The influence of commitment on nurse performance at Bahteramas General Hospital, Southeast Sulawesi Province, Indonesia

The findings in the initial study found that one of the causes of the low performance of health services in hospitals is the lack of commitment of nurses in carrying out their duties during working hours at the hospital. The commitment in question is the willingness and obedience of nurses in carrying out the tasks that are their responsibility. The purpose of this study was to determine the effect of commitment on nurse performance at the Bahteramas General Hospital. The type of research used is quantitative research using a cross sectional study design. The size of the population in this study were 209 people, with a sample size of 138 respondents. As for the method of data collection, it was carried out using interviews and field observations. Implementation Data analysis was carried out using Univariate and Bivariate methods. The results showed that there was an effect of commitment on the performance of nurses at the Bahteramas Regional General Hospital with a p (0.000 <0.05). Conclusion; the commitment variable affects the performance of nurses. Suggestion; The need for education and training on hospital service commitments to increase awareness and willingness of nurses to maintain service commitments.


Introduction
In the era of growing globalization, there are several organizations that compete with each other to improve the quality of their work.In this case an organization that is able to survive in its business competition is an organization that has human resources who have a good work ethic.Human resources (HR) is one of the elements in an organization that has an important role.Emphasizing attention to the human factor in the organization, does not mean that other factors do not play an important role, because the various factors needed in the organization support and complement each other, or in other words, synergize with one another.In this regard, it is necessary to have human resources who are reliable and able to face challenges, create and fill job opportunities, because it is indicated that one of the causes of the economic crisis is the low quality of human resources [1].
Hospitals as one of the links in the health service chain have the main function in healing and recovery.The hospital is required to carry out its mission as an institution that provides quality services to the community so that it will provide its own satisfaction for users [2].Health care quality assurance or quality assurance in health care is one approach or effort that is very important and fundamental in providing health services to patients.Health care professionals, both individuals and groups, must always strive to provide the best quality health services to all patients without exception [3].
The success of a company or organization is largely determined by the quality of its human resources (HR).Along with increasingly competitive competition as a result of changes in customer tastes, technology and landscape changes, every company or organization needs human resources who have superior competence and performance.In other words, organizations are not only required to be able to provide satisfactory service to customers (customer satisfaction), but also to be oriented towards creating value for their customers, thus the organization does not only build and focus on high employee performance and productivity, but also determines the process of creating reliable work performance and productivity through developing employees according to needs.Performance in English is called job performance or actual performance or level of performance, which is the level of success of employees in completing their work.Performance is not an individual characteristic, such as talent or ability, but rather an embodiment of ability in the form of real work or is the result of work achieved by employees in carrying out tasks and jobs originating from the organization [4] Awareness of the importance of the existence of quality human resources, in this case nurses, need to be followed up with various strategies that can improve the quality of nurses.One that is measured in the quality of nurse performance is a matter of discipline.Work discipline is a tool used by managers to communicate with employees so that they are willing to change an effort to increase one's awareness and willingness to comply with all applicable social rules and norms.Factors that influence work discipline are goals and abilities, human relations, remuneration, fairness, legal sanctions, exemplary leadership and firmness [5].
Nurses as one of the health workers in hospitals play an important role in efforts to achieve health development goals.The success of health services depends on the participation of nurses in providing quality care for patients [6].Considering that nurses are the most important resource in running a hospital without minimizing the meaning of other human resources, nurses are required to have intellectual, interpersonal, technical and moral abilities.This aims to maintain and improve quality health services.Nurses provide services in the hospital 24 hours a day, and have constant contact with patients.Therefore nursing services in hospitals are an integral part of health services.The contribution made by nurses greatly determines the quality of service in hospitals.Thus efforts to improve hospital services must be followed by efforts to improve the quality of nursing services [7].
One of the elements that has a large role and greatly determines the quality of hospital health services is nurses, this is because the nursing profession has a relatively large proportion, which almost exceeds 50% of all hospital human resources and interacts the most directly with patients.They have more work and duties than other staff, because the nature and function of this staff is to support medical services in the form of nursing services known as nursing care [8].Attention to improving the performance of nurses in providing nursing services in hospitals is a very basic demand, because these factors can shape the performance of nurses in hospitals so as to support the implementation of their duties and responsibilities in providing nursing services.If this does not receive enough attention and is left without proper handling efforts, it is feared that it will have an impact on the success of improving the quality of health personnel resources, especially in providing nursing services in hospitals [7].
Preliminary studies conducted by researchers found that, one of the causes of the low performance of health services in hospitals is the lack of commitment of nurses in carrying out office duties during working hours at the hospital.The commitment in question is the willingness and compliance of nurses in carrying out the tasks that are their responsibility.
Likewise, data on achieving minimum service standards at Bahteramas Hospital shows that several programs that have been carried out have not reached the specified Minimum Service Standards (SPM), namely customer satisfaction in the Emergency Department.(34.0%) from standard ≥70%, outpatient satisfaction (73.21%) from standard ≥90%, inpatient satisfaction 60.89% from standard ≥90% [9].Based on the above data, there is a need for research on the effect of nurse commitment on nurse performance at the Bahteramas Regional General Hospital, Southeast Sulawesi Province.The research objective was to determine the effect of commitment on the performance of nurses at the Bahteramas Regional General Hospital, Southeast Sulawesi Province.

Methodology
The type of research used is quantitative research using a cross-sectional study design, in which the researcher observes or measures variables at a certain time.The size of the population in this study were 209 people, with a sample size of 138 respondents.As for the method of data collection, it was carried out using interviews and field observations.Implementation Data analysis was carried out using Univariate and Bivariate.

Commitment
Nurse work commitment is an action and willingness to work of a nurse in achieving hospital goals which can be measured by their participation in completing the responsibilities and mandates that have been set.The distribution of respondents according to the commitment of nurses at Bahteramas hospital, Province of Southeast Sulawesi, is presented in table 1.

Performance
Performance is the achievement of work performed by nurses in completing work based on the main tasks and functions that have been determined by law applicable at the Bahteramas General Hospital.The distribution of respondents according to nurse discipline at the Bahteramas Hospital in Southeast Sulawesi Province is presented in table 2;  The effect of commitment on nurse performance at Bahteramas Hospital in this study is presented in table 3.
Table 3 shows that of the 90 respondents (100%) who have a high commitment there are more nurses who have high performance, namely as many as 75 respondents (83.3%) compared to nurses who have low performance as many as 15 respondents (16.7%).Meanwhile, of the 48 respondents (100%) who had low commitment, there were fewer nurses who had high performance, namely 19 respondents (39.6%), compared to nurses who had low performance, namely 26 respondents (60.4%) Chi square test results the value of p = 0.000 (p> 0.05) means that Ho is accepted.This shows that there is a significant influence between commitments to the performance of nurses in the Bahteramas General Hospital, Southeast Sulawesi Province.

Discussion
Optimal employee performance is the most important requirement in achieving company goals.Achievement of company goals is obtained from the company's efforts to manage human resources with the potential to improve work results.The management of human resources carried out by the company is reflected in the performance of the resulting employees and the achievement of company goals.Implementation of an effective and efficient employee performance system will greatly affect the achievement of employee performance which has an impact on achieving company performance.One company that requires employees with high levels of performance is a company engaged in the health sector, especially hospitals [1].
Organizational commitment is defined as the relative strength of an individual in identifying his involvement in the organization.One of the successes of organizational management is its ability to foster employee organizational commitment.How far the employee's organizational commitment to the organization will determine the achievement of organizational goals.Organizational commitment is very important because employees who have a strong commitment to the organization will show their best performance and be productive in carrying out their work.In fact, in many organizations organizational commitment is an absolute requirement in holding certain managerial positions.Employee organizational commitment is the identification of feelings, involvement, and loyalty shown by employees towards the organization where they serve and work.Employee organizational commitment is shown in an attitude of acceptance, a strong belief in the values and goals of the organization.Likewise, there is a strong urge to maintain being an important part of the company's members in order to achieve organizational goals.Strong employee organizational commitment will affect the performance displayed by employees [4].
The results of the research findings in table 1 show that, in general, there are more nurses who have a high commitment than nurses who have a low commitment.This shows that the higher the commitment, the higher the performance of nurses in completing the work that is their responsibility in providing health services to patients and their families.However, conversely, the lower the commitment, the lower the performance level of nurses in completing the work that is their responsibility in providing quality health services.This condition is because nurses have instilled a strong spirit and patriotism as a good service to the community for their duties and responsibilities as servants of the state and servants of the community and it is more important to fulfill them than other jobs.Likewise at this time, nurses assume that they increasingly understand that the main tasks and additional tasks they carry out as servants of the state and servants of the community are the top priority in their lives, compared to their responsibilities in household affairs.So that with a high corps spirit, encouraging nurses in hospitals to be more active in providing quality health services and satisfying patients is their main responsibility, because nurses feel that their dedication as civil servants is a must to prioritize.
Nurse commitment is a person's emotional attachment to the profession, a person's perception of obligations in the profession and the benefits of carrying out the profession.Where, when someone who has a high professional commitment they will tend to maintain the profession they are running and are proud to be part of that profession.These feelings will arise when circumstances in the internal environment of the organization such as values, regulations, and work atmosphere are positively captured and absorbed by individuals through their perceptions.It is this organizational climate that can influence several things to shape employee expectations with the consequences that will arise from several actions [10].
To achieve high performance, one of them is influenced by the nurse's individual commitment.Where if the nurse in the hospital has low work commitment then she will also tend to show poor work quality, let alone facing high targets and timely demands in completing work, then the nurse will experience quite heavy work pressure, this can have an impact on low their commitment.However, if the nurse has a high work commitment, she will try hard to show better performance, because in the soul of the nurse a high awareness is embedded to complete the job successfully and smoothly.
Many factors affect individual performance in a company or public organization, especially the work of nurses.HR is the key to obtaining results as expected by the company.The work culture which is the basic values contained in the environment in the company through the process becomes an important value of HR because it can function as a tool to increase work efficiency, effectiveness and productivity.A strong and positive work culture will help improve performance because it provides the structure and control needed without having to be guided by a formal bureaucracy which is sometimes rigid and can hinder motivation and innovation.There are several important factors that must be considered by companies or public organizations if they want to improve employee performance, namely work culture, company regulations and managerial policies and so on [1] Other findings that were obtained during the study were the lack of commitment of nurses in carrying out hospital goals, namely the lack of leadership support at work, an unsupportive work environment, unfair distribution of incentives, high workload and limited career development.This is in line with the results of research [11] showing that organizational commitment is influenced by personal characteristics, job characteristics, organizational structure, work experience and organizational support.
Employment status and organizational commitment are important for the organization, especially to maintain continuity and achieve goals.But to get a high commitment, adequate conditions are needed to achieve it.With commitment, individuals must prioritize what has been promised to their organization rather than self-interest.The factors that influence the degree of commitment are the intrinsic and extrinsic factors of the employee concerned.Employee intrinsic factors can include aspects of the socio-economic conditions of the employee's family, age, education, work experience, personality stability, and gender.While extrinsic factors that can encourage a certain degree of commitment include exemplary management, especially top management in committing to various aspects of the organization.In addition, it is also influenced by management factors, employee recruitment and selection, training and development, compensation, performance management, career management, and the control function of superiors and co-workers.Job satisfaction can be achieved by motivating organizational managers and appreciating their work.
Performance is a real achievement displayed by someone after the person concerned has carried out his duties and role in the organization.Productive performance is a level of achievement that shows high effectiveness [12].
Individual commitment to the organization is nothing more than a loyalty to the organization in which members of the organization express their concern for the success and welfare of the organization.Organizational commitment as a daily manifestation of the values and traditions that exist within the organization.This can be seen from the behavior of employees, their expectations of the organization and co-workers, as well as the conditions that are said to be normal that are shown by employees when carrying out their duties, manifestations in activities.Organizational commitment is an important component in the success of organizational performance, because it is a motivating element for someone to do work alone or in groups [13].
Nurses generally have a good commitment by not only working as they are but also giving maximum work effort, this is related to efforts to achieve their success in carrying out the tasks of the organization where they work.Usually nurses have understood the tasks that are their own responsibility.Nurses have a strong drive to complete work with full responsibility.Doing this work is not a form of devotion to the state, but more than that the quality of their work is a measure of the public services they have provided.The commitment form of nurses will be dedicated not only for today but also to achieve health development goals in the future which in the end is to increase the quality of community health status and satisfy customers.
The results of the chi square test obtained a value of p = 0.000 (p> 0.05) meaning that Ho is accepted.This shows that there is a significant influence between commitment to the performance of nurses in the Bahteramas General Hospital, Southeast Sulawesi Province.The results of this study are in line with the results of research [2] which state that there is an effect of organizational commitment on the performance of implementing nurses.The results of the study [14] said that there was a positive influence of the organizational commitment variable on the performance of nurses at the PKU Muhammadiyah Hospital, Bantul.The results of the study [1] say that officer commitment affects employee performance.The results of the study [12] said that organizational commitment had a positive and significant indirect effect on employee performance at the Kajuara Health Center UPTD.The results of the study [15] say that there is an effect of employee commitment on nurse performance at Hermina Depok Hospital.The results of the study [14] said that there was an effect of organizational commitment on nurse performance at PKU Muhammadiyah Hospital, Bantul.
The results of the study [16] say that from the results of the analysis it is known that there is an influence of organizational commitment on performance.The results of the study [17] said that organizational commitment has a simultaneous effect on the performance of nurses in the Inpatient Room of the Ibnu Sina YW Hospital UMI Makassar.
In addition to work culture, employee commitment also plays an important role in influencing employee performance.Employee commitment is an important aspect as a result of which they perform better.There is evidence to confirm the impact of commitment as an organizational outcome variable.A lack of commitment from personnel can be harmful to an organization, resulting in poorer performance and higher costs.Employees with high commitment generally have good attendance and performance records, show a desire for loyalty to company policies, have lower turnover rates and have high productivity, satisfaction and work motivation.Thus this is expected to be able to increase public trust in health services and be a good way to improve the health status of the community itself [1].

Conclusion
The commitment variable influences nurse performance.Suggestion; The need for education and training on hospital service commitments to increase awareness and willingness of to maintain service commitments.

Table 1
Distribution of respondents according to the commitment of nurses at Bahteramas hospital, Province of Southeast Sulawesi

Table 1 .
Shows that out of 138 respondents, the majority of nurses have a high commitment namely as many as 90 respondents (65.2%) compared to nurses who have a low commitment, namely as many as 48 respondents (34.8%)

Table 2
The distribution of respondents according to nurse discipline at the Bahteramas Hospital in Southeast Sulawesi Province is presented in table2 Source: Primary data, 2022

Table 2
shows that, out of a total of 138 respondents, most have high performance, namely as many as 94 respondents (68.1%) compared to nurses who had low performance, namely 44 respondents (31.9%)3.3.

The effect of nurse commitment on nurse performance at Bahteramas Hospital in Southeast Sulawesi ProvinceTable 3
Analysis of the Effect of Commitment on Nurse Performance in Bahteramas General Hospital in Southeast Sulawesi Province Source: Primary data, 2022