Factors That Influence The Performance Of Emergency Installation Nurses At Bunda Thamrin Medan Hospital in 2018

Nurses as one of health workers in the hospital having an important role in achieving health development goals. The success of health services depends on the participation of nurses to provide high quality care nursing for patients . This research is quantitative and uses cross sectional design. The purpose of this research is to see what factors that can influence the performance of the emergency room in Bunda Thamrin Hospital Medan 2018. This research use total sampling or exhausted sampling and The source data of this research is using questionnaires and then followed by using univariate analysis, bivariate analysis, and multivariate analysis with the SPSS program. The results of this research is that work load (p=0,000), stress of work (p=0,000),competition (p=0,000), incentive (p=0,000),length of working (p=0,000) have influences for performance of nurses. After multivariate analysis the most influential variable is work load (p=0,000. The result showed that there was correlation between work load, stress of work, competition, incentive, length of working has influences against work performances of nurses. Therefore, there is a need to improve nursing service that can be made to improve the performance of nurses with increased knowledge through education nursing sustainable and improving skills nursing is absolutely necessary. The arrangement of a work conducive environment is so important, so that nurses can work effectively and efficiently .Creating a work that could lead to a nurse to do the best.


Introduction
Nurses are one of the professions in hospitals that have an important role in providing health services.(1)Therefore, hospitals where nurses work always make various efforts aimed at improving the quality of nurses' professionalism.Nursing is an integral part of the health service system and is one of the factors that determines the quality of health services.(2) For this reason, it is necessary to pay attention to the performance of nurses in carrying out their duties and functions in providing health services to patients.The public still often complains about the services provided by nurses.The spotlight on nurses' performance is a problem that must be addressed immediately, because nursing services determine the quality of hospital services.Performance is the appearance of the work of personnel in both quantity and quality in an organization.(3)Performance can be an individual performance or the work of a group of personnel.The display of work results is not limited to personnel who hold functional or structural positions, but also to all levels of personnel within the organization.Various factors can influence a nurse's performance.Basically, the level of performance of nurses is influenced by factors within the nurse herself and factors outside the nurse.Factors within nurses include knowledge and skills, competencies appropriate to their work, work motivation and job satisfaction.Meanwhile, factors from outside the nurse, namely workload and leadership style in the organization, play a major role in influencing nurse performance.3 Several factors that influence nurse performance are workload and work stress.b.For Hospitals As input, consideration and attention in improving things that influence the performance of nurses, it can be hoped that from this research the work performance of officers will be better.c.For Academics This research can be used as material or source in studying the science of medical records and health information as well as increasing information insight regarding the matter being researched.Also as information material for future researchers to follow up on the results of this research.

Research methods
The research was carried out with a quantitative research design and a cross sectional approach and was carried out at the Bunda Thamrin General Hospital, Medan.The time of the research was January 2019.The population in this study were 40 nurses at Bunda Thamrin Hospital, Medan, with a large sample size (Total Sampling).The data in this research is primary data with data obtained through questionnaires.Univariate data were analyzed descriptively and bivariate data were analyzed using the Pearson correlation test.Multivariate data were analyzed using linear logistic regression tests.between individual characteristics and workload with nurse performance in the inpatient installation room at RSU Haji Makassar, which stated that there was a relationship between workload and nurse performance.The same research was also conducted by Afandi (2013) at Saras Husada Hospital, Purworejo, which stated that there was a relationship between workload and nurse performance.However, contrary to the results of research conducted by Mudayana (2012), entitled The Relationship between Workload and Employee Performance at Nur Hidayah Hospital Bantul in 2012, it was stated that workload had no effect on employee performance at Nur Hidayah Hospital Bantul.In general, workload is not related to nurse performance, however, hospitals also need to be aware of excessive workload to prevent undesirable things from occurring due to the impact of high workload.

Table14. Correlation of Job Stress with the Performance of Emergency Room Nurses at Bunda Thamrin Hospital, Medan
Variable Pearson correlation (r)

P value
Job Stress -0,753 0,000 Analysis of the relationship between work stress and nurse performance shows a negative r value with a p value of 0.000, meaning that work stress is related to nurse performance.The strength of the relationship between the work stress variable and nurse performance is in the significant category (r= -0.753), meaning that the higher the level of nurse work stress, the nurse performance will decrease.This is also in line with Nopa's research (2016), at Tanjung Pura Langkat Regional Hospital, regarding the Effect of Work Stress on the Performance of Inpatient Room Nurses, where it was found that there was a significant relationship between work stress (variable physical symptoms, psychological symptoms and behavioral symptoms) and performance.
inpatient room nurses and have a significant influence with a negative correlation value.
Likewise with the results of research conducted by (Nainggolan, 2017) Spearman rho correlation, p value = 0.0001 and r = -0.932,shows a negative correlation value and has a significant relationship between work stress and the performance of nurses at RSU Bina Kasih Medan.

Table15. Correlation of Competency with the Performance of Emergency Room Nurses at Bunda Thamrin Hospital, Medan Variable Pearson correlation (r) P value
Kompetensi 0,484 0,000 Analysis of the relationship between competency and nurse performance shows a positive r value with a p value of 0.000, meaning that competency is related to nurse performance.The strength of the relationship between the competency variable and nurse performance is in the significant category (r= 0.484), meaning that the higher the nurse's competency, the better the nurse's performance will be.This is in line with research conducted by Sayuni (2012) where it was found that competency influences the performance of implementing nurses.Likewise, with the results of Sitepu's research (2010), there is a significant influence between competence (attitudes and skills) on nurse performance.The most dominant variable influencing nurse performance is skill.H However, in contrast to the results of research conducted by Mandagi, et al (2015) with probability research results (significance) greater than 0.05 (0.409>0.05),H1 was rejected or there was no relationship between nurse competency and nurse performance.

Table16. Correlation of Incentives with the Performance of Emergency Room Nurses at Bunda Thamrin Hospital, Medan Variable Pearson correlation (r) P value
Incentive 0,412 0,000 Analysis of the relationship between incentives and nurse performance shows a positive r value with a p value of 0.000, meaning that incentives are related to nurse performance.The strength of the relationship between the incentive variable and nurse performance is in the significant category (r= 0.412), meaning that the higher the incentives given to nurses, the better the nurse's performance will be.The results of this research are also in accordance with research conducted by Renyaan (2016) on the Relationship Between Incentives, Motivation, Supervision and Nurse Performance in the Inpatient Room of the Regional General Hospital of Sorong Regency, West Papua, stating that there is a significant relationship between incentives and nurse performance in Inpatient Room at the Regional General Hospital of Sorong Regency, West Papua.Shove with a value of 0.048 and p value> 0.05.Correlation Analysis between work periods with nurse performance show a positive r value with a p value of 0.000, meaning that length of service is related to nurse performance.The strength of the relationship between the work period variable and nurse performance is in the significant category (r= 0.412), meaning that the longer a nurse's work period, the better the performance will be.The results of this research are in line with research conducted by Kumajas (2014) with the results obtained with a p value of 0.000, which means that Ho is rejected so it can be concluded that there is a relationship between length of service and the performance of nurses at Bhayangkara TKIII Hospital, Manado.(5)However, this is not in line with research conducted by Palar, et al (2018) with statistical test results using Chi-square with an error rate of 0.06, obtaining a p value of 0.536.This means that Ho is accepted so that there is no relationship between the periods work with the performance of nurses at Bhayangkara TKIII Manado Hospital.(6)Conclusion a.The results of the study showed that the majority of nurses were women, aged 30-40 years, had a DIII degree in nursing, income <2,700,000, not married and had worked <5 years.b.There is a correlation between workload and nurse performance with rworkload = -0.804and p value = 0.000.This means that the higher the nurse's workload, the more it will affect the nurse's performance.c.There is a correlation between work stress and nurse performance with r, work stress = -0.753and p value = 0.000.This means that the higher the level of work stress of nurses, the more it will affect nurse performance.d.There is a correlation between competency and nurse performance with rcompetence = 0.484, and p value = 0.000, meaning that the higher the nurse's competency, the better the nurse's performance.e.There is a correlation between incentives and nurse performance with rinse incentive = 0.412 and p value = 0.000, meaning that with incentives given to nurses, nurse performance will be better.f.There is a correlation between work experience and nurse performance with r work period = 0.401 and p value = 0.000, meaning that the higher the nurse's work experience, the more satisfactory the nurse's performance will be.g.Of all the variables, the workload variable is the variable that has the most influence on nurse performance with an F value = 0.403 (F> 0.005) with a 2-tailed sign = 0.001 (P value <0.005).So it can be concluded that workload has a significant influence on nurse performance.

Recommendation a. For nursing education
It is hoped that the results of this research can provide additional information and input for nursing education, especially nursing management, so that material emphasis needs to be placed on the factors that influence the performance of nurses in hospitals.b.For nursing services From the research results, it was found that workload was one of the factors that had the most influence on nurse performance.It is hoped that this research can be an input for hospitals in considering the needs of nurses so that nurse performance becomes better, especially in service units.c.For further nursing research This research can be used as a basis for developing further research regarding factors that influence nurses' workload.For further research, this phenomenon needs to be researched again because this phenomenon has been widely studied but there is no significant solution to reduce the factors that influence nurse performance by using a larger number of respondents to obtain data variations.Bibliography (4) Special purpose a.To analyze the effect of workload on nurse performance http://ejournal.urindo.ac.id/index.php/JournalOfAgeingAndFamily/indexb.To analyze the effect of work stress on nurse performance c.To analyze the influence of competency on nurse performance d.To analyze the effect of incentives on nurse performance e.To analyze the effect of work experience on nurse performance f.To analyze the factors that most influence nurse performance Benefits of research a.For Researchers It is hoped that the results of this research can develop insight and knowledge about the factors that influence the performance of nurses in the emergency installation at Bunda Thamrin Hospital, Medan City in 2018. /ejournal.urindo.ac.id/index.php/JournalOfAgeingAndFamily/index

Table 5 . Distribution of Respondents Based on Marriage Test No Marriage
Based on the table above, the distribution of respondents based on marital status is dominated by unmarried people, numbering 22 people (55%) while those who are married are 18 people (45%).

Table 6 . Distribution of Respondents Based on Length of Work No Length of
Based on the table above, the distribution of respondents based on length of work is dominated by those working <5 years, amounting to 29 people (72.5%) while those working for 5-10 years are 11 people (27.5%).

Correlation of Workload with the Performance of Emergency Room Nurses at Bunda Thamrin Hospital, Medan Variable Pearson correlation (r) P value
http://ejournal.urindo.ac.id/index.php/JournalOfAgeingAndFamily/index