Influence of Awards System, Education and Nurse Working Toward Competency and Nurse Performance in Care Room

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Published on International Journal of Health, Nursing, & Medicine
Publication Date: May 7, 2019

Lydia Moji Lautan, Syamsul Anwar & Suhendar
Postgraduate Master of Nursing Programme Faculty of Nursing, Muhammadiyah University Jakarta
Faculty of Nursing, Muhammadiyah University Jakarta
Indonesia

Journal Full Text PDF: Influence of Awards System, Education and Nurse Working Toward Competency and Nurse Performance in Care Room (Study at Hermina Jatinegara Hospital and Hermina Podomoro Hospital).

Abstract
Performance of the nurse is the performance of the work done by the associate nurse in performing the duties of nursing care so as to produce decent output in quantity and quality in accordance with the direction given by the leadership and the competence or ability of the nurse in the work. This study aims to analyze the effect of reward system, education and the nurse’s working term on the competence and performance of the nurse. The method used in this research is, the study design was analytic descriptive with cross-sectional study approach. Data analysis technique using path analysis. The object of the study was conducted on two Hermina hospitals with a sample of 66 respondents based on the total sampling with the respondents were the associate nurse who had followed and passed the internal competence test of Hermina hospital at least 1A level. The results of this study indicate that, this research produces education and work period have the biggest direct influence to nurse competence with big influence 0,276 with value α = 0,026 and reward system has the biggest direct effect to nurse performance with big influence 0,301 with value α = 0,008, the biggest indirect is the influence of education and work period on nurse performance through nurse competence with big influence 0,079. The conclusion in this study is , this study establishes the conclusion that the reward system, education and working lives of nurses significantly affect the performance of nurses with competence as intermediate variables. The hospital is expected to make the policy of performance appraisal system based on nurse education level according to the nurse competency level and for the nurse to improve the performance by maintaining the quality of competence.

Keywords: Associate Nurse, Award System, Competence Nurse, Education And Work Term Nurse, Nurse Performance.

1. INTRODUCTION
Performance is a function of ability, motivation, and opportunity or work environment (Nursalam, 2014). Ability is built on the knowledge, skills, and attitude of a person who can form a person’s competence in work. With good competence then a worker produces a good performance. This is consistent with studies Mc. Clelland in Sudarmanto (2014), demonstrated competence in non-academic can predict individual performance on the job in the future.
Determining the level of competence needed in order to determine the level of performance expected. Spencer stated, 1993 in Sudarmanto (2014), the nature of which is characteristic of competence is covering a person’s personality, and predicting the attitudes in the activities of the work, competence can be used to predict the performance of a person, and competence must have a referral that is used as a specific criteria or standards in predicting the nurse to perform its activities.
Hermina Jatinegara Hospital and Hermina Hospital Podomoro the first and second branches of Hermina Hospital Group (HHG). This hospital is type B has been accredited plenary. Based on preliminary studies in February 2016 and obtained the interview with the manager of nursing at the hospital related to the performance evaluation process for headroom nurse performed every 6 months. The performance appraisal process nurse did the headward and the quality team Hermina Jatinegara Hospital and Hermina Hospital Podomoro is assessing the nursing documentation. The nursing quality team of Hermina Jatinegara Hospital and Hermina Podomoro Hospital stated that nursing documentation has been standardized by Hospital Accreditation Committee, but 15-20% have not done nursing documentation in accordance with the standard that has been determined by the reason of the nurses occupation in the room and the knowledge of the nurses who are lacking in analyzing the service nursing. data on nurse turnover during 2015 is 15% (ideally 5-10%/ year) with the average nurse’s working period is under 5 years and the reasons are mostly more on personal reasons such as taking care of the family.
Based on the conditions at Hermina Jatinegara Hospital and Hermina Podomoro Hospital, the competency level of the nurse is still considered as a measuring tool for assessing the performance of the nurse. Nurses who have followed the internal competence test of the hospital are still few and exist in some treatment rooms have not done nursing documentation in accordance with the standard set the hospital but the results of interviews and preliminary observations that the researchers do preliminary study can be preliminary data to examine the effect of award system that is given organization of Hermina Jatinegara Hospital and Hermina Podomoro Hospital, the education system and working lives of nurses to the competency of nurses and nurse’s performance in the nursing care in inpatient units Hermina Jatinegara Hospital and Hermina Hospital Podomoro.

2. METHODOLOGY
The research design is using analytical descriptive with cross-sectional approach. Population and sample in this research are all of the nurse executors who have followed competency test with a minimum level of competence level 1A in hospital unit of Hermina Jatinegara Hospital and Hermina Podomoro Hospital as many as 66 nurses. The inclusion criteria of this study are the nursing nurse of the nursing unit who has followed the minimum competency test at the level I A, the minimum educational background of the Nursing Diploma III, as a permanent employee and willing to be a research respondent proven by the willingness to sign informed consent. The study was conducted at Hermina Jatinegara Hospital and Hermina Podomoro Hospital, the study was conducted during June 2018.
The data collected in this study are, Primary Data included is the instrument used was a questionnaire with grid questionnaire in this research are questionnaires A demographic data such as gender, age, recent education, employment status, work unit and length of employment. Questionnaire B: Choice System that uses a Likert scale consists of 20 statements with indicators of financial and nonfinancial rewards. Rated 5 if the nurse replied very adequate, a value of 4 if adequate, a value of 3 if sufficient (CM), 2 if it is inadequate, and 1 if it is not adequate. Questionnaire C: Performance nurse also using a Likert scale consists of 20 statements with performance indicators of nurses in implementing the process of nursing care. Nursing competence assessment sheets, using standard assessment instruments of the competence of HHG nursing committee, namely Hermina Jatinegara Hospital center, and Hermina Podomoro Hospital. The competency test system has been performed by HHG, therefore the researcher does not test again but uses the results and is recorded on the observation sheet with 5 if very competent (8-9), 4 if competent (6-7), 3 if competent enough (score 5), 2 if less competent (3-4), 1 if not competent (1-2). Secondary Data included is data obtained indirectly, the data in the form of documentation data of competency test results of nurses at Hermina Jatinegara Hospital and Hermina Podomoro Hospital, hospital statistic data, and reports related to this research.
The instrument test was conducted on 30 nurses at the hospitalization unit at Hermina Depok Hospital, on the grounds that Hermina Depok Hospital has the same criteria and type of hospital as well as the characteristics of the same nurse and culture with Hermina Jatinegara Hospital and Hermina Podomoro Hospital. Based on the results of questionnaire test analysis of 30 respondents with 40 statements by using Pearson Product Moment then got the value of r count is 0.374 and get the value of r count in the column Corrected Item-Total. Correlation is greater than the value of r table, then in concluded from 40 questions in the answer by 30 respondents stated valid. Reliability measurement is done by comparing Alpha Cronbach’s value with r table. Obtained Cronbach’s Alpha value 0.946, it was concluded that 40 questions in the respondent’s answer based on the alpha value in the above reliability table can be drawn a conclusion all respondents answer is very reliable because it is in the alpha range 0.80-1.00.
Technical procedures for data collection was conducted in the treatment room, after obtaining a research permit from the field of Education and Training of Hermina Hospital Group (HHG), the researcher requested permission from the nursing manager, the head of the inpatient installation and the head of the room in the inpatient unit. Researcher assisted by 1 research assistant. Respondents were asked to consent through informed consent sheet. Researchers and research assistants distributed questionnaires and allowed the respondents to fill in for 20-30 minutes, the researchers left the room to give freedom of charge for the respondents. Once completed, the questionnaires were returned to the researchers by the respondent. The researcher will re-examine the completeness of the questionnaire.
Data analysis technique in this research using path analysis test. Path analysis is a statistical technique used to test the causal relationship between two or more variables. The essence of path analysis is based on a system of linear equations. Different path analysis and regression analysis, where the analysts paths allow testing using variables mediating/ intervening. The influence of independent variables on dependent variables in path analysis can be either direct or indirect influence (Kadir, 2015).

3. RESULTS

Table 1. Distribution of Frequency Characteristics
Variables Total %
Gender Women 66 100
Age 1. < 25 years 1 1,5 2. 25-29 years 18 27,3 3. 30-34 years 18 27,3 4. 35-39 years 24 36,4 5. > 40 years 5 7,6
Education and Working Period 1. Diploma in Nursing <5 years 8 12,1 2. Diploma in Nursing 5-9 years 27 40,9 3. Diploma in Nursing 10-14 years 13 19,7 4. Diploma in Nursing 15-19 years 14 21,2 5. Diploma in Nursing > 5 years. 4 6,1

Nurse in inpatient respondents is women 66 (100%) (Table 1). The average age of nurses who were respondents aged 35-39 years 24 people (36.4%). The education level of nurses is Diploma in Nursing with a working period of 5-9 years the majority of 27 people (40.9%).

Table 2. Beta Coefficient of System of Awards, Education and Working Period on Competence
Model Unstandardized Coefficients Standardized Coefficients t Sig
B Std Error Beta
1 (Constant) 1.777 .601 2.958 .004
Award System .382 .182 .253 2.098 .040
Education and time during work .236 .103 .276 2.287 .026
Endogen: Competence Nurse

There is a probability value of the reward system 0.04 <0.05 then Ho is rejected (Table 2), meaning that there is the significant influence on the reward system of competence. The probability value of education and working period in table 2 is 0,026 <0,05 so Ho is rejected, meaning there are the significant influences of education and work period on the competence of nurse. The effect of X1 variable (reward system) and variable X2 (education and working period) to the variable Y1 (competence nurse) is described in equation sub structure 1 is Y1 = ρY1X1 + ρY1X2 + ε1Y1, or Y1 = 0.253 X1 + 0.276 X2 + ε1Y1. The reward system directly and significantly influences the competence of nurses. the value of the direct influence of the awards system on the competence of nurses is 0.253, while the direct education and working period of the nurses have an effect and significant on the competence of the nurse. The direct influence of nurse education and work period on the competence of nurses is 0.276. Two variables are used as predictors of nurse competence so that the variables of education and working period are identified as the strongest variables that affect the competence of nurses be compared to the reward system variables. Table 3. The coefficient of Beta Award System, Education and Working Period, Competence on Nurse Performance Model Unstandardized Coefficients Standardized Coefficients t Sig B Std Error Beta 1 (Constant) 2.904 .275 10.551 .000 Award System .223 .081 .301 2.751 .008 Education and working period .100 .046 .237 2.158 .035 Competence .141 .054 .228 2.610 .011 Endogen: Nurse Performance Value of reward system probability of 0.008 <0.05 then Ho is rejected (Table 3), meaning there is a significant effect of reward system on the performance of nurses. The probability value of education and working period of is 0,035 <0,05 so Ho is rejected, so there is the significant influence of education and working period on the performance of nurse. Competence probability value of 0.011 <0.05 then Ho rejected, meaning there is a significant influence of competence on the performance of nurses. The effect of X1 variable (reward system) and variable X2 (education and duration of work) and variable Y1 (competence nurse) to variable Y2 (performance of nurse) to equation sub-structure 2 that is Y2 = ρY2X1 + ρY2X2+ ρY2Y1 + ɛ2Y2. Directly the reward system has an effect on and significant to nurse’s performance. the value of the direct impact of the reward system on performance is 0.301. Directly nurse education and working time have an effect on and significant to nurse performance. The value of direct influence of education and working period on nurse performance is 0.237. The competence directly and significantly influence the performance of the nurse. The value of direct influence of competence on nurse performance is 0.288. The direct influence of the rewards system to the performance of the nurse = ρY2X1 = 0,301. The direct influence of education and years of service to the performance of nurses ρY2X2 = 0,237. The indirect effect of reward system through nurse competence to nurse performance = ρY1X1 x ρY2Y1 = 0,253 x 0,288 = 0,073. Indirect influence of education and working period through nurse competence to nurse performance = ρY1X2 x ρY2Y1 = 0,276 x 0,288= 0,079. Total effect = ρY2X1 + ρY2X2 + (ρY1X1 x ρY2Y1) + (ρY1X2 x ρY2Y1) = 0,301 + 0,237 + 0,073 + 0,079 = 0,69. 4. DISCUSSION 1. Demographic Characteristics All respondents are female that is 66 respondents (100%). Rusnawati study (2012), women considered appropriate role as a nurse for the confluence is more flexible for working in the care of patients with no specific restrictions. Female nurses have the authority to care for male and female patients. Majority of respondents age is 35-39 years 24 respondents (36.4%). Dyne and Graham in Sudarmanto (2014) that older employees tend to have more sense of interest or commitment to the organization than younger ones, increasing their loyalty to the organization.