Correlation between Quality of Work Life ( QWL ) with Nurse productivity in inpatient room Bhayangkara Tk III Hospital Manado

Background: Productivity is a universal concept that applies to all systems because every activity requires productivity in its implementation. Individual productivity can be assessed from what the individual does in his work. Based on this fact, the purpose of this study is to know the relationship between quality of work life (employee involvement, career development, pride of institution, balanced compensation, job security, available facilities, work environment safety, problem solving and communication) with Work Productivity on Nurse profession at Inpatient Room Bhayangkara TK III Manado Hospital. Method: Study design using cross-sectional analytic approach which was conducted in July December 2017 at Bhayangkara TK III Manado Hospital. Total sampling technique was used by considering inclusion criteria nurses who work> 3 months, and exclusion criteria are nurses who are taking furlough time. The analysis used chi-square test and started from univariate, bivariate and multivariate. Results: The results showed that the p-value of employee involvement (0.089), career development (0.006), pride of institutions (0.060), balanced compensation (0.005), available facilities (0.014), occupational security (0.388) work safety (0.003), problem-solving (0.006), communication (0.009) with work productivity of inpatient nurses at Bhayangkara Tk III Manado Hospital. Conclusions: There is a relationship between career development, balanced compensation, available facilities, work environment safety, communication and problem solving are the variables most related to work productivity of inpatient nurses at Bhayangkara TK III Manado


INTRODUCTION
Hospitals as one of the health service facilities have a vital role in the term to accelerate the improvement of the health status of Indonesian society.One of the professions that have a critical part in the hospital is nursing.Nursing is one of the professions in hospitals that play an essential role in the implementation of efforts to maintain the quality of health services in hospitals.
Law of the Republic of Indonesia No. 38 of 2014 on Nursing stressed that a nursing service is a form of professional service which is an integral part of health services based on the science and tips of nursing aimed at individuals, families, groups, or communities, both healthy and ill. 1 Nurses are professions that provide constant and continuous 24-hour service to patients every day, and nurses are the most important human resources in hospitals because their numbers are dominant, reaching 55-65%.According to Rifiani & Sulihandri, nursing service as an integral part of health services has a very decisive contribution to the quality of service in hospitals, so that every effort to improve the quality of hospital services should also be accompanied by efforts to improve the quality of nursing services.
Nursing problems that often arise in the hospital concerning nursing services include performance and attitude in carrying out its role, such as about skills, friendliness, discipline, attention, and responsibilities that are less well implemented due to low motivation of work.Problems that occur in the work environment will affect the performance of nurses in the hospital. 2roductivity is a universal concept that applies to all systems because every activity requires productivity in its implementation.Productivity is a measurement of how productive a process produces an output, productivity is also defined as a ratio between input and output, with a focus on the output produced by a process. 3ndividual productivity can be assessed from what the individual does in his work, in other words, the individual's productivity is how a person performs his work or performance.A productive person will describe the potential, perception, and creativity that always contribute to his ability to benefit himself and his environment. 4uality of working life is an essential issue in health organizations.From the results of the Canadian study, it was reported that the nursing

ORIGINAL ARTICLE
crisis experienced can be addressed by arranging a strategy by the Advisory Committee on Health Human Resource (ACHHR), in which the improvement of the quality of work life of the nurse was identified as the resolution of the nursing crisis in Canada.The American Nurses Association (NAS) has conducted a survey of 76,000 nurses to find out which elements affect the nurses' job satisfaction where the results of the survey will be recommendations for the ANA's National Center for Nursing Quality (NCNQ) to solve problems related to patient safety, quality of nursing service, and quality of work life.
Some research indicates that the quality of work life significantly affects the performance of nurses in providing health services to the community.Irmayana examines "The Relationship of Quality of Working Life with Work Productivity of Nurse at West Pasaman RegionGeneral Hospital." Population in this research is all of nurses who exists in the inpatient room of West Pasaman Region General Hospital are as many as 57 people.The results showed that the quality of working life in the category is quite good and the work productivity of nurses in the inpatient ward is still not optimal.The results obtained p> 0.05 (p = 0.145) which means there is no significant relationship between quality of work life with nurse productivity. 5he result of Artha research at Indrasari Rengat Regional Hospital Indragiri Hulu Riau showed that from 79 respondents, the majority (78%) stated that the quality of work life of the nurse is high.This indicates that the quality of the nurse's working life is in a good category.The result of quality component of nurse work life showed that employee involvement was in high category of 79.7%, career development equal to 86.1%, problem solving 88.6%, communication 91.1%, facility 72.2%, job security 100%, work environment safety equivalent to 67.1%, compensation equivalent to 91.1%, institutional pride of 93.7%. 6ahayangkara Hospital Tk.III Manado is a C type hospital managed by the police and is one of the hospitals that has developed quite rapidly in several years.This can be seen through the efforts of hospitals in the year 2017 to organize the assessment of Public Service Agency, accreditation of the hospital which is planned to be done in the same year, and the regular schedule of audit from Police medical and health center every year.This development is reflected in the increasing number of inpatient visits in the last three years, in

METHOD
Study design using cross-sectional analytic approach which was conducted in July -December 2017 at Bhayangkara TK III Manado Hospital.Total sampling technique was used considering inclusion criteria with nurses who work >3 months, and exclusion criteria are nurses who are taking furlough time.The analysis used chi-square test and started from univariate, bivariate and multivariate.

a. Association Between Employee Involvement With Work Productivity Nurse at Inpatient Room, Bhayangkara Hospital TK III Manado.
Based on cross-tabulation above between employee involvement and work productivity of nurse, obtained data that from 27 respondents (67.6%) with good employee involvement, good productivity 18 respondents (45.0%) and 9 respondents with poor productivity (22.5%), while from 13 respondents (32.5%) with poor employee involvement, good work productivity 5 respondents (12.5%) and poor productivity 8 respondents (20.0%).Based on the results of Chi-Square test analysis obtained results with the value of p = 0.089 (p>0.05) which shows no The success of a company is strongly influenced by the performance of individual employees.Every company will always strive to get the best performance from its employees, in the hope that what the company's goals will be achieved.Companies that pay little attention to the quality of work life will find it difficult to retain workers in accordance with the needs of the company; even it will be difficult to generate the performance of existing employees. 7ompetition between hospitals both government, private and foreign will be increasingly hard to seize the open market free.Planning the human resource needs appropriately in accordance with the service function of each unit, part and installation of the hospital becomes a critical effort to face the challenges of the hospital in the present and future.Accuracy in the selection, acceptance, management, and development of hospital personnel is the key to hospital success developing in the future.
Human resources are the primary drivers of the activities of an organization.Likewise in the context of business or corporate organizations, the advancement of the organization or company is determined by the existence of human resources, so that human resources in a company become an essential concern to achieve the goals of the organization or company. 8ne of nursing contribution services to the quality of health services depends on the management, and one measure of the success of good nursing services is how much the productivity of the nurses in providing good nursing care to patients and their families.Productivity in the organization of nursing is realized through the provision of nursing care that guaranteed quality and quantity based on predetermined standards, and effectiveness and efficiency. 8

b. Association Between Career Development With Work Productivity Nurse at Inpatient Room, Bhayangkara TK III Manado Hospital.
Based on cross-tabulation above between career development with work productivity of nurse, obtained data that from 22 respondents (55.0%) with good career development, good productivity 17 respondent (42.5%) and poor 5 respondent (12.5%), while from 18 respondents (45.0%) with poor career development, good work productivity as many as 6 respondents (15.0%) and 12 respondents with poor productivity (30.0%).Based on Chi-Square test results obtained p-value 0.006 (p <0.05) which indicates there is a significant relationship between career development with work productivity of nurse at inpatient ward Bhayangkara TK III Manado Hospital.
Purnomo in his research "QWL Development Recommendation Based on QWL's Influence Analysis on Job Satisfaction of Nurse at Leprosy Hospital Sumberglagah Pacet Mojokerto" found that social support had positive and significant effect on career opportunity.Career is defined as a level chosen by the individual to be able to meet the nurse's job satisfaction and lead to the success of the job (performance) so that it will eventually contribute to the field of his chosen profession. 9ursing staff is one health worker who also participates in carrying out the handling of patient.The demands and needs of quality nursing care in the future is a challenge that must be prepared in a truly and handled fundamentally, directed from the hospital. 10essler defines productivity as the ratio between the totality of expenditure at a given time divided by the whole of inputs during that period.Productivity is also described as the price-size ratio for inputs and outcomes, the difference between a set of expenditures and inputs expressed in a single unit (unit). 8hus productivity is an interdisciplinary approach to determining useful goals, plan-productive use of resources efficiently and maintaining high quality, integrated utilization of human resources and skills, technological capital goods, management, information, energy and other resources leading to the development and improvement of people's living standards.To achieve maximum employee productivity, organizations must ensure that the right person with the right job and conditions are in place to enable them to work optimally.

d. Association Between Balance Compensation With Work Productivity Nurses at Inpatient Room, Hospital Bhayangkara TK III Manado.
Based on cross-tabulation conducted between balance compensation to work productivity of nurse, obtained data that from 20 respondents (50.0%) that good balanced compensation, good productivity counted 16 respondent (40.0%) and 4 respondent with poor productivity (10.0%), while from 20 respondents (50.0%) with poorly balanced compensation, good work productivity of 7 respondents (17.5%) and 13 respondents with poor productivity (32.5%).Based on Chi-Square test results obtained p value 0.005 (p<0.05) which indicates there is a significant relationship between the compensation balanced with work productivity of inpatient nurses at Bhayangkara TK III Manado Hospital.
The results of the Almalki et al. study entitled "The relationship between quality of work life and turnover of intention of primary health care nurses in Saudi Arabia" by using a quality work-life questionnaire according to Brooks theory show that respondents are not satisfied with their working life, among others, due to factors compensation is less salary.The lower the salary, the more likely it is for the nurse to quit his job.

ORIGINAL ARTICLE
Cross-Sectional research was conducted by Moradi et al. with the title "Quality of Working Life of Nurses and its Related Factors." The researchers used a questionnaire on the quality of work life according to Walton's theory where the results showed that 60% (n = 92) nurses had moderate quality of work life while 37.1% (n = 56) quality of working life was less and 2% (n = 3) good.Bivariate analysis showed no significant correlation between the quality of nurse work life with salary (P = 0.052).
The literature review by Phan and Vo to 56 QWL research journals accessed through PubMed, Science Direct and Cochrane Library databases until February 2015 in Asian, American and European countries.Obtained 16 journals that meet the criteria, the study focuses on QWL nurses involving more than 200 participants.The results of the study found that the factors affecting QWL are compensation. 14

e. Association Between Facilities Available With Work Productivity Nurse at Inpatient Room, Bhayangkara TK III Manado Hospital.
Based on cross tabulation between available facility and work productivity of the nurse, it is found that from 21 respondents (52.5%) that facilities are good, good productivity counted 16 respondent (40.0%) and 5 respondent with poor productivity (12.5%), while from 19 respondents (47.5%) with poorly available facilities, good work productivity is 7 respondents (17.5%) and 12 respondent with poor productivity (30.0%).Based on Chi-Square test results obtained p-value 0.014 (p<0.05)indicating there is a significant relationship between the facilities available with work productivity nurse inpatient ward at Bhayangkara TK III Manado Hospital.
Amalia et al. examined the Effect of Quality of Working Life on Job Satisfaction And Organizational Citizen Behavior (OCB) Employee of Hassanudin University General Hospital.The results of this study indicate that the variables affecting OCB directly include the availability of facilities.Nurses as human resources with the most significant number of hospitals have an essential role in achieving the goals and quality of the hospital.To be able to reach hospital goals requires nurses with good organizational commitment and performance, Quality of Nursing Work Life (QNWL) is one of the critical factors affecting the dedication and performance of nurses.The pleasant physical workplace condition contributes significantly to improving worker productivity, including good ventilation, a clean working environment and a work environment free from air pollution. 12he results of the Almalki et al. study on Saudi health care nurses in Saudi Arabia using a quality work-life questionnaire according to Brooks's theories suggest that respondents are not satisfied with their work life. 13The factors that most influences are the lack of facilities for nurses.The work environment of employees includes employee relationships, relationships with leaders, temperature and lighting environments and so on.It is critical to get the attention of the company because often employees are reluctant to work because there is no cohesiveness in workgroups or uncomfortable workspaces.This kind of situation disrupts employee work. 11

f. Relationship Between Sense of Security to Work With Work Productivity Nurse at Inpatient Room, Bhayangkara Hospital TK III Manado
Based on cross-tabulation conducted between job security with work productivity of nurse, obtained data that from 28 respondents (70.0%) who feel safe to good job, good productivity counted 17 respondent (42.5%) and poor productivity 11 respondents (27.5%), while from 12 respondents (30.0%) with poor job security, good work productivity as much as 6 respondents (15.0%) and poor productivity 6 respondents (15.0%) .Based on Chi-Square test results obtained p-value 0.388 (p>0.05) which shows no significant relationship between the sense of security to work with work productivity nurse inpatient ward at Bhayangkara TK III Manado Hospital.

ORIGINAL ARTICLE
Many factors that can increase the productivity of nurses work are creating a conducive working environment including a sense of security to the job.Sense of security plays a crucial role in efforts to improve the productivity of nurses work.High sense of security will accelerate the achievement of organizational goals, and a low sense of security will be a barrier and slow down the purposes of the organization. 10To achieve this, it is necessary to support a good working environment in the form of a working environment that can promote smoothness, safety, cleanliness, and comfort in work and adequate facilities so that the nurse feels safe, calm, happy in carrying out the tasks that are charged and the responsibility.
Company attention and service to every employee, supporting health and safety.With the hope that employees are more passionate and have a passion for work.Leadership role in determining the level of employee discipline because the leader is an example and role model by his subordinates.The leader must realize that his behavior will be emulated and imitated by his subordinates.This is what requires the leadership has good discipline so that his subordinates have a good discipline as well. 8

g. Relationship Between Work Environment Safety With Work Productivity Nurse at Inpatient Room, Bhayangkara TK III Manado Hospital.
Based on cross-tabulation conducted between work environment safety with work productivity of nurse, obtained data that from 25 respondent (62.5%) which is good work environment safety, good productivity counted 19 respondent (47.5%) and poor productivity 6 respondent (15.0%), while from 15 respondents (37.5%) with poor working environment safety, good work productivity 4 respondents (10.0%) and poor productivity 11 respondent (27.5%).Based on the results of Chi-Square test analysis obtained p-value 0.003 (p<0.05)indicating there is a significant relationship between workplace safety with work productivity of nurses inpatient ward at Bhayangkara TK III Manado Hospital.
Quality of life of the nurse (Quality of Nursing Work Life) is a concept that describes the nurse's perception of the fulfillment of needs through work experience in the organization, so the purpose of the quality of work life can be aligned with the management function to manage the superior human resources and have maximum work productivity and the employee gets personal satisfaction for the fulfillment of his needs.
According to Siagian et al. work environment is the factors outside the human both physical and nonphysical in an organization.Physical factors include work equipment, workplace temperatures, tightness and compliance, noise and workplace space, while non-physical work relationships are formed in the organization between superiors and subordinates as well as between employees.
The work environment is everything that is around the nurse who can influence him in carrying out the tasks that have been put on him.The work environment is very influential to the morale where nurses are unlikely to be able to do the job as expected without supported work environment that supports the comfort of nurses in carrying out their daily work. 10

h. Association Between Problem Solving With Work Productivity Nurse Inpatient Room At Bhayangkara TK III Manado Hospital.
Based on cross-tabulation conducted between problem solving with work productivity of nurse, obtained data that from 32 respondents (80.0%) with good problem solving, good productivity counted 22 respondent (55.0%) and poor productivity 10 respondents (20.0%), while from 8 respondents (20.0%) with poor problem solving, good work productivity is 1 respondent (2.5%) and poor productivity 7 respondent (17.5%).Based on Chi-Square test results obtained p-value 0.006 (p<0.05)indicating there is a significant relationship between problem-solving with work productivity nurse inpatient ward at Bhayangkara TK III Manado Hospital.A harmonious humanitarian relationship among employees helps to create good discipline in a company.The creation of a cooperative human relationship will create a comfortable environment and working environment that motivates good discipline in the company. 8Supervision is the most effective action in realizing the discipline of hospital employees.Through supervision, the boss can directly know the ability and discipline of each subordinate, in other words, supervision requires the existence of active togetherness between superiors and subordinates in achieving the goals of the institution so that the realization of good cooperation and harmonics that support the establishment of good nurse discipline.Penalty sanctions play an important role in maintaining employee discipline.The severity of punitive sanctions that will be applied will affect both the lousy discipline of employees.Penalty sanctions should be reasonable for every level of discipline, educational, and a motivational tool for fostering discipline within the company.
Leadership's firmness in taking action will affect the discipline of the company's employees.The boss must be courageous and resolute to punish any disciplined employee in accordance with the punishment sanctions and regulations set by the company. 11

i. Relationship Between Communication With Work Productivity Nurse Inpatient Room At Bhayangkara TK III Manado Hospital
Based on cross-tabulation conducted between communication with work productivity of nurse, obtained data that from 11 respondents (27.5%) which good communications, good productivity counted 3 respondent (7.5%) and poor productivity 8 respondent (20.0%), whereas from 29 respondents whose poor communications, good work productivity is 23 respondents (57.5%) and poor productivity 6 respondents (15.0%).Based on the result of Chi-Square test analysis obtained p-value 0.007 (p<0.05) which show there is significant relationship between communication with work productivity of nurse of inpatient room at Bhayangkara TK III Manado Hospital.
The work productivity of a nurse can be seen from two dimensions, that is individual dimension and organizational dimension, where the individual see the productivity of nurse in relation to personality characteristic of individual nurse that appear in the form of mental attitude and contain meaning of desire and effort of individual nurse who always try to improve the quality of his / her self, while the organizational dimension looks at the productivity of the nurse within the framework of the technical relationship between the input and the output. 8ndre et al. studied "Exploring Nursing Staffs Communication In Stressful And Non-Stressful Situations" The results showed that when two perspectives, 'communication in non-stressful situations' and 'communication under stress, ' compared, there was a significant difference of 8 out of 12 factor.The stress situation is characterized by low marks in task orientation, caring, criticism, loyalty, acceptance, engagement, and empathy; Only creativity factors have a higher value. 15he importance of work productivity for nurses is an evaluation material to make continuous improvement for all hospital components, improving the quality of work by hospitals.The impact of hospitals that have low productivity will result in the decrease in the number of customers due to the low quality of service generated so that customers will move on to other organizations that have high work productivity and the creation of quality service quality.

Table 2 Association Between Career Development With Work Productivity Nurse at Inpatient Room Bhayangkara TK III Manado Hospital
*Chi-Square test ORIGINAL ARTICLE c.

Association Between Proud of Institution With Work Productivity Nurse at Inpatient Room, Bhayangkara TK III Manado Hospital.
12ality of WorkLife) is required in the work environment of the hospital.Through human resources management approach must be able to create a quality of working life that can provide self-development opportunities, welfare that can cover the basic needs of workers, as well as a safe and comfortable working environment to generate morale to achieve goals better.Everyone can develop the potential that exists within him, given the opportunity of achievement, then the employees will increase productivity.Hackman et al. state that "the quality of working life is the degree to which members of the organization are able to meet personal needs through their experiences in the organizations in which they work."Amalia et al. examined the Effect of Quality of Working Life on Job Satisfaction And Organizational Citizen Behavior (OCB) Employee of University Hasanudin General Hospital.The purpose of this study was to determine the effect of quality of work life comprising compensation, communication, workplace safety, conflict resolution, employee involvement, facility availability, career development, job security and a sense of pride towards the organization, on job satisfaction and OCB on employees Hasanuddin University General Hospital.The research sample is all employees of Hasanuddin University Hospital.Method of sampling with probability sampling with cluster system (group) based on work unit with sample size 123.Data analysis conducted is path analysis to know the direct and indirect effect of quality of work component of OCB component through job satisfaction.The results of this study indicate that of the nine elements of quality of work life there is only one variable that can affect the level of OCB employees through job satisfaction is career development, while for variables that affect OCB directly among others is a sense of pride to the organization.12

Table 4 Association Between Balance Compensation With Work Productivity Nurses at Inpatient Room, Hospital Bhayangkara TK III Manado
*Chi-Square test

Table 3 Association Between Proud of Institution With Work Productivity Nurse at Inpatient Room Bhayangkara TK III Manado Hospital Proud of Institution Work Productivity Nilai P*
*Chi Square test

Table 5 Association Between Facilities Available With Work Productivity Nurse at Inpatient Room, Bhayangkara TK III Manado Hospital
*Chi Square testTabel 6

Relationship Between Sense of Security to Work With Work Productivity Nurse at Inpatient Room, Bhayangkara Hospital TK III Manado
*Chi Square test

Table 8 Association Between Problem Solving With Work Productivity Nurse Inpatient Room At Bhayangkara TK III Manado Hospital
*Chi Square test

Table 7 Relationship Between Work Environment Safety With Work Productivity Nurse at Inpatient Room, Bhayangkara TK III Manado Hospital
*Chi Square test

Table 9 Relationship Between Communication With Work Productivity Nurse Inpatient Room At Bhayangkara TK III Manado Hospital
*Chi Square test