The Influence of Motivation and Work Environment on Nurses Performance in Public Hospitals Sundari Medan

Hospital is a means of health efforts that carry out health service activities and is an institution for providing services. Complex services need to be managed professionally for human resources. One of the service providers at the hospital is a nursing staff. The purpose of this study was to determine the effect of motivation and work environment on the performance of nurses at RSU Sundari Medan in 2020. The research method used was an analytic survey with a cross sectional approach. The sample in this study were 60 nurses at Sundari Hospital Medan. The sampling method using the total population. The results of the study prove that motivation has a significant effect on the performance of nurses at Sundari Hospital Medan. This shows the results with a P-value (0.000) which is significantly smaller than α = 0.05. The work environment has a significant effect on the performance of nurses at Sundari Hospital Medan, showing the results with a p-value (0.081) which is significantly smaller than α = 0.05. The conclusion from the results of this study shows the influence of motivation, work environment on the performance of nurses in the hospital. Sundari Medan in 2020. It is hoped that the nursing managers can improve the quality of hospital services both in quality and quantity and minimize work stress and workload for nurses.


Introduction
Human resources are the most important and very determinant of all the resources available in an organization, both public and private organizations. Human resources are the only resources that have reason, feelings, desires, abilities, skills, knowledge, drive, resources and work. All the potential of human resources is very influential on the organization's efforts in achieving its goals. Technological sophistication, the rapid development of information, the availability of capital, and adequate materials in the organization will not be able to achieve company goals without the support of potential human resources (Hamali, 2018).
World Health Organization (WHO) stated that the density of health workers has a strong relationship with the probability of survival, both for the safety of the life of infants, children and mothers. And the performance of these nurses is strongly influenced by work motivation, wages or salaries, work environment, and achievement opportunities and education (Librianty, 2018).
Nursing as a form of professional service is an integral part that is inseparable from health services as a whole. This is emphasized in the Republic of Indonesia Law No.36 of 2009 concerning Health, which is carried out with medication and / or care. Nursing is an effort to achieve a maximum health degree based on the potential that is owned in carrying out activities in the fields of promotive, preventive, curative and rehabilitative by using the nursing process (Hidayat, 2017).
The Directorate of Nursing, Ministry of Health of the Republic of Indonesia in collaboration with WHO in 2000 in four provinces in Indonesia, namely DKI Jakarta, North Sumatra, North Sulawesi and East Kalimantan, found that 47.4% of nurses did not have a written job description, 70.9% of nurses had never attended training in 3 In the last year, 39.8% of nurses carry out non-nursing tasks, and a nurse performance monitoring and evaluation system has not been developed (Hidayat, 2017).
Based on the results of the pariset conducted by the researcher, Mitra Medika General Hospital has problems with the performance of its nurses. Where the performance of nurses has decreased due to the occurrence of new nurses in and out, this also results in a decrease in the motivation of nurses to work, marked by the services provided by nurses at the hospital, besides the lack of awards given by the hospital such as promotion so that it affects performance the nurse herself. In addition to motivation, the authors also received information that the workload of nurses increased as a result of the change of new nurses, so that senior nurses experienced double jobs, where nurses had to direct and provide training on the job for new nurses. So that the job responsibilities given are neglected (Astuti & Lesmana, 2019).
Motivation is needed because with motivation, employees will be more enthusiastic and responsible for their work so that performance can be better. Motivation is a human psychological characteristic that contributes to a person's level of commitment. This includes the factors that cause, transmit, and sustain human behavior in a certain direction. Motivation is a feeling or thought that encourages someone to do work or exercise power, especially in behavior (Nursalam, 2014) The work environment is the environment where the employee works. The work environment for employees will have no small influence on the running of the agency's operations. The work environment will affect employees so that it will directly or indirectly affect the productivity of the agency. A good work environment and satisfying employees will certainly improve the performance of the nurses. Conversely, a bad work environment will reduce the performance of the nurses and indirectly also reduce the productivity of the institution (Budianto & Katini, 2017).
Based on the results of the initial interview survey conducted on January 12, 2020 at the Sundari General Hospital, Medan, hospital nurses tend not to be able to complete tasks given by their superiors properly and on time. This is due to the lack of interaction between superiors and subordinates, such as providing guidance, encouragement or motivation to all members to achieve goals. In addition, the absence of attractive motivational tools for employees makes them willing to work hard and be responsible, resulting in low performance.

Methods
The research design used was analytical with a cross sectional design, where the independent and dependent variables were studied together, which aims to determine the relationship between the influence of motivation and work environment on the performance of nurses at Sundari General Hospital Medan in 2020. This research was conducted at the Sundari Medan General Hospital in 2020. Jln.Jend. T.B Simatupang No.13, Postal Code 20127 on the grounds that the samples needed in the study were available; there is a permit from the institution where the research is conducted; affordable to researchers. The implementation of this research was carried out from March to April 2020 at the Sundari General Hospital, Medan. Population is the whole object of research or object under study. The population in this study were all nurses at the Medan Sundari General Hospital in February 2020, as many as 60 people.
Sampling is part of the number and characteristics possessed by the population. Sampling means taking a sample or taking something part of the population or universe as a representative (representation) of the population or universe. Sampling in this study is based on the Total Sampling technique in which the entire population is used as a a sample of 60 people. Data analysis using SPSS for windows program, univariate analysis is used to describe the characteristics of respondents, samples, distribution and frequency of variables, bivariate analysis to see the relationship between variables with the Chi-Square test, to see the effect of variables used the Simple Paired Test. The results then continued with the multivariate analysis with the Phi test.

Results and Discussion
Characteristics of respondents: Table 1 shows that the gender of nurses is mostly female as many as 36 respondents (60%) and male gender as many as 24 respondents (40%). The age of nurses was mostly at the age of 31-45 years as many as 34 respondents (34%), at the age of 20-30 years as many as 22 respondents (36.7) and the least age> 45 as many as 4 respondents (6.7%). Nurse education was mostly at the S1 level as many as 41 respondents (68.3%) and the D3 level as many as 19 respondents (31.7%). Length of work for nurses is between 5-10 years at most as many as 45 respondents (75%) and those who work <5 years are 15 respondents (25%). From table 2 above it can be seen that of the 60 respondents (100%) nurses who said the performance of nurses were good as many as 29 respondents (48.3%), 24 respondents (40%) had good enough performance and 7 respondents ( 11.7%). Meanwhile, 29 respondents (48.3%) said good motivation, 35 respondents (29%) had good enough motivation and 10 respondents (16.7%) had poor motivation.
From the results of statistical tests with the Chi-square method, it shows that the value in the Asymp.sip column. (2-sided) of 0.000 (p <0.05). This shows that there is a relationship between the influence of motivation on the performance of nurses at the Sundari General Hospital in 2020. From table 3 above, it can be seen that of the 60 respondents (100%) nurses who said the performance of nurses were good as many as 20 respondents (33.9%), 26 respondents (44.1%) had good enough performance and 13 nurses' performance was not good. respondents (22%). Meanwhile, there were 28 respondents (47.5%) who said good work environment, 21 respondents (35.6%) had a good enough working environment and 10 respondents (16.9%) had a poor working environment.
From the results of statistical tests with the Chi-square method, it shows that the value in the Asymp.sip column. (2-sided) 0.081 (p <0.05). This shows that there is a relationship between the influence of the work environment on the performance of nurses at the Sundari General Hospital in 2020. Motivation Sundari Hospital has a duty to improve the quality of work as stated in the vision and mission of the hospital not only in terms of what nurses need, but what must be done to increase nurses' motivation in carrying out their duties and obligations. This is measured in motivation with the results of the performance of nurses, it can be seen in the results of the study that 29 respondents (48.3%) stated that motivation with the performance of nurses was good, while motivation with the performance of nurses was quite good as many as 24 respondents (40%) and motivation with the performance of nurses was less good as many as 7 respondents (11.7%). It is necessary to explain that in a work scope, it really requires a target in work to achieve an achievement, in which case it requires an expertise of nurses to complete prioritized work, with the intention of health workers to complete each job, each health worker will be given an achievement. according to what has been done. The responsibility of every health worker is not very easy, every thing that is done cannot be separated from his own responsibility so that in the future every job can be accounted for according to his own profession.
This shows that motivation affects the performance of nurses as evidenced by the results of research conducted by 29 respondents (48.3%) who said that motivation is good. From the results of the Chi-square test, it is found that work motivation has a relationship with nurse performance, with a p value of 0.000 (p <0.05).
According to research conducted by Deniati & Yanti (2019), this study showed that most of the work motivation of the nurses in the inpatient room at Alimuddin Umar Hospital, West Lampung Regency, was not good, as many as 32 people (53.3%). Leaders should be able to maintain motivation to nurses, so that nurses always have high performance, namely by providing incentives or bonuses to nurses who work overtime or have good performance.
According to research conducted by Dewi (2018), it shows that there is an effect of achievement, recognition, responsibility, development, salary, working conditions, interpersonal relationships, supervision of nurse performance, of the ten motivational variables that have the greatest influence on nurse performance, namely work.
According to research conducted by Sitinjak & Wardhana (2016) shows that nurses' responses to motivation variables have a percentage of 79.6% which is in the "good" category, the performance variable gets a value of 78% where the percentage is in the "good" category and motivation affects the performance of nurses at the Carnation Pavilium installation of the Budi Mulia Hospital. batam by 80.5%.

Work Environment
The atmosphere in the work environment can affect individuals either directly or indirectly. The aspects of the work environment are lighting, temperature, humidity, air circulation, noise, unpleasant smells, decoration and security. The higher the score obtained, it is assumed that the work environment will be higher, but the lower the score obtained, it is assumed that the work environment will be lower. This is measured in the work environment with the results of the performance of nurses, it can be seen in the results of the study that most nurses stated that the work environment was not good as many as 13 respondents (22%), the work environment was quite good as many as 26 respondents (44.1%) and the work environment was good as many as 20. respondents (33.9%).
The real conditions obtained by researchers when conducting research are that the work environment can affect the performance of nurses, the comfort and discomfort of a nurse in the work environment has an impact on performance and service results at work at Sundari General Hospital Medan. However, most of these things are not in accordance with what the workers expect, on the other hand, because this is the responsibility of every health worker so that workers do not prioritize their own interests or comfort in work.
This shows that the work environment affects the performance of nurses as evidenced by the results of research conducted by 26 respondents (44.1%) who said the work environment was quite good. From the results of the Chi-square test, work environment has a relationship with nurse performance, with a p value of 0.081 (p <0.05).
According to research conducted by Yulizar (2019), suggest that calculations using analysis using environmental variables and simultaneous variables have a significant effect on the performance of nurses at Bangkinang Hospital. According to research conducted by Amankwah et al. (2019), there is a significant influence between interpersonal relationships and work environment on nurses' job satisfaction. According to research conducted by Suwuh (2016) multiple linear analysis Motivation and work discipline simultaneously affect employee performance.

Conclusion
The motivation variables consist of achievement, reward, responsibility, career = and job. From the results of statistical tests with the Chi-square method, it shows that the value in the