pinocchio_fishie: makalah keprof askep hukum dan regulasi dalam keperawatan

ASPEK HUKUM DAN REGULASI PRAKTIK KEPERAWATAN

ASPEK HUKUM DAN REGULASI PRAKTIK KEPERAWATAN

A. Definisi Hukum

Hukum adalah keseluruhan kumpulan peraturan-peraturan atau kaidah-kaidah dalam suatu kehidupan bersama; atau keseluruhan peraturan tingkah laku yang berlaku dalam suatu kehidupan bersama, yang dapat dipaksakan pelaksanaannya dengan suatu sanksi.

Hukum adalah keseluruhan peraturan yang mengatur dan menguasai manusia dalam kehidupan bersama. Berkembang di dalam masyarakat dalam kehendak, merupakan sistem peraturan, sistem asas-asas, mengandung pesan kultural karena tumbuh dan berkembang bersama masyarakat.

Pengertian hukum kesehatan adalah ketentuan-ketentuan yang mengatur hak dan kewajiban baik dari tenaga kesehatan dalam melaksanakan upaya kesehatan maupun dari individu dan masyarakat yang menerima upaya kesehatan tersebut dalam segala aspek promotif, preventif, kuratif dan rehabilitatif serta organisasi dan sarana.

B. Pentingnya Undang-Undang Dalam Praktik Keperawatan

Ada beberapa alasan mengapa Undang-Undang Praktik Keperawatan dibutuhkan. Pertama, alasan filosofi. Perawat telah memberikan konstribusi besar dalam peningkatan derajat kesehatan. Perawat berperan dalam memberikan pelayanan kesehatan mulai dari pelayanan pemerintah dan swasta, dari perkotaan hingga pelosok desa terpencil dan perbatasan. Tetapi pengabdian tersebut pada kenyataannya belum diimbangi dengan pemberian perlindungan hukum, bahkan cenderung menjadi objek hokum (WHO, 2002).

Kedua, alasan yuridis. UUD 1945, pasal 5, menyebutkan bahwa Presiden memegang kekuasaan membentuk Undang-Undang dengan persetujuan Dewan Perwakilan Rakyat. Demikian Juga UU Nomor 23 tahun 1992, Pasal 32, secara eksplisit menyebutkan bahwa pelaksanaan pengobatan dan atau perawatan berdasarkan ilmu kedokteran dan atau ilmu keperawatan, hanya dapat dilaksanakan oleh tenaga kesehatan yang mempunyai keahlian dan kewenangan untuk itu. Sedang pasal 53, menyebutkan bahwa tenaga kesehatan berhak memperoleh perlindungan hukum dalam melaksanakan tugas sesuai dengan profesinya. Ditambah lagi, pasal 53 bahwa tenaga kesehatan dalam melakukan tugasnya berkewajiban untuk mematuhi standar profesi dan menghormati hak pasien. Disisi lain secara teknis telah berlaku Keputusan Menteri Kesehatan Nomor1239/Menkes/SK/XI/2001 tentang Registrasi dan Praktik Perawat.

Ketiga, alasan sosiologis. Kebutuhan masyarakat akan pelayanan kesehatan khususnya pelayanan keperawatan semakin meningkat. Hal ini karena adanya pergeseran paradigma dalam pemberian pelayanan kesehatan, dari model medikal yang menitikberatkan pelayanan pada diagnosis penyakit dan pengobatan, ke paradigma sehat yang lebih holistik yang melihat penyakit dan gejala sebagai informasi dan bukan sebagai fokus pelayanan (Cohen, 1996).

Disamping itu, masyarakat membutuhkan pelayanan keperawatan yang mudah dijangkau, pelayanan keperawatan yang bermutu sebagai bagian integral dari pelayanan kesehatan, dan memperoleh kepastian hukum kepada pemberian dan penyelenggaraan pelayanan keperawatan. Keperawatan merupakan salah satu profesi dalam dunia kesehatan . Sebagai profesi, tentunya pelayanan yang diberikan harus professional, sehingga perawat/ners harus memiliki kompetensi dan memenuhi standar praktik keperawatan, serta memperhatikan kode etik dan moral profesi agar masyarakat menerima pelayanan dan asuhan keperwatan yang bemutu.

Berdasarkan hasil kajian (Depkes & UI, 2005) menunujukkan bahwa terdapat perawat yang menetapkan diagnosis penyakit (92,6%), membuat resep obat (93,1%), melakukan tindakan pengobatan didalam maupun diluar gedung puskesmas (97,1%), melakukan pemeriksaan kehamilan (70,1%), melakukan pertolongan persalinan(57,7%), melaksanakan tugas petugas kebersihan (78,8%), dan melakukan tugas administrasi seperti bendahara,dll (63,6%).

Pada keadaan darurat seperti ini yang disebut dengan “gray area” sering sulit dihindari. Sehingga perawat yang tugasnya berada disamping klien selama 24 jam sering mengalami kedaruratan klien sedangkan tidak ada dokter yang bertugas. Hal ini membuat perawat terpaksa melakukan tindakan medis yang bukan merupakan wewenangnya demi keselamatan klien. Tindakan yang dilakukan tanpa ada delegasi dan petunjuk dari dokter, terutama di puskesmas yang hanya memiliki satu dokter yang berfungsi sebagai pengelola puskesmas, sering menimbulkan situasi yang mengharuskan perawat melakukan tindakan pengobatan. Fenomena ini tentunya sudah sering kita jumpai di berbagai puskesmas terutama di daerah-daerah tepencil. Dengan pengalihan fungsi ini, maka dapat dipastikan fungsi perawat akan terbengkalai. Dan tentu saja ini tidak mendapat perlindungan hukum karena tidak dipertanggungjawabkan secara professional.

Pada tahun 1989, PPNI sebagai organisasi perawat di Indonesia mulai memperjuangkan terbentuknya UU Keperawatan. Berbagai peristiwa penting terjadi dalam usaha mensukseskan UU Keperawatan ini. Pada tahun 1992 disahkanlah UU Kesehatan yang didalamnya mengakui bahwa keperawatan merupakan profesi ( UU Kesehatan No.23, 1992). Peristiwa ini penting artinya, karena sebelumnya pengakuan bahwa keperawatan merupakan profesi hanya tertuang dalam peraturan pemerintah (PP No.32, 1996). Dan usulan UU Keperawatan baru disahkan menjadi RUU Keperawatan pada tahun 2004.

Perlu kita ketahui bahwa untuk membuat suatu undang-undang dapat ditempuh dengan 2 cara yakni melalui pemerintah (UUD 1945 Pasal 5 ayat 1) dan melalui DPR (Badan Legislatif Negara). Selama hampir 20 tahun ini PPNI memperjuangkan RUU Keperawtan melalui pemerintah, dalam hal ini Depkes RI. Dana yang dikeluarkan pun tidak sedikit. Tapi kenyataannya hingga saat ini RUU Keperawatan berada pada urutan 250-an pada program Legislasi Nasional (Prolegnas) , yang ada pada tahun 2007 berada pada urutan 160 (PPNI, 2008).

Tentunya pengetahuan masyarakat akan pentingnya UU Keperawatan mutlak diperlukan. Hal ini terkait status DPR yang merupakan Lembaga Perwakilan Rakyat, sehingga pembahasan-pembahasan yang dilakukan merupakan masalah yang sedang terjadi di masyarakat. Oleh karena itu, pencerdasan kepada masyarakat akan pentingnya UU Keperawatan pun masuk dalam agenda DPR RI.

Dalam UU Tentang praktik keperawatan pada bab 1 pasal 1 yang ke-3 berbunyi :

“ Asuhan keperawatan adalah proses atau rangkaian kegiatan pada praktik keperawatan baik langsung atau tidak langsung diberikan kepada sistem klien disarana dan tatanan kesehatan lainnya, dengan menggunakan pendekatan ilmiah keperawatan berdasarkan kode etik dan standar pratik keperawatan.

Dan pasal 2 berbunyi : “ Praktik keperawatan dilaksanakan berdasarkan pancasila dan berdasarkan pada nilai ilmiah, etika dan etiket, manfaat, keadilan, kemanusiaan, keseimbangan dan perlindungan serta keselamatan penerima dan pemberi pelayanan keperawatan.

C. Undang-Undang yang Berkaitan Dengan Praktik Keperawatan

Undang-undang praktik keperawatan sudah lama menjadi bahan diskusi para perawat. PPNI pada kongres Nasional ke duanya di Surabaya tahun 1980 mulai merekomendasikan perlunya bahan-bahan perundang-undangan untuk perlindungan hukum bagi tenaga keperawatan. Tidak adanya Undang-Undang perlindungan bagi perawat menyebabkan perawat secara penuh belum dapat bertanggung jawab terhadap pelayanan yang mereka lakukan. Tumpang tindih antara tugas dokter dan perawat masih sering tejadi dan beberapa perawat lulus pendidikan tinggi merasa prustasi karena tidak adanya kejelasan tentang peran, fungsi dan kewenangannya. Hal ini juga menyebabkan semua perawat dianggap sama pengetahuan dan ketrampilannya, tanpa memperhatikan latar belakang ilmiah yang mereka miliki.

UU dan peraturan lainnya yang ada di Indonesia yang berkaitan dengan praktek keperawatan :

1. UU No. 9 tahun 1960, tentang pokok-pokok kesehatan

Bab II (tugas Pemerintah), pasal 10 antara lain menyebutkan bahwa pemerintah mengatur kedudukan hukum, wewenang dan kesanggupan hukum.

2. UU No. 6 tahun 1963 tentang tenaga kesehatan

UU ini merupakan penjabaran dari UU No. 9 tahun 1960. UU ini membedakan tenaga kesehatan sarjana dan bukan sarjana. Tenaga sarjana meliputi dokter, doter gigi dan apoteker. Tenaga perawat termasuk dalam tenaga bukan sarjana atau tenaga kesehatan dengan pendidikan rendah, termasuk bidan dan asisten farmasi dimana dalam menjalankan tugas dibawah pengawasan dokter, dokter gigi dan apoteker. Pada keadaan tertentu kepada tenaga pendidik rendah dapat diberikaqn kewenangan terbats untuk menjalankan pekerjaannya tanpa pengawasan langsung.

UU ini boleh dikatakan sudah using karena hanya mengklaripikasikan tenaga kesehatan secara dikotomis (tenaga sarjana dan bukan sarjana). UU ini juga tidak mengatur landasan hukum bagi tenaga kesehatan dalam menjalankan pekerjaannya. Dalam UU ini juga belum tercantum berbagai jenis tenaga sarjana keperawatan seperti sekarang ini dan perawat ditempatkan pada posisi yang secara hukum tidak mempunyai tanggung jawab mandiri karena harus tergantung pada tenaga kesehatan lainnya.

3. UU kesehatan No. 14 tahun 1964, tentang wajib keja paramedic

Pada pasal 2,ayat (3) dijelasakan bahwa tenaga kesehatan sarjana muda, menengah dan rendah wqajib menjalankan wajib kerja pada pemerintah selama 3 tahun. Dalam pasal 3 dihelaskan bahwa selama bekerja pada pemerintah, tenaga kesehatan yang dimaksut pada pasal 2 memiliki kedudukan sebagain pegawai negeri sehingga peraturan-peraturan pegawai negeri juga diberlakukan terhadapnya. UU ini untuk saat ini sudah tidak sesuai dengan kemampuan pemerintah dalam mengangkat pegawai negeri. Penatalaksanaan wajib kerja juga tidak jelas dalam UU tersebut sebagai contoh bagai mana sisitem rekruitmen calon pesrta wajib kerja, apa sangsinya bila seseorang tidak menjalankaqn wajib kerja dll. Yang perlu diperhatikan dalam UU ini,lagi posisi perawat dinyatakan sebagai tenaga kerja pembantu bagi tenaga kesehatan akademis termasuk dokter, sehingga dari aspek propesionalisasian, perawat rasanya masih jauh dari kewenangan tanggung jawab terhadap pelayanannya sendiri.

4. SK Menkes No. 262/per/VII/1979 tahun 1979

Membedakan para medis menjadi dua golongan yaitu paramedic keperawatan (termasuk bidan) dan paramedic non keperawata. Dari aspek hukum, sartu hal yang perlu dicatat disini bahwa tenaga bidan tidak lagi terpisah tetapi juga termasuk kategori tenaga keperawatan.

5. Permenkes. No. 363/ Menkes/ per/XX/1980 tahun 1980

Pemerintah membuat suatu pernyataan yang jelas perbedaan antara tenaga keperawatan dan bidan. Bidan seperti halnya dokter, diizinkan mengadakan praktik swasta, sedangkan tenaga keperawatan secara resmi tidak diizinkan. Dokter dapat membuka praktik swasta untuk mengobati orang sakit dan bidan dapat menolong persalinan dan pelayanan KB. Peraturan ini boleh dikatakan kurang relevan atau adil bagi propesi keperawatan. Kita ketahuai Negara lain perawat diizinkan membuka praktik swasta. Dalam bidang kuratif banyak perawat harus menggantikan atau mengisi kekujrangan tenaga dokter untuk mengobati penyakit terutam dipuskesmas- puskesmas tetapi secara hukum hal tersebut tidak dilindungi terutama bagi perawat yang memperpanjang pelayanan dirumah. Bila memang secara resmi tidak diakui, maka seharusnya perawat dibebaskan dari pelayanan kuratif atau pengobatan untuk benar-benar melakuan nursing care.

6. SK Mentri Negara Pendayagunaan Aparatur Negara No. 94/Menpan/ 1986,tanggal 4 Nopember 1989, tentang jabatan fungsional tenaga keperawatan dan system kredit poin.

Dalam system ini dijelaskan bahwa tenaga keperawatan dapat naik jabatannya atau naik pangkatnya setiap 2 tahun bila memenuhi angka kredit tertentu. Dalam SK ini, tenaga keperawatan yang dimaksud adalah : penyenang kesehatan, yang sudah mencapai golongan II/a, Pengatur Rawat/ Perawat Kesehatan/Bidan, Sarjana Muda/D III Keperawatan dan Sarjana/S I Keperawatan.

System ini menguntungkan perawat karena dapat naik pangkatnya dan tidak tergantung kepada pangkat/ golongan atasannya

7. UU kesehatan No. 23 tahun 1992

Merupakan UU yang banyak member kesempatan bagi perkembangan termasuk praktik keperawatan professional karena dalam UU ini dinyatakan tentang standar praktik, hak-hak pasien, kewenangan, maupun perlindungan hukum bagi profesi kesehatan termasuk keperawatan.

Beberapa pernyataan UU kes. No. 23 Th. 1992 yang dapat dipakai sebagai acuan pembuatan UU praaktik keperawatan adalah :

a. Pasal 32 ayat 4.

Pelaksanaan pengobatan dan atau perawatan berdasarkan ilmu kedokteran dan ilmu keperawatan, hanya dapat dilaksanakan oleh tenaga kesehatan yang mempunyai keahlian dan kewenangan untuk itu.

b. Pasal 53 ayat I.

Tenaga kesehatan berhak memperoleh perlindungan hukum dalam melaksanakan tugas sesui dengan profesinya.

c. Pasal 53 ayat 2.

Tenaga kesehatan dalam melakukan tugasnya berkewajiban untuk mematuhi standar profesi dan menghormati hak pasien.

D. Definisi Regulasi

Regulasi keperawatan (regristrasi & praktik keperawatan) adalah kebijakan atau ketentuan yang mengatur profesi keperawatan dalam melaksanakan tugas profesinya dan terkait dengan kewajiban dan hak.

Registrasi merupakan pencantuman nama seseorang dan informasi lain pada badan resmi baik milik pemerintah maupun non pemerintah. Perawat yang telah terdaftar diizinkan memakai sebutan registered nurse. Untuk dapat terdaftar, perawat harus telah menyelesaikan pendidikan keperawatan dan lulus ujian dari badan pendaftaran dengan nilai yang diterima. Izin praktik maupun registrasi harus diperbaharui setiap satu atau dua tahun.

Undang – undang praktik keperawatan sudah lama menjadi bahan diskusi para perawat. PPNI pada kongres Nasional keduanya di Surabaya tahun 1980 mulai merekomendasikan perlunya bahan-bahan perundang-undangan untuk perlindungan hukum bagi tenaga keperawatan.

Tidak adanya undang-undang perlindungan bagi perawat menyebabkan perawat secara penuh belum dapat bertanggung jawab terhadap pelayanan yang mereka lakukan. Tumpang tindih antara tugas dokter dan perawat masih sering terjadi dan beberapa perawat lulusan pendidikan tinggi merasa frustasi karena tidak adanya kejelasan tentang peran, fungsi dan kewenangannya. Hal ini juga menyebabkan semua perawat dianggap sama pengetahuan dan ketrampilannya, tanpa memperhatikan latar belakang ilmiah yang mereka miliki.

E. Klasifikasi Regulasi

Dalam masa transisi professional keperawatan di Indonesia, sistem pemberian izin praktik dan registrasi sudah saatnya segera diwujudkan untuk semua perawat baik bagi lulusan SPK, akademi, sarjana keperawatan maupun program master keperawatan dengan lingkup praktik sesuai dengan kompetensi masing-masing.

Pengaturan praktik perawat dilakukan melalui Kepmenkes nomor 1239 tahun 2001 tentang Registrasi dan Praktik Perawat, yaitu setiap perawat yang melakukan praktik di unit pelayanan kesehatan milik pemerintah maupun swasta diharuskan memiliki Surat Izin Praktik (SIP) dan Surat Izin Kerja (SIK). Pengawasan dan pembinaan terhadap praktik pribadi perawat dilakukan secara berjenjang, mulai dari tingkat Propinsi, Kabupaten sampai ke tingkat puskesmas. Pengawasan yang telah dilakukan selama ini oleh pemerintah (Dinas Kesehatan Kabupaten Tanjung Jabung Timur) belum sesuai dengan Keputusan Menteri Kesehatan nomor 1239 tahun 2001.

· SIP adalah suatu bukti tertulis pemberian kewenangan untuk menjalankan pekerjaan keperawatan diseluruh wilayah indonesia oleh departemen kesehatan.

· SIK adalah bukti tertulis yang diberikan perawat untuk melakukan praktek keperawatan disarana pelayanan kesehatan.

· SIPP adalah bukti tertulis yang diberikan kepada perawat untuk menjalankan praktik perwat perorangan atau bekelompok, Perawat yang memiliki SIPP dapat melakukan asuhan dalam bentuk kunjungan rumah.

Standar profesi yaitu pedoman yang harus dipergunakan sebagai petunjuk dalam menjalankan profesi secara baik.

F. Tujuan Dari Regulasi

Adapun tujuan dari makalah ini adalah untuk mengetahui masalah-masalah RUU praktik keperawatan.

1. Mengetahui definisi dan tujuan praktik keperawatan

2. Mengetahui pentingnya Undang-undang Praktik Keperawatan terkait dengan profesi

3. Untuk meningkatkan kebutuhan masyarakat akan pelayanan kesehatan khususnya pelayanan keperawatan

4. Mengetahui isi Undang-Undang yang ada di Indonesia yang berkaitan dengan praktik keperawatan

5. Mengetahui tugas pokok dan fungsi Keperawatan dalam RUU Keperawatan

G. Komponen Regulasi

Pertama, keperawatan sebagai profesi memiliki karakteristik yaitu adanya kelompok pengetahuan (body of Knowledge) yang melandasi keperampilan untuk menyelesaikan masalah dalam tatanan praktik keperawatan; pendidikan yang memenuhi standar dan diselenggarakan diperguruan tinggi; pengendalian terhadap stndar praktik; bertanggung jawab dan bertangguang gugat terhadap tindakan yang dilakukan; memilih profesi keperawatan sebagai karir seumur hidup; dan memperoleh pengakuan masyarakat karena fungsi mandiri dan kewenangan penuh untuk melakukan pelayanan dan asuhan keperawatan yang berorientasi pada kebutuhan system klien (individu, keluarga, kelompok dan komunitas).

Kedua, kewenangan penuh untuk bekerja sesuai dengan keilmuan keperawatan yang dipelajari dalam suatu system pendidikan keperawatan yang formal dan terstandar menurut perawat untuk akuntabel terhadap keputusan dan tindakan yang dilakukannya. Kewenangan yang dimiliki berimplikasi terhadap kesediaan untuk digugat, apabila perawat tidak bekerja sesuai standar dan kode etik. Oleh karena itu, perlu diatur system registarasi, lisensi dan sertifikasi yang ditetapkan denga nperaturan dan perundang-undangan. Sistem ini akan melindungi masyarakat dari praktik perawat yang tidak kompeten, karena konsil keperawatan Indonesia yang kelak ditetapkan dalam UU praktik keperawatan akan menjalankan fungsinya. Konsil Keperawatan melalui uji kompetensi akan membatasi pemberian kewenagan melaksanakan praktik keperawatan hanya bagi perawat yang mempunyai pengetahuan yang dipersyaratakan untuk praktik. Sistem registrasi, lisensi dan sertifikasi ini akan meyakinkan masyarakat bahwa perawat yang melakukan praktik keperawatan mempunyai pengetahuan yang diperlukan untuk bekerja sesuai standar.

Ketiga, perawat telah memberikan konstibusi besar dalam meningkatkan derajat kesehatan. Perawat berperan dalam memberikan pelayanan kesehatan mulai dari layanan pemerintah dan swasta, dari perkotaan hingga pelosok desa terpencil dan perbatasan. Tetapi pengabdian tersebut pada kenyataannya belum diimbangi dengan pemberioan perlindungan hukum, bahkan cendrung menjadi objek hukum. Perawat juga memiliki kompetensi keilmuan, sikap rasional, etis dan professional, semangat pengabdian yang tinggi, berdisiplin, kreatif, terampil, berbudi luhur, dan dapat memegang teguh etika profesi. Disamping itu, UU ini memiliki tujuan lingkup profesi yang jelas, kemutlakan profesi, kepentingan bersama berbagai pihak (masyarakat, profesi, pemerintah dan pihak terkait lainnya), keterwakilan yang seimbang, optimalisasi profesi, fleksibilitas, efisiensi dan keselarasan, universal, keadilan, serta kesetaraan dan kesesuaian interprofesioan (WHO, 2002).

Keempat, kebutuhan masyarakat akan pelayanan kesehatan khususnya pelayanan keperawatan semakin meningkat. Hal ini karena adanya pergeseran paradigm dalam pemberian pelayanan kesehatan, dari model medical yang menitikberatkan pelayanan pada diagnosis penyakit dan pengobatan, ke paradigm sehat yang lebih holistic yang melihat penyakit dan gejala sebagai informasi dan bukan sebagai focus pelayanan (Cohen, 1996). Disamping itu, masyarakat membutuhkan pelayanan keperawatan yang mudah dijangkau, pelayanan keperaweatan yang bermutu sebagai bagian yang integrar dari pelayanan kesehatan, dan memperoleh kepastian hukum kepada pemberian dan penyelenggaraan pelayanan keperawatan.

ASPEK HUKUM DAN REGULASI DALAM KEPERAWATAN

PENDAHULUAN
Keperawatan sebagai suatu profesi harus memiliki suatu landasan dan lindungan yang jelas.Para perawat harus tahu berbagai konsep hukum yang berkaitan dengan praktik keperawatan karena mereka mempunyai akutabilitas terhadap keputusan dan tindakan profesional yang mereka lalukan.secara umum terhadap dua alasan terhadap pentingnya para perawat tahu tentang hukum yang mengatur praktiknya. Alasan pertama untuk memberikan kepastian bahwa keputusan dan tindakan perawat yang dilakukan konsisten dengan prinsip-prinsip hukum.Kedua,Untuk melindungi perawat dari liabilitas.

TUJUAN
Setelah membaca makalah ini di harapkan mampu :

Mengetahui masalah-masalah RUU keperawatan
Mengetahui pentingnya undang-undang praktik keperawatan
Hukum keperawatan
Fungsi Hukum dalam keperawatan
Undang-undang Praktik keperawatan

PENGERTIAN
Aspek Hukum dan Regulasi dalam Keperawatan
Hukum adalah keseluruan kumpulan peraturan-peraturan atau kaidah-kaidah dalamsuatu kehidupan bersama atau keseluruhan peraturan dan tingkah laku yang berlaku dalam suatu kehidupan bersama yang dapat dilaksanakan pelaksanaannya dengan suatu sanksi.

Regulasi adalah kebijakan atau ketentuan yang mengatur profesi keperawatan dalam melaksanakan tugas profesinya dan terkait dengan kewajiban dan hak dengan sebagai berikut :

Kewajiban Perawat

- Perawat wajib mematuhi istitusi yang bersangkutan
- Perawat wajib menghormati hak-hak pasien

Hak Perawat

- Perwat berhak untuk mendapatkan perlindungan hukum dalam melaksanakan tugasnya sesuai dengan profesinya
- Perawat berhak untuk mengembangkan diri melalui kemampuan spesialisasi sesuai latar belakang pendidikannya

FUNGI HUKUM DALAM KEPERAWATAN

Hukum mempunyai beberapa fungsi bagi keperawatan:

Hukum memberikan kerangka untuk menentukan tindakan keperawatan mana yang sesuai dengan hukum
Membedakan tanggung jawab perawat dengan profesi tindakan keperawatan mandiri
Membantu dalam mempertahankan standar praktek keperawatan dengan meletakkan posisi perawat memiliki akutabilitas di bawah hukum

ASPEK HUKUM DAN REGULASI KEPERAWATAN

Aspek Hukum Dalam keperawatan

By ZAINAL ABIDIN, S.Kep, Ns

Pengertian Hukum
² Hukum adalah keseluruhan kumpulan peraturan-peraturan atau kaidah-kaidah dalam suatu kehidupan bersama; atau keseluruhan peraturan tingkah laku yang berlaku dalam suatu kehidupan bersama, yang dapat dipaksakan pelaksanaannya dengan suatu sanksi.
² Hukum adalah keseluruhan peraturan yang mengatur dan menguasai manusia dalam kehidupan bersama. Berkembang di dalam masyarakat dalam kehendak, merupakan sistem peraturan, sistem asas-asas, mengandung pesan kultural karena tumbuh dan berkembang bersama masyarakat.
Pengertian hukum kesehatan :
Adalah ketentuan-ketentuan yang mengatur hak dan kewajiban baik dari tenaga kesehatan dalam melaksanakan upaya kesehatan maupun dari individu dan masyarakat yang menerima upaya kesehatan tersebut dalam segala aspek promotif, preventif, kuratif dan rehabilitatif serta organisasi dan sarana.
Fungsi Hukum dalam pelayanan keperawatan
² Memberikan kerangka untuk menentukan tindakan keperawatan
² Membedakan tanggung jawab dengan profesi yang lain
² Membantu mempertahankan standar praktek keperawatan dengan meletakkan posisi perawat memiliki akuntabilitas di bawah hukum
Hak – hak pasien
² Memberikan persetujuan (consent)
² Hak untuk memilih mati
² Hak perlindungan bagi orang yang tidak berdaya
² Hak pasien dalam penelitian
Hak – hak perawat
² Hak perlindungan wanita
² Hak berserikat dan berkumpul
² Hak mengendalikan praktek keperawatan sesuai yang diatur oleh hukum
² Hak mendapat upah yang layak
² Hak bekerja di lingkungan yang baik
² Hak terhadap pengembangan profesional
² Hak menyusun standar praktek dan pendidikan keperawatan

Informed Consent
² Ada 3 hal yang menjadi hak mendasar dalam Menyatakan Persetujuan
Rencana Tindakan Medis yaitu hal untuk mendapatkan pelayanan kesehatan (the right to health care), hak untuk mendapatkan informasi (the right to information), dan hak untuk ikut menentukan (the right to determination)
Hak atas informasi
² Sebelum melakukan tindakan medis baik ringan maupun berat.
² Pasien berhak bertanya tentang hal-hal seputar rencana tindakan medis yang akan diterimanya tersebut apabila informasi yang diberikan dirasakan masih belum jelas,
² Pasien berhak meminta pendapat atau penjelasan dari dokter lain untuk memperjelas atau membandingkan informasi tentang rencana tindakan medis yang akan dialaminya,
² Pasien berhak menolak rencana tindakan medis tersebut
² Semua informasi diatas sudah harus diterima pasien SEBELUM rencana tindakan medis dilaksanakan. Pemberian informasi ini selayaknya bersifat obyektif, tidak memihak, dan tanpa tekanan. Setelah menerima semua informasi tersebut, pasien seharusnya diberi waktu untuk berfikir dan mempertimbangkan keputusannya.
Informasi yang diperoleh:
² Bentuk tindakan medis
² Prosedur pelaksanaannya
² Tujuan dan keuntungan dari pelaksanaannya
² Resiko dan efek samping dari pelaksanaannya
² Resiko / kerugian apabila rencana tindakan medis itu tidak dilakukan
² Alternatif lain sebagai pengganti rencana tindakan medis itu, termasuk keuntungan dan kerugian dari masing-masing alternatif tersebut
Kriteria pasien yang berhak
² Pasien tersebut sudah dewasa. batas 21 tahun.
² Pasien dalam keadaan sadar.
Pasien harus bisa diajak berkomunikasi secara wajar dan lancar.
² Pasien dalam keadaan sehat akal.
Jadi yang paling berhak untuk menentukan dan memberikan pernyataan persetujuan terhadap rencana tindakan medis adalah pasien itu sendiri. Namun apabila pasien tersebut tidak memenuhi 3 kriteria tersebut diatas maka dia akan diwakili oleh wali keluarga atau wali hukumnya.
Hak suami/istri pasien
Untuk beberapa jenis tindakan medis yang berkaitan dengan kehidupan berpasangan sebagai suami-istri. Misalnya tindakan terhadap organ reproduksi, KB, dan tindakan medis yang bisa berpengaruh terhadap kemampuan seksual atau reproduksi dari pasien tersebut.
Dalam keadaan gawat darurat
Proses pemberian informasi dan permintaan persetujuan rencana tindakan medis ini bisa saja tidak dilaksanakan oleh dokter apabila situasi pasien tersebut dalam kondisi gawat darurat. Dalam kondisi ini, dokter akan mendahulukan tindakan untuk penyelamatan nyawa pasien. Prosedur penyelamatan nyawa ini tetap harus dilakukan sesuai dengan standar pelayanan / prosedur medis yang berlaku disertai profesionalisme yang dijunjung tinggi.
Setelah masa kritis terlewati dan pasien sudah bisa berkomunikasi, maka pasien berhak untuk mendapat informasi lengkap tentang tindakan medis yang sudah dialaminya tersebut.
Tidak berarti kebal hukum
Pelaksanaan informed consent ini semata-mata menyatakan bahwa pasien (dan/atau walinya yang sah) telah menyetujui rencana tindakan medis yang akan dilakukan. Pelaksanaan tindakan medis itu sendiri tetap harus sesuai dengan standar proferi kedokteran. Setiap kelalaian, kecelakaan, atau bentuk kesalahan lain yang timbul dalam pelaksanaan tindakan medis itu tetap bisa menyebabkan pasien merasa tidak puas dan berpotensi untuk mengajukan tuntutan hukum. Informed consent tidak menjadikan tenaga medis kebal terhadap hukum atas kejadian yang disebabkan karena kelalaiannya dalam melaksanakan tindakan medis.
UU yang berkaitan dengan Praktek keperawatan
² UU No. 9 tahun 1960, tentang pokok-pokok kesehatan
Bab II (Tugas Pemerintah), pasal 10 antara lain menyebutkan bahwa pemerintah mengatur kedudukan hukum, wewenang dan kesanggupan hukum.
² UU No. 6 tahun 1963 tentang Tenaga Kesehatan.
UU ini membedakan tenaga kesehatan sarjana dan bukan sarjana. Tenaga sarjana meliputi dokter, dokter gigi dan apoteker. Tenaga perawat termasuk dalam tenaga bukan sarjana, termasuk bidan dan asisten farmasi dimana dalam menjalankan tugas dibawah pengawasan dokter, dokter gigi dan apoteker. Pada keadaan tertentu kepada tenaga pendidikan rendah dapat diberikan kewenangan terbatas untuk menjalankan pekerjaannya tanpa pengawasan langsung.
UU yang berkaitan dengan Praktek keperawatan
² UU Kesehatan No. 14 tahun 1964, tentang Wajib Kerja Paramedis.
Pada pasal 2, ayat (3)dijelaskan bahwa tenaga kesehatan sarjana muda, menengah dan rendah wajib menjalankan wajib kerja pada pemerintah selama 3 tahun.
Yang perlu diperhatikan bahwa dalam UU ini, lagi posisi perawat dinyatakan sebagai tenaga kerja pembantu bagi tenaga kesehatan akademis, sehingga dari aspek profesionalisasian, perawat rasanya masih jauh dari kewenangan tanggung jawab terhadap pelayanannya sendiri.

UU yang berkaitan dengan Praktek keperawatan
² SK Menkes No. 262/Per/VII/1979 tahun 1979
Membedakan paramedis menjadi dua golongan yaitu paramedis keperawatan (temasuk bidan) dan paramedis non keperawatan. Dari aspek hukum, suatu hal yang perlu dicatat disini bahwa tenaga bidan tidak lagi terpisah tetapi juga termasuk katagori tenaga keperawatan.
UU yang berkaitan dengan Praktek keperawatan
² Permenkes. No. 363/Menkes/Per/XX/1980 tahun 1980
Pemerintah membuat suatu pernyataan yang jelas perbedaan antara tenaga keperawaan dan bidan. Bidan seperti halnya dokter, diijinkan mengadakan praktik swasta, sedangkan tenaga keperawatan secara resmi tidak diijinkan. Peraturan ini boleh dikatakan kurang relevan atau adil bagi profesi keperawatan. Kita ketahui negara lain perawat diijinkan membuka praktik swasta.
UU yang berkaitan dengan Praktek keperawatan
² SK Menteri Negara Pendayagunaan Aparatur Negara No. 94/Menpan/1986, tanggal 4 November 1986, tentang jabatan fungsional tenaga keperawatan dan sistem kredit point.
Dalam sistem ini dijelaskan bahwa tenaga keperawatan dapat naik jabatannya atau naik pangkatnya setiap dua tahun bila memenuhi angka kredit tertentu.
Sistem ini menguntungkan perawat, karena dapat naik pangkatnya dan tidak tergantung kepada pangkat/golongan atasannya
UU yang berkaitan dengan Praktek keperawatan
² UU Kesehatan No. 23 Tahun 1992, merupakan UU yang banyak memberi kesempatan bagi perkembangan termasuk praktik keperawatan profesional karena dalam UU ini dinyatakan tentang standar praktik, hak-hak pasien, kewenangan,maupun perlindungan hukum bagi profesi kesehatan termasuk keperawatan.
² Beberapa pernyataaan UU Kes. No. 23 Th. 1992 yang dapat dipakai sebagai acuan pembuatan UU Praktik Keperawatan adalah :
² Pasal 53 ayat 4 menyebutkan bahwa ketentuan mengenai standar profesi dan hak-hak pasien ditetapkan dengan peraturan pemerintah.
² Pasal 50 ayat 1 menyatakan bahwa tenaga kesehatan bertugas menyelenggarakan atau melaksanakan kegiatan sesuai dengan bidang keahlian dan kewenangannya
² Pasal 53 ayat 4 menyatakan tentang hak untuk mendapat perlindungan hukum bagi tenaga kesehatan.

Namun kenyataannya sampai sekarang UU praktek keperawatan belum juga disahkan ……

ASPEK HUKUM DAN REGULASI DALAM KEPERAWATAN

DISUSUN OLEH :

Anik Rahayu (1408004)

Cholida Novilanti (1408008)

Deasy Nurul Fadhilah (1408010)

Nurlaelah (1408023)

Selistya Eris (1408044)

KATA PENGANTAR

Puji syukur atas kehadirat Tuhan YME. Karena dengan rahmatnya penyusun dapat menyelesaikan makalah keperawatan professional ini. Dan makalah ini disusun guna untuk memenuhi tugas Keperawatan Profesional semester III, yang dibimbing oleh Ibu Nina Pamela S. Kep.Ns. Makalah ini menjelaskan tentang kebijakan atau ketentuan yang mengatur profesi keperawatan dalam melaksanakan tugas profesinya dan terkait dengan kewajiban dan hak.

Perawat mempunyai hak & tindakan keperawatan yang sesuai dengan standar yang berlaku perlu ada ketetapan hukum yang mengatur hak & kewajiban seseorang yang berhubungan erat dengan tindakannya perawat sebagai tenaga kesehatan. Dengan memandang manusia secara biopsikososial spiritual yang komperehensif. Akan tetapi ada kalanya perawat melupakan atau tidak memperhatikan hal tersebut secara keseluruhan. dan makalah ini diharapkan dapat memberikan gambaran pada pembaca, agar dapat mengetahui dan memahami konsep tentang peraturan, kebijakan dan perundangan yg berlaku dlm melaksanakan Praktik Keperawatan Profesional.

Dan diharapkan dapat menerapkan kebijakan atau ketentuan yang mengatur profesi keperawatan dalam melaksanakan tugas profesinya dan terkait dengan kewajiban dan hak. Dan penulis mengucapkan banyak terima kasih pada pihak Ibu Nina Pamela S. Kep.Ns. dan semua pihak yang telah membantu dalam penyelesaian makalah ini. Semoga makalah ini dapat bermanfaat bagi pembaca.

Yogyakarta, 25 Oktober 2009

Penyusun

BAB II

TINJAUAN PUSTAKA

A. DEFINISI

Regulasi keperawatan (regristrasi & praktik keperawatan) adalah kebijakan atau ketentuan yang mengatur profesi keperawatan dalam melaksanakan tugas profesinya dan terkait dengan kewajiban dan hak. Beberapa regulator yang berhubungan dengan perawat dan keperawatan Indonesia.

B. KLASIFIKASI

SIP adalah suatu bukti tertulis pemberian kewenangan untuk menjalankan pekerjaan keperawatan diseluruh wilayah indonesia oleh departemen kesehatan. SIP mempunyai kewenangan dan hak:

1. Melakukan pengkajian.

2. Melakukan terapi keperawatan.

3. Melakukan observasi.

4. Memberikan pendidikan & konseling.

5. Melakukan intervensi medis yang didelegasi.

6. Melakukan evaluasi tindakan keperawatan diberbagai tatanan yankes.

SIK adalah bukti tertulis yang diberikan perawat untuk melakukan praktek keperawatan disarana pelayanan kesehatan.

IPP adalah bukti tertulis yang diberikan kepada perawat untuk menjalankan praktik perwat perorangan atau bekelompok, Perawat yang memiliki SIPP dapat melakukan asuhan dalam bentuk kunjungan rumah.

Standar profesi yaitu pedoman yang harus dipergunakan sebagai petunjuk dalam menjalankan profesi secara baik.

C. (Penjelasan)

Aspek legal atau hukum, legal=sah, aspek legal dalam keperawatan =sah, perawat mempunyai hak & tindakan keperawatan yang sesuai dengan standar yang berlaku perlu ada ketetapan hukum yang mengatur hak & kewajiban seseorang yang berhubungan erat dengan tindakannya perawat sebagai tenaga kesehatan diatur dalam:

1. UU No. 23 Tentang Kesehatan

2. PP Nomor 32 Tentang Tenaga Kesehatan

3. Perda Kab. Kudus No. 11 Tahun 2004 Tentang Retribusi Pelayanan Tenaga Kesehatan

4. SKB MENKES-KABKN NO.733-SKB-VI-2002 NO.10 th 2002 Tentang Jabatan

5. UU No. 43 Th. 1999 Tentang POKOK2 KEPEGAWAIAN

6. PERPRES No. 54 Th. 2007 Tentang Tunjangan Fungsional Tenaga Kesehatan

7. PERPRES No. 26 Tahun 2007 Tentang Tunjangan Jabatan Struktural

8. PP No. 12 Tahun 2002 Tentang Kenaikan Pangkat PNS

9. PP No. 13 Tahun 2002 Tentang Pengangkatan PNS Dalam Jab. Struktural

10. PP No. 13 Tahun 2007 Tentang Penetapan Pensiun Pokok

11. PP No. 43 Tahun 2007 Tentang PHD Menjadi PNS

12. PP No. 099 Tahun 2000 Tentang Kenaikan Pangkat PNS

13. PP No. 12 Tahun 2002 Tentang Perubahan PP 99 Th 2000 Kenaikan Pangkat PNS

14. PP Nomor 09 Tahun 2003 Tentang Pengangkatan, pemindahan dan pemberhentian PNS

15. KEPMENPAN No. 138 Tahun 2002 Tentang Penghargaan Pegawai Negeri Sipil Teladan.

Pengaturan penyelenggaraan praktik keperawatan bertujuan untuk:

1. Memberikan perlindungan dan kepastian hukum kepada penerima dan pemberi jasa pelayanan keperawatan.

2. Mempertahankan dan meningkatkan mutu pelayanan keperawatan yang diberikan oleh perawat.

3. Mendorong para pengambil kebijakan dan elemen-elemen yang terkait lainnya untuk memberikan perhatian dan dukungan pada model praktik keperawatan komunitas.

4. Mendorong pemerintah mengeluarkan regulasi yang dapat memberikan jaminan pada penyelenggaraan praktik keperawatan komunitas yang profesional

5. Mendorong terbentuknya sistem monitoring dan evaluasi yang efisien dan efektif

Lingkup praktik keperawatan meliputi:

1. Memberikan asuhan keperawatan pada individu, keluarga, kelompok dan masyarakat dalam menyelesaikan masalah kesehatan sederhana dan kompleks.

2. Memberikan tindakan keperawatan langsung, pendidikan, nasehat, konseling, dalam rangka penyelesaian masalah kesehatan melalui pemenuhan kebutuhan dasar manusia dalam upaya memandirikan sistem klien.

3. Memberikan pelayanan keperawatan di sarana kesehatan dan tatanan lainnya.

4. Memberikan pengobatan dan tindakan medik terbatas, pelayanan KB, imunisasi, pertolongan persalinan normal dan menulis permintaan obat/resep.

5. Melaksanakan program pengobatan secara tertulis dari dokter.

Manfaat sistem regulasi/ pengaturan

1.Pelaksanakan tugas keperawatan diluar batas waktu yang ditentukan.

2.Kegagalan memen standar yankep

3.Mengabaikan bahaya yang mungkin muncul.

4.Tidak mempunyai ketrampilan.

5.Kurang pengetahuan.

6.Kelalaian (sengaja/tidak)

7.Meninggalkan tugas tanpa delegasi yang tepat.

D. Legislasi Keperawatan

Merupakan bagian yang integral dari:

1. UU RI no 23 tahun 1992, tentang Kesehatan.

2. PP no. 32 tahun 1996 tentang Tenaga Kesehatan.

Legislasi keperawatan:

Pembukaan UU atau penyempurnaan perangkat hukum yg sdh ada, yg mempengaruhi ilmu & kiat dalam praktek keperawatan.(Sand,Robles 1981).

Prinsip dasar legislasi keperawatan:

1. Harus jelas perbedaan tiap katagori tenaga keperawatan.

2. Badan yang mengurus legialasi bertanggung jawab terhadap pencatatan.

3. Ada batas waktu minimal masa lesensi.

4. Pembuat lesensi berdasarkan pendidikan dan tugas yang ditetapkan.

5. Kegiatan yang boleh & tidak boleh harus lebih rinci.

6. Info tentang tanggung jawab legal praktek disediakan oleh institusi pendidikan, profesi, dan badan legislasi.

Tujuan legislasi:

Memberikan perlindungan kepada masyarakat.
Memfokuskan kepada masyarakat tentang yan kes yang diberikan dan tanggung wajab para praktisi profesional.
Memelihara kwalitas yan kep.
Memberi kejelasan batas wewenang suatu katagori tenaga.
Menjamin ada perlindungan hukum bagi perawat.
Mmotivasi pengembangan profesi.
Meningkatkan profesi tenaga perawat.

DAFTAR PUSTAKA

Priharjo Robert. Konsep dan Prespektif Praktik Keperawatan Profesional, Jakarta EGC,2008

LEGAL AND REGULATORY PRACTICE NURSING

LEGAL AND REGULATORY PRACTICE NURSING

A. Legal Definition

The law is the entire collection of rules or norms in a common life, or overall behavior rules apply in a life together, which can be imposed with any sanctions implementation.

Laws are rules that govern the overall and master of man in life. Flourishing in the community in the will, a system of rules, system principles, containing cultural message as it grows and develops with the community.

Understanding the health law are provisions governing the rights and obligations of both health workers in implementing health measures as well as of individuals and communities who receive health efforts in all aspects of promotive, preventive, curative and rehabilitative as well as organizations and facilities.

B. The Importance of Law in Practice Nursing

There are several reasons why the Nursing Practice Act required. First, the reason philosophy. Nurses have given a great contribution in improving health status. Nurse's role in providing health care services ranging from government and private sectors, from urban to remote rural and frontier. But devotion is in fact not been matched by the provision of legal protection, even tended to be the object of legal (WHO, 2002).

Second, legitimate reasons. 1945 Constitution, Article 5, states that the President has the power to make law with the approval of the House of Representatives. Also such Act No. 23 of 1992, Article 32, explicitly states that the implementation of medication and or treatment based on science or medicine and nursing, can only be carried out by health workers who have the expertise and authority to do so. Medium Section 53, which states that health workers are entitled to legal protection in carrying out duties in accordance with the profession. Moreover, article 53 of the health personnel in performing their duties shall be obliged to comply with 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 of Registration and Practice Nurses.

Third, sociological reasons. Health care needs of the community nursing service in particular is increasing. This is due to the paradigm shift in the delivery of health care, medical model of care that focuses on the diagnosis and treatment of disease, to a more holistic health paradigm that saw the disease and symptoms as information and not as the focus of care (Cohen, 1996).

Besides that, people need nursing care that is easily accessible, quality nursing care as an integral part of the health service, and obtain legal certainty to the provision and delivery of nursing services. Nursing is a healthcare profession in the world. As a profession, of course, the service provided must be professional, so the nurse / nurses should have the competence and standards of nursing practice, and considering the professional code of ethics and morals so that people receive the services and care that good-quality keperwatan.

Based on the results of the study (MOH & UI, 2005) menunujukkan that there are nurses who make a diagnosis of the disease (92.6%), making prescription drugs (93.1%), treatment action inside and outside the building clinic (97.1%), do a pregnancy (70.1%), did aid deliveries (57.7%), janitor duty (78.8%), and perform administrative tasks such as treasurer, etc. (63.6%).

In an emergency like this is called a "gray area" is often difficult to avoid. So the nurse whose duties are in addition to clients 24 hours a frequent client emergencies while no doctor on duty. This makes the nurse had to do medical procedures that are not authority for the safety of the client. Actions taken without any delegation and guidance of physicians, especially in primary health centers have only one doctor who serves as the manager of community health centers, often leading to situations in which a nurse take action treatment. This phenomenon of course is frequently encountered in various health centers, especially in areas tepencil. With the transfer of this function, it can certainly be neglected nursing functions. And of course this is not a legal protection, because it is not accounted for in a professional manner.

In 1989, as an organization PPNI nurses in Indonesia began to struggle for the development of Nursing Law. Various important events happening in the business success of this Nursing Act. In 1992 disahkanlah Health Act within which recognizes that nursing is a profession (Health Law No.23, 1992). This event is important because previous recognition that nursing is a profession merely expressed in government regulation (PP 32, 1996). And proposed a new law passed a bill Nursing Nursing in 2004.

We need to know that to make a law can be done in 2 ways ie through government (the 1945 Constitution Article 5, paragraph 1) and by the House of Representatives (State Legislature). For nearly 20 years fighting for the bill PPNI keperawtan through the government, in this case the MOH. Funds spent was not small. But the fact that until now the Bill of Nursing was ranked in the program's 250-National Legislation (Prolegnas), which was in the year 2007 are on the order of 160 (PPNI, 2008).

Of course, knowledge of the importance of the law of Nursing absolutely necessary. This is related to the status of the House of Representatives which is the institution, so that discussions are conducted is an issue that is going on in the community. Therefore, pencerdasan to the public on the importance of Nursing Law was included in the agenda of Parliament.

In Law On practice nursing in Chapter 1 Article 1 that all three states:

"Nursing care is a process or series of activities in nursing practice either directly or indirectly given to the client system disarana and other health order, using a scientific approach to nursing by the code of ethics and standards of nursing pratik.

And Article 2 reads: "The practice of nursing implemented based on Pancasila and based on the value of scientific, ethical and etiquette, benefits, justice, humanity, balance and protection and safety of recipients and providers of nursing services.

C. Governing Law Relating to Nursing Practice

The law practice of nursing has long been discussed nurses. PPNI on its second national congress in Surabaya in 1980 began recommending materials need legislation for legal protections for nursing personnel. Absence Act protections for nurses has not been able to nurse fully responsible for the services they do. Overlap between duty doctors and nurses still occurs and some higher education graduated nurses feel prustasi the absence of clarity about the roles, functions and authority. It also causes all nurses are considered equal knowledge and skills, regardless of scientific background they have.

Laws and regulations in Indonesia related to nursing practice:

1. Law no. 9 In 1960, on issues of health

Chapter II (duty of government), including article 10 states that the government regulate the legal position, authority and legal ability.

2. Law no. 6 year 1963 on health

This law is a translation of the Law. 9 1960. The law distinguishes health care and not a graduate degree. Labor scholars include doctors, dentists and pharmacists doter. Nurses not included in the graduate labor or health workers with low education, including midwives and pharmacy assistants in performing duties which under the supervision of physicians, dentists and pharmacists. In certain circumstances the low educators can diberikaqn terbats authority to carry out their work without direct supervision.

This Act may be said to have been using since only a dichotomous mengklaripikasikan health workers (labor and not a graduate degree). The law also does not regulate the legal basis for health workers in carrying out their work. In this Act has not listed the various types of power it is today nursing graduates and nurses are placed in a position that does not have a legally independent responsibility of having to depend on other health professionals.

3. No health legislation. 14 of 1964, concerning mandatory keja paramedic

In article 2, paragraph (3) that the health dijelasakan baccalaureate, medium and low wqajib shall work with the government running for 3 years. In chapter 3 dihelaskan that while working for the government, health workers dimaksut in article 2 has sebagain position that civil servants civil service rules also apply to them. The law for the time being is not in accordance with the government's ability to raise civil servants. Management of work shall also not clear in the law as an example of how where sisitem pesrta compulsory recruitment of candidates for employment, what sanctions if a person is not required to work etc menjalankaqn. Noteworthy in this Act, another nurse position expressed as labor helpers for academic health professionals including doctors, so that from the aspect propesionalisasian, nurse it's still far from the authority responsible for his own ministry.

4. No. SK Menkes. 262/per/VII/1979 year 1979

Differentiate into two groups, namely medical paramedic nursing (including midwifery) and non keperawata paramedic. From the legal aspect, sartu thing to be noted here that midwives are no longer separate, but also the category of nursing personnel.

5. Permenkes. No. 363 / Minister / per/XX/1980 1980

The government made a clear statement difference between nursing staff and midwives. Midwives as well as doctors, authorized conduct private practice while nursing personnel are not legally permitted. Doctors can open a private practice to treat the sick and midwives to help birth and family planning services. This rule may be said to be irrelevant or unfair to propesi nursing. We ketahuai Other countries allowed private practice nurse. In the field of curative nurses must replace or fill kekujrangan for doctors to treat disease chiefly dipuskesmas-clinic but legally it is not protected, especially for nurses who extend service at home. If it is not officially recognized, the nurse should be exempt from curative care or treatment to actually undergo a nursing care.

6. Decree of Minister of State for Administrative Reform No.. 94/Menpan / 1986, dated 4 November 1989, about functional nursing personnel and the system of credit points.

In this system, explained that the nursing staff can take a position or rank up every 2 years if it fulfills certain credit score. In this decree, the nursing personnel are: penyenang health, which had reached class II / a, Regulatory Rawat / Health Nurse / Midwife, Bachelor / Diploma of Nursing and Bachelor / SI Nursing.

This system is advantageous because nurses can rise in rank and are not dependent on rank / group supervisor

7. No health legislation. 23 of 1992

It is a law that many members opportunities for professional development including nursing practice as stated in this law on standards of practice, patient rights, authority, and legal protection for the health professions, including nursing.

Some statements chan Act. No. 23 Th. 1992 which can be used as a reference for nursing praaktik lawmaking is:

a. Article 32 paragraph 4.

Implementation of medication and or treatment based on medical science and nursing science, can only be carried out by health workers who have the expertise and authority to do so.

b. Article 53 paragraph I.

Health workers are entitled to legal protection in carrying out tasks within their profession.

c. Article 53, paragraph 2.

Health personnel in performing their duties shall be obliged to comply with professional standards and respect the rights of patients.

D. Definitions Regulation

Regulation of nursing (Regristrasi & nursing practice) are policies or regulations governing the nursing profession and the profession in carrying out tasks related to the duties and rights.

Registration is the inclusion of a person's name and other information on the official agencies both government and non-government. Registered nurse who has been allowed to use the title registered nurse. To be registered, the nurse must have completed nursing school and passed the examination of the registration agency with the value received. Permission practice and registration must be renewed every one or two years.

Act - legislation nursing practice has long been discussed nurses. PPNI the second national congress in Surabaya in 1980 began recommending materials need legislation for legal protections for nursing personnel.

The absence of protective legislation for nurses has not been able to nurse fully responsible for the services they do. Overlap between duty doctors and nurses are still common and some higher education graduated nurses feel frustrated due to lack of clarity about the roles, functions and authority. It also causes all nurses are considered equal knowledge and skills, regardless of scientific background they have.

E. Classification Regulation

Nursing professionals in transition in Indonesia, the licensing system and registry practice soon realized it was time for all good for graduate nurses SPK, college, graduate nursing and nursing master's program with the scope of practice in accordance with their respective competences.

Nursing practice settings through Kepmenkes 1239 number 2001 on the Registration and Practice Nurses, that every nurse who practice in health care units owned by the government and private sector are required to have a Permit Practice (SIP) and Work Permit (SIK). Supervision and guidance to nurses in private practice conducted in phases, starting from the Provincial, District down to the clinic. Supervision has been done so far by the government (Department of Health East Tanjung Jabung) is not in accordance with the Decree of the Minister of Health the number 1239 2001.

· SIP is a written proof of granting authority to carry out nursing jobs throughout the territory of Indonesia by the health department.

· SIK are given written proof nurses to practice nursing disarana health services.

· SIPP is written evidence given to nurses to practice individually or bekelompok perwat, Nurses who have SIPP can do care in the form of home visits.

Professional standards are guidelines to be used as guidelines in running a good profession.

F. The purpose of Regulation

The purpose of this paper is to investigate the problems of nursing practice bill.

1. Knowing the definition and purpose of nursing practice

2. Knowing the importance of Nursing Practice Act related to the profession

3. To improve the health care needs of the community nursing service in particular

4. Knowing the contents of Law in Indonesia related to nursing practice

5. Knowing the duties and functions of the Bill Nursing Nursing

G. Component Regulation

First, nursing as a profession has a characteristic that is a group of knowledge (Body of Knowledge) which underlies keperampilan to resolve the problem within the framework of nursing practice, education that meets high standards and held diperguruan; stndar control over practice; bertangguang responsible and accountable to the actions taken ; chose the nursing profession as a lifelong career, and gained public recognition as an independent function and full authority to administer and nursing care system oriented to the needs of clients (individuals, families, groups and communities).

Second, the full authority to work in accordance with the nursing science is learned in a formal nursing education system and standardized according to the nurse to be accountable for decisions and actions. Authorities of the implications for the willingness to be sued, if the nurse does not work according to the standards and code of ethics. Therefore, the system should be regulated registarasi, licenses and certifications specified premises nperaturan and legislation. This system will protect the public from incompetent practice nurses, nursing council Indonesia as stipulated in the Act that would be nursing practice function. Nursing Council through competency test would limit the provision of nursing practice kewenagan perform only for nurses who have knowledge dipersyaratakan to practice. System of registration, licensing and certification will reassure the public that nurses who practice nursing has the knowledge required to work according to standards.

Third, the nurse has given konstibusi in improving health status. Nurse's role in providing health services ranging from government and private services, from urban to remote rural and frontier. But devotion is in fact not been matched by pemberioan legal protection, and even tend to be the object of the law. Nurses also have the competence scientific, rational attitude, ethical and professional, high spirit of dedication, disciplined, creative, skilful, virtuous, and to uphold professional ethics. In addition, the scope of the law profession has a clear purpose, absolute profession, common interests of various parties (the public, the profession, the government and other stakeholders), a balanced representation, optimization of the profession, flexibility, efficiency and harmony, universal, justice, and equality and suitability interprofesioan (WHO, 2002).

Fourth, the health care needs of the community nursing service in particular is increasing. This is due to the paradigm shift in the delivery of health care, medical model of care that focuses on the diagnosis and treatment of disease, to a more holistic paradigm healthy and disease symptoms are seen as information and not as the focus of service (Cohen, 1996). Besides that, people need nursing care that is easily accessible, quality services keperaweatan integrar as part of the health service, and obtain legal certainty to the provision and delivery of nursing services.

Legal and Regulatory Aspects in Nursing

CHAPTER I

INTRODUCTION

A. BACKGROUND

Act - legislation nursing practice has long been discussed nurses. PPNI the second national congress in Surabaya in 1980 began recommending the need for materials legislation for legal protections for nursing personnel. The absence of protective legislation for nurses has not been able to nurse fully responsible for the services they do. Overlap between duty doctors and nurses are still common and some higher education graduated nurses feel frustrated due to lack of clarity about the roles, functions and authority. It also causes all nurses are considered equal knowledge and skills, regardless of scientific background they have.

May 12, 2008 is World Nursing Day. In Indonesia, the momentum will be used to encourage the various parties ratify the Bill of nursing practice. Indonesian National Nurses Association (PPNI) assuming that the Act would provide legal protection for the public against nursing care and the nursing profession. Indonesia , Laos and Vietnam are three ASEAN countries that do not have Nursing Practice Act. Whereas , Indonesia produce large amounts of nurses. This resulted in us behind countries Asia , Especially the lack of regulation of nursing practice, which affects the difficulty of penetrating globalization. The nurse is hard to enter and get recognition from other countries, while they would easily fit into our country.

Still should we question again, whether there should be a Nursing Practice Act in this country? The answer to a fundamental question, whether the Indonesian people have the right to receive quality nursing service, is the answer to ensuring that the Nursing Practice Act, too late for ratification, let alone to question. While ASEAN countries such as Philippines, Thailand, Singapore, Malaysia, already has a Law Practice Nursing (Nursing Practice Acts) since many years ago.

They are ready to protect society more and more prepared to face the globalization of foreign nurses and caregivers enter the country to work in another country. When signing the Mutual Recognition Arrangement on the Philippines in 2006, Indonesia is the same as Vietnam, Laos and Myanmar .., that do not have Nursing Council. Concerned .....!!! Very reasonable, if PPNI on Rakernas II in Semarang declared "National Movement: Nursing Practice Act a success." National Movement uses momentum International Nurses Day, May 12, 2008, as the Day of Resurrection Nursing Indonesia. Arise Nurses Indonesia .... Give the best for the community Indonesia . Together Nurses, Public Health ...!! '

B. PURPOSE

The purpose of this paper is to investigate the problems of nursing practice bill.

Knowing the definition and purpose of nursing practice

Knowing the importance of Nursing Practice Act

To improve the health care needs of the community nursing service in particular

Knowing the contents of the Act that is in Indonesia related to nursing practice

Knowing the purpose and components of regulation in nursing practice

C. METHOD

In making this paper, the method used is descriptive method that covers the collection of books and literature and group discussions.

D. Systematics

The systematics in the preparation of this paper are:

CHAPTER I Preliminary

CHAPTER II Basic Concepts

CHAPTER III Discussion

CHAPTER III Cover

REFERENCES

CHAPTER II

BASIC CONCEPTS AND LEGAL ASPECTS OF LAW

RELATED TO NURSING

A. IMPORTANCE OF NURSING PRACTICE LAW

There is several reasons why the Nursing Practice Act required. First, the reason philosophy. Nurses have given a great contribution in improving health status. Nurse's role in providing health care services ranging from government and private sectors, from urban to remote rural and frontier. But devotion is in fact not been matched by the provision of legal protection, even tended to be the object of legal (WHO, 2002).

In an emergency like this is called a "gray area" is often difficult to avoid. So the nurse whose duties are in addition to clients 24 hours a frequent client emergencies while no doctor on duty. This makes the nurse had to do medical procedures that are not authority for the safety of the client. Actions taken without any delegation and guidance of physicians, especially in primary health centers have only one doctor who serves as the manager of community health centers, often leading to situations in which a nurse take action treatment. This phenomenon of course is frequently encountered in various health centers, especially in areas tepencil. With the transfer of this function, it can certainly be neglected nursing functions. And of course this is not a legal protection, because it is not accounted for in a professional manner.

In 1989, as an organization PPNI nurse Indonesia began to struggle for the development of Nursing Law. Various important events happening in the business success of this Nursing Act. In 1992 disahkanlah Health Act within which recognizes that nursing is a profession (Health Law No.23, 1992). This event is important because previous recognition that nursing is a profession merely expressed in government regulation (PP 32, 1996). And proposed a new law passed a bill Nursing Nursing in 2004.

We need to know that to make a law can be done in 2 ways ie through government (the 1945 Constitution Article 5, paragraph 1) and by the House of Representatives (State Legislature). For nearly 20 years fighting for the bill PPNI keperawtan through the government, in this case Department of health RI . Funds spent was not small. But the fact that until now the Bill of Nursing was ranked in the program's 250-National Legislation (Prolegnas), which was in the year 2007 are on the order of 160 (PPNI, 2008).

In Law On practice nursing in Chapter 1 Article 1 that all three states:

And Article 2 reads:

"The practice of nursing implemented based on Pancasila and based on the value of the scientific, ethical and etiquette, benefits, justice, humanity, balance and protection and safety of recipients and providers of nursing services.

B. LAW RELATING TO PRACTICE NURSING

The law practice of nursing has long been discussed nurses. PPNI on its second national congress in Surabaya in 1980 began recommending the need for materials legislation for legal protections for nursing personnel. Absence Act protections for nurses has not been able to nurse fully responsible for the services they do. Overlap between duty doctors and nurses still occurs and some higher education graduated nurses feel prustasi the absence of clarity about the roles, functions and authority. It also causes all nurses are considered equal knowledge and skills, regardless of scientific background they have.

Laws and regulations that exist in Indonesia related to nursing practice:

1. Law no. 9 In 1960, on issues of health

Chapter II (duty of government), including article 10 states that the government regulate the legal position, authority and legal ability.

2. Law no. 6 year 1963 on health

3. No health legislation. 14 of 1964, concerning mandatory keja paramedics

4. No. SK Menkes. 262/per/VII/1979 year 1979

5. Permenkes. No. 363 / Minister / per/XX/1980 1980

The government made a clear statement difference between nursing staff and midwives. Midwives as well as doctors, authorized conduct private practice, while nursing staff are not legally allowed. Doctors can open a private practice to treat the sick and midwives to help birth and family planning services. This rule may be said to be irrelevant or unfair to propesi nursing. We ketahuai Other countries allowed private practice nurse. In the field of curative nurses must replace or fill kekujrangan for doctors to treat disease chiefly dipuskesmas-clinic but legally it is not protected, especially for nurses who extend service at home. If it is not officially recognized, the nurse should be exempt from curative care or treatment to actually undergo a nursing care.

6. Decree of Minister of State for Administrative Reform No.. 94/Menpan / 1986, dated 4 November 1989, about functional nursing personnel and the system of credit points.

In this system, explained that the nursing staff can take a position or rank up every 2 years if it fulfills certain credit score. In SK This nursing personnel in question are: penyenang health, which had reached class II / a, Regulatory Rawat / Health Nurse / Midwife, Bachelor / Diploma of Nursing and Bachelor / SI Nursing.

This system is advantageous because nurses can rise in rank and are not dependent on rank / group supervisor

7. No health legislation. 23 of 1992

Some statements chan Act. No. 23 Th. 1992 which can be used as a reference for nursing praaktik lawmaking is:

a. Article 32 paragraph 4

Implementation of medication and or treatment based on medical science and nursing science, can only be carried out by health workers who have the expertise and authority to do so.

b. Article 53 paragraph I

Health workers are entitled to legal protection in carrying out tasks within their profession.

c. Article 53 paragraph 2

Health personnel in performing their duties shall be obliged to comply with professional standards and respect the rights of patients.

C. LAW RELATING TO HEALTH

1. Act - Act 23 of 1992 on health

Article 32

(1) Healing sickness and recovery keschatan organized to restore the health status of the disease, restore body functions due to defective or eliminate defects.

(2) Healing sickness and health recovery done with medication and or treatment.

(3) Medication and or treatment can be done based on the science of medicine and nursing or other means that can be accounted for.

(4) Implementation of medication and or treatment based on medical science or nursing can only be performed by qualified health personnel and the authority to do so.

Article 50

(1) Health workers on duty conduct or conduct health activities in accordance with its expertise and competence of health workers or bcrsangkutan.

Article 53

(1) Health workers are entitled to legal protection in carrying out duties in accordance with the profession.

(2) Health personnel in performing their duties shall be obliged to comply with professional standards and respect the rights of patients.

Article 54

(1) Against keschatan power who make mistakes or omissions of data to carry out their profession subject to disciplinary action.

(2) Determination of the presence or absence of mistake or kalalaian referred to in subsection (1) is determined by the Disciplinary Panel of Health Workers.

Article 55

(1) Everyone is entitled to damages due to errors or omissions committed health workers.

2. PP no.32 of 1996 on health

Article 4

(1) Health workers can only do health measures after health workers concerned have permission from the Minister.

3. KEPMENKES No.1239/2001 concerning the Registration and Nursing Practice

Chapter III

Article 8

(1) Nurses can carry out the practice of nursing in health care facilities, and individual or group practices.

(2) Nurses in implementing nursing practice in health care facilities should have a SIK.

(3) Nurses practice in conducting individual / group must have siip.

Chapter IV

Article 15

Nurses in nursing practice is authorized to carry out:

(1) Implement nursing care which includes assessment, nursing diagnosis determination, planning, implementing and evaluating nursing actions nursing.

(2) Nursing actions as referred to in point a include: nursing interventions, nursing observation, education and health counseling.

(3) In implementing nursing care as referred to paragraphs a and b must be in accordance with the standards of nursing care established by professional organizations.

(4) Service medical action can only be made by a written request from the doctor

Article 17

Nurses in implementing nursing practice must be in accordance with the authority given, based on education and experience and to provide services required to comply with professional standards.

Article 20

(1) In life-threatening emergencies person / patient, nurse authorized to perform services outside the health authority as referred to in Article 15.

(2) Emergency services referred to in paragraph (1) is intended for saving lives.

CHAPTER III

DISCUSSION PROBLEM

A. Malpractice

Malpractice is a very general term and does not necessarily connote its jurisdiction. Literally "mall" has the meaning of "one" and "practice" has the meaning of "implementation" or "action", so malpractice means "execution or misconduct." Although the literal meaning of the term so but most used to describe the act is wrong the implementation of a profession.

While the definition of health professional malpractice is "negligence of a person's doctor or nurse to use the level of skill and knowledge in treating and caring for patients, which is commonly used for patients or those injured by size within the same" (v. Valentin. La Society de Bienfaisance mutuelle de Los Angelos, California, 1956).

B. SOME PROBLEMS OF LAW AND PRACTICE NURSING

Various legal issues in nursing practice have been identified by experts. Some issues are briefly discussed here include:

· Signing Legal Notices

Nurses are often asked or required to sign as a witness. In this case, the nurse should not make statements that can be interpreted to eliminate the influence. In regard to the testimony of the nurse suggested referring hospital policy or policies of superiors.

· Format Approval (Consent)

Various formats approval services provided by the institution in the form of a quite varied. Some hospitals provide consent form at the beginning of the patient in the hospital that contains statements and ability to care for patients undergoing treatment. Other form of agreement is format the operating agreement. Nurses in the approval process is usually served as a witness. Prior information from the surgeon or nurse about what to do with risk.

· Insident Report

Every time a nurse find a good accident on patients, visitors and health care workers, nurses must immediately make a written report called the incident report. In clinical situations, accidents often occur as the patient fell from the bathroom, her fingers cut off by the tool during melakuakan treatment, medication errors and provide others. In each accident, the physician should be notified immediately.

Some hospitals have provided a format for this purpose. If the format of the event can not be written without using the book format. Things that need to be considered in recording the incident report include:

- according as it is written incident

- write the action you are doing

- write your name and your signature clearly

- mentioned the time of the incident found

· Recording

Registration is day-to-day activities that can not be separated from the nursing care performed by nurses. Logging is one of the important components that provide legal testimony sources. However mahirnya your skills in providing care, if not recorded or recorded but walkin complete, can not help in the trial. Each finished doing an action the nurse should be noted clearly tindkan performed and the patient's response and action lists and action given time signature that gives the action.

· Supervision of Drug Use

Government Indonesia have set the distribution and use of drugs. No drug that can be bought freely, and others must be purchased with a prescription. Medications such as narcotics kept stored in a secure and locked and only authorized individuals oprang can remove it. For only legally acceptable in spending and use of this class of drugs nartkotik, nurses should always pay attention to the correct procedures and pncatatan.

· Abortion And Beyond Natural Pregnancy

Abortion is an initial outlay of fetal gestation period that fetus currently do not have the strength to survive. Abortion is the destruction of an unlawful act, or causing premature human fetus before the birth naturally.

Abortion has become an international issue, and various opinions have been put forward both in favor and against. Factors that promote abortion in part because:

- Rape

- Men are not responsible

- For mental health

- Health

- Not being able to care for baby

- Teens

- Still in school

- Economy

(KR, 1994)

What is meant by that is beyond birth naturally include birth acquired through sexual intercourse with a married couple where it should be. For example through invirto fertilization (IVF).

In Indonesia every year there were 2.6 million abortions. As many as 700,000 abortions perpetrators are teenagers or women aged under 20 years. The main cause is a lack of protection for women. "Survey of the World Health Organization (WHO), 2006, resulting in 68,000 deaths abortion. Abortion causes millions of women injured and permanently disabled, "(Atwirlany). According to Deputy III Women's Protection Ministry of Women Empowerment Susilowati Poerjoto Endang said, most players have an abortion because of unwanted pregnancies. It shows one of the main factors is the lack of protection of abortion on women.

Often women, especially young women, are treated indecency of male friends. Not infrequently they have experienced sexual violence from relatives, neighbors, or even father. According Susilowati, lack of protection of women's drug addiction resulted in young girls. In 2007, The Women's Ministry of drug abuse deaths recorded 15,000 people per year. "The Ministry has facilitated 135 districts and city in Indonesia established the protection of women in order to prevent the case it does not grow and spread to the villages, "he said. Each local government, he added, need to create a policy-based gender equality. They should implement a zero tolerance policy on violence against women.

"From the research who, it is estimated 20-60 percent of abortions in Indonesia is intentional abortion (induced abortion). research in 10 city large and six counties in Indonesia estimates that about 2 million cases of abortion, 50 percent occurred in urban areas. cases of abortion in urban done secretly by health (70%), while in the countryside conducted by a shaman (84%). Most abortion clients are in the age range 20-29 years.

Abortion in Indonesia prohibited by law (Act) ri number 23 year 1992 about health and also to the fatwa by Muslim clerics council Indonesia (MUI) number 4 in 2005. (But fatwa allowing abortion in an emergency where the life of the mother is threatened).

Abortion Controversy

Abortion in Indonesia is still an act that is clearly prohibited, unless there is a specific medical indication resulting in endangerment of the life of the mother. In the international world itself there are two major groups, namely pro-life (against abortion) and pro-choice (which is not opposed to abortion) follows with arguments melatarbelakanginya.Di Indonesia itself, although abortion is prohibited, but still many women who have abortions. Well done based on a specific medical indication or indications of non-medical.

In abortion, we tend to see it from the non-moral, because the moral problem must be placed in the corridor alone, and certainly not moral in moral corridor incorporated elements of law. Some examples of how sometimes the moral and legal, in his view, was not able to answer the problem.

Example A: A woman who was raped turned out to get a pregnancy she does not want. These women are victims of rape in terms of the force of ethnic cleansing in which he was one of the ethnic groups who want to be swept clean.

Example B: A woman who was raped turned out to get a pregnancy she does not want. These women are victims of rape in the context of crime in the family.

Example C: A woman who was raped turned out to get a pregnancy she does not want. These women are victims of rape in the context of crime in the workplace. He himself is married and has children who are good and funny

Example D: A woman who was raped turned out to get a pregnancy she does not want. These women are victims of rape in the context of ordinary crime. She was raped because there are robbers who entered her home.

Example E: A woman who was about to hold a marriage, was already pregnant before the marriage takes place. While her husband own escape somewhere and can not be traced back

If these women are required to maintain the pregnancy, we are sure she will bear a heavy psychological burden and give birth to an unwanted child would be a burden and a heavy blow to them both. And it could be a birth to children even not well taken care of, either by himself or his family. If this happens the cycle of violence is endless

From this point, sometimes I think, should abortion is the way out? and if he wanted to have an abortion, and if abortion is illegal, it will actually threaten his own life, because he would go to clinics or even third-class to a traditional healer, as some recent cases.

· Death and Related issue

Legal issues related deaths denagn include a statement of death, post-mortem / autopsy and organ donation. Death by a doctor and declared legally written in letter pronouncement of death. Letter This statement is usually made several copies and family got one sheet to be used as the basis for notice to relatives and insurance purposes. In certain circumstances such as for the purposes of justice, to do post-mortem on the dead.

C. Legal protection FOR NURSING

Nurses as professionals accountable for decisions and actions. In carrying out everyday tasks it is possible to make errors and omissions nurses either intentional or unintentional.

To run the practice, the nurse must legally protected primarily from malpractice lawsuits and negligence in an emergency. For example, suppose there is a law in the United States called the Good Samaritan Acts that protect health workers in delivering relief in emergencies. In Canada, there is a traffic law that allows each person to help accident victims in every situation, called Traffic Acts.

In Indonesia, has been rising with 23 health legislation in 1992 to provide a way for government regulation, including laws here governing nursing practice guidance and protection from malpractice. In many developed countries where malpractice claims against professionals in increasing numbers, the various areas of service health has been protecting health workers, including nurses liability insurance or malpractice insurance. Along with the times, it is possible future malpractice insurance should also be considered for all health workers including nurses in Indonesia .

D. PREVENT LEGAL ISSUES

Malpractice is still a topic in the health world. Various health, including nursing practice has been directed to prevent malpractice. Various health law practice has begun strived to provide direction for professional practice and health protection practices. Judicial profession more widely discussed for the health law thinkers (eg PERHUKI and government) which can provide legal guardianship for health workers and the community.

The problem is the law is complex because it involves the fate of mankind. In response to this we so remember the old slogan "prevention is better than cure". It would prevent legal problems better than legal sanction. For this the nurse should know the principles in preventing law.

Below are discussed some things you can do is nurse nurse defender of the legal issues:

1. Know the law or the laws that govern your practice.

2. Do melakuakn anything you do not know how to do it (if necessary, learn how).

3. Keep your practice competition, it is important to follow nursing continuing education.

4. As a prosecutor for improving practice, get feedback, and knowledge gaps / skills do self-assessment, the evaluation, audit and evaluation of the supervisor.

5. Do not be careless in the practice of nursing.

6. Keep attention on patients and their families.

7. Often communicate with others, do not shut down.

8. Record an accurate, objective and complete, not removed.

9. Delegate is safe and legitimate, the preparation and the ability to know the people under your supervision.

10. Help support the development of policies and procedures (the legal entity).

11. Follow malpractice insurance, if it is currently available.

(Jones, 1993)

E. REGULATIONS IN NURSING PRATIK

1. Underlying Importance of Regulation

In order to protect the public from incompetent practice nurses, as Nursing Council Indonesia the future of nursing practice set out in the Act shall perform its functions. Nursing Council through competency test would limit the awarding authority implementing nursing practice for nurses yan just have the knowledge required to practice. System of registration, licensing and certification will reassure the public that nurses who practice nursing has the knowledge required to work according to standards. Society needs nursing services as part integrar quality of health care, and obtain kepastianhukum the delivery and organization of nursing services.

2. PURPOSE OF REGULATIONS

The purpose of the regulation is as follows:

To be more professional nurses and proportionally to the responsibilities that must be met.

Is not expected to happen any overlap.

Avoiding malpractice occurs which may occur.

Improving the quality of professional services by following the development of science and technology through education and training in accordance with the field.

3. COMPONENTS OF REGULATIONS

First, nursing as a profession has a characteristic that is a group of knowledge (Body of Knowledge) which underlies keperampilan masalahg in order to complete the nursing practice, education that meets high standards and held diperguruan; stndar control over practice; bertangguang responsible and accountable to the actions taken ; chose the nursing profession as a lifelong career, and gained public recognition as an independent function and full authority to administer and nursing care system oriented to the needs of clients (individuals, families, groups and communities).

Second, the full authority to work in accordance with the nursing science is learned in a formal nursing education system and standardized according to the nurse to be accountable for decisions and actions. Authorities of the implications for the willingness to be sued, if the nurse does not work according to the standards and code of ethics. Therefore, the system should be regulated registarasi, licenses and certifications specified premises nperaturan and legislation. This system will protect the public from incompetent practice nurses because nursing council Indonesia the future of nursing practice set out in the Act shall perform its functions. Nursing Council through competency test would limit the provision of nursing practice kewenagan perform only for nurses who have knowledge dipersyaratakan to practice. System of registration, licensing and certification will reassure the public that nurses who practice nursing has the knowledge required to work according to standards.

Third, nurse has given konstibusi in improving health status. Nurse's role in providing health services ranging from government and private services, from urban to remote rural and frontier. But devotion is in fact not been matched by pemberioan legal protection, and even tend to be the object of the law. Nurses also have the competence scientific, rational attitude, ethical and professional, high spirit of dedication, disciplined, creative, skilful, virtuous, and to uphold professional ethics. In addition, the scope of the law profession has a clear purpose, absolute profession, common interests of various parties (the public, the profession, the government and other stakeholders), a balanced representation, optimization of the profession, flexibility, efficiency and harmony, universal, justice, and equality and suitability interprofesioan (WHO, 2002).

Fourth, the health care needs of the community nursing service in particular is increasing. This is due to the paradigm shift in the delivery of health care, medical model of care that focuses on the diagnosis and treatment of disease, into a more holistic paradigm that healthy look and disease symptoms as information and not as the focus of service (Cohen, 1996). Besides that, people need nursing care that is easily accessible, quality services keperaweatan integrar as part of the health service, and obtain legal certainty to the provision and delivery of nursing services.

CHAPTER III

CLOSING

A. CONCLUSION

The conclusion of the paper that has been discussed in the previous chapter are as follows:

1. Nurses have given a great contribution in improving health status.

2. Health care needs of the community nursing service in particular is increasing.

3. May 12, 2008 is World Nursing Day. In Indonesia, memontum will be used to encourage the various parties ratify the Bill of nursing practice.

4. Indonesian National Nurses Association (PPNI) assuming that the Act would provide legal protection for the public against nursing care and the nursing profession.

5. Indonesia , Laos and Vietnam are three ASEAN countries that do not have Nursing Practice Act. Whereas , Indonesia produce large amounts of nurses.

6. Nurse Indonesia assessed level can not compete globally.

7. Nursing Practice Act, too late for ratification, let alone to question. While ASEAN countries such as Philippines, Thailand, Singapore, Malaysia, already has a Law Practice Nursing (Nursing Practice Acts) since many years ago.

8. The absence of protective legislation for nurses has not been able to nurse fully responsible for the services they do.

9. Konsil keperawatan bertujuan untuk melindungi masyarakat, menentukan siapa yang boleh menjadi anggota komunitas profesi (mekanisme registrasi), menjaga kualitas pelayanan dan memberikan sangsi atas anggota profesi yang melanggar norma profesi (mekanisme pendisiplinan).

10. UU Praktik Perawat, selain mengatur kualifikasi dan kompetensi serta pengakuan profesi perawat, kesejahteraan perawat, juga diharapkan dapat lebih menjamin perlindungan kepada pemberi dan penerima layanan kesehatan di Indonesia .

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