The Effect of Workload, Work Environment, Work Stress and Responsibility on Nurses' Job Satisfaction at Business Engaged in Health Service Sector

The purpose of this study is to determine the impact of workload on job satisfaction. The study population consisted of 212 nurses at businesses engaged in the health service sector. This research includes quantitative research using survey procedures. Collection of information by observation, interviews, and questionnaires. The sample consisted of 139 nurses. Data analysis used a simple linear regression method. The research results obtained show that workload has a negative effect on job satisfaction. The temporal demands dimension has the most substantial negative relationship with the operating procedures dimension. This indicates that the more nurses are required to work quickly, the less job satisfaction nurses will have in implementing procedures. There is an influence of the work environment on nurse job satisfaction.


INTRODUCTION
Hospital is one form of organization engaged in health services.Health services in hospitals are one of the most important services, especially professional nursing services.The nursing profession has a major role in contact with patients in a hospital.The majority of medical procedures given to patients are performed entirely by nurses.There are various efforts to increase employee job satisfaction, in this case nurses, namely by paying attention to organizational culture (Bey, M. T., &;Dewi, R. C. K., 2018), intensive (N urali N., 2019) and workload.According to Rivai (2011) Workload is the demands of work that is carried out daily and is considered a burden.When facing a task, a nurse is expected to complete the task at a certain time.But in reality, the workload of many nurses is not in accordance with their abilities.
Workload is anything that includes factors that describe a certain number or difficulty contained in a person's work (Bowling & Kirkendall, 2012).From research that has previously been conducted by (Haryanti, Aini & Purwaningsih, 2013) it was obtained that the workload received by nurses is activities that include installing intravenous catheters, hecting wounds experienced by patients, documenting nursing care, and cleaning medical instruments and consumables and so on.Different things were found in research conducted by (Samodra, 2017) that the workload of nurses in hospitals is to carry out health services such as reviewing, planning, implementing, and evaluating basic nursing performance of individuals or community groups.
Job satisfaction is meaningful, especially during a pandemic where the number of people with Covid-19 is very large.On November 27, 2021, there were 4 people with Covid-19.255.672 people in Indonesia (https:// covid19.go.id/).Job satisfaction must be possessed by nurses so that they can work reliably.Spector (1997) explains that job satisfaction refers to how a person feels about his job and different aspects of his job, in other words job satisfaction is the growth of only feelings of liking (satisfied) or dislike (dissatisfied) at his job.
Job satisfaction is important because it can improve nurse performance (Yanidrawati, 2012).In addition, job satisfaction can reduce nurses' intention to quit their jobs (Fitria, 2015).The higher the nurse's job satisfaction, the better the organization's civic behavior (Fanani and Djati, 2016).One aspect that causes the high level of nurse job satisfaction is the workload.Barahama et.al. (2019) reported that workload was negatively related to nurses' job satisfaction.Nurse workload is all activities or activities that are tried by nurses during duties in a nursing service unit.Workload includes physical or mental workload (Efendy, 2009).
The results of Syabana's research (2011) at RSUD Ambarawa found that there was a relationship between the workload of nurses and the fulfillment of spiritual needs in preoperative patients where the results of light workload as much as 33.3% and heavy workload as much as 66.7%.The results of the study showed that the workload of nurses at RSUD Ambarawa was high.The results of data collection conducted by the medical records section of RSUD Ambarawa during August 2012 resulted in the number of patients entering 950 patients.At Ungaran Hospital, during August there were 865 patients.
The results of research from Rubbiana (2015) show the most workload carried out by nurses, namely indirect nursing.The high implementation of indirect nurse activities is because this activity is a routine nurse reporting activity to the head of the room regarding the number of patients, patient conditions and nursing actions.Factors that affect the nurse's workload are the demands of the situation and external influences where a nurse will carry out nursing duties in the ward so that it is felt burdensome for nurses.Excessive workload will cause fatigue either physical or mental and emotional reactions.While in too little workload where work that occurs due to repetition of motion will cause boredom in daily routine work (Mastini, 2013).
A comfortable and safe work environment will make employees also feel comfortable working so that the tasks performed by nurses are also good and it also affects employee job satisfaction.Fathonah and Utami (2012) that employees will work optimally if the work environment is comfortable and supportive because employees are satisfied with the existing work environment.Conversely, job dissatisfaction will increase job stress in nurses.
Research conducted by Kurnia (2012) with variables of work environment and job satisfaction found a correlation result of 0.464 which shows that the work environment has an influence on job satisfaction.in a study conducted by Yunanda (2012) with the results of the R square value showed a value of 0.172% or 17.2%.This means that job satisfaction is influenced by the work environment.
According to Siagian (2014) stress is a condition of tension that affects emotions, thoughts, and physical condition of a person.Stress that cannot be overcome properly usually results in the inability of people to interact positively with their environment, both in the work environment and the outside environment.Stress conditions will affect employee work performance, because good performance results from employee satisfaction with their organization.Stress experienced by nurses can lead to depression, isolation from patients, and decreased abilities.
According to Al Hosisi, Mersal, Keshk ( 2013) that work stress can affect the physical and mental health of nurses.Lumbangaol (2016) states that the stress response is one of the body's physical reactions to existing sources of stress or stimuli that attack the body.These stressors include ambiguity in individual employee expectations, role conflicts between instruction givers and receivers, and excessive workload in a job position.These three elements of role conflict occur simultaneously, two or more pressures in the world of work that will initiate stress that burdens employees.In addition, job satisfaction is related to the level of absenteeism or absence, employees who are less satisfied tend to be absent and vice versa (Hamali, 2018).
The results of job satisfaction research conducted by Sugiri (2015) in the Nakula room of Sanjiwani Gianyar Hospital found that good job satisfaction will indirectly affect the performance of the employees themselves.The higher the nurse's job satisfaction, the higher her performance.The results of another study conducted by Sutarni (2008) showed that there was a meaningful relationship between workload and job satisfaction with an OR value = 17,333, meaning that heavy workload had a 17,333 times chance of job satisfaction compared to light workload.
The novelty / novelty of this study is research from Lia Amalia (2017), the independent variables used are workload and commitment variables, and intervening variables use nurse job satisfaction variables while in the current study using independent variables, namely workload variables.And the dependent variable used the job satisfaction variable in nurses.If the research from Riny Chandra (2017), the independent variables used are workload and work stress variables, and do not use intervening variables, while in the current study using independent variables, namely workload variables.And the dependent variable used the job satisfaction variable in nurses.
The purpose of this study was to determine the effect of workload on nurses' job satisfaction at Bakti Timah Hospital Bangka Belitung.This research includes quantitative research using survey procedures.Data analysis uses simple linear regression techniques.The hypothesis in this study is Ha: there is an effect of workload on nurses' job satisfaction at Bakti Timah Hospital Bangka Belitung.

RESEARCH METHOD
This research design is a type of correlative descriptive survey research, with a cross-sectional approach.The independent variable is workload, work environment, salary, and responsibility and the dependent variable is job satisfaction.The study population included all nurses at the Bakti Timah Hospital in Belitung City as many as 212 people.The sample amounted to 139 nurses calculated using the Slovin formula with an error rate of five percent.Data collection uses a Likert scale with a range of 1 -5 with answer response choices from the highest, namely Strongly Agree, Agree, Doubt, Disagree and Strongly Disagree.The scale is disseminated through a Google form.Workload analyzers adapted from Rubio-Valdehita et.al.( 2017) while job satisfaction is adapted from Spector (1985).Data analysis uses simple linear regression techniques.Descriptive analysis is used to see an overview of variables and respondents.The validity test uses the Pearson correlation while the reliability test uses the Cronbach Alpha.Test normality using Kolmogorov Smirnov.Heteroscedasticity test using glejser method.The R Square test is used to see the contribution of workload to job satisfaction.The correlation matrix between dimensions is used to determine the relationship of dimensions in different variables.Data is processed with the help of SPSS 20.0 software for Windows.
The hypothesis in this study is Ha: there is an influence of workload, work environment, work stress, and responsibility on the job satisfaction of nurses at Bakti Timah Hospital Bangka Belitung.

RESULTS AND DISCUSSION
The study respondents consisted of 36 male nurses and 103 female nurses.The length of work under 5 years amounted to 36 respondents, the age between 5-10 years amounted to 28 respondents, the age between 10-15 years amounted to 38 respondents, the age between 15-20 years amounted to 25 respondents, and the age over 20 years amounted to 12 respondents.The respondents' education levels are 2 people high school/ equivalent, 110 diplomas, 27 bachelors.A total of 29 respondents were unmarried and the remaining 110 people had been married.
Robbin (2017) states that age is not a determining factor in displaying positive performance at work, but the commitment of individuals to do their best at work.According to researchers, age is not one of the determining factors that a person will be satisfied in his job, even though he is still young but has a commitment to progress and develop, they will strive to work well and achieve job satisfaction.
In Gillies' opinion (1994) that nurses who have higher education also have higher work abilities so that they have high demands on the organization and have an impact on satisfaction.According to researchers, the average nurse implementing the education level is D-III Nursing where they try to show good performance for career improvement, the possibility that those who have not had the opportunity can decrease in work.
Research results from Rachman ( 2006) that there is no meaningful relationship between job satisfaction of married and unmarried nurses.While the results of Robbin's research (2006), that married employees have lower absenteeism rates, have lower resignation rates and are more satisfied with their jobs compared to unmarried ones.
A total of 29 workload items and 35 job satisfaction items were processed in this study.The workload validity test results are in the range of 0.200 -0.684 with a reliability value of 0.873.The results of the job satisfaction validity test are in the range of 0.175 -0.701 with a reliability value of 0.914.
The classical assumption tests used are normality and heteroscedasticity tests.Asymp value.Sig. in the normality test of 0.200, because it is greater than 0.05, the data of this study is declared to be normally distributed.Sig value.0.308 was obtained in the heteroscedasticity test, because it is greater than 0.05, the research data is considered free of heteroscedasticity.The R Square value is obtained at 0.216 which means that the influence of workload contributes 21.6% to job satisfaction and the remaining 78.4% is influenced by other factors.
The results of the hypothesis test stated that workload had a significant nega tive effect on job satisfaction with a calculated t value of -6.149 and a significance value of 0.000.This means that the increasing workload of nurses has an impact on the decreasing level of job satisfaction of nurses at the Bakti Timah Hospital Belitung City.This discovery is supported by previous research conducted by Safitri and Astutik (2019).
Based on the research data obtained, in accordance with the concept that explains the positive relationship between workload and job satisfaction.Altaf and Mohamad Atif, (2011) stated that workload negatively affects job satisfaction.High workload has a negative influence on job satisfaction.In Mustapha's research, (2013) states that job satisfaction is influenced by daily workload, employees are more satisfied when they are given a lower workload.Lower job satisfaction was found in higher workloads in the research of Mansoor, et al., (2011).In Tunggareni and Thinni, (2013) suggests that nursing personnel who have a medium objective workload tend to have a greater level of job satisfaction than a high objective workload.Nursing is a job that requires a diversity of skills, has a task identity, is a meaningful task, needs autonomy and job feedback.Performance and satisfaction are the levels to which employees achieve job requirements.So that the arrangement or assessment of the nursing manager must be done properly (Nursalam, 2014).
Based on the research data obtained, in accordance with the concept that explains the positive relationship between workload and job satisfaction.Altaf and Mohamad Atif, (2011) stated that workload negatively affects job satisfaction.High workload has a negative influence on job satisfaction.In Mustapha's research, (2013) states that job satisfaction is influenced by daily workload, employees are more satisfied when they are given a lower workload.Lower job satisfaction was found in higher workloads in the research of Mansoor, et al., (2011).In Tunggareni and Thinni, (2013) suggests that nursing personnel who have a medium objective workload tend to have a greater level of job satisfaction than a high objective workload.
According to researchers, the workload feels heavy if it is not balanced with the appropriate amount of energy, unclear job descriptions, and not balanced with continuous addition of knowledge and skills.In addition, the length of work will also affect the work so that it is said that nurses who have long experience then the nurse becomes more skilled.This is in accordance with Siagian's opinion (2007) that the longer a person works, the more skilled and experienced he will be in dealing with problems in his work.Based on the results of the study, the current condition of nurses in the Adult Care Room of GMIM Pancaran Kasih Hospital Manado is satisfied with the workload that is categorized as heavy, so it is expected that hospital managers must maintain or increase the level of nurse job satisfaction.
Chi-square test analysis obtained results with a value of α = 0.004 with p < 0.05, then H1 is accepted, meaning that there is an influence of the work environment on nurse job satisfaction.The work environment itself concerns the workplace, equipment layout, workspace, light, ventilation, or air circulation, occupational safety and health guard equipment and promotion (Sedarmayanti 2009).The hospital has provided every nurse with the opportunity to participate in promotion, the company provides occupational safety and security to employees.Then regarding working conditions such as space, temperature, color, air ventilation that provide comfort to most nurses.Likewise with company leaders by supervising or monitoring every work activity carried out by nurses.
The relationship between the work environment and job satisfaction means that nurses will feel comfortable with the existing working environment conditions, if the environmental conditions suit them and do not feel disturbed when they work.So that with this comfort they are encouraged to work, this can cause a lot of work to be completed properly.Of course, job satisfaction does not come by itself, besides the willingness and effort in nurses, there are several factors that can affect this.One that can affect job satisfaction is the work environment.
Chi Square statistical test between work stress variables on Work Center obtained p = 0.001 ≤ α = 0.05 which means that there is an influence between work stress and nurse job satisfaction at Bakti Timah Hospital Bangka Belitung.Hasibuan (2012), stated that work stress experienced by nurses is often caused by difficult and excessive workloads, pressure and attitudes of leaders who are not fair and reasonable, conflicts between individuals and leaders or work groups, inadequate work time and equipment.
According to the Health and Safety Executive (2017) states that workload is the main factor causing work stress.According to Widiharti (2016), one indication that causes work stress in nurses is the high workload because there is a shortage of nursing staff in the inpatient room, making it one of the causes of work stress.Work stress certainly does not only come from workload, but also from various factors.Cooper (in Saam and Wahyuni, 2012) mentions other factors besides high workload (overload), stress can be influenced by working conditions, work that is no longer challenging, and work with too high risk.According to Moustaka et al.., (2011) hospital nurses will experience work stress because they are often exposed to the obligation to control the emotional needs of patients causing anxiety that will develop into stress.
Chi-square test analysis obtained results with a value of p = 0.007 < α = 0.05 which shows there is an influence between responsibility for nurses' job satisfaction at Bakti Timah Hospital Bangka Belitung.This study has the same results as the research conducted by Nurfrida (2018), that the variable nurse responsibility has no relationship with the job satisfaction of inpatient room nurses at Tugurejo Hospital Semarang.Job satisfaction is related to the level of absenteeism or absence, employees who are less satisfied tend to be absent and vice versa (Hamali, 2018).
Based on the statement of the theory, the author concludes that the cause of the lack of relationship between responsibility and job satisfaction in this study is because there are still respondents who often replace colleagues who are unable to attend according to the shif, meaning that there are still nurses who are not present to work, but related to the results of the analysis of respondents' answers to the statement of job satisfaction, all respondents are satisfied with the distribution of shif.According to Hardiansyah (2018), the most reasonable thing if employees who do not have job satisfaction will tend to neglect their work.For this reason, the hospital management must pay more attention to the absence of nurses and provide affirmation and to nurses who neglect their work.

CONCLUSION
The results of the hypothesis test stated that workload had a significant negative effect on job satisfaction with a calculated t value of -6.149 and a significance value of 0.000.This means that the increasing workload of nurses has an impact on the decreasing level of job satisfaction of nurses at the Bakti Timah Hospital Belitung City.The temporal demands dimension on the workload variable has the greatest influence on the operating procedures dimension on the job satisfaction variable.There is an effect of the work environment on nurses' job satisfaction (p = 0.004).There is an effect between salary and job satisfaction (p = 0.001), and there is an influence between responsibility and job satisfaction (p = 0.007).

RECOMMENDATION
Advice for hospital management is to pay more attention to the demands of working time from nurses because it can reduce job satisfaction.You do this by increasing the number of nurses so that nurses or hiring contract nurses during the pandemic due to the workload is too high.Researchers can then add variables outside this study that affect job satisfaction including career development and communication, work discipline, and K3 (Occupational Safety and Health).