Functional Factors Related to Nursing Performance in Inpatient Installation

. Nurses have a major role to play in providing timely, quality health services in hospitals. As nursing performance is directly related to patient outcomes in the inpatient installation, identifying factors related to nursing performance at various levels could contribute to improving those outcomes. Method: A cross-sectional descriptive design was employed with a convenience sample of 59 nurses having worked at least 6 months in the inpatient installation. Data collected using a questionnaire filled out by the employees themselves and data were analyzed univariately through frequency distribution table and bivariate analysis with chi-square test. The results of the study indicated that nurses have rated the following as below average: Motivation (β=0.036, P<0.01), competency (β=0.792, P<0.01), supervision (β=0.058, P<0.05), and workload (β=0.019, P<0.01) have significant effect on nursing performance. Conclusion: This study highlighted that motivation, supervision, and workload were significant predictors of nursing performance. Hospital organization should give more attention to factors that contribute to organizational commitments to improve nursing performance.


Introduction
The hospital is an institution or health service organization with broad and comprehensive functions, expert-intensive and capital-intensive. Hospitals carry out broad functions so they must have resources, both capital and experienced and professional humans.
Nurses are one of the health workers in hospitals with nursing services. Nursing services include professional services from the type of health services available 24 hours continuously during the client's care period. The nursing profession has an important role in providing quality health services in hospitals, because the types of services they provide are biological, psychological, social, spiritual and carried out in a sustainable manner (Annonim, 2004).
According to Gibson (1990), individual nurse performance is influenced by 3 variables, namely individual variables, organizational variables and psychological variables. Individual variables, consisting of abilities, skills, knowledge, demographics and family background. Psychological variables consist of perception, attitude, motivation, personality and learning. Organizational variables consist of resources, rewards, workload, structure, supervision and leadership. Nurses' clinical performance is influenced by internal and external factors, internal factors are the skills and motivation of nurses, while external factors are supervision, leadership style and monitoring (Hasmoko, 2008).
In a study conducted by Yuliastuti (2007) it was found that the lack of training obtained by nurses made them not optimal in providing services to patients. In line with that, research conducted by Qalbia (2013) found a relationship between motivation and supervision on the performance of nurses. In a study conducted by Mukti (2013) at Woodward Hospital Palu, it was found that the good or bad performance of nurses in documenting complete nursing care, can be influenced by motivation, leadership and reward factors. Based on the results of research reported by Anwar (2012) about the relationship of knowledge, motivation and supervision with the performance of nurses at Dr. RSUP. Wahidin Sudirohusodo showed that there was a significant relationship between knowledge, motivation and supervision with nurse performance.

Research method
A cross-sectional descriptive design was employed with a convenience sample of 59 nurses having worked at least 6 months in an the inpatient installation. Data collected using a questionnaire filled out by the employees themselves and data were analyzed univariately through frequency distribution table and bivariate analysis with chi-square test. The data shows that the majority of respondents are female, as many as 54 people (91.5%), while men are 5 people (8.5%). The data shows that the majority of respondents aged 30-39 are 22 people (40.7) while 50-59 years are 3 people (5.1%). The data shows that the majority of respondents have SKep education, namely 21 people (35.6%) while Ns is 8 people (13.6%). The data shows that the majority of respondents have a working period of 1-9 years . The data shows that the majority of respondents are married, namely 44 people (74.6%) while 15 people are unmarried (25.4%).

Serum The Relationship Between Motivation And Nurse Performance
Based on the results of the Chi-Square test analysis, the results obtained with a value of p = 0.036 <0.05 which indicates that there is a significant relationship between motivation and performance. Sigit (2003) says, there are four approaches to performance appraisal, namely the trait approach , the behavioral approach , the result approach and the contingency approach . The contingency approach does not have specific criteria for assessing performance, but states that each approach can be used depending on the situation, so there is no absolute criteria for an assessment approach.
Zulviliansah's research (2011) aims to determine the level of work competence, work motivation, job satisfaction, and employee performance, as well as to determine whether there is an influence of work competence, work motivation, and job satisfaction on the performance of administrative employees with civil servant status in the UPI Bumi Siliwangi Campus. Based on the results of the study, it can be concluded that work motivation has a positive and significant effect on employee performance .
Theoretically, to achieve the goals of an organization (hospital) it is necessary to have a motivation so that employees are able to work well, and one of the motivations is to fulfill the wishes of the staff, including: good salary or wages, safe work, good atmosphere. conducive work, appreciation for the work done, fair and wise leadership, reasonable directions and orders, organizations or workplaces that are appreciated by the community or by seeking incentives that are proportional in size and also progressive which means that they are in accordance with career paths, because incentives are very needed to spur the performance of employees so that they are always at the highest (optimal) level according to their respective abilities.

Relationship Between Competence And Nurse Performance
Based on the results of the Chi-Square test analysis, the results obtained with a value of p = 0.792 > 0.05, which indicates that there is no significant relationship between competence and performance. Theoretically, the etymological meaning of competence is defined as the ability needed to do or carry out work based on knowledge, skills and work attitudes, so it can be formulated that competence is defined as a person's ability that can be observed covering knowledge, skills and work attitudes in completing a job. or task according to established performance standards. The results of this study are also supported by Priasmara (2013) who examines the relationship between employee competence and employee performance at the Office of the Regional Personnel Agency, Tana Tidung Regency. The results of his research stated that employee performance was influenced by employee competence.
Adiputri (2014) examined the relationship between competence, financial compensation and supervision with the performance of village midwives in Bangli Regency. The results showed that the competence of village midwives in Bangli Regency was mostly in the poor category. There is a significant relationship between competence and the performance of village midwives in Bangli Regency. Zulviliansah (2011) conducted a study to determine the level of work competence, work motivation, job satisfaction, and employee performance, as well as to determine whether there is an effect of work competence, work motivation, and job satisfaction on the performance of administrative employees with civil servant status in the UPI Bumi Siliwangi Campus. Based on the results of the study, it can be concluded that work competence has a positive and significant effect on employee performance. Competence is the level of a person's ability to complete tasks based on the level of knowledge, attitudes and skills.

Relationship between supervision and nurse performance
Based on the results of the Chi-Square test analysis, the results obtained with p value = 0, 058 > 0.05 which indicates that there is no significant relationship between supervision and performance. Adipurri (2014) examined the relationship between competence, financial compensation and supervision with the performance of village midwives in Bangli Regency and found that good supervision was more likely to have good performance (31.1%) while respondents with poor supervision were more likely to have poor performance. (46.4 %). Implementers or those responsible for carrying out supervision are superiors, namely those who have advantages in the organization. The advantages referred to here are often associated with higher status, but for the success of supervision, the priority is the excess in knowledge and skills (Hamid, 2000).
Because supervision pays attention to implementers, it is necessary to pay attention to the scope of work and the conditions of good cooperation, the leadership must try as much as possible to create comfortable working conditions which include a harmonious physical environment and working atmosphere among nursing staff and other personnel. Also includes the amount of supplies and equipment that are adequate or suitable for use to facilitate the implementation of tasks. A healthy environment is one that can provide a sense of freedom and the desire to be able to work well. Leaders must create a spirit of togetherness among employees by paying more attention to planning, implementing and supervising the work of implementers.
Although supervisors pay attention to work conditions and results, the main concern is people. Leaders must know each individual and be able to stimulate each implementer to want to improve themselves. One of the main objectives of supervision is orientation, training and individual guidance based on individual needs and leads to the utilization of abilities and the development of new skills. Leaders must provide explanations in the form of directives to implementers.

Relationship Between Workload And Nurse Performance
Based on the results of the Chi-Square test analysis, the results obtained with a value of p = 0.019 < 0.05 which indicates that there is a significant relationship between workload and performance. Artadi (2015) examined the effect of job satisfaction and workload on employee performance at PT. Merapi Agung Lestari. The results showed that the workload had a positive effect on the performance of the employees of PT. Merapi Agung Lestari with a value (β) of 0.427 (p<0.01; p=0.000), In the researcher's interview with several nurses, there were still some nurses who were burdened with multiple tasks due to limited resources, so that many nurses still held concurrent positions and duties. The number of tasks and responsibilities given to nurses causes the results achieved to be less than optimal because nurses only have little time to complete many tasks.
The workload of nurses needs to be considered so that there is no overwork that can cause stress and result in decreased nurse performance. Although this does not have a direct effect, it can cause stress which results in nurse performance. High workloads can cause stress that affects performance.
To overcome the dual work of nurses , previously the RSU management carried out a job analysis so that the workload received was not too excessive with the addition of the workload so that nurses could work optimally. Although some nurses are temporary employees, this is not a serious problem for the hospital. Instead, this is used as a strategy to improve hospital performance with good human resource management. Management must also be aware of this if they do not have a supply of nurses . The existence of a hospital development process makes the nurse 's workload increase because employees are required to bring out all their potential. The increasing workload makes the performance appraisal carried out by the management very important because it is related to work performance and the amount of incentives that will be received by nurses .
According to information, the evaluation carried out by the RSU management has not been carried out routinely and periodically as well as an obstacle to measuring the level of implementation of the job description, because the evaluation has so far been limited to incidental according to management needs, while the nurse 's performance assessment is currently only used for the provision of salaries and amounts. incentives to be received.

Conclusion
The results of the study indicated that nurses have rated the following as below average: Motivation (β=0.036, P<0.01), competency (β=0.792, P<0.01), supervision (β=0.058, P<0.05), and workload (β=0.019, P<0.01) have significant effect on nursing performance. Conclusion: This study highlighted that motivation, supervision, and workload were significant predictors of nursing performance. Hospital organization should give more attention to factors that contribute to organizational commitments to improve nursing performance.