The Influence of the Quality of Nurses’ Work-Life against Performance of Nurses at

The quality of work-life has an impact on workers, one of which is the performance of these workers will increase. This can be a positive impact on workers and companies. The study was to analyze the effect of the quality of nurses' work life on the performance of nurses at Dr. Pirngadi Hospital Medan. The study was non-experimental quantitative research with a cross-sectional descriptive approach. Seventy-four nurses were selected using random sampling. The results of the study on the quality of nurse's work-life (QNWL) were the majority in the sufficient category (score 91-135) as many as 42 people (56.8%), nurses' performance the majority of nurses had sufficient performance (score 71-110) as many as 47 people (63.6%). The quality of nurses’ work-life (QNWL) on nurse performance has a significance value of 0.004 <0.005. Suggestions for education as an additional reference in the development of nursing education regarding the quality of nurses' work life, for nursing services as an input for nursing in carrying out nursing care to patients as nurse performance, for future researchers as a reference for comparison for research. The next step is about the Quality of Nurses' Work-Life (QNWL) with different variables


INTRODUCTION
Nurse performance is an activity of nurses who have competencies that can be used and are shown from the results of applying effective knowledge, skills, and considerations in the application of nursing care (1). One method of assessing the performance of nurses in the inpatient room is by looking at the quality of the nurse's work life (2). Quality of nurses' work-life (QNWL) is the extent to which nurses are satisfied with their personal needs (growth, opportunity, security) as well as organizational requirements (increased productivity, decreased turnover) through their experiences in their work organizations to achieve organizational goals (3).
The study was found that 48% of Indian nurses had a poor QNWL. QNWL in Iraqi nurses showed the same thing, namely 27.2% in the moderate category and only 6.7% had a good quality of nursing work life (4). In Indonesia, it was found that QNWL was categorized as moderate in work life, home life, and work design at Surabaya Premier Hospital. The study explained that the length of work contributed negatively to QNWL, the longer the working period of a nurse, the lower the perceived QNWL. New nurses have a high QNWL because they tend to come to work with high expectations (5).
Problems faced by nurses today such as the poor working environment of nurses have an impact on nurse satisfaction and performance, stating that there are problems in job satisfaction, dissatisfaction with pay, the number of hours worked, not getting enough vacations, lack of flexibility in work, the time needed to go to and come home from work. This causes many nurses to leave or turnover (6). The results showed that the number of respondents was 50 nurses, indicating that respondents with high workloads had a desire to change jobs as many as 15 respondents (68.2%) and not as many as 5 respondents (17.9%) while respondents with low workloads had a desire to change jobs. moved as many as 7 respondents (31.8%) and not as many as 23 respondents (82.1%) (7).
The results of the study on QNWL at Pangandaran Health Center with 48 respondents, the results showed that the average QNWL and other employees at Pangandaran Health Center did not feel wellbeing in their work, namely in the work environment aspect (35.29%), relations with the manager (14.50%), work conditions (33.94%), job perception (42.88%), except for the support service aspect which has a value above the midpoint (19.31) which means that in this aspect health workers (especially nursing) have felt a feeling of satisfaction and wellbeing in the support of the other team/officers at the Pengandaran Health Center (8). According to Schermerhorn explains that high performance (effectiveness and efficiency) can be achieved with a sense of personal satisfaction by the people who do the work. He also said the concept of personal satisfaction is reflected in the quality of work-life or commonly called quality of work-life (QWL) (9).
The low QNWL in hospitals will result in high absenteeism and turnover. A positive quality of work-life will contribute to quality patient care, thus the QNWL is closely related to the work performance of nurses which will have an impact on the quality of nursing care provided to patients (10). Each nurse in different units has a different QNWL and this difference can be attributed to the circumstances of each unit. Therefore, it is important to conduct a QNWL assessment in every hospital and then follow up with appropriate interventions according to the problems faced by each hospital (11). Thus, the study was conducted to analyze the effect of the quality of nurses' work life on the performance of nurses at Dr. Pirngadi Hospital Medan.

METHOD
The study was quantitative with a crosssectional approach. Seventy-four nurses who volunteered to participate in this study were selected by random sampling. Inclusion criteria: 1) executive nurses; 2) permanent and temporary employee; 3) working period of 5-10 years; and 4) executive nurses in the inpatient room. Data collection was conducted by questionnaire QNWL with validity index and reliability 0.7059 and 0.9374 ( (12)). The nurse performance was measured by the questionnaire that describing the results of nursing actions consisting of assessment, diagnosis, intervention, implementation, and evaluation (13). Data were analyzed using the Mann-Whitney test.

RESULT AND DISCUSSION
Respondents involved in this study amounted to 74 nurses in the inpatient Dr. Pirngadi hospital Medan. Characteristics of respondents based on gender in this study showed that the majority of nurses who were inpatients were female as many as 58 people (78.3%), based on the age of the majority aged 36-45 years as many as 35 people (47.3%), based on education level, the majority of respondents had Diploma 3 education as many as 41 people (55.40%), based on the length of work the majority had worked 7-10 years as many as 39 people (52.7%) ( Table 1).
As well as the results of the study said that the majority of respondents were female as many as 68 people (86.1%) (14). This is in line with the results of the study said that there were differences in nurse job satisfaction between females and males, female employees have higher job satisfaction than male nurses (15). The results of the research conducted that the majority of respondents were female as many as 38 people (66.67%). The results of crosstabulation between respondents' gender and job satisfaction in this study showed that 9 female employees had a high level of job satisfaction, while only 8 male employees had a high level of job satisfaction (16).
In contrast to a study conducted that the majority of respondents in the study had an average age of 36 years, namely 52 people (65.8%) (14). The study was conducted that the majority of respondents aged 21-30 years as many as 39 people (68.42%). The results of the cross-tabulation between age and job satisfaction show that as many as 12 employees who have a high level of job satisfaction are in the age range of 21-30 years, while for employees aged 31-40 years only 2 people have a level of job satisfaction in the category tall. Employees aged 41-50 years who have job satisfaction in the high category are 1 person, and employees aged 51-60 years who have job satisfaction in the high category are 2 persons (16).
In line with the results of the study was conducted said that the majority of respondents in their research have the highest level of education at D 3 Nursing as many as 63 people (79.7%) (14). The results of the research conducted that the majority of respondents have the latest diploma education as many as 23 people (40.35%). The results of the crosstabulation between education level and job satisfaction show that employees with a high level of job satisfaction in the highest category are employees who have a final bachelor's education as many as 9 people, then followed by a diploma level of final education as many as 4 people, and a high school education level/equivalent as many as 4 people. This shows that the higher the level of education employees tend to have high job satisfaction as well (16).
In contrast to the results of research conducted that the longest working period of the respondent is 33 years, with an average length of work of 15 years as many as 63 people (79.7%) (14). This shows that tenure influences job satisfaction. This is in line with research conducted which states that there is an influence between tenure and job satisfaction (17). Also, other studies said that employees with longer tenures tend to have higher job satisfaction compared to employees who have new tenures, in other words, job satisfaction will increase along with the length of an employee's tenure (18).
Based on the results of table 2, it can be seen that the QNWL on the performance of nurses has a significance value of 0.004 <0.005. So it can be concluded that there is an effect of the QNWL on the performance of nurses.
In contrast to the results of a study that stated that there was no relationship between the quality of work-life and the performance of nurses at Teluk Kuantan General Hospital, the p-value was 0.817 (19). These results are in line with research conducted at Imelda Hospital Medan that there is no significant relationship between the quality of work-life and the performance of nurses and the quality of worklife factors that have a significant relationship with performance are balanced compensation factors, problem-solving factors, and pride factors to the institution, while other factors do not have a significant relationship with performance (20).
The results showed that respondents who assessed the quality of work-life in the adequate category with job satisfaction in the medium category obtained results as many as 32 respondents (80.0%), while respondents who assessed the quality of work-life in the good category with job satisfaction in the high category obtained results as much as 9 people (52.90%). The results of a simple linear regression test to analyze the effect of the quality of work-life on job satisfaction showed a significance value (p-value) of 0.024 and smaller than, which was 0.05. So it can be concluded that there is an effect of quality of work-life on job satisfaction (16).
The positive influence of the quality of worklife on job satisfaction is supported by a study that showed that the quality of work-life has a positive effect on job satisfaction (21). It is based on the concept that employee job satisfaction can be seen from two aspects. First, the feeling of belonging to the organization, and the second is the responsibility that employees have to create work productivity. Strong feelings towards these two aspects are a manifestation of the quality of work-life that is getting better.
Based on the results of the study, it can be seen that applying good quality of work-life, can have various benefits, including being able to increase employee job satisfaction, being able to improve employee health both physically and psychologically to create a positive atmosphere, increase employee productivity, and be able to build an image as an organization that has employees with high motivation at work. The techniques that can be done by an organization to improve the quality of work-life are job redesign, career development, flexible work schedules, and job security guarantees. If a hospital can improve the quality of work-life, it can have an impact on patient satisfaction (22).

RESEARCH ETHICS
This study has received ethical approval from the Research Ethics Commission of the Faculty of Nursing, University of North Sumatra number 1959/UN5.2.1.13/PRS/2021. Furthermore, this research is considered ethically appropriate according to seven 2011 WHO standards, they are 1) social values, 2) scientific values, 3) distribution of expenses and benefits, 4) risk and benefits potentials, 5) exploitation, 6) confidentiality, and privacy, and 7) consent after the explanation. The standards refer to the 2016 CIOMS guideline and are indicated by the fulfillment of each standard.