong, and positive relationship between the career path of clinical nurses and the implementation of public service interaction behavior.
The higher the career level of a nurse, the better her interaction behavior.
Therefore, the career level system has proven to be effective as an instrument to improve the quality of nursing services.
Keywords: Career Path.
Clinical Nurse.
Public Service Interaction and Hospital.
INTRODUCTION
Quoted from the Suarabaruid Ae Jepara media.
Acting Regent of Jepara Edy Supriyanta admitted that he still often receives complaints and complaints from the public regarding health services in Jepara.
As a result, many Jepara residents prefer to seek treatment outside Jepara.
Therefore, health services to the community, especially in Jepara Regency, must be improved.
The health service ranks must be improved.
(Priyanto.
A hospital is a health institution that provides health services, both medical services carried out by doctors and nursing services by nurses.
The quality of hospital services depends on the professionalism of employees, service effectiveness and patient satisfaction.
The low quality of service will cause patient dissatisfaction and cause various complaints.
Nursing services are one of the important components of health services in hospitals that contribute directly to patient satisfaction.
The quality of services provided by nurses is influenced by various factors, one of which is career path.
Previous studies have shown a close relationship between service quality, nurse performance, and patient satisfaction.
Rafliadi et al.
found that the quality of service had a significant effect on the satisfaction of BPJS participants and general patients, with a p value of < 0.
The Empathy dimension is the most dominant indicator with an influence score of 38.
9%, showing that the empathy attitude of nurses in providing services is able to increase patients' positive perception of service quality.
In addition.
Sri Yulianty Mozin et al.
reported that the application of public service ethicsAiwhich includes honesty, responsibility, transparency, and concern for the communityAiis positively correlated with increasing community satisfaction and service efficiency.
The Ombudsman survey .
cited in the study showed that the public complained about convoluted requirements .
4%), slow services .
3%), lack of transparency .
7%), convoluted bureaucracy .
3%), inadequate infrastructure .
6%), high costs .
4%), inappropriate services .
2%),
illegal levies .
8%), unclear procedures .
8%), unresponsiveness to complaints .
6%), low human resource competence .
0%), and unfriendly behavior .
7%).
Meanwhile, research by Tina Krisnawati et al.
showed a significant relationship between nurse performance and patient satisfaction at Panti Waluya https://ijhp.
International Journal of Health and Pharmaceutical Hospital Malang, with a Spearman correlation value of 0.
355 and a p-value of 0.
A total of 68.
42% of respondents assessed the performance of nurses to be in the good category, and 63.
16% of respondents stated that they were very satisfied with the performance of nurses.
These results reinforce the view that good quality of nurse performance can significantly increase patient satisfaction levels.
Although studies have proven the importance of service quality, ethical application, and nurse performance to patient satisfaction, studies that specifically highlight the relationship between nurses' career paths and public service interaction behavior are limited.
In fact, career paths can affect the motivation, professionalism, and interpersonal skills of nurses which have implications for the quality of interaction with patients.
Therefore, this study was conducted to fill this gap by examining the relationship between nurses' career paths and public service interaction behavior in hospitals, which is expected to contribute to improving the quality of health services.
The behavior of public service interaction is a reflection of the values of professionalism, ethics, and accountability in health services.
Good interaction between nurses and patients not only impacts patient comfort and satisfaction, but can also increase trust in healthcare institutions as a whole.
In the dr.
Rehatta Hospital in Central Java Province, nurses with various levels of clinical careers have a direct role in serving the community, especially in direct service units such as inpatient, outpatient, and emergency installations.
Although the career level system has been implemented, there are still indications of inequality in the implementation of ideal interaction behavior between nurses from PK I to PK V.
This is an important issue that needs to be studied scientifically to ensure that the career level system implemented really contributes to improving the quality of public services through superior and sustainable interaction behavior.
Seeing the importance of the role of nurses in creating a quality public service experience, as well as the potential for inequality in interaction behavior based on clinical career path, research is needed that can empirically reveal the relationship between nurse career level and the implementation of public service interaction behavior in This research is relevant to support efforts to improve service quality and strengthen the competency-based nursing career system.
Dr.
Rehatta as a hospital owned by the provincial government that implements the career path of nurses according to the Minister of Health Regulation No.
40 of 2017, is the right location to study this phenomenon in depth.
The results of this study are expected to contribute to hospital policy makers in developing a strategy for developing nursing resources that are more effective and responsive to the needs of public services (Permenkes RI, 2.
The outcome indicators of nursing care in the aspect of patient care management system are patient safety and patient satisfaction with caregivers, as in the results of Rusnoto's research.
Noor Cholifah .
on the implementation of surgical patient safety in nurses in the operating room of RSI Sunan Kudus showed results that most nurses carried out Surgical Patient Safety by 71.
This means that there are several factors related to the performance of nurses in providing care to achieve these outcomes.
However, the study has not recognized the indicator of customer satisfaction with public service interaction Public Service interaction can be a contributing factor in satisfaction indicators.
Interaction Behavior Research is an important competency as the implementation of surgical patient safety that has been conducted (Rusnoto & Cholifah, 2.
Research on ways to discuss nurse competencies was also conducted by Iwan Ardian.
Rusnoto Rusnoto.
Rizka Himawan.
Umi Faridah.
Nutrisia Nu'im Haiya.
Intan Rismatul Azizah .
entitled "The Role of Leadership.
Attitudes, and Competencies of Nurses in Improving Sharia-based Nursing Care".
However, the career path in Nursing has not been discussed.
Where the results of this study are the majority of leadership in the good category of various variables.
From these various variables, the number of leadership variables .
%), attitude variables .
%), competency variables .
%), personality variables .
%), sharia-based nursing care variables .
(Research et al.
, 2.
The importance of the implementation of public service interaction behavior by nurses in providing health services cannot be ignored, considering the role of effective interaction in creating a quality service experience.
Good interaction behaviors, such as active listening, showing empathy, and providing clear explanations, go a long way in increasing patient satisfaction and trust in healthcare.
Patients who feel valued and treated with respect are more likely to adhere to medical recommendations, which ultimately supports the success of the healing process.
In addition, professional interaction behavior helps reduce potential conflicts between nurses, patients, and patients' families, thus creating a conducive and https://ijhp.
International Journal of Health and Pharmaceutical harmonious service environment.
This implementation also supports the effectiveness of health services, as good communication accelerates informed clinical decision-making.
Furthermore, interaction behavior that meets standards reflects the professionalism of nurses and is an important indicator in assessing the quality of health services, such as in the hospital accreditation process.
By paying full attention to the communication aspect, nurses not only fulfill the patient's right to quality service, but also strengthen the positive image of the nursing profession in the eyes of the public.
II.
METHODS
This type of research is quantitative with the research design used is quantitative correlation with a cross-sectional approach.
To find out the relationship between the career path of clinical researchers and the implementation of public service interaction behavior.
The population in this study was clinical nurses who carried out duties in a 9-room inpatient unit (Pigeon.
Cendana.
Flamboyan 1.
Flamboyan 2.
Carnation.
Jasmine.
Edelweiss.
Dahlia.
ICU).
Rehatta Hospital.
Central Java Province within a period of four weeks (June - July 2.
From the human resource data, there are 106 inpatient nurses.
In this study, the sample was a clinical nurse working in the inpatient room of dr.
Rehatta Hospital.
Central Java Province, who was randomly selected from a population of 106 people.
Data collection in this study uses primary data, namely data obtained directly from respondents through filling out questionnaires.
The questionnaire was compiled based on the indicators of each variable, namely the career path of clinical nurses and the behavior of public service interactions.
The data analysis method in this study uses a quantitative approach with the help of statistical software (SPSS).
The analysis methods used include univariate analysis and bivariate analysis.
RESULT AND DISCUSSION
Univariate Analysis Respondent Characteristics Table 1.
Characteristics of Respondents by Demographics .
Characteristics Gender
Final Education Career Path
Categories Male
Women
Total
D3 Nursing Ners Total
PK I
PK II
PK i Total
38,10
61,90
52,38
35,71
11,90
Based on Table 1 Characteristics of Respondents Based on Demographics .
univariate analysis of 84 clinical nurse respondents at dr.
Rehatta Hospital.
Central Java Province, it was found that the demographic profile showed distinctive characteristics.
In terms of gender, the nursing population is dominated by women with a percentage of 60.
7% .
, while men amount to 39.
3% .
These findings reflect the general condition of the nursing profession which globally and nationally is more preoccupied by women.
Furthermore, the educational background of the respondents was dominated by D3 Nursing graduates with a significant percentage, namely 65.
5% .
, while Nurse graduates amounted to 34.
5% .
This shows that most of the nurses who were the subjects of the study had strong vocational competence.
The most interesting aspect is the distribution of clinical nurse career paths, where almost half of the respondents have reached the PK i level .
8% or 41 peopl.
, followed by PK II .
9% or 36 peopl.
, and only a small number are at the PK I level .
3% or 7 peopl.
These findings indicate that the population of nurses at the research site is professionals who have had considerable experience and competence, which is reflected in the dominance of higher career paths.
This condition also shows that there is a career development system that runs well at dr.
Rehatta, which allows nurses to continuously improve their professionalism as time goes by.
https://ijhp.
International Journal of Health and Pharmaceutical Table 2.
Distribution of Respondents' Age and Respondents' Working Period
Variable Red
Median SD
Min-Max
CI 95%
Age Tenure Based on Table 2 Distribution of respondent age and respondent working period a analysis complements the description of respondent characteristics by presenting data on age and working period in a statistically descriptive manner, which is an important basis in understanding the profile of the research Based on the results of the analysis, the age of the respondents showed a stable demographic picture.
The mean age of respondents was 35,679 years, with a median value of 34,000 years.
The median value adjacent to the average value indicates that the age distribution of respondents tends to be normal, in the absence of significant skews.
The age range of respondents ranged from 27.
0 to 49.
0 years, indicating that the nurses who were the subjects of the study were individuals who were in the productive phase of their The standard deviation value (SD) of 4.
5685 indicates that the distribution of respondents' age data is not too far from the average value, which indicates a fairly homogeneous population in terms of age.
Meanwhile, respondents' working tenure also showed an adequate experience profile.
The average working period of respondents was 10,321 years, with a median value of 9,000 years.
The service life span varies from 5.
0 years to 24.
0 years.
With a standard deviation value of 4.
5869, it can be interpreted that the variation of respondents' work experience is quite diverse, ranging from nurses with relatively short experience to senior nurses with more than two decades of experience.
The 95% confidence interval (CI) ranged from 9,326 years to 11,317 years, which gave confidence that the average working life of the population was within that range.
Overall, this descriptive statistical data shows that the study respondents are nurses who are of productive age and have quite mature work experience.
This combination of age and work experience is an important capital that is very relevant in the implementation of professional nursing practices and quality public service interaction behavior.
Table 3.
Categories of Public Service Interaction Behavior Categories Public service interaction behavior Less Good Total Based on Table 3, it can be seen that the majority of respondents .
people or 70.
2%) are in the category of "Good" public service interaction behavior.
Meanwhile, 25 respondents .
8%) were in the "Less" category.
Bivariate Analysis The Relationship of Clinical Nurse Career Path with Behavioral Immolation of Public Service Interactions Table 4.
Analysis of the Relationship between Clinical Nurse Career Path and the Implementation of Public Service Interaction Behavior
Categories Public interaction behavior
Less Good
PK II
PK i Total Spearman's rho test results .
= 0.
= 0.
Correlation Direction Clinical Nurse Career Path
PK I
Total Based on Table 4 Analysis of the Relationship between Clinical Nurse Career Path and the implementation of public service interaction behavior from a total of 7 nurses at the PK I level, a significant majority, namely 5 people .
4%) showed the category of "Poor" interaction behavior, while only 2 people .
6%) were in the "Good" category.
A similar pattern was also seen at the PK II level, where of the 36 https://ijhp.
International Journal of Health and Pharmaceutical nurses, 20 people .
6%) were in the "Less" category and 16 people .
4%) were in the "Good" category.
However, the most drastic difference can be seen at the PK i level.
of the 41 nurses at this level, all .
%) showed a "Good" category of interaction behavior, and none were in the "Less" category.
This distribution visually and quantitatively reinforces the correlation findings, suggesting a clear transition in the quality of interaction behavior as career paths increase.
The results of the Spearman Correlation Test showed a correlation coefficient value .
638 with a p-value of 0.
The p-value of much less than 0.
05 (=0.
indicates that the relationship found between clinical nurse career path and the implementation of public service interaction behavior is very statistically This means that this relationship does not occur by chance solely in the research sample, but reflects a real relationship in the nurse population at dr.
Rehatta Hospital.
Central Java Province.
The correlation k coefficient of 0.
638 puts the strength of this relationship in the strong category .
ased on the interpretation of rs: 0.
60 Ae 0.
In addition, a positive correlation direction .
ndicated by "Correlation Direction ") means that an increase in the career path of clinical nurses is consistently correlated with an improvement in the quality of implementation of public service interaction behaviors.
In other words, nurses who are at a higher career level tend to exhibit better interaction behavior.
Discussion Respondent Characteristics The analysis of respondent characteristics provides a demographic picture that is essential to understanding the context of the study.
The majority of respondents were female nurses .
7%), which is consistent with gender dominance in the nursing profession globally and nationally.
These findings show that most of the public service interactions at dr.
Rehatta is carried out by female nurses.
The average age of respondents was 35,679 years, with an age range of 27.
0 to 49.
0 years, indicating that the nurses who were the subjects of the study were in a productive phase of their careers.
This productive age is often associated with high levels of energy, adaptability, and willingness to learn, which are important capital in the development of professionalism.
In terms of the last education, the majority of respondents have a D3 Nursing background .
5%), while the rest are Nurse graduates .
5%).
This proportion shows that most nurses have strong vocational competence, which is an important basis in the implementation of nursing However, the existence of nurse graduates also indicates an increase in educational qualifications in the hospital environment, in line with the demands of professionalism that continue to develop.
Respondents' tenure showed an average of 10,321 years, with a range of 5.
0 to 24.
0 years.
This average tenure of more than a decade reflects that respondents have substantial clinical experience, deal with a wide range of patient cases, and have interacted with a wide range of individual This experience theoretically has a profound effect on professional maturity and interpersonal skills, because the longer a nurse practices, the more situations she encounters, which hone interpersonal skills and decision-making.
The most crucial aspect of the respondents' characteristics is the distribution of clinical nurse career paths.
The majority of respondents were at the PK i level .
8%), followed by PK II .
9%), and only a small percentage at PK I .
3%).
This distribution is very interesting because it shows that most of the nurses at dr.
Rehatta has reached a higher career level.
This can be interpreted as an indication of the success of the hospital's career development system, which allows nurses to continuously improve their competencies and gain formal recognition for their experience.
The dominance of nurses at the PK i level indicates that the hospital has a very competent and experienced nurse base, who are expected to be able to become role models and provide high-quality services.
This phenomenon is also in line with the government's efforts through regulations that encourage the improvement of nurses' career paths to ensure the quality of health services.
Implementation Level of Public Service Interaction Behavior A univariate analysis of the dependent variable, namely the behavioral category of public service interactions, showed encouraging findings.
The majority of respondents .
people or 70.
2%) were in the category of "Good" public service interaction behavior.
Meanwhile, only 25 respondents .
8%) were in the "Less" category.
These results indicate that in general, clinical nurses at dr.
Rehatta Hospital.
Central Java Province have shown positive quality of interaction behavior in providing services to the community.
The https://ijhp.
International Journal of Health and Pharmaceutical figure of 70.
2% of nurses with "Good" behavior is a reflection of the professionalism efforts that have been made, both through formal education, training, and practical experience.
It can also be interpreted that most nurses have understood and implemented the principles of public service mandated by regulations.
However, the existence of 29.
8% of nurses who are still in the "Less" category shows that there is still room for This group requires special attention and targeted interventions to improve the quality of their These findings confirm that improving service quality is a continuous process that requires periodic evaluation and coaching.
It is important to identify factors that may contribute to "Lacking" behavior in some nurses, such as high workloads, lack of specific training, or other individual factors, in order to formulate effective improvement strategies.
This gap is a focus area for nursing management to ensure that excellent service standards can be achieved by all nursing staff.
The Relationship of Career Path to Public Service Interaction Behavior The core result of this study is that there is a very significant, strong, and positive relationship between the career path of clinical nurses and the implementation of public service interaction behavior.
The Spearman Correlation Test yielded a correlation coefficient .
638 with a p-value of 0.
A p-value well below 0.
05 indicates that this relationship is statistically significant, eliminating the possibility that this outcome occurred by chance.
The correlation coefficient of 0.
638 confirms that the strength of the relationship is in the "strong" category, which means that the career path has a substantial influence on the quality of interaction behavior.
The positive correlation direction indicates that the higher the career level of a nurse, the better the implementation of public service interaction behavior that she shows.
These findings are visually and quantitatively reinforced by crosstabulation analysis (Table 4 Distribution patterns show a very clear transition in the quality of interaction behavior along with career At the PK I level, the majority of nurses .
4%) showed "Less" behavior, and only a small percentage .
6%) were "Good".
A similar pattern but with a slightly better proportion was seen at the PK II level, where 55.
6% of nurses were still in the "Less" category and 44.
4% in the "Good" category.
However, the most drastic and significant difference occurred at the PK i level, where all nurses .
%) showed "Good" interaction behavior, and none were in the "Less" category.
This is very strong empirical evidence that nurses who have reached the highest career level (PK .
consistently provide services with optimal interaction behaviors.
This strong and significant relationship can be explained through several theoretical and regulatory Theory of Professionalism in Nursing Career paths in nursing are designed to encourage continuous improvement of competence and As nurses move up, nurses are expected to not only master more complex clinical skills, but also internalize the values of professional ethics, accountability, and effective communication skills.
Nurses at higher levels have gone through a process of learning, training, and longer practice experience, which shapes the maturity of their professionalism.
This maturity is reflected in their ability to interact empathic, responsively, and respectfully with patients, even in challenging situations.
This is in line with the view of Nursalam .
who emphasizes that therapeutic communication and caring behavior are integral to the nursing process and contribute directly to the quality of service and patient satisfaction.
Social Cognitive Career Theory (SCCT) This theory emphasizes the role of self-efficacy, outcome expectations, and personal goals in career development and work behavior.
Nurses with higher career paths are more likely to have stronger selfefficacy in their professional abilities, including in interacting.
They also have positive outcome expectations of the impact of good interactions .
, patient satisfaction, better care outcome.
, which encourages them to invest more in the quality of interactions.
Their personal goals also tend to be aligned with excellent service In contrast, early-stage nurses may still be building their self-efficacy and outcome expectations, which can affect the quality of early interactions.
Therefore, the development of a structured career path can increase the self-confidence, expectations of positive outcomes, and personal goals of nurses, which ultimately has an impact on improving the quality of public service interactions.
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International Journal of Health and Pharmaceutical Professional Regulation and Standards Support These findings are strongly supported by various government regulations that regulate the nursing profession and public services Permenkes No.
40 of 2017 concerning the Development of Professional Career Paths of Clinical Nurses This regulation explicitly establishes the level of career level of nurses (PK I to PK V) and outlines the competencies that must be achieved at each level.
These competencies include not only clinical technical aspects, but also professional ethical dimensions, communication, and patient-oriented services.
Therefore, increasing the career ladder directly means an increase in responsibility and ability to interact professionally.
The results of this study prove that the implementation of this Permenkes at dr.
Rehatta has succeeded in encouraging nurses at higher levels to exhibit better interaction behavior.
Permenkes No.
33 of 2019 concerning Guidelines for Public Service Interaction Behavior within the Ministry of Health This regulation specifically mandates professional guidance for civil servants and health workers in providing services, including empathetic communication, polite attitudes, responsiveness, and maintaining ethics and quality standards.
The finding that nurses with higher career levels had better interaction behaviors suggests that they are more likely to implement these guidelines consistently.
This confirms that good interaction behavior is not only ethical, but also regulatory obligations that are integrated in the professionalism of nurses.
Permenkes No.
43 of 2016 concerning Nursing Service Standards This regulation links career paths with the fulfillment of competency standards and the implementation of holistic services, including therapeutic communication.
Career progression means that nurses have met higher standards of providing quality, professional and safe nursing care, where effective communication is an essential component.
IV.
CONCLUSION
Demographic Characteristics of Respondents: This study successfully collected data from 84 clinical nurses in the inpatient room of dr.
Rehatta Hospital.
Central Java Province.
The demographic profile shows that the majority of respondents are female nurses .
7%), which is consistent with the characteristics of the nursing profession in general.
Respondents had an average age of 35,679 years, indicating they were in a productive phase in their careers.
The majority of respondents had a D3 Nursing education .
5%), but there were also Nurse graduates .
5%), showing vocational and academic competence.
The average working life of respondents was 10,321 years, reflecting substantial clinical experience.
The distribution of career paths shows the dominance of nurses at the PK i level .
8%), followed by PK II .
9%), and PK I .
3%),
indicating the success of the career development system in hospitals.
Implementation Rate of Public Service Interaction Behavior: Univariate analysis of dependent variables showed that the majority of respondents .
people or 70.
2%) were in the category of "Good" public service interaction behavior.
However, there are still 25 respondents .
8%) who are in the "Less" category.
This indicates that in general, clinical nurses at dr.
Rehatta has shown a positive quality of interaction, but there is still room for improvement in some nurses.
Very Significant Relationship between Career Path and Public Service Interaction Behavior: The results of the Spearman Rank correlation test showed a correlation coefficient value .
638 with a p-value of 0.
A p-value that is much smaller 05 proves that there is a statistically significant relationship between the career path of clinical nurses and the implementation of public service interaction behavior.
Strong Relationship Strength and Direction Positive: A correlation coefficient value .
638 indicates that the strength of the relationship is in the strong category.
The direction of a positive relationship indicates that the higher the career level of a clinical nurse, the better the implementation of public service interaction behavior that he or she shows.
This was reinforced by crosstabulation analysis which showed that all PK i nurses .
%) had "Good" interaction behavior, while the proportion of "Less" behavior was more dominant at the PK I and PK II levels.
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International Journal of Health and Pharmaceutical REFERENCES