Optimizing the Implementation of a Tiered Nursing Supervision System to Improve Service Quality in the Hospital Emergency Department

Abstract

Nursing supervision is an essential directing and controlling function in maintaining nursing care quality, yet it had never been implemented in the Emergency Department (ED) of Rumah Sakit Ketergantungan Obat (RSKO) Jakarta, a national referral hospital for substance use disorders. This activity aimed to optimize the implementation of a tiered nursing supervision system in the unit. It was conducted from 24 August to 15 September 2026. The implementation method followed the planning stage (developing clinical and managerial supervision instruments), organizing (role allocation), staffing (socialization with pre-test and post-test), actuating (real supervision trials), and controlling (documentation and evaluation), targeting the Head Nurse, 1 Team Leader, and 8 staff nurses. Evaluation used the four-level Kirkpatrick model. Results showed an increase in participants’ understanding after socialization, from an average of 64% to 84.8% (post-test score range 72.7% to 90.9%). The managerial supervision trial achieved 100% (Very Good category) in a single observation, while clinical supervision of 8 staff nurses averaged 89% (Good category), with gaps in withdrawal scale assessment, crisis management skills, the 6 Rights of medication administration (50%), and infection prevention, occupational safety, and documentation. This activity indicates that a tiered supervision system can be run in the unit and may serve as an early detection mechanism for nurse competency gaps. These results can serve as a basis for establishing supervision as formal unit policy, accompanied by continuous training that addresses the identified gaps and periodic evaluation of supervision.