The Relationship Between Work Motivation And Nurse Performance at RSU Royal Prima Medan In 2023

Motivation is an internal impulse that determines what a person does and the enthusiasm for doing it. Motivation itself consists of two types, namely internal and external motivation, internal motivation subvariables which have the strongest relationship with nurse performance in the form of recognition, achievement and development while external motivation subvariables which have the strongest relationship with nurse performance are working conditions, organizational policies, salary/ wages.. Objective: The aim of this research is to determine the relationship between work motivation and nurse performance at RSU Royal Prima Medan in 2023. The type of research used in this research is quantitative research with a cross-sectional design. The population used in this research were 349 nurses at RSU Royal Prima Medan in 2023. Sampling used the Slovin formula with a total sample of 78 samples. The research data used is primary data with the research instrument used, namely a questionnaire. Data analysis in this study used univariate, bivariate and multivariate analysis. The results of the analysis show that the majority of respondents' internal motivation in this study is high and there is a relationship between internal motivation and nurse performance at RSU Royal Prima Medan in 2023 p-value of 0.000 < 0.05. The majority of respondents' external motivation in this study was high and there was a relationship between external motivation and nurse performance at RSU Royal Prima Medan in 2023 p-value of 0.000 < 0.05. The independent variable that has the most influence on the dependent variable is the external motivation variable. There is a relationship between external motivation and the performance of nurses at RSU Royal Prima Medan.


Introduction
In order to maintain and improve service quality, the performance of all human resources is always encouraged to continue to improve.Nurses are one of the health service teams who are required to improve the quality of services in hospitals.When viewed from a nursing perspective, the quality of hospital services includes aspects of the number and abilities of professional staff, work motivation, funds, supporting facilities and equipment, hospital management which needs to be perfected and adapted to developments in science and technology.Because the numbers are very large and the profession has the longest contact with patients, the performance of implementing nurses receives very important attention to improve the quality of service (1).
A nurse is the spearhead in health services, nurses have the duty to provide nursing services that are responsible for improving health, preventing disease and providing care for sick people.Nurses are required to provide nursing services well and professionally (2).One indicator of a person's success in completing a job is performance.Performance itself is referred to as the nurse's ability to perform a particular skill.Performance is very important because with this performance it will be known how far the nurse's ability is to carry out the tasks assigned to him (3).Performance illustrates the usefulness of being given encouragement and the ability to complete individual activities as well as possible with the willingness and level of ability.In order to achieve the expected performance, the company always pays attention to the characteristics of the individual, and provides motivation to improve the employee's performance (4).Different advantages, for example the work can be completed on time, implying that the work is completed with the correct norms and within the time that has been applied (5).
The performance produced by individuals in carrying out their work is a combination of ability and motivation, that performance is a function of ability, motivation and opportunity.
High performance cannot be obtained by work ability alone, but other factors are needed, namely work motivation, that with high work motivation, the completion of work produced by individuals will increase (6).To obtain optimal performance from its employees, companies do various things that can encourage employee motivation, such as providing salaries and benefits that are appropriate to the job, providing health insurance, tourism activities to strengthen interpersonal relationships and employee cooperation (7).Motivation is a force within a person that will influence the direction, intensity and sustainability of voluntary actions to realize goals that have become a common goal (8).
Motivation arises from a sense of need for oneself and the drive of individual desires which are directed at the goal of obtaining satisfaction.The motivation process begins with the recognition of needs.One of the reasons for the complexity of this process is because each employee has different needs so that the employee's work motivation is also different.The higher the work motivation that employees have, the more it will influence employee performance (9).
Motivation is an impulse from within that determines what a person does and the enthusiasm for doing it.Motivation itself consists of two types, namely internal and external motivation, internal motivation subvariables which have the strongest relationship with nurse performance in the form of recognition, achievement and development while external motivation subvariables which have the strongest relationship with nurse performance are working conditions, organizational policies, salary/ wages (3).
Research conducted by Sinambela (10) found that the percentage of nurses' work motivation was sufficient (61.3%) and most of the nurses' performance was adequate (50%).
From the results of the Kendall's Tau correlation test, there is a significant, moderate and positive/unidirectional relationship, shown by a correlation value of 0.355, and (0.001 <α) meaning that the higher the work motivation of each inpatient nurse, the performance achieved will also increase, conversely if the work motivation of the nurse If hospitalization is low, the resulting performance will decrease further.From the explanation of the background above and from the results of previous research, researchers are interested in conducting research with the title "The Relationship between Work Motivation and Nurse Performance at RSU Royal Prima Medan in 2023".

Method
The type of research used in this research is quantitative research with a cross-sectional design.
Quantitative research is a type of research that uses numbers to process data to produce structured information (10).This research was conducted at the Royal Prima Medan Hospital which is located at Jl. Father No. 68A, Sei Putih Tengah, Kec.Medan Petisah, Medan City, North Sumatra 20118.This research was carried out when the author conducted a preliminary survey in June 2023, followed by making a research proposal and collecting data, followed by a results seminar.The population in this study were executive nurses at RSU Royal Prima Medan in 2023, totaling 349 nurses.Sampling in this study used the proportional random sampling method, namely a sampling technique where all members have the same opportunity to be sampled according to their proportions (11).From the results of calculations using the Slovin formula, 77.7 samples were obtained, rounded up to 78 samples.In this study, the data analysis used was analysis using univariate, bivariate and multivariate analysis with data processing using SPSS Version 25 statistical software.Respondents aged 20-30 years were 28 people with a percentage of 35.9%, respondents aged 31-40 years were 43 people with a percentage of 55.1% and respondents aged >40 years were 7 people with a percentage of 9. 0% of the total sample of respondents in this study was 78 respondents.From these results it can be seen that the majority of respondents in this study were aged 31-40 years.it can be seen that the majority of respondents in this study had a Diploma-3 degree in Nursing.There were 24 male respondents with a percentage of 30.8% and 54 female respondents with a percentage of 69.2% of the total sample of respondents in this study of 78 respondents.From these results it can be seen that the majority of respondents in this study were female.The results of the research show that there were 47 respondents whose performance was good with a percentage of 60.3% and nurses whose performance was not good were 31 respondents with a percentage of 39.7% of the total sample of respondents in this study of 78 respondents.

Results
From these results it can be seen that the majority of nurses' performance is good.Table 15 explains the results regarding the independent variables that have the most influence on the dependent variable in this study.From the research results, it can be seen that the highest t value is found in the external motivation variable (X2), namely 3.567.From these results it can be concluded that the independent variable that has the most influence on the dependent variable in this research is the external motivation variable (X2).

Discussion
Research on the relationship between internal motivation and the performance of nurses at RSU Royal Prima Medan in 2023 has been carried out with the results showing that the internal motivation of respondents is high as many as 46 respondents with a percentage of 59.0% and the internal motivation of respondents is low as many as 32 respondents with a percentage amounting to 41.0% of the total sample of respondents in this study of 78 respondents.From these results it can be seen that the majority of respondents' internal motivation in this study was high.From the results of the cross table it can be seen that if the nurses' internal motivation is high then the nurses who perform well are 38 nurses with a percentage of 48.7% and the nurses whose performance is not good are 8 nurses with a percentage of 10.3%, and if the nurses' internal motivation is low then the nurses Those whose performance was good were 9 nurses with a percentage of 11.5% and the nurses whose performance was not good were 23 nurses with a percentage of 29.5%.
The results of the chi square test showed a p-value of 0.000 < 0.05, which means there is a relationship between internal motivation and the performance of nurses at RSU Royal Prima Medan in 2023.The results of this research are in line with the results of research conducted by Barus (12) with the results research, namely the results of statistical analysis of the chi-square test, it was found that the p value was <0.05.This shows that there is a significant relationship between internal motivation and nurse performance at Sembiring General Hospital.Other research that is also in line is research that has been conducted, namely by Halawa ( 13) with the research title namely the influence of motivation on the performance of inpatient nurses at Mitra Medika General Hospital, with the results of the research namely the results of the chi-square regression test with a confidence level of 95% showing that Intrinsic motivation influences nurse performance at a significant level of 0.042<0.05,so Ho is rejected and Ha is accepted.
Work motivation is one of the factors that determines a person's performance.The size of the influence of a person's work motivation depends on how much intensity the motivation is given.In the study of internal motivation components, it was found that several respondents had high motivation because most nurses were responsible for the tasks given.Motivation within nurses needs to be directed, raised and stimulated, such as being given rewards to further increase work motivation so that nurses' work motivation becomes better.If nurses' internal motivation is not paid attention to, it will cause work to not be optimal and the quality of work to be poor (14).In this case, motivation is an input that must be taken into account, both internal motivation and external motivation, so that the nurse's behavior at work will be formed.These two factors influence each other, including the processes of motivation, generation, direction and continuation (15).
In carrying out its performance, a person's underlying drive or motivation is needed.One type of motivation that has an influence on a person to carry out their duties is internal motivation.Internal motivation is a sub-variable of internal motivation factors which has the strongest relationship with nurse performance, namely recognition, achievement and development (3).The results obtained from existing theory show that there is a relationship between internal motivation and the performance of implementing nurses at RSU Royal Prima Medan.Therefore, if the internal motivation of nurses is low, it can be immediately improved, so the level of performance of nurses will certainly be better at work.This can be interpreted as meaning that nurses' work motivation will determine the level of nurse performance.So it can be said that the higher the nurse's work motivation, the better the nurse's performance level, and vice versa, if the nurse's work motivation is lower, the nurse's performance level will decrease.
Research on the relationship between external motivation and the performance of nurses at RSU Royal Prima Medan in 2023 has been carried out with the results showing that the external motivation of respondents is high as many as 42 respondents with a percentage of 53.8% and the external motivation of respondents is low as many as 36 respondents with a percentage amounting to 46.2% of the total sample of respondents in this study of 78 respondents.From these results it can be seen that the majority of respondents' external motivation in this study was high.From the results of the cross table it can be seen that if the nurses' external motivation is high then the nurses who perform well are 37 nurses with a percentage of 47.4% and the nurses whose performance is not good are 5 nurses with a percentage of 6.4%, and if the nurses' external motivation is low then the nurses Those whose performance was good were 10 nurses with a percentage of 12.8% and the nurses whose performance was not good were 23 nurses with a percentage of 33.3%.
The results of the chi square test showed a p-value of 0.000 < 0.05, which means there is a relationship between external motivation and the performance of nurses at RSU Royal Prima Medan in 2023.The results of this research are in line with research conducted by Halawa (13) with the research title namely The influence of motivation on the performance of inpatient nurses at Mitra Medika General Hospital, with research results namely the results of the chi-square regression test with a confidence level of 95% showing that extrinsic motivation influences nurse performance at a significant level of 0.048<0.05,so Ho is rejected and Ha is accepted. .The same results were also obtained from the research results of Ersita (16) with the title the relationship between internal and external motivation on nurse performance.The research results showed that there was a significant relationship between external motivation and nurse performance with a p -value of 0.025 (< 0.05).
Management of nursing workforce development is based on human behavior (14).The quality of hospital services is largely determined by nursing services or nursing care (17).So the success of nursing services is largely determined by the performance of nurses.Nurses are the largest group in hospital organizations who work 24 hours/day so they are more prominent than other health teams (18).Nurses at work also need to pay attention to external motivation, it was even found from the external motivation component that nurses will be motivated to work well if nurses at work receive attention from friends and superiors (15).Therefore, the higher the motivation that a person has from within (internal), the more encouragement or enthusiasm they will be able to provide in carrying out work activities in providing nursing care to patients and nurses must also have external motivation (which comes from outside themselves) to generate encouragement.or work enthusiasm so that it will have an impact on increasing nurse performance.

Conclusions and suggestions
The results of research regarding the relationship between work motivation and nurse performance at RSU Royal Prima Medan in 2023 have been completed with the following conclusions: 1.The majority of respondents in this study were 31-40 years old, 43 respondents, the majority had a recent education of D-3 Nursing, 53 respondents, the majority were female, 54 respondents and the majority had worked for >2 years, 63 respondents .Some suggestions that researchers can give from the results of the research that has been carried out are as follows: 1.For RSU Royal Prima Medan From the results of this research, it is recommended that the management of RSU Royal Prima Medan be able to use the results of this research as input to maintain and also increase the motivation of nurses at RSU Royal Prima Medan so that they become even better in the future.For the management of RSU Royal Prima Medan, increasing nurses' work motivation can be done by implementing several programs to increase work motivation in order to increase nurses' motivation in doing their work.Programs that can be created include holding refreshments so that superiors, subordinates and colleagues can understand each other, this can increase closeness and comfort in the work environment.Apart from that, the management of RSU Royal Prima Medan must also adjust the work carried out by nurses at RSU Royal Prima Medan with the income they provide, such as if nurses work beyond their working hours limit, the hospital must provide additional incentives to nurses in accordance with the regulations for giving incentives available at RSU Royal Prima Medan.

For the Nursing Profession at RSU Royal Prima Medan
Nurses are advised to continue to improve their performance by providing the best quality of service to patients who use health services at RSU Royal Prima Medan.This also aims to increase patient satisfaction with the performance of nurses at RSU Royal Prima Medan which can later be used as evaluation material for management.RSU Royal Prima Medan to give awards to nurses who carry out their performance well.

For Further Researchers
For future researchers who wish to conduct research with the same title as this research, it is recommended that they be able to further develop the problem to be researched, such as adding other variables, and also using other research methods that can later improve the results of research that discusses the performance of nurses in hospitals.

Table 2 . Frequency distribution of respondent characteristics based on education level Level of education
Source: Primary data processed(2023)

Table 2
explains the frequency distribution of respondent characteristics based on education level.Respondents with a SPK education level were 5 people with a percentage of 6.4%, respondents with a D-3 Nursing education were 53 people with a percentage of 67.9% and respondents with a Bachelor of Nursing education level were 20 respondents with a percentage of 25 .6% of the total sample of respondents in this study was 78 respondents.From these results

Table 3 . Frequency distribution of respondent characteristics based on gender
Source: Primary data processed(2023)

Table 3
explains the frequency distribution of respondent characteristics based on gender.

Table 4 . Frequency distribution of respondent characteristics based on length of work
Source: Primary data processed(2023)

Table 4
explains the frequency distribution of respondent characteristics based on length of service.Respondents with a work period of 1-2 years were 24 respondents with a percentage of 30.8% and respondents with a work period of >2 years were 54 respondents with a percentage of 69.2% of the total sample of respondents in this study of 78 respondents.From these results it can be seen that the majority of respondents in this study have worked >2 years.

Table 8
majority of respondents' internal motivation in this study was high.

Table 9
explains the results of respondents' answers regarding external motivation.The results of the research show that 42 respondents had high external motivation with a percentage of 53.8% and 36 respondents had low external motivation with a percentage of 46.2% of the total sample of respondents in this study of 78 respondents.From these results it can be seen that the majority of respondents' external motivation in this study was high.

Table 10
explains the results of respondents' answers regarding respondent performance.

Table 11
explains the relationship between internal motivation and the performance of nurses at RSU Royal Prima Medan in 2023.From the results of the cross table it can be seen that if the internal motivation of nurses is high then the nurses who perform well are 38 nurses with a percentage of 48.7% and the nurses whose performance is not good are as many as 8 nurses with a percentage of 10.3%, and if the nurses' internal motivation is low then the nurses who perform well are 9 nurses with a percentage of 11.5% and the nurses whose performance is not good are 23 nurses with a percentage of 29.5%.The results of the chi square test showed a p-value of 0.000 <0.05, which means there is a relationship between internal motivation and the performance of nurses at RSU Royal Prima Medan in 2023.

Table 12 . The relationship between external motivation and nurse performance at RSU Royal Prima Medan in 2023 External Motivation
Source: Primary data processed(2023)

Table 12
explains the relationship between external motivation and the performance of nurses at RSU Royal Prima Medan in 2023.From the results of the cross table it can be seen that if the external motivation of nurses is high then the nurses who perform well are 37 nurses with a percentage of 47.4% and the nurses whose performance is not good are as many as 5 nurses with a percentage of 6.4%, and if the nurses' external motivation is low then the nurses who perform well are 10 nurses with a percentage of 12.8% and the nurses whose performance is not good are 23 nurses with a percentage of 33.3%.The results of the chi square test showed a p-value of 0.000 <0.05, which means there is a relationship between external motivation and the performance of nurses at RSU Royal Prima Medan in 2023.

Table 13 . Variable selection for multivariate tests
From Table13it can be seen that the internal motivation variable (X1) and external variable (X2) in this study have a p value <0.05.From these results, all variables X1 and X2 are included in the multivariate testing model in Table14below:

Table 14
explains the results of multivariate analysis on the variables internal motivation (X1) and external motivation (X2) on the performance of nurses at RSU Royal Prima Medan in 2023.From the table it can be seen that the significance value is 0.000 < 0.05, which means the independent variable in this study together or simultaneously have an influence on the dependent variable, namely the performance of nurses at RSU Royal Prima Medan in 2023.

Table 15 . The independent variable that has the most influence on the dependent variable Variabel t
Sumber : Data Primer diolah 2023