Length of work improves nurse performance

Technological advances and free competition currently affect various aspects of business and community services, so they are required to continuously change, innovate and develop, especially from the aspect of science and technology. It also affects services in the health sector. Providing quality health care is one of the most challenging issues for health care systems (Mudallal et al., 2017). Hospitals are an integral part of public health services, requiring efforts to develop a service system that is of good quality, fast, safe, and provides comfort in improving the quality of its services. One that affects the quality of service is the performance of nurses. Performance is the achievement of results by a person or group of people in an organization by applicable authority, responsibility, morals, and ethics (Madlabana et al., 2020). Good performance will improve organizational productivity (Ufuophu-Biri & Iwu, 2014). Performance is the result of the work of personnel in the organization both in quality and quantity, a phenomenon obtained in one of the private hospitals in the city of Surabaya is still lacking in the discipline of nursing documentation, including incomplete assessments, delays in recording/documentation, and evaluation of several programs. Less consistent so that efforts to improve problems are rarely carried out, where this is done by implementing nurses with different lengths of working and education levels. Quality health services is an indicator of the quality of nursing services which is one of the factors that play a role in shaping the public's view of the image of health institutions. Nurses are ARTICLE INFORMATION ABSTRACT

the most significant health workers in hospitals that affect health service financing (Dubois et al., 2013). Because nursing is a professional group at the forefront, closest to patients, and the most significant number in a hospital, through performance development, evaluation, and patient safety culture programs, communication and service continuity will increase hospital accountability to patients and the community, this is also stated on the Indonesian standard of nursing practice which is an instrument for professionals in carrying out the safe, effective and ethical nursing practice. Based on the results of a preliminary survey conducted by supervisors of performance assessments on ten nurses on January 14, 2021, in the inpatient room, the researchers found that the average nurse performance assessment was 80% and good at 20%. Still, nursing services are not entirely by nursing practice standards. Because there are 20% fewer performance categories, 20% enough performance categories, 40% good performance, and 20% excellent, which is influenced by practice standards that are lacking in the evaluation aspect, 63% of evaluations of the interventions given sometimes not performed, the standard of co-operation was 60%.
The growing health challenge has been the pressure on health management to unite and provide adequate human resources for health (Nxumalo et al., 2018). Organizational performance programs also need to evaluate whether the performance process is by the target or not so that the actual behavior of employees can be seen as their work performance (Chen et al., 2015). The ineffectiveness of the performance appraisal process will affect individuals and organizations, unfair and inaccurate assessments of individuals create feelings of discomfort and dissatisfaction and will reduce employee performance because they find obstacles to their future and career. In contrast, the organization will lose assets (Nursalam, 2016). From this phenomenon, it is necessary to pay attention to the factors that affect the performance itself, namely by increasing knowledge, skills, abilities (Ability), attitude (Attitude), and motivation; taking into account, it will affect productivity (Work Productivity) (Sagherian et al., 2018). It is essential for health care organizations to develop and implement sound strategies to provide adequate care that appeals to the patients (Cowing et al., 2009). Otherwise, if we ignore service quality standards, it does not rule out the possibility of the impact of the performance itself, including patient satisfaction with services given, employee satisfaction with their performance, quality of hospital services, effective teamwork, enthusiasm for work, and loyalty to the company will increase.
The purpose of this study is to analyze the relationship between the length of service and the performance of nurses in private hospitals in Surabaya. The results of the research can be input for hospital management, especially in the field of nursing, and the nursing committee in improving performance and planning Human resources development programs by considering several main pillars to build employee performance, including increasing employee competence (education, socialization, and training) and employee coaching (monitoring) (Abdulah, 2014). Employee performance, diagnose the need for improvement, determine ways of improvement, and provide constructive feedback to produce quality nurses, especially in private hospitals in Surabaya.

Methods
The research design used correlation with a cross-sectional approach. The population of this study is the implementing nurses at private hospitals in the city of Surabaya who meet the inclusion criteria, namely permanent employees, non-service executive nurses in the COVID 19 isolation room, and are willing to participate in the study. The number of samples was 59 nurses who were taken using simple random sampling.
The instrument this research uses is a nurse performance questionnaire from the Indonesian National Nurses Association (PPNI) and has been tested for validity and reliability with the results of the validity test of the Pearson correlation value of 0.369 -0.773 and the reliability of Cronbach's alpha value of 0.736 -0.746. Before the research, the researcher had asked for research permission from the directors of a private hospital in the city of Surabaya; after

Characteristic respondent
The characteristics of the respondents in table 1 show that of the 59 respondents studied, the respondents aged 25-35 years were 42 (71.2%), 63.3% had a D3 Nursing education, Respondents who had never received a reward were 19 (32.2%), attended seminars/workshop 47 (79.7%) and received feedback on performance appraisal and task design 52 (88.1%).

Length of Work as Nurses
Based on table 2, the length of work of nurses in a private hospital in Surabaya is 57% 5-10 years, 39% 1-5 years, 1.7% >10-15 years, and 1.7% > 15 years.  Table 3 shows data on respondents with excellent performance among as many as 38 (64.4%), good performance among as many as 10 (17%), adequate performance among nine people (15.2%), and poor performance among as many as two people (3.4%).  Table 4 shows a cross-tabulation of nurses' length of work and performance. Length of work 1-5 years, the performance of nurses is less than one respondent, only four respondents, good seven respondents, and very good ten respondents. Working length of >5-10 years, the performance of nurses is less than one respondent, only five respondents, good three respondents, and very good 26 respondents. Length of work >10-15 years excellent performance one respondent. Length of work >15 years excellent performance one respondent. The results of statistical tests with Spearman rank obtained p = 0.031 with a correlation value of +0.281 Based on the results of the study in terms of 47 respondents who had attended the seminar/training, 32 (68%) respondents had an excellent performance. Research results follow the theory that knowledge, ability, interpersonal skills, and technical skills (skills and ability) are determining factors that affect a person's performance (Mangkunegara, 2017). And PPNI in standard professional performance is education; nurses are responsible for acquiring the latest knowledge in nursing practice following the continuous development of science, technology, social, economic, and community education (PPNI, 2010). The theory is supported by SNARS edition 1 (2018) in KKS 8, explaining that every staff must attend education or training inside or outside the hospital, including continuing professional education, to maintain or improve their competence. The researcher argues that there is a match between theory and facts where respondents are allowed to be able to provide professional services to patients and have new knowledge with ongoing changes. From these training/seminars, which are conducted in a short period, with systematic and organized procedures, respondents gain new knowledge which is expected to be able to understand the knowledge gained, make it easier to make decisions and carry out their duties, and is a competitive advantage for the organization. Nurse competence affects increasing work productivity and achieving business goals in general (Tukayo & Hardy, 2020). The results of the study are in line with the results of the study that the performance of nurses is influenced by knowledge, the better knowledge will further improve the performance of nurses (Sukesi et al., 2015). And most importantly, nurses must always pay attention to appearance, be friendly, smile, offer help, and support patients and families (Ruhyanudin, F., 2022). The managers of hospitals are essential to provide the required mechanism for improving occupational factors, such as diversity of skills, job identity, independence, and feedback for increasing the retention of nurses of the hospital and consider organizational factors, such as environmental conditions, rewards, and supervision supports for increasing length of work of the nurses (Shokri Nagharloo & Soloukdar, 2018). The Working period of nurses in this study was 59% (35 respondents) 5-10 years; this data shows that the length of work of implementing nurses has not been long, which affects the quality of services provided to the patient (Asiamah, 2017). So it is essential for hospital institutions to increase the retention of health workers, especially nurses, by providing long service awards (Negussie, 2012).

Relationship length of work and nurse performance
In the results of the study, it was found that 52 respondents who received feedback had an excellent performance rating of 65.4% (34) of the respondents. There are five components of performance indicators, which function to assess sources, processes, results of the implementation of care, and impacts to improve service quality (Kewuan, 2016). The key to implementing human resource management effectively to motivate staff to improve their performance is through employee performance appraisals (Samsudin, 2018). Based on these facts and theories, the researcher argues that there are similarities were providing feedback from the results of performance appraisals is the result of evaluating a job done by nurses and communicated to the nurses themselves, managerial abilities of leaders significantly affect staff performance, assessing the ability of staff to carry out tasks and responsibility. And is an effective form of communication between management and staff so that staff understands, is aware, and motivated. Good feedback makes nurses easy to adapt by using positive coping so that nurses' performance in nursing care increases (Haryuni et al., 2013).
Data on the study result also found that 52 respondents got a straightforward task design and had an excellent performance, as many as 65.4% (34) of the respondents. The complementary productivity theory states that several things affect performance, including job design in work characteristics, determining the function of activities in the work assignment process to achieve organizational targets, and evaluation/feedback is needed in improvement efforts according to the specified target (Nursalam, 2016). The professional standards and nursing code of ethics as a reference for nurses in providing professional care services (PPNI, 2010). Quality of care describes client satisfaction with nurse care, which indicates the client's disease prognosis and describes the quality of hospital services (Ardiana et al., 2020). The researcher argues that there is a match between theory and facts where there are clear policies, guidelines, measuring instruments, and organizational mechanisms by nurses, so nurses will find it easier to carry out the planned program, know what to do and what is expected by the hospital so that it can provide its potential. Ideas, innovation, and energy can be channelled into his work.
Based on the results of statistical tests with Spearman's rank, p = 0.031, p <α, with a correlation value of +0.281 which means that there is a relationship between the length of work and the performance of the implementing nurse with a low strength relationship. Productivity and seniority in work are related to the length of service. The longer a person's working period, the more experience will be, and the better the performance will be (Robbin & Judge, 2017). A person's tenure in an organization will provide opportunities to accept more challenging tasks, greater autonomy, flexibility to work, increasing levels of rewards and opportunities to occupy higher positions, and more excellent personal investment in the organization (thoughts, energy, and time) to foster a sense of loyalty to the organization (Temaluru & Unaradjan, 2019). Hospital administrators can improve nurse performance by ensuring paternalism in their leadership (Safdar et al., 2021). The results of the study follow the theory that respondents who have a more extended working period have excellent performance because respondents already understand their work, have a good appreciation for their workplace, and have also got a good position at work. Long working hours make nurses more skilled in taking action to patients, better mastering nursing care and caring behaviour in providing better care for patients and families. Implementing nurses who work longer hours also get many opportunities to develop themselves, and develop knowledge and skills needed to improve the quality of their work.

Conclusion
Length of work increases the performance of nurses in the inpatient room. The nursing management section is expected to provide good rewards for implementing nurses to feel comfortable and loyal in their work so that they can improve the performance of implementing nurses in providing nursing care to patients so that it has an impact on increasing patient satisfaction and the quality of hospital services.