The Effect of Work Stress on Nurse Performance in The Inpatient Wards Tanjung Pura Hospital on 2016

Nursing care in a hospital is an integral part of health service. A nurse has a constant contact with patients within 24 hours, and her work demand can potentially cause stress. The main purpose of the research was to find out the influence of work stress on nurses’ performance in the Inpatient Wards. The research was a survey with an explanatory research method in order to find out the influence of work stress on nurses’ performance in the Inpatient Wards of RSUD (Regional General Hospital) Tanjung Pura. The population was 63 nurses in the Inpatient Wards, and all of them were used as the samples since their numbers was relatively small. The data were gathered by conducting in-depth interviews and reporting data were obtained from the hospital. The gathered data were analyzed by using linear regression statistic test. The result of the research showed that 77.8% of the respondents had moderate performance, 14.3% of the respondents had good performance, and 7.9% of the respondents had bad performance. It was also found that the variable of work stress influenced the performance at p-value = 0.00001. It is recommended that the hospital management pay attention to the nurses’ condition in each Inpatient Ward. On the other hand, the hospital management should give special attention to the work stress undergone by the nurses in the Inpatient Wards.


INTRODUCTION
Inpatient services are activities carried out in the inpatient room in an effort to improve health in the form of disease prevention, healing, recovery and health care. Health services must be in accordance with the authority, responsibilities and ethical codes of the nursing profession. 1 Nursing provides hospital services 24 hours a day. Therefore, nursing services in hospitals are an integral part of health services.
Information about the performance of nurses from the research results revealed that the performance of health workers is still not optimal. The perception of nurses' performance in government hospitals namely Sumedang District Hospital in the good category was only 49.5% while the rest in the category of less than 50.5% with population characteristics: educational Buletin Farmatera Fakultas Kedokteran (FK) Universitas Muhammadiyah Sumatera Utara (UMSU) http://jurnal.umsu.ac.id/index.php/buletin_farmatera background was nursing III (82.5%), the average length of work in the hospital more than 6.06 years, and most of the age of nurses is 27.96 -29.45 years (productive age). This shows that the average performance of nurses in the hospital is still relatively low despite the individual characteristics of nurses who are already quite optimal in terms of age, education, and length of work. 2 Nurse performance with good category was 56.9% in private hospitals and 44.8% in government hospitals. 3 Duties and responsibilities of nurses are not easy things to bear. On one hand the nurse is responsible for physical, administrative tasks of the institution where he works, dealing with anxiety, complaints and the patient's self defense mechanisms that arise in patients due to illness, tension, boredom in dealing with patients with conditions that suffer from critical illness or terminal conditions, on the other hand he in demand to always have to appear as a good nurse profile by patients. Various situations and demands of work experienced can be a potential source of stress.
Some survey results show that the prevalence of work stress in nurses is quite high. The Canadian Community Health Survey in 2003 showed that 45% of health workers experienced work stress, including nurses. 4 The survey results from the UK Office for National Survey 2011/2012 period also showed that health professionals, especially nurses, still had the highest prevalence of work stress during the three survey periods. 4 Meanwhile the results of a survey conducted in Indonesia by the Indonesian National Nurses Association (PPNI) in 2006 showed that around 50.9% of nurses working in four provinces in Indonesia experienced work stress. 5 Tanjung Pura General Hospital is the only government-owned hospital in Lagkat Regency. Based on an initial survey conducted by researchers at Tanjung Pura District Hospital in January 2016, Tanjung Pura District Hospital has 100 beds with 63 nurses in the inpatient ward.
From the results of research on the performance evaluation of nurses assessed from the recording of nursing care in the medical record, it was found that 61.8% of nurses inpatient room of Tanjung Pura Regional Hospital had not good performance From the observations of researchers and interviews with nurses in the inpatient wards found symptoms of work stress that arise in nurses. From the observations found nurses who are less communicative, irritable, and easily offended. From interviews with 9 nurses found 5 nurses who complained of frequent fatigue at work, 6 nurses who complained of frequent headaches and 4 people complained of difficulty sleeping because of thinking about work problems. This is an indicator of work stress.
The purpose of this study was to explain the stress of nurses' work in carrying out their profession in the inpatient room of Tanjung Pura Regional Hospital in 2016, explain the performance of nurses in carrying out their profession in the inpatient room of Tanjung Pura Regional Hospital in 2016, and explain the effect of work stress on the performance of nurses in running his profession in the inpatient room of Tanjung Pura Regional Hospital in 2016.

METHODS
This study uses survey research with an explanatory research method approach, which explains the effect of work stress on the performance of nurses in carrying out their profession in the inpatient room of Tanjung Pura General Hospital.
This research was conducted at the Tanjung Pura General Hospital, Langkat. The study population was all nurses who worked in the Inpatient Room of Tanjung Pura Regional Hospital. The number of nurses working in the inpatient room is 63 people In connection with the relatively small population, the sampling technique in this study uses total sampling in which the entire population is sampled as 63 people.
The data collection method of this study was carried out with interviews guided by a structured questionnaire with closed answers prepared in advance and using secondary data obtained from reports in the Tanjung Pura Regional Hospital. Data analysis in this study used a linear regression statistical test.

RESULTS
Respondent's work stress is measured through indicators of physical symptoms, psychological symptoms and behavioral symptoms.
Most respondents had a moderate level of work stress as many as 31 people (49.3%), followed by mild work stress as many as 20 people (31.7%) and heavy work stress as many as 12 people (19.0%). The frequency distribution can be seen in the following table: This is in line with research conducted by Gustian (2010), where from the results of research on inpatient nurses in West Pasaman Regional Hospital found 67.8% experienced moderate work stress. Like Tanjung Pura Regional Hospital, West Pasaman Regional Hospital is also a type C regional hospital. 6 Respondents' performance is measured through a standard of nursing practice namely nursing care consisting of nursing studies, nursing diagnoses, nursing care planning, implementation and evaluation of nursing The frequency distribution of nurses' inpatient room performance at Tanjung Pura Regional Hospital can be seen in the following table: Most of the respondents had moderate performance as many as 49 respondents (77.8%), followed by good performance as many as 9 respondents (14.3%) and distribution of respondents who had poor performance as many as 5 respondents (7.9%). The results of this study are slightly different from the results of the study of Firmansyah (2014) where it was found that the performance of nurses in Tanjung Pura Hospital was not good. From the results of this study found 61.8% of nurses with the category of poor performance. This difference occurs in the performance of research Firmansyah (2014) assessed through nursing care documentation on patient status. 7 Bivariate analysis was carried out to determine the relationship between independent and dependent variables. Due to the scale of the data used was the interval, previously the normality of the data was tested with the Kolmogorov Smearnov test.
Results of analysis of normality test data with Kolmogorov Smirnov: 1. Work stress with p value 0.001 (<0.05) means that the data is not normally distributed. 2. The performance of p value 0,0001 (<0.05) means that the data is not normally distributed. Because the two data variables are not normally distributed then the Spearman Rho correlation test is used to see the relationship between work stress and nurse performance.
The results of the relationship of work stress to the performance of work stress relationship to work performance in nurses inpatient nurses in Tanjung Pura Regional Hospital, the majority of nurses' performance is in the medium category with moderate stress in the job category of 30 respondents (96.8%).
In the Spearman rho test results between work stress and the performance of nurses in the inpatient ward of Tanjung Pura Regional Hospital, a value of rs = -0,600 can be obtained, meaning that the correlation of work stress with the performance of nurses has a strong relationship. The coefficient value is a negative correlation value which is a strong relationship and opposite direction so that the heavier or higher work stress on nurses can reduce the nurse's performance and the p-value in the sig (2-tailed) column by 0,0001 <0.05 (significant) . This is interpreted that Ho is rejected, which means that there is a significant relationship between work stress and the performance of the implementing nurses in the Inpatient Room of Tanjung Pura Regional Hospital. The results of the study are in accordance with Gustian's research (2010), stating there is a significant relationship between nurses work stress and the performance of nurses in implementing nursing care in the Inpatient Room of West Pasaman Hospital in 2010 (p = 0.035). 6 This is also in line with Hidayat's (2008) research on the relationship between work stress factors and the performance of nurses in the emergency department of the Premier Surabaya Hospital. Based on the Spearman Rank test results, there was a significant relationship between work stress and nurse performance (p = 0.001 and r = -0.831). 8 This is also in line with Wahyu's research (2015) which states that there is a significant negative relationship between work stress and the quality of nursing services in the Inpatient Room of PKU Muhammadiyah Hospital in Yogyakarta (p = 0.001 and r = -0.389). 9 In the study of Khamisa et al (2015) on 895 nurses at hospitals in South Africa found a significant negative relationship between job stress and nurse job satisfaction. 10 (2015) there was a significant positive effect of job satisfaction on performance (p = 0.043 and coefficient = 0.406). This means that the higher the level of satisfaction the better the performance and vice versa. 11 To find out the effect of work stress on the performance of inpatient nurses in Tanjung pura Hospital, a linear regression test was performed. Linear regression test results can be seen in the following table. The results of simple linear regression analysis showed the number r 2 = 0.366 or 36.6% with a significance of ρ = 0.0001 (significant), meaning 36.6% of nurses' performance variation can be explained by work stress variables. While the rest (100% -36.6% = 63.4%) is explained by other variables outside the model or influenced by other factors not examined by the researcher. This is in line with Riza's research (2015), in Wijaya Kusuma Hospital Lumajang Regency, East Java, where work stress variables have a significant negative effect on nurses' performance, meaning how much work stress there is will have the opposite effect on nurse performance. nurses will decrease and vice versa (p = 0.006 and coefficient = -0.342). 11 The results of this study are also in line with the research of Long et al (2013) conducted on 300 nurses from 7 private hospitals in Malaysia. From this research, it was found that there was a significant negative effect of work stressors on nurses' performance. 12 The results of this study were also in line with Fauji's (2013) research on the employees of PT Karya Mandiri Environment found the effect of work stress on employee morale. Where the higher the job stress, the lower the employee morale (p = 0.015). 13

CONCLUSION
From the results of the research conducted, the following conclusions are drawn: 1. Most nurses in Tanjung Pura Regional Hospital experience moderate work stress followed by mild work stress then severe work stress 2. Most respondents or inpatient nurses have moderate nurse performance, followed by good nurse performance then the poor performance.
3. There is a significant relationship between work stress and nurse performance with a negative correlation which indicates the higher work stress can reduce nurse performance. There is an influence of work stress on the performance of inpatient nurses in Tanjung Pura Langkat Regional Hospital.

SUGGESTION a. For the Tanjung Pura Regional
Hospital.
The hospital is expected to pay attention to the condition of nurses, the work environment, and the completeness of the equipment in each inpatient room. Hospital management should pay more attention to the stress conditions experienced by nurses inpatient rooms. It is recommended to conduct periodic counseling and distribution of questionnaires as an evaluation and consideration material for stress management on nurses. For nurses who work in the Inpatient Room to do stress management in person so that stress levels decrease and performance is getting better, so that nursing services can be provided optimally, especially in providing nursing care to patients.