The Effect of Evaluation by the Chairman on the Performance of Nurses in Investigations in Medan Hajj General Hospital

The purpose of this study is to determine the effect of evaluation by the head of the room on the performance of nurses in the inpatient room of RSU Hajj Medan in 2020. This study used a quantitative method with a cross sectional design. The results of the study found that the effect of behavior evaluation on nurse performance showed a significance value of 0.000 (p <0.05). The effect of the evaluation of professional abilities on the performance of nurses shows a significance value of 0.417 (p> 0.05). The effect of the evaluation of the nursing process on the performance of nurses shows a significance value of 0.006 (p <0.05). The conclusion of this study is that there is an effect of behavior evaluation and nursing process by the head of the room on the performance of nurses in the inpatient room of RSU Hajj Medan in 2020. Evaluation of professional abilities does not have a significant effect on the performance of nurses. The most influential variable is the behavior with the highest coefficient value, amounting to 0.512 with a positive value. The head of the room is expected to optimize his role in evaluating programmed, scheduled, and in accordance with the standards and principles of implementation.


Introduction
Nursing programs are critical in sustaining and enhancing the consistency and safety of patient care, which is understandable given that nurses are one of the most numerous Human Resources (HR) organizations, accounting for 60-70 percent of all human resources in a facility. The nurse is the health provider who has the most direct contact with the customer, and so the quality and efficiency of nursing care has a significant impact on the quality and performance of patient facilities in the facility (Nursalam, 2014).
The standard of nursing care is highly affected by the quality of clinical facilities and is frequently one of the variables influencing how the population perceives the service organization. To sustain and enhance the consistency of nursing care, an assessment framework is used to evaluate the standards of nursing care. This tool should be composed of three components: instruments assessing nursing process standards, patient perception and comfort standards, and nursing practice standards. Nursing care principles function as guidance and benchmarks for nursing practice adoption to ensure that it adheres to ethical ideals, ethics, and obligations (Azwar, 1980). The aim of nursing care guidelines is to serve as a reference and a benchmark for measuring nursing care implementation. Both the method and outcomes of nursing care must be In their novel, Rismawati and Mattala argue that performance assessment or evaluation is a measuring activity taken on different events within a company's value chain. The effects of these assessments are used as input, including details about efficiency, strategy execution, and what changes and controls the business requires (Rismawati, 2018).
Dewi's research indicates that assessment has a beneficial impact on employee success. Where job assessment is an effective instrument for determining if workers delivered satisfactory work outcomes and performed work tasks in compliance with organizational expectations, such as work efficiency, knowledge, dependability, participation and timeliness, and freedom (Dewi, 2011).
The success of nurses is their activity in applying the best available authority, roles, and obligations in order to accomplish the primary duties of the career and the accomplishment of the organizational unit's priorities and objectives. According to the Nursing Law of the Republic of Indonesia No. 38 of 2014, nursing is the practice of caring for people, relatives, organisations, or populations, both ill and well. Nurse output is identical to those of all employees in the organization. Nurses desire to be evaluated against objective expectations that are transparent and easily shared (Kurniadi, 2013).
Nurse efficiency is a critical area of study in order to sustain and enhance the standard of clinical facilities and to provide patients with high-quality nursing care. Nurses who perform poorly or do not meet the requirements established by the Ministry of Health of the Republic of Indonesia may take acts that violate the Standard Operating Procedure (SOP), are ineffective in delivering nursing services, and may result in accidents, damages, and grievances from patients and third parties. Connected parties (Yanti, & Warsito, 2013). Pham et al (2016) Research established this fact. In a survey performed in 11 hospitals across five continents, 52 patient care accidents occurred, with Hong Kong accounting for 31%, Australia 25%, India 23%, America 12%, and Canada 10%. Meanwhile, harmful events in hospitals are expected to occur at a rate of 7.6 percent in Brazil. According to some of the study's findings, there are currently many patient care accidents occurring in different countries around the world, which are exacerbated by a variety of causes, one of which is bad nurse competence (Pham et al., 2016).
Additionally, the new phenomenon shows that numerous customers are already concerned with substandard service quality. In 2019, Girsang conducted research at Djoelham Hospital and found that 68% of clients believed the quality of nursing care was still insufficient (Girsang, 2020).
Rusmiati's 2012 study revealed that the majority of nurse managers performed poorly (50.5 percent). This demonstrates that nurses' nursing services continue to fall short of standards and that nurses' performance statistics have not yet met the goal set by the Indonesian Ministry of Health, namely an achievement rate of at least 75% of nurses' results in delivering treatment or nursing services (Rusmiati & Hastono, 2015).
General Hospital for Hajj Medan Hajj Medan is the North Sumatra Province's government hospital, situated in Medan City, North Sumatra. The assessment procedure used at RSU Hajj Medan by the head of the room is deemed inefficient. This is since, depending on the findings of the presurvey, the head of the room does not regularly review the nurse in charge's improvement, while the assessment phase is sometimes conducted every month or every six months. Additionally, the head of the room does not have a specific format for assessing the success of nurses; typically, each head of the room chooses his or her own measurement, which results in inconsistent appraisal results and possible assessment mistakes, such as certain points not being included in the points for assessment.
The actions of nurses demonstrates this issue, as some nurses seem to demonstrate a lack of care for patients, are slow to offer help, and are not welcoming to patients, with nurses speaking in blunt voices such as reprimanding the patient or the patient's relatives. Several difficulties are encountered when carrying out the nurse in charge's tasks, which are classified as human errors. The ineffectiveness of nurses is also evident in the findings of the researchers' preliminary survey of inpatient satisfaction. The researcher distributed a questionnaire of 18 questions addressing various facets of nursing activity, communication, and ability. Just four patients (out of twelve) expressed satisfaction with the care and results of nurses at Hajj Medan General Hospital (RSU). On average, the eight patients who expressed dissatisfaction worried about the nurse's lack of contact with the patient. For example, details regarding hospital regulations and services. Additionally, patients expressed dissatisfaction with the results of nurses who were perceived to be sluggish to provide assistance as required.
The initial survey at RSU Hajj Medan also revealed that the hospital's phlebitis incidence was 1.9 percent in 2018 (Report on Hospital Infection Surveillance Outcomes (Healthcare Associated Infections) Medan Hajj Hospital in 2018), above the standard for nasocomial infection incidence in hospitals, which is 1.5 percent. This demonstrates that nasocomial infections continue to be prevalent (Pham et al., 2016).
Nurses also have coordination issues with the head of the room. For example, as nurses encounter challenges or difficulties when doing duties, they seldom address them with the head of the room but often with other nurses. This demonstrates a lack of communication between the room's lead nurse and the charge nurse.
As this occurs in a health care institution, it results in a reduction in service efficiency and a decrease in general interest in the facility. According to the author's preliminary report completed in February 2020, there were 110 nurses and 254 beds. Additionally, data on the amount of inpatients treated at the Medan Hajj Hospital in 2017 were collected, which totaled 10,129. In 2018, there were 8,586 uninsured people. In 2019, there were 9,160 hospitalized patients. These statistics show that the number of admitted patients at RSU Hajj Medan has decreased over the last three years.
The application of Nursing Care Standards at RSU Hajj Medan in 2020 revealed that the implementation of nursing care standards for the success of implementing nurses was short of predetermined standards. Observations in nursing care documentation reveal twenty distinct models of nursing care, twelve of which lack adequate nursing care and do not adhere to nursing care philosophy. Nursing history is important since it contains notes that may be used with communications, accounting invoices, schooling, reports, research, and audits, as well as legal documentation.
According to interviews with medical record verification unit agents, regulation of nursing care reporting was a significant concern, with about 60-70% of instances including inadequate recording of subjective, empirical, calculation, and plan (SOAP) formats. According to the preliminary survey, there is a trend or problem concerning the nurses' performance at RSU Hajj Medan.
According to a preliminary study conducted by researchers after interviewing the nursing staff's boss, the head of the room could not have an optimal evaluation in light of the nurse not receiving enough guidance and instruction when conducting routine tasks due to an unreasonable workload. Nurses' performance in the inpatient setting is less than adequate due to a lack of appraisal. As a consequence of the above, the researcher felt compelled to conduct research on the following: The Effect of Room Head Evaluation on the Performance of Implementing Nurses in the Medan Hajj General Hospital's Inpatient Room in 2020.

Methods
This is a comparative study using analytic survey methods to determine the impact of the head of the room's assessment on the success of nurse executives. In this analysis, the independent variables are attitudes, technical abilities, and nursing procedure, while the dependent variable is the nurse in charge's output. This analysis took a cross sectional strategy. The population for this research was comprised of all nurses admitted to the General Hospital of Hajj Medan, which numbered up to 110 individuals. The survey method or method used to assess nurse output is relative random selection of 86 nurses.

Result and Discussion
Univariate Analysis   Based on the frequency distribution table of the evaluation of professional abilities by the head of the room in the inpatient room of the Medan Hajj General Hospital which is very good as many as 52 people (60.5%), both 31 people (36%), quite good as many as 3 people (3.5 %). Based on the frequency distribution table of the evaluation of the nursing process by the head of the room in the inpatient room of the Medan Hajj General Hospital which was very good as many as 47 people (54.7%), both 38 people (44.2%), 1 person was good enough (1 , 2%).   According to the table above, of the 86 respondents, the findings of the head of room's assessment of conduct were quite favorable; there were five individuals, two of whom (40 percent) had quite favorable nurse output and three of whom (60 percent) had favorable nurse performance. The findings of the head of room's appraisal of conduct were positive; there were 27 participants, with 24 people (88.9 percent) rating their nurse's output as good and three people (11.1 percent) rating their nurse's performance as really good. The findings of the head of room's assessment of conduct were excellent; there were 54 patients, including 8 people (14.8 percent) whose nurse output was excellent. and 46 individuals (85.2 percent) who rated their nurse's work as excellent. The Kendall Tau statistical test revealed that p = 0.000, indicating that "There is an association between the Head of the Room's Behavior Evaluation and the Performance of Implementing Nurses in the Inpatient Room of the Medan Hajj General Hospital in 2020," or that the theory is acknowledged. that was decent, and one (33.3 percent) with a nurse performance that was quite nice. The findings of the head of a strong room's assessment of technical skills is 31 participants, with 28 people (90.3 percent) rated as having good nurse output and three people (9.7 percent) rated as having really good nurse performance. The findings of the head of room's assessment of clinical skills were excellent; 52 participants were evaluated, with 1 individual (1.9 percent) having very good nurse skill, 6 people (11.5 percent) having good nurse performance, and 45 people (86.5 percent) having quite good nurse performance. The Kendall Tau statistical test revealed that p = 0.000, indicating that "there is an association between the Professional Ability Evaluation by the Head of the Room and the Performance of Implementing Nurses in the Inpatient Room of the Medan Hajj General Hospital in 2020," or that the theory is acknowledged.  According to the table above, the findings of the head of the room's assessment of the nursing phase were very favorable for 86 respondents; nevertheless, there was one individual, specifically one person (100 percent ), whose nurse output was quite favorable. The findings of the head of a strong room's assessment of the nursing phase were 38 participants, with 1 individual (2.6 percent) having very good nurse performance, 30 people (78.9 percent) having good nurse performance, and 7 people (18.4 percent) having quite good nurse performance. The findings of the head of room's assessment of the nursing method were excellent; there were 47 participants, including 1 individual (2.1 percent) whose nurse output was very high. 4 individuals (8.5%) whose nurse performance was satisfactory, and 42 individuals (89.4%) whose nurse performance was excellent. The Kendall Tau statistical test revealed a value of p = 0.000, indicating that "there is an association between the head of the room's assessment of the nursing method and the nurses' success in the inpatient room of the Medan Hajj General Hospital in 2020," or that the theory is acknowledged. Based on the table above, it shows that all variables, namely behavior, professional abilities, and the nursing process have a p value <0.25. Thus, all of these variables deserve to be included in the multivariate model. The preceding formula may be explained as follows:

Multivariate Analysis
A constant value of 4894,870 means that the statistic used to evaluate the nurse's actions, technical skills, and nursing processes has a value of 0. If this value is 0, the nurse's score is 4894,870.
The Behavior coefficient (X1) has a positive value of 1.460. This assumes that with every time the behaviour assessment is increased by one, the nurse's output will improve by 1.460, assuming all other factors remain unchanged. And achieved a significance value of 0.000, which is less than the threshold (0.00 0.05). As a result, the theory may be acknowledged.
Skilled ability (X2) has a positive coefficient value of 0.246. This assumes that for every time an assessment of technical skills is increased by one, the nurse's output will improve by 0.246, assuming all other factors remain unchanged. And received a significance degree of 0.417 (0.417>0.05). As a result, the theory may be ruled out.
The nursing phase coefficient (X3) has a positive value of 0.821. This assumes that with any additional period the nursing phase is evaluated, the nurse's output would improve by 0.821, assuming all other factors remain unchanged. And achieved a significance value of 0.006, which is less than the threshold (0.006 0.05). As a result, the theory may be acknowledged.
The maximum beta coefficient norm value is action (X1) of 0.512 for a positive value. This suggests that in 2020, the behaviour assessment component would have the greatest impact on the success of nurses in the RSU Hajj Medan inpatient bed.

The Effect of Behavior Evaluation by the Head of the Room on the Performance of Implementing Nurses
The regression analysis revealed that the head of room's appraisal of the nurses' actions had an impact on their success in the inpatient room of the General Hospital of Hajj Medan (p = 0.000 0.05). Additionally, the regression test findings indicate a strong association. This state demonstrates that increasing the nurse's assessment by the head of the room maximizes her success. The beta coefficient of 0.152 derived from the test effects indicates how strongly the action variable influences the output variable in comparison to other factors. The findings of this study corroborate those of Yulizar's 2019 studies at a public hospital in the Bengkinang district, which found a relevant value of disciplinary action with a p value of 0.000 0.05 and a tcount (5.676)> ttable value (2.132). According to the findings of multivariate research using multiple linear regression tests, the most significant variable affecting nurse administrators' success is disciplinary behaviour, as opposed to the tcount environment (3.666). (Yulizar, 2019) Yulizar This is supported by Arina's 2016 study, which examined the effect of work discipline, motivation, and incentives on the performance of inpatient nurses at a regional mental hospital. Dr. Amino Gondhohutomo Semarang City demonstrates that there is a strong correlation between job discipline activity and the nurse in charge's results. According to the findings of the multiple linear regression examination, job discipline has a favorable and important impact on nurse success ( Manasikana & Djastuti, 2017). However, this is in contrast to Ela's 2018 report, which found little correlation between actions and employee results (Nurdiawati, & Atiatunnisa, 2018).
According to researchers' conclusions, a person's success cannot be divorced from his or her disciplinary actions. If a person's action is disciplined, he can perform optimally if he wishes to follow the established guidelines. A person's sense of duty for the duties entrusted to him is reflected in his discipline. This fosters commitment to service, appreciation for work, and achievement of the hospital's objectives.
This relates to Sutrisno's point of view, in which punitive action aims to avoid sluggish job starts or premature work termination due to tardiness or laziness. Additionally, disciplinary action aims to overcome conflicts between workers and to discourage disobedience, as well as to remedy errors and carelessness (Daya, 1996).

The Effect of Professional Knowledge Evaluation by the Head of the Room on the Performance of Implementing Nurses
The regression analysis revealed that the head of room's assessment of technical skills had no major impact on the success of nurses in the inpatient room at Hajj Medan General Hospital (p = 0.417> 0.05). Additionally, the regression test findings indicate a strong association. This state demonstrates that by increasing the head of the room's assessment of the nurse's technical skills, the nurse's success can be maximized. The beta coefficient of 0.081 derived from the test results indicates how much the technical talent variable impacts the output variable in comparison to other variables. This is consistent with Arie Soeti's 2016 study on the Impact of Intellectual and Emotional Intelligence on Employee Performance with Professionalism as an intervening component. The findings of the study of the inner and outer models indicate that discipline has a major detrimental impact on employee success when it comes to interfering with analytical knowledge. And the detrimental impact of emotional intelligence intervention on job results is negligible (Yani, & Istiqomah, 2016). However, this is in contrast to Tati Setiawati's 2009 study, which found a strong association between competency outcomes and success. Additionally, as shown by the partial hypothesis test findings, expertise has a major impact on success ( Yani & Istiqomah, 2016). This is also in contrast to the findings of Tiara's 2015 report, which found that professionalism has a strong and important impact on success (Sari, 2013).
According to the researchers' assumptions, evaluating professional ability has no major impact on results since each nurse is trained with professional skills appropriate for their nursing duties. As a result, even without technical ability assessment, the efficiency of nurses is still very high. However, it was discovered in the analysis that the association benefit was positive, indicating that if technical skills were evaluated more accurately, the nurse's output would strengthen. This relates to Suwanto's assertion that preparation enhances talents, expertise, and skills ( Priansa & Suwatno, 2011). The Effect of Nursing Process Evaluation by the Head of the Room on the Performance of Implementing Nurses The regression analysis revealed that the head of room's assessment of the nursing phase had a major impact on the nurses' success in the inpatient room of the General Hospital of Hajj Medan (p = 0.006> 0.05). Additionally, the regression test findings indicate a strong association. These criteria mean that by increasing the head of the room's assessment of the nursing operation, the nurse's success would be maximized. The beta coefficient of 0.255 derived from the test results indicates how much the nursing phase variable impacts the output variable in comparison to other variables. This is consistent with research performed by Mohamad As'ad Efendy in 2017 titled "Analysis of the Implementation of Nursing Documentation Standards and the Quality of Nursing Services in the Inpatient Room of Gambia Hospital." The findings indicate that there is a correlation between the application of nursing documentation standards and the quality of nursing services in the Inpatient Room. Regional Hospital of Gambia ( Efendy, 2017). This is also reinforced by Elisa Claudia's 2019 study on the effectiveness of delivering quality nursing care by the implementation of the nursing method; the findings indicate that there is a correlation between the application of the nursing process and the success of providing quality nursing care. The nursing method will contribute to the enhancement of the standard of nursing care. The healthcare method simplifies the process of developing nursing care policies for nurses (Simanjuntak, 2019).
According to the researchers' conclusions, when the nursing procedure is carried out correctly, the continuity of nursing treatment offered is assured, since knowledge regarding the patient's situation is gathered via a series of structured and coordinated phases. This relates to Potter and Perry's assertion that the nursing phase is a method of problem solving that allows nurses to coordinate and provide high-quality nursing care (Potter, 2006).

Conclusion
The study's hypothesis is focused on its goals and findings, namely that there is an impact of behavioral assessment by the head of the room on the success of nurses in the inpatient room of RSU Haji Medan in 2020. There is no impact of the head of the room's assessment of technical skills on the success of nurses in the inpatient room of RSU Haji Medan. The year 2020. There is an impact of the head of room's assessment of the nursing phase on the success of nurses in the RSU Haji Medan inpatient room in 2020. With a correlation coefficient of 0.512, the predictor of behaviour assessment by the head of the room has the greatest impact on the success of nurses in the inpatient room of RSU Hajj Medan in 2020.