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Factors Affecting Nurse Performance in Medical Ward

Article  in  Indian Journal of Public Health Research and Development · March 2020

DOI: 10.37506/v10/i12/2019/ijphrd/192092

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 Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03  1479

Factors Affecting Nurse Performance in Medical Ward

Desy Puspa Sari1, Bayu Saputera2, Muhammad Saleh2,

Qomariyatus Sholihah3, Ibrahim Daud4
1
Resbaharti Clinic, Tanah Bumbu, South Borneo, Indonesia; 2Dr. H. Andi Abdurrahman Noor General Hospital,
Tanah Bumbu, South Borneo, Indonesia; 3 Faculty of Engineering, Brawijaya University, Malang City, East Java,
Indonesia; 4Graduate Programs, Indonesian School of Economics,Banjarmasin, South Borneo, Indonesia.

Abstract
Context: Nurses are the world’s fastest-growing professions. The number of registered nurses increases
every year. Nurse performance becomes the determinant of a hospital’s accountability. Factors affecting
performance were divided based on their perspectives: individual differences, situational, and regulation.
This research was analytic descriptive study with cross-sectional approach. The study was conducted in
dr. H. Andi Abdurrahman Noor General Hospital, Indonesia from September to October 2017. The sample
consisted of 24 nurses in the medical ward. An open-ended structured questionnaire was used as an instrument
of data collection. Design the questionnaire based on observations of the literature that has been presented.
Data were analyzed using a cumulative percentage system and presented in tables. Some respondents were
dissatisfied with his personal appearance. This was influenced by eleven factors, with the most important
factors were overwork, lack of facilities, and inability to control stress. From a situational perspective,
some factorsaffecting nurse performance were workload (83.3%), facilities (66.7%), cooperation (29.1%),
and work environment (12.5%). Supervision (45.8), salaries (37.5%), service fee (45.8%), and rewards
(12.5%) were grouped according to the regulation perspective. While the ability (54.1%), skills (12.5%), and
motivation (8.3%) had an individual impact.

Keywords:  Factor, hospital management, nurse, performance.

Introduction
Nurses are the world’s fastest-growing professions.
The number of registered nurses increases every year.
In 2003, there were 2,449,000s and became 2,888,000s
in 2014 (18 percent increase).1 In Indonesia, nurses
are the largest health professions (compared to general
practitioners, specialists, midwives, pharmacists and
dentists) with 296,876 members (49%) in 2016. The
national nurses ratio is 113.40 per 100,000 population
Correspondence:
Bayu Saputera
Dr. H. Andi Abdurrahman Noor General Hospital, H.
M. Amin Street, Sepunggur, Tanah Bumbu District,
South Borneo Province, Indonesia.
Te:+62 821 5698 8281
e-mail: blacklecture@yahoo.com
in the same year, which is far from the target of 180 per
100,000 population in 2009.2 In these circumstances, the
nurses - who is the first line in health care - is required to
always do the best. So the assumption that the nurses are
an important factor in determining the accountability of
the hospital is not wrong.
Nurse performance in patient care is influenced by
various factors. Study by Adatara et al (2016) found
that optimal nursing performance was influenced by
ability, mutualism, motivation, professionalism, clear
assignment and target, availability of equipment, and
functional feedback systems.3 While based on Yaghoubi
et al study (2013) was found that the nurse performance
correlated significantly with work environment, legality
of work, continuous work evaluation, incentives,
assistance from management to achieve work goals,
clarity of main tasks and functions, and individual
capability.4
1480  Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03
Previous study was conducted by Kamati et al
(2014) at a national referral hospital in Namibia. The
study was conducted on 48 nurses from a 284 total
population, using a questionnaire. The results showed
that there was negative correlation between the nurses
performance with short working mad, bad feedback,
low remuneration, poor work environment, and poor
training. Limitations in this study were the absence of
control that elements and the results were done in one
hospital due to lack of resources.5
The large number of factors that affecting nurse
performance as employees makes Sonnentag and
Frese divide them into three parts according to their
perspectives: individual differences, situational, and
regulation.6
Individual Differences Perspective: Many studies
illustrate how individual differences perspective affects
to their performance. To get a well-performing of
nurses, the hospital must select individuals based on
their abilities, work experience, and motivation and
personality.3,5,6
Situational Perspective: This perspective refers
to environmental factors that could support the
improvement of nurse performance. The most basic
question in this perspective: “In what situations could the
individual perform the best performance?”Some factors
in this perspective are job characteristics, capabilities/
circumstances that allow for stress control, and forced
situations.4,5,6
Regulation Perspective: This perspective focuses
on performance processes and concepts as a result of
work. The most important question in this perspective:
“How is performance generated?” And “What happens
when a person works?” This regulation could be either
financial or non-financial (feedback, social reward)
interventions.3,4,5,6
Despite the numerous studies conducted, in its
development, nurse performance remains an important
point in hospital marketing. Therefore, strengthening the
theory about the factors that affecting nurse performance
should continue to be done, as an effort to improve
service to patients and build a good hospital image.
Material and Method
This research was analytical descriptive study with
cross-sectional approach. The place this study was dr.
H. Andi Abdurrahman Noor General Hospital, located
in Tanah Bumbu District, South Borneo Province,
Indonesia. Data is collected between September and
October 2017. The population of this study was all nurses
who numbered 165 people. Form total population, there
were 24 samples of nurses who served in medical ward.
An open-ended structured questionnaire was used as
an instrument of data collection. Design the questionnaire
based on observations of the literature that has been
presented. Open-ended questions allow respondents to
be spontaneous in conveying and focusing opinions in
their own words. Respondents were asked questions
about the factors that according to their perspectives had
the highest effect on nurse performance in the first order,
to the last sequence they thought had the least influence.
Data were analyzed using a cumulative percentage
system. Demographic characteristics, performance
satisfaction levels, and factors that impact the nurses
performance were analyzed with descriptive statistics
and presented in tables.
Results
Respondents consisted of 54.2% of female, with 16
respondents aged between 21-30 years, one respondent
aged between 41-50 years, and the rest in middle
age. More than half of the respondents had a diploma
in nursing. More than 70% of respondents are non-
permanent employees/contracts with varying work
experiences, dominantly respondents worked less than
four years as a nurse in this hospital.
Based on personal assessment of respondents,
66.7% were satisfied with his personal appearance. Most
respondents felt that they had made the best effort to
serve patients even though the equipment available at
the hospital was not yet complete. While the rest felt
not able to perform maximum service to patients (see
Table 1).
Table 1: Level of satisfaction with personal
performance
Level of Satisfaction Frequency Percent
Not Satisfied 8 33.3
Satisfied 16 66.7
Factors affecting nurse performance were ranked
from the most-mentioned to the least. The most frequently
mentioned factor in this case was the excessive workload
(83.3% of the total respondents). This was influenced by
 Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03  1481
the ratio between the nurses and the bed in medical ward
(only about 1:12) and the documentation on the medical
record which time-consuming for the nurses. Lack of
facilities became the second largest factor (66.7%). The
facilities include medical and non-medical equipment,
such as diagnostic equipment, emergency equipment
and personal protective equipment. The inability to
control stress in the workplace is the third largest factor
(54.2%). This stress was mainly due to pressure from
supervisors and leaders (see Table 2).
Table 2: Factors that result in poor of nurse
performance
Factors Frequency Rank
Excessive workload 20 1st
Lack of facilities 16 2nd
Inability to control stress 13 3rd
Lack of supervision 11 4th
Non-compliance ofservicefee with
11 5th
workload
Salary incompatibility with minimum
9 6th
wage
Poor cooperation between different
7 7th
profession of employees
Lack of non-financial rewards 3 8th
Inconvenience work environment 3 9th
Unavailability of continuing education 3 10th
Status as a non-permanent employee/
2 11th
contract
Discussion
One that affects the workload of the nurses was the
ratio between the patient and the nurses. According to
the California Nurse Association (CNA), the number of
patients supervised by the nurses varies according to the
work unit, but does not exceed six patients.7 While, at
the hospital where the research was conducted, the fact
was still far from the ideal situation, where the average
ratio was only 1:12. Document overload also results in
excessive workload of nurses. When viewed from the
Hospital Accreditation Standard of Indonesia 2012,
there were still many overlapping forms on the medical
record so that the time to complete the document
becomes longer.8 This will impact on shorter nursing
services and lead to limited nurse-patient interactions.
In 2015, Muhammadi et al studied the factors that
affectingnurse performance who work in intensive care
unit (ICU). There were many things that cause poor of
the nurse performance, including difficulty sitting down
to work on documentation, unfriendly workplaces, poor
workplace settings and inventory space, poor equipment
conditions, drug delays, unpredictable situations, and
poor cooperation.9
Inadequate facilities were the second most mentioned
factor. This was in accordance with study conducted
by Adatara et al (2016) who found that the availability
of equipment affects the poor performance of 28% of
respondents.4 While stress and ability to control it is the
third largest factor affecting the nurses performance.
Simanjorang et al (2015) found a significant relationship
between job stress and the nurses performance.10 It was
also found in this study, in which the ability to control
stress has been mentioned by more than half the number
of respondents.
Other studies had also shown that organizational
factors, interpersonal cooperation, nurses cooperation
with other professions, and relationships with leaders or
supervision had an impact on the nurses performance.
Good relationships and regular supervisory supervision
with various parties in the workplace will improve
nurses ability and motivation to perform their duties
better.11,12,13 Despite other influencing factors such
as motivation, salary in accordance with regional
minimum wages, and non-financial rewards. This was
in accordance with James et al (2015) study, in which
financial and non-financial rewards had a positive impact
on the performance of health workers. Non-financial
rewards can be promoted or candidates for specialized
training.14
The work environment was also an important
factor, although it was ranked ninth from eleven factors
that affecting nurse performance.15 While, the least-
mentioned factor was the employment status. There
was no evidence-base showing the relationship between
employment status and nurse performance, but it was
assumed that the status of government employees has
higher income than contract workers, with the same
workload. This clearly impacts financially for the nurses.
Conclusion
From this research, there were eleven factors that
influence nurse performance. If grouped according
to Sonnentag and Frese theories, then the situational
perspective had a great impact on nurse performance,
followed by individual differences and regulation
perspectives. Factors of the situational perspective in
this study were the workload (83.3%), facilities (66.7%),
cooperation (29.1%), and work environment (12.5%).
1482  Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03
Supervision (45.8), salaries (37.5%), service fee
(45.8%), and rewards (12.5%) were grouped according
to the regulation perspective. While the ability (54.1%),
skills (12.5%), and motivation(8.3%) have an individual
impact. It was important to know by the hospital
management, because if they improve the nurses
performance means simultaneously they also improve
the image of the hospital in a community perspective.
Conflict of Interest: The authors declare that
theyhave no confict interest.
Source Funding: This study done by self funding
from the authors.
Ethical Clearence: In this study we followed the
guidelines from the Committee of Ethics,Indonesian
School of Economics, Banjarmasin. The informed
consent included the research tittle, purpose,
participants’s right, confidentiality and signature.
Acknowledgement: Alhamdulillah. All praise is
only to Allah azza wa jalla, who has given His guidance.
Shalawat to Rasullullah shalallahu’alaihi wasallam, the
best example of human life. Thanks to Arman Jaya Rikki
as Director of dr. H. Andi Abdurrahman Noor General
Hospital, for his suggestion in this study.
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