INTRODUCTION
Health Human Resources are health workers who are
involved, work and devote themselves to various kinds of health efforts and
management. Nursing services are a form of health services where in this case
nurses are one of the health workers who play a role in providing nursing care
according to their authority and scientific field which is carried out
independently or in collaboration with other members of the health workforce (Sesrianty et al., 2019).
Human resources that have a relatively large proportion,
the most presence in hospitals, as well as having the longest time in terms of
interacting with clients are nurses. Nursing services are the center of
attention in every hospital because this service is a basic activity that can
be a benchmark for assessment of health services in hospitals, especially in
inpatient rooms (Kurniati & Efendi,
2012).
Performance is the achievement of a person's achievements
in an organization that are influenced by individual, organizational, and
psychological factors (Panjaitan, 2018). Employee performance is influenced by 3
variables, namely the individual variable (I), the organizational variable (O),
and the psychological variable (P). Nurse performance can be influenced by a
variety of factors, namely individual variables that include abilities and
skills, background, and demographics; organizational variables that include
resources, leadership, rewards, structure, and job design; and psychological
variables that include perception, attitude, personality, learning and
motivation.
The performance of the nurse can be seen in accordance
with part of the nurse's function as a provider of nursing care services (Syafawani, 2020). Good performance is the first step in
achieving the company's goals. Substandard nurse performance can be caused by
several factors such as poor nurse skills, lack of work motivation possessed by
nurses, to factors of poor work atmosphere that affect the performance of the nurse
concerned (Perceka, 2018). Therefore, it is necessary to make efforts to
improve the performance of nurses, although this is not easy because of many
influencing factors, one of which is the performance appraisal itself.
Performance appraisal is a process by which a company or
institution evaluates or assesses the performance of its nurses. Nurse
performance assessment is a measurement of the efficiency, competence and effectiveness
of the nursing process and activities carried out by nurses in caring for
patients to maintain, improve and motivate nurse behavior (Zulkarnaen, 2018). Assessment of nurse performance is carried out
to determine nurse satisfaction and to improve the implementation of nurse
work, inform nurses that the nursing care provided to patients is not
satisfactory, as well as to promote positions, raise salaries, improve
communication between superiors and subordinates and determine the training
required by nurses who are judged to need special guidance.
A nurse is a person who receives a special education and
is assigned to provide nursing care. The discipline of nurses in their work as
a provider of nursing care is very important for nurses and other health
workers in order to achieve the goals of health institutions, prevention of
complaints, healing and recovery of patients from diseases/ accidents (Hardin & Silmi, 2021). The work discipline of the nurse exerts a
noticeable influence on the results of work. If work discipline is not
improved, it will directly have an impact on reducing the performance of the
driver so that the ultimate goal of the company is not achieved.
Bali Mandara Regional General
Hospital is a type B regional general hospital that has been part of the UPTD
of the Bali Provincial Health Office since the establishment of the Decree of
the Governor of Bali Number 115 of 2016 dated December 28, 2016 concerning the
Establishment of Organizational Structure and Work Procedures. Bali Mandara Regional General Hospital was established to
provide services to the wider community with the vision of "Becoming a
Quality Hospital By Prioritizing Service, Education
and Research Towards a World-Class Hospital in 2025". Based on the Decree
of the Governor of Bali, in its financial management, Bali Mandara
Hospital has become a Regional Public Service Agency since January 1, 2018.
Performance measurement is carried out against the
established Key Performance Indicators (IKU). The achievement of indicators
based on the Work Plan at Bali Mandara Hospital, Bali
Province in 2021 in the Fulfillment of Individual Health Efforts and Public
Health Efforts with performance indicators of the Service Percentage program
that meets the Standard Operating Procedures (SPO) at the UPTD of Bali Mandara Hospital is targeted to reach 100% and its
realization reaches 85.45%.
Based on the annual profile of Bali Mandara
Hospital in 2020, the provision of salaries and benefits for health workers
that are paid is targeted at 100%, and those that have been successfully
achieved are 98.48%. As for the target in 2021 of 90% and achieved by 87.07%. Compensation is all income in
the form of money, direct or indirect goods that the employee receives in
exchange for services provided to the company (Gibson et al., 2008). Service services
are the provision of additional money outside of salaries carried out by the
institution in recognition of employee contributions and work achievements
shown by employees to the institution. The purpose of providing services is to
provide motivation to all employees to improve the quality and quantity of
their work.
Another important factor in nurse
performance is work engagement which is a positive passion and a sense of
fulfillment at work where an individual has vigor, dedication, and passion
(absorption) at work. The characteristic of a worker who has work engagement is
that the individual feels compelled to strive to continue to advance to achieve
challenging goals, and always wants success (Bakker & Leiter, 2010). In addition, work engagement also reflects the
energy of workers brought to their work.
Based on the results of a preliminary study conducted
through interviews and observations of several inpatient room nurses at Bali Mandara Hospital, data was obtained by most nurses
revealing that they were not satisfied with the payment system for medical
services provided by the hospital. The services provided are not in accordance
with work risks, workloads and responsibilities for work.
In addition, there are also several things that indicate
that the nurse's work engagement is still lacking, such as when working less
excited, delaying work, chatting some things outside of work, lack of
enthusiasm in completing work, not happy in providing services and some rushing
home before returning home. These things can have an impact on the performance
of nurses in a hospital.
Based on these problems, researchers are interested in
conducting research on the Analysis of the Relationship between Service
Delivery and Work Engagement on the Performance of Inpatient Room Nurses at
Bali Mandara Hospital in 2022.
METHOD
This study used an observational design with a cross-sectional
approach method (Creswell & Poth, 2016). In
this study, variable measurements were carried out at one time that had been
determined by researchers which aimed to analyze the effect of service delivery
and work engagement as free variables on
the performance of inpatient room nurses as dependent variables.
The population in this study was inpatient room nurses at
Bali Mandara Hospital, which amounted to 268 people.
The sampling technique used is probability sampling with proportionate
stratified random sampling technique.
The number of samples that met the inclusion criteria and exclusion
criteria was 241 people. The variables used in this study are service delivery and
work engagement as free
variables. The bound variable in this study was the performance of inpatient
room nurses.
Bivariate analysis was carried out to analyze the
relationship between service delivery and work engagement variables with nurse
performance variables using the Chi
Square test. Multivariate
analysis aims to look at the relationship of independent variables with
dependent variables controlled with role variables. The statistical test used
is the Multiple Logistic Regression multivariate test.
Based
on the description above, the hypothesis is compiled as follows:
H1: There is a relationship between the provision of
services and the performance of inpatient room nurses at Bali Mandara Hospital in 2022.
H2: There is a relationship between work engagement and
the performance of inpatient room nurses at Bali Mandara
Hospital in 2022.
RESULTS
AND DISCUSSION
A. Characteristics of Respondents
Table 1
Respondents’
Characteristics
|
No.
|
Characteristic
|
Frequency
|
Percentage
|
|
1
|
Age
|
|
|
|
< 25 years
|
65
|
27,0
|
|
25 - 30 years
|
96
|
39,8
|
|
31 - 35 years old
|
58
|
24,1
|
|
36 - 40 years old
|
20
|
8,3
|
|
41 - 45 years old
|
2
|
0,8
|
|
2
|
Gender
|
|
|
|
Man
|
71
|
29,5
|
|
Woman
|
170
|
70,5
|
|
3
|
Education Level
|
|
|
|
Ners
|
111
|
46,1
|
|
Diploma IV
|
1
|
0,4
|
|
Diploma III
|
129
|
53,3
|
|
4
|
Employment Status
|
|
|
|
Civil servants
|
94
|
39,0
|
|
CPNS
|
23
|
9,5
|
|
Non PNS
|
124
|
51,5
|
|
5
|
Length of service life
|
|
|
|
< 1 year
|
23
|
9,5
|
|
1 year
|
23
|
9,5
|
|
2 years
|
53
|
22,0
|
|
3 years
|
70
|
29,0
|
|
> 3 years
|
72
|
29,9
|
B.
Nurse Performance Based
on Work Quality and Discipline Indicators
Table
2
Nurse Performance Based on Work Quality Indicators
|
No
|
Quality of Work
|
Frequency
|
Percentage
|
|
1
|
Good
|
222
|
92,1
|
|
2
|
Not Good Enough
|
19
|
7,9
|
The quality of work of
inpatient room nurses at Bali Mandara Hospital can
already be declared Good. This is shown by the dominance of the Good work
quality statement which amounted to 222 people or reached 92.1 percent.
Respondents with poor work quality were 19 people or 7.9 percent.
Table
3
Nurse Performance Based on Discipline Indicators
|
No
|
Discipline
|
Frequency
|
Percentage
|
|
1
|
Discipline
|
195
|
80,9
|
|
2
|
Lack of Discipline
|
46
|
19,1
|
The
discipline of inpatient room nurses at Bali Mandara
Hospital can already be declared Discipline. This is shown by the dominance of
the Discipline which amounts to 195 people or reaches 80.9 percent. Respondents
who were declared Lacking in Discipline were 46 people or 19.1 percent.
Table 4
The Relationship of
Service Delivery to Performance Based on the Quality of Work of Inpatient Room
Nurses
|
No
|
Service Delivery
|
Quality of
Nursing Work
|
|
Not Good Enough
(n = 19)
|
Good
(n = 222)
|
Total
(n = 241)
|
P-value
|
|
n
|
%
|
n
|
%
|
n
|
%
|
|
1.
|
Fairness
Indicators
|
0,002
|
|
Unfair
|
14
|
14,6
|
82
|
85,4
|
96
|
39,4
|
|
Fair
|
5
|
3,4
|
140
|
96,6
|
145
|
100
|
|
2.
|
Decent and Reasonable
Indicators
|
0,091
|
|
Unworthy
and Reasonable
|
6
|
5,0
|
115
|
95,0
|
120
|
49,8
|
|
Feasible and Reasonable
|
19
|
7,9
|
222
|
92,1
|
121
|
50,2
|
|
3.
|
Punctuality
Indicators
|
0,021
|
|
Not on Time
|
9
|
14,8
|
52
|
85,2
|
61
|
26,6
|
|
On
time
|
10
|
5,6
|
170
|
94,4
|
180
|
73,4
|
Based on table 4 above,
showing the results of the analysis of the relationship between service
delivery and the quality of nurses' work there is a significant relationship.
This is indicated by a p-value
that is smaller than the error rate set in this study (α = 0.05).
Table
5
The Relationship of Service Delivery to Performance Based
on the Discipline of Inpatient Room Nurses
|
No
|
Service Delivery
|
Discipline
|
|
Lack of Discipline
(n =46)
|
Discipline
(n = 195)
|
Total
(n = 241)
|
P-value
|
|
n
|
%
|
N
|
%
|
n
|
%
|
|
1.
|
Fairness Indicators
|
0,002
|
|
Unfair
|
18
|
18,8
|
78
|
81,3
|
96
|
39,8
|
|
Fair
|
28
|
19,3
|
117
|
80,7
|
145
|
60,2
|
|
2.
|
Decent and Reasonable
Indicators
|
0,002
|
|
Unworthy and Reasonable
|
28
|
23,3
|
92
|
76,7
|
120
|
49,8
|
|
Feasible and Reasonable
|
18
|
19,9
|
103
|
85,1
|
121
|
50,2
|
|
3.
|
Punctuality Indicators
|
0,003
|
|
Not on Time
|
13
|
21,3
|
48
|
78,7
|
61
|
25,3
|
|
On time
|
33
|
18,3
|
147
|
81,7
|
180
|
74,7
|
Based on table 5 above, it shows that the results of the
analysis of the relationship between service delivery and nurse discipline have
a significant relationship. This is indicated by a p-value that is smaller than the error rate set in this study (α
= 0.05).
Table 6
The Relationship of Work Engagement to Performance
Based on the Quality of Work of Inpatient Room Nurses at Bali Mandara Hospital in 2022
|
No
|
Work Engagement
|
Quality of Nursing Work
|
|
Bad
(n = 28)
|
Good
(n = 213)
|
Total
(n = 241)
|
P-value
|
|
n
|
%
|
n
|
%
|
n
|
%
|
|
1.
|
Vigor
Aspect (Spirit)
|
0,004
|
|
Weak
|
24
|
85,7
|
20
|
9,4
|
54
|
22,4
|
|
Strong
|
4
|
14,3
|
193
|
90,6
|
187
|
77,6
|
|
2.
|
Dedication Aspect
|
0,003
|
|
Less Dedicated
|
25
|
89,3
|
21
|
9,9
|
47
|
19,1
|
|
Dedicated
|
3
|
10,7
|
192
|
90,1
|
194
|
80,9
|
|
3.
|
Absorption Aspects
|
0,001
|
|
Lack of Perseverance
|
23
|
82,1
|
25
|
11,7
|
97
|
19,9
|
|
Diligent
|
5
|
17,9
|
188
|
88,3
|
144
|
80,1
|
Based on table 6 above, showing the results of the
analysis of the relationship between work engagement and the quality of nurses' work there is a
significant relationship. This is indicated by a p-value smaller than the error rate set in this study (α =
0.05).
Table 7
The Relationship of Work
Engagement to Performance Based on Nurse Discipline
|
No
|
Work Engagement
|
Discipline
|
|
Undisciplined (n=19)
|
Discipline
(n = 222)
|
Total (n = 241)
|
P-value
|
|
n
|
%
|
n
|
%
|
n
|
%
|
|
1.
|
Vigor
Aspect (Spirit)
|
0,001
|
|
Weak
|
10
|
18,5
|
44
|
81,5
|
54
|
22,4
|
|
Strong
|
9
|
4,8
|
178
|
95,2
|
187
|
77,6
|
|
2.
|
Dedication Aspect
|
0,000
|
|
Less Dedicated
|
1
|
2,1
|
46
|
97,9
|
47
|
19,1
|
|
Dedicated
|
18
|
9,3
|
176
|
90,7
|
194
|
80,9
|
|
3.
|
Absorption Aspects
|
0,000
|
|
Lack of Perseverance
|
10
|
10,3
|
37
|
89,7
|
97
|
19,9
|
|
Diligent
|
18
|
9,3
|
176
|
90,7
|
144
|
80,1
|
Based on table 7 above, showing the results of the
analysis of the relationship between work
engagement and nurse discipline there is a significant relationship.
This is indicated by a p-value
smaller than the error rate set in this study (α = 0.05).
The statistical analysis used is a multiple logistic
regression test, with hypothesis test results obtained from each research
variable as follows:
1. There was a positive and significant influence between
service delivery on the performance of inpatient room nurses with a significance
value of 0.001 which means it is smaller than the error rate in this study (α =
0.005).
2. There was a positive and significant influence between work engagement on the performance of
inpatient room nurses with a significance value of 0.000 which means it was
smaller than the error rate in this study (α = 0.005).
Thus, it can be concluded that there is a
relationship between service delivery and work engagement to the performance of inpatient room nurses at
Bali Mandara Hospital in 2022.
DISCUSSION
H1: The Effect of Service Delivery on the Performance of
Inpatient Room Nurses
The results of the
analysis test on the variables of service delivery on nurse performance showed
that there was a positive and significant influence between service delivery
and nurse performance.
(Gibson et al., 2008) states that employee performance is influenced
by individual variables, organizational variables, and psychological variables.
Organizational variables include resources, leadership, rewards or
compensation, structure, and job design.
(Hasibuan, 2014) states that the
award of compensation must be determined on the principle of fairness and
decency and with due regard to applicable laws and regulations. The amount of
services paid to each employee must be fair and adjusted to work performance,
type of work, job risk, responsibilities, worker position and meet consistency
requirements.
Eligibility
in providing compensation means comparing the amount of service with other
companies engaged in similar business fields. If the service in the company
concerned is lower than other companies, then the company/ agency will get
problems, namely in the form of a decrease in employee performance which can be
known from various forms due to employee dissatisfaction with the service.
The principle of
compensation is according to the fact that (Hasibuan, 2014) compensation must be paid on time and do not
cause delays, so that employee confidence in the company's bona fide, calmness,
and concentration of work will be better. Companies must understand that
repayment will be used by employees and their families to meet their needs,
where those needs cannot be delayed.
The results of this study are in line with (Tambunan & Aulia, 2019)
research which states that the principle
of fairness in the provision of medical services
is a variable that affects the performance of
nurses. Similarly, the study (Risma, 2020)
found that the service and compensation variables had a positive and significant effect
on the performance of Public Health Center employees.
This means that health care institutions that have
employees in this case are nurses who feel that the provision of services is
fair, feasible and reasonable, and on time will have a higher level of
performance than nurses who feel unfair, unfit and reasonable, and not timely
in providing services. So that the provision of services will affect the
performance of a nurse, in this case related to the nurse of the inpatient room
at Bali Mandara Hospital.
H2: The Effect
of Work Engagement on
the Performance of Inpatient Room Nurses
The results of the
analysis test on the work engagement variable on nurse performance showed that
there was a positive and significant influence between work engagement and nurse performance.
The results of this study
are in line with the theory put forward by (Schaufeli & Bakker,
2010), that vigor (spirit) is a strong outpouring of
energy and mentality during work, the courage to try your best in completing a
job and perseverance in facing work difficulties.
Dedication
as one aspect of work engagement means
feeling very strongly involved in a job and experiencing a sense of
meaningfulness (significance), enthusiasm, inspiration, pride, and challenge.
High dedication is related to the way employees work which is able to cause
enthusiasm and challenges in completing their job duties.
Absorption is also one of the important aspects that
represents Work Engagement. In working,
workers are always full of concentration and serious about a job so that
workers will feel that time seems to pass so quickly and find difficulties in
separating themselves from work.
The results of this study are in line with the research
conducted by (Manalu et al., 2021)
the results that moral distress and
work engagement have a
significant effect on nurse performance. In line with research (Manalu et al., 2021)
that shows that work engagement has a positive and significant influence on
employee performance.
The quality of nurses' work can be viewed from the
aspects of passion, dedication, and passion. Based on the
results of the study, it was found that these three aspects have been fulfilled
at the Bali Mandara Regional Hospital. Through these
results, it can be seen that good nurse performance will increase morale, dedication,
and involvement in their work so as to improve the quality of work.
CONCLUSION
From
this study, the following conclusions were obtained; (1) the description of the
provision of inpatient nurse services at Bali Mandara
Regional General Hospital is classified as Fair, Decent and Reasonable, and
Timely, (2) the picture of the work engagement of inpatient room nurses at Bali Mandara Hospital is good in terms of vigor aspects,
dedication aspects, and passion aspects, (3) the performance of inpatient room
nurses at Bali Mandara Regional General Hospital has
been good in terms of work quality indicators and discipline indicators, (4)
there is a significant relationship between the provision of services and the
quality of work of inpatient nurses at Bali Mandara
Regional General Hospital, and (5) there is a significant relationship of work
engagement to the quality of work of inpatient nurses at Bali Mandara Regional General Hospital
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THE
RELATIONSHIP BETWEEN SERVICE DELIVERY AND WORK ENGAGEMENT ON NURSE PERFORMANCE
AT BALI MANDARA HOSPITAL 2022