JURNAL APLIKASI MANAJEMEN VOLUME 21 ISSUE 1 MARCH 2023

THE EFFECT OF WORKLOAD, BURNOUT,

JAM AND WORK MOTIVATION ON NURSE
Jurnal Aplikasi Manajemen
Journal of Applied Management
Volume 21 Number 1
PERFORMANCE
March 2023

21 | 1 | 2023 Fivi Kurniawati

Postgraduate Program of Management, Faculty of Management,
Adhirajasa Reswara Sanjaya University, Indonesia
Received November ‘22 A. Rohendi
Revised November ‘22
December ‘22 Bayu Wahyudi
January ‘23 Faculty of Management, Adhirajasa Reswara Sanjaya University,
Accepted February ‘23
Indonesia

Abstract: Nurse performance is an essential component in the hospital which

can affect the quality of service. Nurses are identified as having a high level
of stress due to workload and also the high demands of patients can cause
burnout on nurses. Nurses should have work motivation to be able to support
their performance. The purpose of this study was to determine the effect of
workload, burnout, and work motivation on nurse performance at a specified
public hospital in Batam. There were 111 samples of nurses in this research.
Data analysis and processing used a statistics program software. The results
showed workload and burnout had a negative effect on nurse performance,
while work motivation had a positive effect on nurse performance.
Workload, burnout, and work motivation impact nurse performance partially
INDEXED IN
and simultaneously. Therefore, hospital management needs to pay more
DOAJ - Directory of Open Access attention to the factors that affect nurse performance. This study uses the
Journals
ACI - ASEAN Citation Index latest references in literature studies and research instruments.
SINTA - Science and Technology
Index
Dimensions
Google Scholar
ReseachGate
Keywords: Workload, Burnout, Work Motivation, Nurse Performance
Garuda
IPI - Indonesian Publication
Index
Indonesian ONESearch

CORRESPONDING AUTHOR

Nama
Fakultas,
Universitas,
Negara

EMAIL

nama@ub.ac.id

OPEN ACCESS
e ISSN 2302-6332
p ISSN 1693-5241 CITATION
Family Name, Fist Name. 2023. Title. Jurnal Aplikasi Manajemen, Volume 21, Issue 1, Pages 01-
20. DOI: http://dx.doi.org/10.21776/ub.jam.2022.021.1.01.

Copyright (c) 2023 Jurnal Aplikasi Manajemen

1
 JURNAL APLIKASI MANAJEMEN
INTRODUCTION
World Health Organization (WHO)
established a common language of 6 building
blocks to strengthen nations health system in the
objective of moving toward universal health
coverage (WHO 2010, 2023b). They claimed that
health systems can be solely run by health
workers, greater healthcare coverage, and right
fulfillment for the enjoyment of the highest
attainable standard of health (UN 1966; WHO
2023a). However, health workers become one of
greatest expenditure areas that will face a
shortcoming of 10 million health workers by
2030, mainly in lower– and middle–income
nations (WHO 2023a; WHO and WB 2017). A
recent report showed that in South East Asia
region, the density of nurse and midwives per
10,000 population during 2014–2021 was only
20.4 which is far below the European (WHO
2023c). On the other hand, the pandemic led to
numerous mental health problems for health
workers, especially nurses. The prevalence
estimation of anxiety and burnout of health
workers during the pandemic were range between
23–46% and 41–52%, respectively (Rahim et al.
2022). Therefore, health workers are a good,
targeted investment in a country health system
strengthening and support for their health and
well-being is importantly needed (Søvold et al.
2021; WHO 2016).
In Indonesia, hospital is defined as an
institution that provides comprehensive
individual healthcare and offers inpatient,
outpatient, and emergency services is required to
develop, implement, and maintain the quality of
health services as a benchmark for patient care
(Republik Indonesia, 2009) (MoH, 2018). This
service delivery process substantially affects the
quality of healthcare services in hospitals.
Consequently, resources and the professionalism
of health professionals are required to increase
the quality of health services in the future in
order to positively impact the consumer loyalty
(Hastuti, Haliah, and Munir 2021). As most
essential component of efforts to achieve the
highest level of health in Indonesia, a planning on
human resources in health must be managed as
effectively as possible in accordance with the
community's dynamics, developments, and needs
(RI, 2014). Undeniable, nursing has the largest
2 NAMA ET AL.
VOLUME 21 NUMBER 1 MARCH 2023
workforce of any healthcare specialty (Wakefield
et al. 2021). In 2018, there was more than
600,000 registered nurses in Indonesia and the
density trended to increase (MoH 2020).
However, as the nursing workforce increases, the
number of Indonesia population and diseases are
also inclining. In addition, the unequal
distribution all around the country and their
mental health rises to become an important issue
after the pandemic (Asa et al. 2022; MoH 2020).
A study showed a moderate level of anxiety,
stress, and depression of health workforce during
the pandemic (Muliantino et al. 2021). Certainly,
even minor changes in their level of anxiety and
stress can have an impact on their performance.
Performance in every occupation is
essentially more individual due to distinct ability
and capability of each employee to complete the
work demanded (Gunawan and Sondakh 2019).
Nurse performance can impact patient
satisfaction and service quality and they are
required to meet the needs of patients and are
unintentionally involved in the patient's intense
emotional issues. To the extent of patient, the
clinical state of patient becomes the major causal
factor of nurses’ workload and at greater
magnitude, it is escalated by the working
environment physically, insufficient provision of
resources and facilities, the family requirements
variety, and inadequate team communication
(Khademi, Mohammadi, and Vanaki 2015). This
workload increase is also a result of high work
pressure, tight deadlines, and long working hours
(Hafeez 2018). In addition, working for long
hours in an environment with high levels of stress
and workload can accelerate the onset of burnout
in nurses which may increase the likelihood of
medical errors, depression, and a reduction in
service quality (Dimitriu et al. 2020; Drennan
and Ross 2019). Thus, nurses need strong
motivation to deal with that such high demands
of work in hospital that influencing their
performance. Motivation may drive them to work
diligently and enthusiastically to achieve a high
degree of work productivity is possible (Umpung
et al. 2020). As a result, more research related to
this are required in Indonesia to identify the
effect of factors influencing their performance
such as the workload, burnout, and motivation in
order to develop appropriate policies to assist
 JURNAL APLIKASI MANAJEMEN
them providing health care (Wakefield et al.
2021).
This study was conducted at a specified
public hospital in Batam. In accordance with
Government Regulation No. 47 of 2021,
hospitals are required to provide safe, high-
quality, anti-discrimination, and effective health
services by placing patients’ interests first and
adhering to hospital service standards. Nurses
were chosen as responders for this study because
they have direct contact with patients and are
aware of their daily development. In order to
meet patient expectations and enhance patient
safety, nurses are required to maintain
professionalism in their work. It is in line to a
study showing that nurses in Southeast Asian
hospitals are overworked due to the pressure of
non-nursing responsibilities (Pamungkas and
Sridadi 2020).
The effect identification of between
workload, burnout, and work motivation on
nurse’ performance may become valid evidence
to enhance the quality of health services. For the
reasons explained above, the researcher
conducted this study to determine the effect of
workload, burnout, and work motivation on
nurses’ performance at Batam Public Hospital.
LITERATURE REVIEW
Workload
Workload is divided into quantitative and
qualitative. Quantitative workload relates to the
large amount of work, working too fast or too
hard, too many things to do, and excessive
pressure to get the job done. While the qualitative
workload is related to the quality or results of
work that is not in accordance with what is
expected or do not feel that they have enough
time to give their best (Kuschel, 2015).
Source: Kuschel (2023)
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VOLUME 21 NUMBER 1 MARCH 2023
Figure 1. Quantitative & Qualaitative Workload
Burnout
In the past decade, burnout has developed
into a significant psychosocial issue due to
prolonged stress at work that cannot be
effectively managed. Burnout is a syndrome
characterized by excessive physical and mental
exhaustion due to work demands or heavy
workloads, negative responses to work and
withdrawal from work, as well as decreased
productivity at work and feelings of
incompetence and failure at work
(Dewa et al., 2017)
. Burnout can decrease the vigilance of
healthcare workers, cause them to neglect self-
protection, and increase the risk of infection. This
can lead to depression, suicidal tendencies, and
medical conditions if it continues
(Shanafelt et al., 2010)
.
Burnout consists of 3 dimensions, there are
Emotional Exhaustion (EE), Depersonalization
(DP), and Low Personal Accomplishment (PA).
Emotional exhaustion is a feeling of excessive
tiredness and a drained of energy both physically
and mentally due to work demands or heavy
workloads. Depersonalization is also known as
cynicism, which is a negative response to work,
withdrawing from work and lack of enthusiasm at
work, and reducing involvement with patients.
Low personal accomplishment is a decrease in
achievement, this can be caused by decreased
productivity at work, feelings of incompetence
and failure of efforts made at work, and negative
self-assessment (Maslach & Jackson, 1981) .
Burnout is a real phenomenon that can manifest
in various ways. Individuals with effective stress
management can prevent burnout and create a
more productive work environment
(Dimitriu et al., 2020)
.
Work Motivation
Motivation will encourage someone to
engage in activities to reach a particular goal. A
person's motivation will determine the caliber of
the work they produce. In addition, motivation is
something that causes or supports human
behavior so that individuals desire to work hard
and achieve the best results possible
(Mangkunegara, 2009). According to
(Hee et al., 2016)
, motivation has two dimensions, there is
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intrinsic and extrinsic motivation. Intrinsic abilities, skills, and work experience.
motivation is an internal force that directs Psychological factors associated with fatigue,
someone to fulfill personal and organizational include perception, role, attitude, and motivation.
goals because they think a job or task is While organizational variables such as leadership
interesting, challenging, and fun. While extrinsic and work systems are important, health workers,
motivation is an external force that directs a particularly nurses, are identified as having a
person to fulfill personal and organizational high level of stress due to the fatigue associated
goals. This leads a person to perform a task using with providing services to patients
(Odonkor & Frimpong, 2020).
instructions or coercion in order to get a reward
in return. Extrinsic motivation includes salaries,
awards, benefits and bonuses, and can also be in HYPOTHESIS DEVELOPMENT
the form of good working conditions. Workload and Nurse Performance
The workload is an important issue. It is
Performance the main trigger of work stress and the main
According to cause of mental health disorders ( ILO, 2016) .
Gibson (1997 in Pamungkas & Sridadi, 2020)
, three factors that affect The causes of workload are organizational
performance are individual factors, psychological elements, cultural norms, excessive development
factors, and organizational factors. Individual of information
factors relate to the workload and include
Figure 2. Research Framework

technology, and commitments outside the work
such as family commitments (Kuschel, 2015) .
According to the outcomes of a study by
Pamungkas & Sridadi (2020) on 40 low care
inpatient service nurses in X Hospital Surabaya
showed that there was a significant negative
effect between work overload and nurse
performance directly nor indirectly. Accordingly,
the results of a study by Bogaert et al. (2013)
show that there is a significant effect between
workload and quality of care.
H1: Workload has a negative and significant
effect on the performance of nurses.
Burnout and Nurse Performance
The causes of burnout identified in
research (Odonkor & Frimpong, 2020) were
administrative work, being confronted with
suffering, individual decision-making,
relationship with colleagues, relationships with
patients, relationships with relatives of patients,
and time pressure. Burnout can occur in all
professions (de Hert, 2020) . According to
Ruga et al. (2022)
, on 84 inpatient service nurses in
Bhakti Asih General Hospital Tangerang show
that there is an effect between physical and
mental workload on nurse performance. Similar
findings were found in a study by
Pamungkas & Sridadi (2020)
, which concluded that burnout had
a significant impact on nurse performance.

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H2: Burnout has a negative and significant
effect on the performance of nurses.
Work Motivation and Nurse Performance
According to research
(Suharno & Despinur, 2017)
on administrative staff of Jakarta
State University, employee performance is
positively impacted by work motivation. In
addition, research by Hastuti et al. (2021) in
Mamuju District demonstrates the same results
that work motivation has a positive and
statistically significant effect on employee
performance.
H3: Work motivation has a positive and
significant effect on the performance of
nurses.
H4: Workload, burnout, and work motivation
affect the performance of nurses.
METHOD
This is a quantitative study using an
observational analytic approach with a cross-
sectional method. This study was conducted at a
specified public hospital in Batam in November
2022. All participants in this study were
registered nurses. This study used non-
probability sampling with accidental sampling.
The inclusion criteria were permanent nurses
who had worked for more than six months. This
study collected data via a questionnaire sheet.
The distribution of 120 questionnaires to nurses
who met the inclusion criteria. There were 111
respondents who filled out the complete
questionnaire with a response rate of 92.5%.
In the first section of the questionnaire,
there are several items pertaining to the
respondents' demographic information. The
demographic data includes age, gender, marital
status, recent education, and years of service.
The second section was derived from the
NASA task load index (NASA-TLX) by
(Hart & Staveland, 1988)
in order to collect workload
data. This section contains six questions, each of
which represents a different workload dimension:
Mental Demand (MD), Physical Demand (PD),
Temporal Demand (TD), Performance (OP),
Effort (EF), and Frustration (FR). Each
respondent was requested to provide a rating on a
scale from 0 to 100.
The third section adopted the Maslach
Burnout Inventory – Human Services Survey
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VOLUME 21 NUMBER 1 MARCH 2023
(MBI-HSS) to obtain data on mental stress
(Maslach & Jackson, 1981) . There are 22 items
divided into three dimensions. There are 9 items
on the Emotional Exhaustion (EE) dimension, 5
items on the Depersonalization (DP) dimension,
and 8 items on the Personal Accomplishment
(PA) dimension. Each respondent was asked to
provide an assessment with a 7-point Likert scale
(0-6) as follows: never (0), several times a year
(1), less than or once a month (2), several times a
month (3), once a week (4), several times a week
(5), and every day (6).
Furthermore, in the fourth part, the
Multidimensional Work Motivation Scale
(MWMS) is adopted to assess work motivation
(Gagné et al., 2015). There are a total of 19 items
and respondents were asked to provide an
assessment with a 7-point Likert scale (1-7),
namely: not for this reason (1), very little (2), a
little (3), enough/moderate (4), strong (5), very
strong (6), and really for this reason (7).
The final section to measure performance
has been adopted from the Individual Work
Performance Questionnaire (IWPQ) developed
by (Koopmans et al., 2014) and translated into
Indonesian by (Widyastuti & Hidayat, 2018) .
There is a total of 18 items, which are divided
into three dimensions: task performance,
contextual performance, and counterproductive
work behavior. Respondents were asked to use a
5-point Likert scale (0-4) as follows: rarely (0),
occasionally (1), occasional (2), very often (3),
and always (4).
Validity and Reliability Test
The validity test is used to measure the level
of validity or legitimacy of a questionnaire
question. The validity test was carried out by
comparing the Pearson correlation for each item
with the moment product rtable. If rcount > rtable then
the statement item is declared valid. The results
of the validity test with α = 5%, the r table value is
0.1848. The questionnaire is declared valid if
r i >0.1848 . The result of validity test as shown
in Table 1.
Table 1. Validity Test Result
Variable Rcount Rtable Descriptio
n
Workload 0.361 – 0.854 0.1848 Valid
Burnout 0.186 – 0.624 0.1848 Valid
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respondents were aged 30-50 years (63.96%) and

at least > 50 years old with a percentage of
Work 3.60%. Most of the respondents with educational
0.196 – 0.601 0.1848 Valid
Motivation level diplomas with a percentage of 70.27% and
Performanc 0.186 – 0.780 0.1848 Valid have worked > 5 years with a percentage of
e 65.77%.
Source: Processed Data (2022)
Table 3. Characteristics of Respondents
According to (Ghozali, 2018), the
Data Demographic n %
reliability test is used for determining whether
the research instrument is utilized; in this case, Gender
the questionnaire can be utilized multiple times,
or at least by the same respondent. Using the Male 15 13,51
Alpha Cronbach formula, the consistency of the Female 96 86,49
questionnaire data is determined when Age
calculating reliability. A reliable indicator must
possess a correlated item-total correlation value < 30 years old 36 32,44
of at least 0.60. The result of reliability test as 30 – 50 years old 71 63,96
shown in Table 2.
Table 2. Reliability Test Result > 50 years old 4 3,60
Educational Level
Cronbach's
Variable Description Diploma 78 70,27
Alpha
Workload 0.753 Reliable Bachelor 28 25,23
Burnout 0.661 Reliable Ners 5 4,50
Work Motivation 0.737 Reliable
Working Period
Performance 0.898 Reliable
< 1 year 17 15,31
Source: Processed Data (2022)
1 – 5 years 21 18,92
Based on the results of the validity test of
> 5 years 73 65,77
the correlation coefficient of the question items
in the table above, it is determined that for each Source: Processed Data (2022)
variable, rcount > rtable for all question items. The
result showed that each question item is valid, Classic Assumption Test
then the reliability test was performed. According The purpose of this test is to obtain
to the results of the reliability test presented in estimates and initial conditions so that the linear
the table above, all variables have Cronbach's regression test can be conducted. This test is
Alpha value of > 0.60, so it can be concluded that performed in the early stages after the data has
all variables are reliable. been collected. The traditional assumption test
consists of the tests for normality,
multicollinearity, and heteroscedasticity. The
RESULTS
normality test is used to determine whether the
Respondent Characteristics
residual data is normally distributed (Ghozali,
This study used a total of 111 respondents
2018). In this study, the Kolmogorov-Smirnov
divided into several work units in the hospital.
test was used to analyze the normality test
Based on the questionnaire results, the profile of
because the sample size was greater than 30. In
the respondents is divided into some
the Kolmogorov-Smirnov normality test, a
characteristics. Table 3 shows that most of the
conclusion can be reached by comparing the
respondents in this study were female with a
probability value (p-value), with the significance
percentage of 86.49%, and the rest were male
with a percentage of 13.51%. Most of the used 𝛼=0.05. Table 4 shows the Asymp. Sig. (2-

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 JURNAL APLIKASI MANAJEMEN VOLUME 21 NUMBER 1 MARCH 2023

tailed) > 0.05 (0.051) on Kolmogorov Smirnov, heteroscedasticity. The result of

which means the normality assumption is heteroscedasticity test as shown in Table 6.
fulfilled.
Table 6. Heteroscedasticity Test
Table 4. Normality Test
Variable Sig. Description
Kolmogorov-Smirnov Test
There is no
Workload 0.168
Result Description heteroscedasticity
Asymp. Sig. (2-tailed) 0.051 Normal There is no
Burnout 0.253
heteroscedasticity
Source: Processed Data (2022)
Work
There is no
The multicollinearity test is used to Motivatio 0.128
heteroscedasticity
determine whether a correlation exists between n
independent variables in a regression model Source: Processed Data (2022)
(Ghozali, 2018). A multicollinearity problem
exists if there is a correlation. Variance Inflation Multiple Linear Regression Analysis
Factor (VIF) and Tolerance values can be utilized Multiple linear regression analysis
to determine whether multicollinearity occurs. A measures the strength of the relationship between
good regression model if the Tolerance value > two or more variables and reveals the direction of
0.10 and the VIF < 10. From the the relationship between independent and
Multicollinearity test, the VIF value < 10 (1.002 dependent variables (Ghozali, 2018). The results
– 1.007) and Tolerance > 0.10 (0.993 – 0.998), so of multiple linear regression analysis are shown
that multicollinearity symptoms did not occur. in Table 7.
Table 5 show the result of multicollinearity test.
Table 7. Multiple Linear Regression Analysis
Result
Table 5. Multicollinearity Test
Variable Tolerance VIF Description Unstandardized
Variable Coefficients Sig.
There is no
Workload 0.998 1.002 β
multicollinearity
There is no (Constant) 38.789
Burnout 0.995 1.005
multicollinearity Workload - 0.031 0.036
Work There is no Burnout - 0.222 0.011
0.993 1.007
Motivation multicollinearity
Work Motivation 0.217 0.012
Source: Processed Data (2022)
Source: Processed Data (2022)

The heteroscedasticity test aims to Based on the results of multiple linear

determine whether the residual observations of a
regression model have unequal variances
(Ghozali, 2018). The heteroscedasticity test in
this study used the Glejser test. If the probability
value (p-value) exceeds (Sig.) 0.05 or 5%, it
means that the assumption of homoscedasticity is
met, which indicates that there are no
symptoms of heteroscedasticity. The
Heteroscedasticity test with Glejser shows a Sig.
> 0.05, so there were no symptoms of
regression analysis presented in the preceding
table, the following regression model is derived:
Y = 38.789 – 0.031X1 – 0.222X2 + 0.217X3
The regression coefficient for the workload
(X1) is negative, indicating that if the workload
increases by 1 point and the other variables
remain constant, the performance will decrease
by 0.031 and vice versa. The regression
coefficient for burnout (X2) is also negative,
which means that if the burnout increases by 1

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 JURNAL APLIKASI MANAJEMEN
point and the other variables remain constant, the
performance will decrease by 0.222 and vice
versa. The work motivation (X3) has a positive
regression coefficient indicating that if the other
variables remain constant and it increases by 1
point, the performance will increase by 0.217 and
vice versa.
Hypothesis Testing
The purpose of hypothesis testing is to
determine whether the independent variables
have a partial or simultaneous effect on the
dependent variable or not (Ghozali, 2018). In this
study, multiple linear regression analysis was
used to predict the degree of relationship between
workload, burnout, and work motivation. This
test was calculated using a statistic program
software, and the results of the hypothesis test
were divided into two categories, there are
simultaneous tests utilizing the F-test and partial
tests utilizing the t-test.
Simultaneous tests were conducted to
determine the effect of several independent
Table 8. Partial and Simultaneous Test (t and F - Test)
Variable
t-test
Workload (X1) -2.127
Burnout (X2) -2.578
Work Motivation (X3) 2.559
X1, X2, X3 on Nurse Performance (Y)
Source: Processed Data (2022)
DISCUSSION
Based on the results of the t-test in Table
8, the p-value (Sig.) of workload is 0.036, which
is less than 0.05 and negative t count (-2.127) is
smaller than ttable (-1.982) means that the
workload has a negative and significant effect on
the performance of nurses. So, the first
hypothesis (H1) is accepted. If the workload
increase, nurse performance will decrease,
whereas if the workload decreases, then nurse
performance will increase. It has a similar result
to the findings (Pamungkas & Sridadi, 2020) that
workload had a negative and significant impact
direct and indirect on nurse performance. To
avoid excessive workload, nurses should carry
8 NAMA ET AL.
VOLUME 21 NUMBER 1 MARCH 2023
variables simultaneously on one dependent
variable. If the p-value < 0.05 or Fcount > Ftable, the
independent variables have an effect on the
dependent variable simultaneously. With total
respondents of 111, three independent variables,
and a significance level of 5%, the F table is 2.688.
The partial test was conducted to determine the
effect of each independent variable on the
dependent variable partially.
The partial test can be done through t-test
statistics by comparing the p-value with an α-
value of 0.05 and tcount with ttable. If p-value < 0.05,
or if it is positive when tcount > ttable, whereas if it is
negative when -tcount < -ttable then the independent
variable has a partial effect on the dependent
variable. By using a sample of 111, three
independent variables, and a 5% significance
level, the ttable is 1.982. The results of partial and
simultaneous test (t and F test) are shown in
Table 8.
Result Sig. Description
F-test
0.036 Affected
0.011 Affected
0.012 Affected
5.789 0.001 Affected
out their duties according to the job desk and not
be burdened by non-nursing tasks.
The t-test showed p-value of burnout is
0.011, which is less than 0.05. The result for t count
(-2.578) is less than ttable (-1.982). It indicates that
burnout has a negative and significant effect on
the performance of nurses. Then the second
hypothesis (H2) is accepted. It means if burnout
increases, nurse performance will decrease,
whereas if burnout decreases, then performance
will increase. This is consistent with research
conducted by (Pamungkas & Sridadi, 2020)
where burnout had a direct negative effect on
nurse performance. Similar findings were found
in a study by (Ruga et al., 2022) , which
concluded that burnout had a significant impact
 JURNAL APLIKASI MANAJEMEN VOLUME 21 NUMBER 1 MARCH 2023

on nurse performance. There are several signs positive and significant effect on nurse
and symptoms of burnout, including cynicism, performance. To avoid an excessive workload,
depersonalization, emotional exhaustion, low nurses should carry out their duties according to
personal achievement, irritability, insomnia, the job desk and not be burdened by non-nursing
depressive reactions to stress, aggressive tasks. Creating a comfortable and harmonious
reactions to stress, increased mistakes, and atmosphere or work environment can decrease
increased employee turnover burnout. In the meantime, rewards can be used to
(Bradley & Chahar, 2020)
. Burnout can be reduced by creating an improve work motivation. This research can
atmosphere provide scientific evidence regarding the factors
that can affect the performance of nurses, thereby
or work environment that is comfortable and enhancing the quality of health services.
harmonious.
The p-value of work motivation in t-test is IMPICATIONS
0.012, which is less than 0.05. the result for t count Based on the results of this research, the
(2.559) is more than t table (1.982). It means that hospital management should make a performance
work motivation affects nurse performance, so analysis of health workers because there are
the third hypothesis (H3) is accepted. It can be many public complaints about the services in
stated that if work motivation increases, hospital. In addition, to improve the quality of
performance will increase, whereas if it hospital services, it is necessary to conduct some
decreases, performance will decrease. According training and update knowledge for all health
to research (Suharno & Despinur, 2017) , workers especially nurses that treat patients
employee performance is positively impacted by directly. For structural nurses, it is better to
work motivation. In addition, research by attend workshops and seminars for the
(Hastuti et al., 2021) demonstrates the same development of knowledge and managerial
results that work motivation has a positive and strategies. Periodic audits also need to be carried
statistically significant effect on employee out regarding the completeness of medical record
performance. There are five factors that influence filling, the completeness of emergency
work motivation in health workers, namely equipment and medicines in each unit and the
workplace characteristics, working conditions, management of emergency patients.
individual characteristics, individual priorities, Workload, burnout, and work motivation
and internal psychological states also need attention. Nurses should do their job in
accordance
(Toode et al., 2011) while work motivation can bewith their main
increased dutiesrewards.
by giving and functions
to prevent work overload. Burnout can be
According to the results of the F-test, a p- overcome by creating an atmosphere or work
value is 0.001 which is less than 0.05 and Fcount environment that is comfortable and harmonious.
(5.789) is greater than Ftable (2.688) indicating that Meanwhile, work motivation can be increased
workload, burnout, and work motivation have an with rewards. The authors hope this research can
effect on nurse performance. Consequently, the be useful to help management improving nurse
fourth hypothesis (H4) is also accepted. Thus, it performance to get better service quality and
can be concluded that the independent variables patient satisfaction.
of workload, burnout, and work motivation
simultaneously affect the dependent variable of LIMITATIONS
performance. The weaknesses of this study are the
respondents are not evenly distributed. The
CONCLUSIONS respondents were from several work units, but
Workload, burnout, and work motivation each unit had a different number of respondents
have both partial and simultaneous effects on and different tasks. In addition, due to a large
nurse performance. Workload and burnout had a number of questionnaire items that needed to be
negative and significant effect on nurse filled out and the limited time, some respondents
performance while work motivation had a did not fill out the questionnaire’s entirety.

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 JURNAL APLIKASI MANAJEMEN VOLUME 21 NUMBER 1 MARCH 2023

G., Jacota-Alexe, F., Badiu, C. D.,

RECOMMENDATIONS Smarandache, C. G., & Socea, B. (2020).
Future researchers are expected to be able Burnout syndrome in Romanian medical
to use more variables and hoped to use more residents in time of the COVID-19
specific samples in order to reduce confounding pandemic. Medical Hypotheses,
factors and also adopting qualitative studies 144(May),109972.https://doi.org/10.1016/j
needed to explain further the factors of nurse .mehy.2020.109972
performance. Drennan, V. M., & Ross, F. (2019). Global nurse
shortages - The facts, the impact and action
REFERENCES for change. British Medical Bulletin,
Bradley, M., & Chahar, P. (2020). Burnout of 130(1),.25–37.
healthcare providers during COVID-19. https://doi.org/10.1093/bmb/ldz014
Cleveland Clinic Journal of Medicine, 1–3. Gagné, M., Forest, J., Vansteenkiste, M.,
https://doi.org/10.3949/ccjm.87a.ccc051 Crevier-Braud, L., van den Broeck, A.,
Choon Hee, O., Hayati Kamaludin, N., & Lee Aspeli, A. K., Bellerose, J., Benabou, C.,
Ping, L. (2016). Motivation and Job Chemolli, E., Güntert, S. T., Halvari, H.,
Performance among Nurses in the Health Indiyastuti, D. L., Johnson, P. A., Molstad,
Tourism Hospital in Malaysia International M. H., Naudin, M., Ndao, A., Olafsen, A.
Review of Management and Marketing H., Roussel, P., Wang, Z., & Westbye, C.
Motivation and Job Performance among (2015). The Multidimensional Work
Nurses in the Health Tourism Hospital in Motivation Scale: Validation evidence in
Malaysia. International Review of seven languages and nine countries.
Management and Marketing, 6(4), 668– European Journal of Work and
672. http:www.econjournals.com Organizational Psychology, 24(2), 178–
De Hert, S. (2020). Burnout in healthcare 196..https://doi.org/10.1080/1359432X.20
workers: Prevalence, impact and 13.877892
preventative strategies. In Local and
Regional Anesthesia (Vol. 13, pp. 171–
183). Dove Medical Press Ltd.
https://doi.org/10.2147/LRA.S240564
Debora Umpung, F., Maja Pertiwi, J., & Ester
Caroline Korompis Prodi Ilmu Kesehatan
Masyarakat Pascasarjana Universitas Sam
Ratulangi Manado, G. (2020). Faktor-
Faktor yang Mempengaruhi Motivasi
Kerja Tenaga Kesehatan di Puskesmas
Kabupaten Minahasa Tenggara Pada Masa
Pandemi Covid 19. Journal of Public
Health and Community Medicine, 1(4).
Dewa, C. S., Loong, D., Bonato, S., &
Trojanowski, L. (2017). The relationship
between physician burnout and quality of
healthcare in terms of safety and
acceptability: A systematic review. BMJ
Open,.7(6).https://doi.org/10.1136/bmjope
n-2016-015141
Dimitriu, M. C. T., Pantea-Stoian, A., Smaranda,
A. C., Nica, A. A., Carap, A. C.,
Constantin, V. D., Davitoiu, A. M.,
Cirstoveanu, C., Bacalbasa, N., Bratu, O.

10 NAMA ET AL.
 JURNAL APLIKASI MANAJEMEN
Mangkunegara, A. P. (2009). Manajemen Sumber Daya Manusia. Bandung: PT. Remaja Rosdakarya.
Ghozali, I. (2018). Aplikasi Analisis Multivariate dengan Program IBM SPSS. Semarang: Badan
Penerbit Universitas Diponegoro.
John L. Crompton, P. C.-C. (1992). Positioning: The Example of the Lower Rio Grande Valley in the
Winter Long Stay Destination Market. Journal of Travel Research, 20-31.
Asa, Gregorius Abanit, Nelsensius Klau Fauk,
Melkianus Ratu, Paul Russell Ward, and
GAA. 2022. “The Impact of Working in
COVID-19 Hospital on Indonesian Nurses’
Mental Health and Wellbeing: A
Qualitative Study.” BMC Nursing 21(1):1–
11. doi: 10.1186/s12912-022-01131-6.
Dimitriu, Mihai C. T., Anca Pantea-Stoian,
Alexandru C. Smaranda, Anca A. Nica,
Alexandru C. Carap, Vlad D. Constantin,
Ana M. Davitoiu, Catalin Cirstoveanu,
Nicolae Bacalbasa, Ovidiu G. Bratu,
Florentina Jacota-Alexe, Cristinel D. Badiu,
Catalin G. Smarandache, and Bogdan
Socea. 2020. “Burnout Syndrome in
Romanian Medical Residents in Time of the
COVID-19 Pandemic.” Medical
Hypotheses 144(May):109972. doi:
10.1016/j.mehy.2020.109972.
Drennan, Vari M., and Fiona Ross. 2019. “Global
Nurse Shortages - The Facts, the Impact and
Action for Change.” British Medical
Bulletin 130(1):25–37. doi:
10.1093/bmb/ldz014.
Gunawan, Hananiel M., and Oliandes Sondakh.
2019. “The Impact of Work Motivation,
Work Engagement, and Job Satisfaction
Toward Job Performance in PT. XYZ
Surabaya.” European Journal of Business
and Management 11(20):48–56. doi:
10.7176/EJBM/11-20-07.
Hafeez, Shahid. 2018. “The Impact of Job Stress
on Performance of Employees: A Study of
Social Security Hospital of District Okara &
Sahiwal.” Journal of Neuropsychology &
Stress Management 3:4–12.
Hastuti, Haliah, and Abdul Razak Munir. 2021.
“The Effect Of Motivation And Work
Environment On Performance Through
Work Satisfaction As Intervening Variable
On Public Health Center Employees In
Mamuju District.” Quest Journals Journal
WWW.JURNALJAM.UB.AC.ID
VOLUME 21 NUMBER 1 MARCH 2023
of Research in Business and Management
9(8):2347–3002.
Khademi, Mojgan, Easa Mohammadi, and
Zohreh Vanaki. 2015. “Resources-Tasks
Imbalance: Experiences of Nurses from
Factors Influencing Workload to Increase.”
Iranian Journal of Nursing and Midwifery
Research 20(4):476–83. doi: 10.4103/1735-
9066.160994.
MoH. 2020. Human Resources for Health
Country Profiles Indonesia. Jakarta.
Muliantino, Mulyanti Roberto, Emil Huriani,
Boby Febri Krisdianto, Rika Sarfika,
Marnila Yesni, Endang Sulistyowati,
Kristanti Wahyuningtyas, Ucip Sucipto, R.
Ad. Sukarna, Eko Prasetyo, and Khatijah
Binti Abdullah. 2021. “Psychological
Responses Among Indonesian Nurses In
The Outbreak Of Covid-19 Pandemic.”
Journal of Nursing Care 4(2). doi:
10.24198/jnc.v4i2.31195.
Pamungkas, Astria Primadhani, and Ahmad
Rizki Sridadi. 2020. “Pengaruh Work
Overload Terhadap Nurse Performance
Dengan Burnout Sebagai Variabel
Intervening Di Rumah Sakit X Surabaya.”
Business and Finance Journal 5(2):85–94.
doi: 10.33086/bfj.v5i2.1788.
Rahim, Hanan F. Abdul, Meredith Fendt-Newlin,
Sanaa T. Al-Harahsheh, and Jim Campbell.
2022. Our Duty of Care: A Global Call to
Action to Protect the Mental Health of
Health and Care Workers. Doha.
RI. 2014. “Undang-Undang RI Nomor 36 Tahun
2014 Tentang Tenaga Kesehatan.” Presiden
Republik Indonesia 1–78.
Søvold, Lene E., John A. Naslund, Antonis A.
Kousoulis, Shekhar Saxena, M. Walid
Qoronfleh, Christoffel Grobler, and Lars
Münter. 2021. “Prioritizing the Mental
Health and Well-Being of Healthcare
Workers: An Urgent Global Public Health
11
 JURNAL APLIKASI MANAJEMEN
Priority.” Frontiers in Public Health
9(May):1–12. doi:
10.3389/fpubh.2021.679397.
Umpung, Festy Debora, Junita Maja Pertiwi,
Grace Ester, and Caroline Korompis. 2020.
“Faktor-Faktor Yang Mempengaruhi
Motivasi Kerja Tenaga Kesehatan Di
Puskesmas Kabupaten Minahasa Tenggara
Pada Masa Pandemi Covid 19.” Indonesian
Journal of Public Health and Community
Medicine 1:18–27.
UN. 1966. International Covenant on Economic,
Social and Cultural Rights. General
Assembly.
Wakefield, Mary K., David R. Williams,
Suzanna Le Menestrel, and Jennifer Lalitha
Flaubert. 2021. The Future of Nursing
2020-2030: Charting a Path to Achieve
Health Equity. edited by M. K. Wakefield,
D. R. Williams, S. Le Menestrel, and J. L.
Flaubert. Washington, DC: National
Academies Press.
WHO. 2010. Monitoring the Building Blocks of
Health Systems: A Handbook of Indicators
and Their Measurement Strategies. Geneva:
WHO Press.
WHO. 2016. Working for Health and Growth.
Geneva: WHO Press.
WHO. 2023a. “Health Workforce.” World
Health Organization. Retrieved
(https://www.who.int/health-topics/health-
workforce#tab=tab_1).
WHO. 2023b. “Universal Health Coverage
(UHC).” World Health Organization.
Retrieved (https://www.who.int/news-
room/fact-sheets/detail/universal-health-
coverage-(uhc)).
WHO. 2023c. World Health Statistics 2023.
Geneva: WHO Press.
WHO, and WB. 2017. Tracking Universal
Health Coverage: 2017 Global Monitoring
Report. Geneva: WHO Press.
Gunawan, H. M. (2019). The Impact of Work
Motivation, Work Engagement, and Job
Satisfaction Toward Job Performance in
PT. XYZ Surabaya. 11.
https://doi.org/10.7176/EJBM
12 NAMA ET AL.
VOLUME 21 NUMBER 1 MARCH 2023
Hafeez, S. (2018). The Impact of Job Stress on
Performance of Employees: A Study of
Social Security Hospital of District Okara
& Sahiwal. In Journal of Neuropsychology
& Stress Management (Vol. 3).
Hart, S. G., & Staveland, L. E. (1988).
Development of NASA-TLX (Task Load
Index): Results of empirical and theoretical
research. In P. A. Hancock & N. Meshkati
(Eds.), Human mental workload (pp. 139–
183)..North-Holland.
https://doi.org/10.1016/S0166-
4115(08)62386-9
Hastuti, Haliah, & Munir, A. R. (2021). The
Effect of Motivation And Work
Environment on Performance Through
Work Satisfaction as Intervening Variable
on Public Health Center Employees In
Mamuju District. Quest Journals, 9(8),
44–55.
International Labor Organization (ILO). (2016).
Workplace stress: A collective challenge –
world day for safety and health at work.
Turin-Italy: International Labor
Organization (ILO)
Khademi, M., Mohammadi, E., & Vanaki, Z.
(2015). Resources-tasks imbalance:
Experiences of nurses from factors
influencing workload to increase. Iranian
Journal of Nursing and Midwifery
Research, 20(4), 476–483.
https://doi.org/10.4103/1735-9066.160994
Koopmans, L., Bernaards, C. M., Hildebrandt, V.
H., de Vet, H. C. W., & van der Beek, A. J.
(2014). Measuring individual work
performance: Identifying and selecting
indicators. Work, 48(2), 229–238.
https://doi.org/10.3233/WOR-131659
Kuschel, K. (2015). Quantitative and qualitative
work overload and its double effect on the
work-family Interface. No 27, Serie
Working Papers. Universidad del
Desarrollo, School of Business and
Economics, Santiago, Chile.
Mangkunegara, A. P. (2009). Manajemen
Sumber Daya Manusia. Bandung: PT.
Remaja Rosdakarya.
Maslach, C., & Jackson, S. (1981). Le MBI:
Maslach Burnout Inventory. Palo Alto, 2,
49–78.
 JURNAL APLIKASI MANAJEMEN
Mohammadi, M., Mazloumi, A., Kazemi, Z., &
Zeraati, H. (2016). Evaluation of Mental
Workload among ICU Ward’s Nurses.
Health Promotion Perspectives, 5(4), 280–
287.
https://doi.org/10.15171/hpp.2015.033
Odonkor, S. T., & Frimpong, K. (2020). Burnout
among Healthcare Professionals in Ghana:
A Critical Assessment. BioMed Research
International, 2020.
https://doi.org/10.1155/2020/1614968
Pamungkas, A. P., & Sridadi, A. R. (2020).
Pengaruh Work Overload terhadap Nurse
Performance dengan Burnout sebagai
Variabel Intervening di Rumah Sakit X
Surabaya. Business and Finance
Journal, 5(2), 85–94.
https://doi.org/10.33086/bfj.v5i2.1788
Pemerintah Indonesia. (2009). Undang-Undang
No. 44 Tahun 2009 tentang Rumah Sakit.
Lembaran Negara RI Tahun 2009, No. 44.
Sekretariat Negara. Jakarta.
Pemerintah Indonesia. (2014). Undang-Undang
No. 36 Tahun 2014 tentang Tenaga
Kesehatan. Lembaran Negara RI Tahun
2009, No. 36. Sekretariat Negara. Jakarta.
Pemerintah Indonesia. (2018). Peraturan Menteri
Kesehatan Republik Indonesia Nomor 4
Tahun 2018 tentang Kewajiban Rumah
Sakit dan Kewajiban Pasien. Lembaran
Negara RI Tahun 2018, No. 4. Sekretariat
Negara. Jakarta.
Pemerintah Indonesia. (2021). Peraturan
Pemerintah Republik Indonesia Nomor 47
Tahun 2021 tentang Penyelenggaraan
Bidang Perumahsakitan. Lembaran Negara
RI Tahun 2021, No. 47. Sekretariat
Negara. Jakarta.
Ruga, F. B. P., Kusumapradja, R., & Pamungkas,
R. A. (2022). Impact of physical workload
and mental workload on Nurse
Performance: A path analysis.
International Journal of Nursing and
Health Services (IJNHS), 5(2), 219–225.
https://doi.org/10.35654/ijnhs.v5i2.604
Shanafelt, T. D., Balch, C. M., Bechamps, G.,
Russell, T., Dyrbye, L., Satele, D.,
Collicott, P., Novotny, P. J., Sloan, J., &
Freischlag, J. (2010). Burnout and medical
errors among American surgeons. Annals
WWW.JURNALJAM.UB.AC.ID
VOLUME 21 NUMBER 1 MARCH 2023
of Surgery, 251(6), 995–1000.
https://doi.org/10.1097/SLA.0b013e3181bf
dab3
Suharno, P., & Despinur, D. (2017). The impact
of work motivation and competence on
employee performance through service
quality in administrative staff of
Universitas Negeri Jakarta, Indonesia.
Russian Journal of Agricultural and
Socio-Economic Sciences, 1(61), 160–171.
https://doi.org/10.18551/rjoas.2017-01.16
Toode, K., Routasalo, P., & Suominen, T. (2011).
Work motivation of nurses: A literature
review. In International Journal of
Nursing Studies (Vol. 48, Issue 2, pp. 246–
257).
https://doi.org/10.1016/j.ijnurstu.2010.09.0
13
Umpung, F. D., Pertiwi, J. M., & Korompis, G.
E. C. (2020). Faktor-Faktor Yang
Mempengaruhi Motivasi Kerja Tenaga
Kesehatan Di Puskesmas Kabupaten
Minahasa Tenggara Pada Masa Pandemi
Covid 19, 18–27.
Widyastuti, T., & Hidayat, R. (2018). Adaptation
of Individual Work Performance
Questionnaire (IWPQ) into Bahasa
Indonesia. International Journal of
Research Studies in Psychology, 7(2).
https://doi.org/10.5861/ijrsp.2018.3020
13