Factors Influencing the Performance of Nurses in the Emergency Room at Bunda Thamrin General Hospital Medan

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 using cross sectional design. The purpose of this research is to see what factors that can influence over the performance of nurses of emergency room in Bunda Thamrin Hospital Medan 2018. This research use total sampling or exhaustic sampling and The source data of this research is using questionnaire and then followed by using univariate analysis, bivariate analysis, and multivariate analysis with SPSS program. The results of this research is that work load (p=0,000),strees of work (p=0,000),competention (p=0,000), insentive (p=0,000),length of working (p=0,000) have influences for performance of nurse. After multivariate analysis the most influence variable is work load (p=0,000. The result showed that there was correlation between work load, strees of work, competention, insentive, length of working has influences against work performances of nurse. Therefore, needs toimprovenursing service that can be made to improving 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 so important, so that nurses can work effectively and efficiently .Creating a work that could lead to a nurse to do the best.


Introduction
Nurse is one of the professions in a hospital that has an important role in providing health services. Therefore, the hospital where nurses work always makes various efforts aimed at improving the quality of nurse professionalism. Nursing is an integral part of the health service system and is one of the factors that determine the quality of health services. 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 service provided by nurses is still often complained about by the community. The spotlight on the performance of nurses 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. Performance can be an individual performance or a group work of personnel. The appearance of the work is not limited to personnel in functional or structural positions, but also to the entire personnel within the organization. There are various factors that can affect the performance of a nurse. Basically, the level of performance of nurses is influenced by factors from within the nurse itself and factors outside the nurse. Factors from within the nurse include knowledge and skills, competence in accordance with the job, job motivation and job satisfaction. While factors from outside the nurse, namely workload and leadership style in the organization which plays a role in influencing the performance of nurses. This study aims to analyze the factors that influence the performance of nurses in the emergency department at Bunda Thamrin Hospital Medan.

Methods
The study was conducted with a quantitative research design and with a cross sectional approach and was carried out at the General Hospital of Bunda Thamrin Medan. The research time was January 2019. The population in this study were 40 nurses at the Bunda Thamrin Hospital Medan with a sample size (total sampling). The data in this study are primary data with data obtained through a questionnaire. Univariate data were analyzed descriptively and bivariate data were analyzed using Pearson correlation test. Multivariate data were analyzed using linear logistic regression test.  Based on the table above, the distribution of respondents based on education is dominated by the educational level of Nursing DIII amounting to 22 people (55%) while for the S1 education level there are 18 people (45%). Based on the table above, the distribution of respondents based on income is dominated by income <2,700,000 totaling 24 people (60%), while for income> 2,700,000, 16 people (40%). Based on the table above, the distribution of respondents based on marital status is dominated by 22 people (55%) while 18 people (45%) are married. Based on the table above, the distribution of respondents based on length of work is dominated by working time <5 years totaling 29 people (72.5%) while for working time 5-10 years there are 11 people (27.5%). Based on the table above, the workload frequency distribution of the IGD nurses at the Bunda Thamrin Hospital in Medan is dominated by a high workload level of 35 people (87.5%) while with a moderate workload level of 5 people (12.5%).  Based on the table above, the frequency distribution of the competency distribution of IGD nurses at Bunda Thamrin Hospital Medan is dominated by good competence as many as 22 people (55.0%), moderate competence as many as 17 people (42.5%) while poor competence is 1 person (2.5%) . Based on the table above, the frequency distribution of incentives for emergency nurses at Bunda Thamrin Hospital Medan is dominated by good incentives as many as 19 people (47.5%), moderate incentives are 10 people (25%) while low incentives are 11 people (27.5%). Based on the table above, the frequency distribution of IGD nurses at Bunda Thamrin Hospital Medan is dominated by 22 people (55.0%) medium working tenure, 15 people (37.5%) high working tenure, while 3 low tenure , 5%). Based on the table above, the frequency distribution of the performance of emergency nurses at Bunda Thamrin Hospital Medan is dominated by high performance as many as 29 people (72%), while the performance of moderate nurses is 11 people (27.5%). Analysis of the relationship between workload and nurse performance shows a negative r value with a p value of 0.000, meaning that workload is related to nurse performance. The strength of the relationship between the workload variable and the nurse's performance is a significant category (r = -0.804), meaning that the higher the workload of the nurse, the nurse's performance will decrease. This research is in line with research conducted by Masni et al (2010), concerning the Relationship between Individual Characteristics and Workloads with Nurses' Performance in the Inpatient Installation Room of RSU Haji Makassar which states that there is a relationship between workload and nurse performance. The same research was also conducted by Nursalam et al (2013) which stated that there was a relationship between workload and nurse performance.

Results and Discussion
However, contrary to the results of research conducted by Mudayana (2013), entitled The Relationship between Workload and Employee Performance at Nur Hidayah Hospital, Bantul, 2012 states that workload does not affect the performance of employees at Nur Hidayah Hospital Bantul. In general, the workload is not related to the performance of nurses, however, the hospital also needs to be aware of excessive workloads to prevent unwanted things from the impact of high workloads. Analysis of the relationship between job stress and nurse performance shows a negative r value with a p value of 0.000, meaning that job stress is related to the performance of nurses. The strength of the relationship between work stress and nurse performance is a significant category (r = -0.753), meaning that the higher the level of work stress of the nurse, the nurse's performance will decrease. This is also in line with research by Nopa et al (2020), at the Tanjung Pura Langkat Regional Hospital, on the effect of work stress on the performance of inpatient nurses, which found a significant relationship between work stress (variable physical symptoms, psychological symptoms, and behavioral symptoms) and performance. inpatient room nurses and has a significant influence with a negative correlation value.
Likewise with the results of research conducted by (Nainggolan, 2018) Spearman rho correlation, p = 0.0001 and r = -0.932, shows a negative correlation value and has a significant relationship between job stress and the performance of nurses at Bina Kasih Hospital Medan The analysis of the relationship between competence and nurse performance shows a positive r value with a p value of 0.000, meaning that competence is related to nurse performance. The strength of the relationship between the competency variable and the nurse's performance is a significant category (r = 0.484), meaning that the higher the competence of the nurse, the better the nurse's performance. This is in line with research conducted by Sayuni (2012) where it was found that competence affects the performance of nurses. Likewise with the results of research by Sitepu (2010), there is a significant influence between competence (attitudes and skills) on nurse performance. the most dominant variable affecting the performance of nurses is skills.
However, in contrast to the results of research conducted by Mandagi et al. (2015) with the results of the probability study (significance) greater than 0.05 (0.409> 0.05), H1 is rejected or there is no relationship between nurse competence and nurse performance. The analysis of the relationship between incentives and nurses' performance shows a positive r value with a p value of 0.000, meaning that the incentive is related to the nurse's performance. The strength of the relationship between the incentive variable and the nurse's performance is a significant category (r = 0.412), meaning that the higher the incentive given to nurses, the better the nurse's performance.
The results of this study are also in accordance with the research conducted by Renyaan (2016) regarding the relationship between incentives, motivation, supervision and the performance of nurses in the inpatient room of the Regional General Hospital of Sorong Regency, Papua-Barat, which states that there is a significant relationship between incentives and nurse performance. Inpatient Room at the Regional General Hospital of Sorong Regency, Papua-Barat. Slide with a value of 0.048 and p value> 0.05. Analysis of the relationship between tenure and the performance of nurses shows a positive r value with a p value of 0.000, meaning that tenure is related to the performance of nurses. The strength of the relationship between the tenure variable and the nurse's performance is a significant category (r = 0.412), which means that the longer a nurse is working, the better the performance will be.
The results of this study are in line with the research conducted by Kumajas (2014) with the results obtained by a p value of 0.000, which means that Ho is rejected, so it can be concluded that there is a relationship between tenure and the performance of nurses at Bhayangkara Hospital TKIII Manado. However, it is not in line with the research conducted by Ku et al. (2019) which suggest that there ino relationship between masses work with the performance of nurses at the Manado TKIII Bhayangkara Hospital.

Conclusion
The results showed that most of the nurses were women, 30-40 years old, nursing education DIII, income <2,700,000, unmarried and <5 years working period. There is a correlation between workload and nurse performance with workload = -0.804 and p value = 0.000. This means that the higher the workload of nurses, it will affect the performance of nurses. There is a correlation between work stress and nurse performance with, job stress = -0.753 and p value = 0.000. This means that the higher the level of work stress of nurses, it will affect the performance of nurses. There is a correlation between competence and nurse performance with rkompetency = 0.484, and p value = 0.000, which means that the higher the competence of nurses, the better the nurse's performance. There is a correlation between the incentive and the performance of nurses with the incentive = 0.412 and p value = 0.000, which means that with the incentives given to nurses, the nurse's performance will be better. There is a correlation between tenure and nurse performance with work period = 0.401 and p value = 0.000, which means that the higher the work tenure of nurses, the more satisfying the nurse's performance will be. Of all the variables, the workload variable is the variable that most influences the nurse's performance with a value of F = 0.403 (F> 0.005) with Sign 2-tailed = 0.001 (P value <0.005). So it can be concluded that the workload has a significant influence on the performance of nurses.