The Relation Between Work Motivation and Nurse Performance of Inpatient Installations at Methodist General Hospital Medan

Motivation is defined as something in a person that can be pushed, and direct person behaviour. In other word, motivation is intentions in ourself, hope, desire and purposed to be achieved. Nurses have an important role in determining good or bad quality hospital service. Motivation owned by nurses is important as a force spesifically to provide health service to health service users in the hospital. This research is quantitative and using cross sectional design. The purpose of this research is to see what factors that can related over the performance of nurses of emergency room in Methodist Hospital Medan 2018. This research use total sampling and the source data of this research is using questionnaire and then followed by using univariate analysis, bivariate analysis, multivariate analysis with SPSS program. The results of this research is that responsibility (p=0,004), supervision (p=0,001), insentive (p=0,003), achievement (p=0,002), promotion (p=0,004), related to nurse performance and the most related variable is supervision with r square 0,026, F=1,279, and sign F 95% CI=0,264. The result showed that there related between motivation and nurse performance. The most related factor is supervision. Supervision done by head of nursing routinely to all nurse. In order optimize performance, quality and health services increase the motivation for this to work and to the way of administering the able more, creates an enabling environment, companion at good relations with, guarantee work, good relations between superiors with subordinate, and including nurse in seminars and sustainable trainings nursing.


Introduction
Nurses have a very important role in determining the good or bad quality of the hospital because nurses are the human resources who have the most direct contact with patients. In providing health services to patients, nurses have the motivation to encourage nurses to provide the best service. Nurse motivation is a very important component for nurses in providing services to patients. The motivation possessed by nurses is a special encouragement to provide health services to users of health services in hospitals.
Motivation can come from internal and external encouragement. Nursing services contribute to determining the quality of hospital services, so that every effort to improve the quality of hospital services must also be accompanied by efforts to improve the quality of nursing services, one of which is by increasing the performance of nurses (Abdullah et al., 2013).

Methods
This research is quantitative and using cross sectional design. The purpose of this research is to see what factors that can related over the performance of nurses of emergency room in Methodist Hospital Medan 2018. This research use total sampling and the source data of this research is using a questionnaire and then followed by using univariate analysis, bivariate analysis, multivariate analysis with SPSS program. Based on the table above the distribution of respondents based on gender, the majority are women as many as 38 people (76%) and men as many as 12 people (24%).  Based on the table above, the distribution of respondents based on education is dominated by the DIII Nursing education level totaling 41 people (82%) while for the S1 education level there are 9 people (18%). Based on the table above, the distribution of respondents based on income is dominated by income <2,700,000 totaling 32 people (64%), while for income> 2,700,000, it is 18 people (36%). Berdasarkan tabel diatas distribusi responden berdasarkan status pernikahan didominasi oleh status menikah berjumlah 27 orang (54%) sedangkan untuk yang belum menikah berjumlah 23 orang (46%). Based on the table above, the distribution of respondents based on length of work is dominated by working time <5 years totaling 24 people (48%), for working time 5-10 years amounted to 22 people (44%), while for working hours> 10 years totaled 4 people (8 %). Based on the table above, the frequency distribution of the supervision variable is dominated by a good level of supervision totaling 27 people (54%), for the moderate level of supervision there are 19 people (38%), while for the poor level of supervision there are 4 people (8%).  Based on the table above, the frequency distribution of the incentive variable is dominated by high incentives totaling 29 people (58%), for moderate incentives there are 15 people (30%), while for low incentives there are 6 people (12%). Based on the table above, the frequency distribution of the promotion variable is dominated by a good level of promotion totaling 27 people (54%), for a moderate level of promotion there are 19 people (38%), while for bad promotions there are 4 people (8%). Based on the table above, the frequency distribution of nurses' performance is dominated by the performance of nurses who are currently 28 people (56%), for good performance of nurses there are 20 people (40%), while for poor performance of nurses there are 2 people (4%). Based on the table above the responsibility variable has r = 0.455 with p value = 0.004. Responsibility has a moderate, significant and positive relationship with nurse performance, meaning that the greater the responsibility given to nurses, the better the nurse's performance.

Bivariate Analysis
In line with research conducted by Murniyati et al. (2013) with the Fisher's Exact test results obtained a p value of 0.021 which indicates that there is a relationship between responsibility and the performance of the nurse. This is in line with research conducted by Irena (2017) based on the results of the Pearson Correlation Test using the help of a data processing application, the Pearson Correlation value between the relationship of responsibility and nurse performance is 0.416 with a Sig value. (2tailed) = 0.000. A variable is said to be significantly related if its significance value is less than the 5% probability level (0.05). This means that if the responsibility of a nurse is increased, the performance of the nurse will also increase. Based on the table above, the independent sub variable supervision has r = 0.674 with p value = 0.001. Supervision has a moderate, significant and positive relationship with nurse performance, meaning that the greater the supervision given to nurses, the better the nurse's performance. This is in line with research conducted by Irena (2017), based on the results of the Pearson Correlation test, a significant value of 0.008 was obtained which is smaller than the 5% probability level (0.000 <0.05). So with these results it can be interpreted that supervision has a significant (real / significant) relationship to the performance of nurses. From the results of the Pearson Correlation test, it can be seen that if the level of supervision of a nurse increases, the performance it has will also increase, and vice versa, the lower the level of supervision the nurse has, the performance will also decrease.
In line with the research conducted by Nur (2013) with the results of statistical tests using chi-square, the value of p = 0.002 was obtained, because the p value <0.05 then Ho was rejected, which means that there is a significant relationship between supervision and the performance of the nurse in implementing patient safety Hasanuddin University Hospital inpatient room. In addition, through the phi and cremer tests, it was found that the relationship between variables was in the medium category. Andriani (2012) states that supervision is an effort to assist in fostering and increasing the ability of those under supervision so that they can carry out their assigned activities efficiently and effectively. Based on the table above, the independent sub incentive variable has r = 0.4999 with p value = 0.003. Incentives have a moderate, significant and positive relationship with nurse performance, meaning that the greater the incentive given to nurses, the better the nurse's performance. This is in line with research conducted by Irena (2017) where the results of the Pearson Correlation test obtained a significant value of 0.000 which is smaller than the 5% probability level (0.000 <0.05). So with these results it can be interpreted that incentives have a significant relationship (real / meaningful) to the performance of nurses. From the results of the Pearson Correlation test, it can be seen that if the incentive level received by a nurse is increased, the performance it has will also increase, and vice versa, the lower the level of incentive received by nurses, the performance will also decrease because of this.
Theoretically, according to Susan (2019) incentives are all compensation received by employees in the form of financial compensation (remuneration) and non-financial compensation (promotion, transfer, praise, award). Incentives can be used as a tool to motivate employees to realize organizational goals, because incentives are a compensation approach by rewarding certain work results that employees have achieved. Based on the table above, the independent sub-variable of achievement has r = 0.572 with p value = 0.002. Achievement has a significant and positive relationship with nurse performance, meaning that the greater the achievement given to nurses, the better the nurse's performance. In line with the results of Nurjahjani's (2007) research on the effect of financial rewards, interpersonal rewards, and promotions on employee work performance, the results of the study concluded that work performance affects job promotion, by increasing an employee's performance, the higher the promotion. Achievement is one of the factors that influence nurses' motivation to improve performance. However, it is different from the research results of Suryono et al. (2018) stated that there is no relationship between work performance appraisals and employee performance. Based on the table above, the independent sub variable promotion has r = 0.772 with p value = 0.004. Promotion has a significant and positive relationship with nurse performance, meaning that the greater the promotion given to nurses, the better the nurse's performance.
The results obtained are in accordance with the results of research conducted by Agus (2013) which found a significant relationship between job promotion and the performance of health workers in Polmas Regency. Promotion is one of the motivators. Promotion is an encouragement to achieve because you want a promotion or an increase in status as a form of appreciation from the leadership for good performance. Based on table 18, the supervision sub-variable has an r square value of 0.026 and an F value of 1.279 with a Sign.F value with a 95% CI 0.264. The value of the supervision subvariable has the smallest r square and F values with the Sign value. F is the highest. So it can be concluded that supervision is the most dominant subvariable and is related to nurse performance.

Conclusion
The results showed that most of the nurses were women, 30-40 years of age, nursing education, income <2,700,000, married and <5 years of service. Promotion sub variable and responsibility variable are the sub variables that are most related to nurse performance. There is a relationship between responsibility and nurse performance. With r = 0.455 with p value = 0.004, which means that responsibility has a moderate, significant, and positive relationship with the performance of nurses, meaning that the greater the responsibility, the better the nurse's performance. There is a relationship between incentives and nurse performance. With the incentive r = 0.499 with p value = 0.003, which means that the incentive has a moderate, significant, and positive relationship with the nurse's performance, meaning that the greater the incentive given, the better the nurse's performance. There is a relationship between achievement and nurse performance. With r = 0.572 with p value = 0.002, which means that achievement has a moderate, significant, and positive relationship with the performance of nurses, meaning that the higher the level of achievement, the better the nurse's performance. There is a relationship between supervision and nurse performance. With the result r = 0.672 with p value = 0.001, which means that the higher the supervision, the better the nurse's performance. There is a relationship between promotion and nurse performance. With the result r = 0.772 with p value = 0.004, which means that the greater the promotion given, the better the nurse's performance. Of all the variables that most influenced the nurse's performance was the variable r square value 0.026 and F value 1.279 with a Sign.F value with 95% CI 0.264. The value of the supervision sub variable has the smallest r square and F values with the Sign value. F is the highest. So it can be concluded that supervision is the most dominant sub variable and is related to nurse performance.