The Influence of the Supervision of the Head on the Performance of Nurses in the Medan Hajj General Hospital

A study conducted by the Directorate of Nursing Services, Ministry of Health of the Republic of Indonesia (2011) found that the nursing services provided by nurses to patients had not reached the set target, namely a minimum figure of 75% of the nurse's performance was said to be good.This type of research is quantitative, with adesign cross-sectional which aims to see the effect of headroom supervision on the performance of nurses in the inpatient room of the  General Hospital Hajj Medan in 2020. The sampling technique used is proportioanl stratified random. sampling. Data collection using primary data by distributing questionnaires to the nurse administrators and secondary data obtained from the hospital, namely the hospital profile. Data analysis used Chi square test (α = 0.05) and multiple linear regression.The results showed that the variables that influence the performance of nurses are planning (p = 0.000), guiding (p = 0.045), monitoring (p = 0.000), evaluation (p = 0.002), recording and reporting (p = 0.000). The variables that did not affect the nurse's performance were organizing (p = 0.382) and directing (p = 0.065). In conclusion, the most influential variable is recording and reporting with the highest coefficient value, amounting to 1.674 with a positive value. It is recommended that the head of the room carry out supervision in a programmed, scheduled manner, in accordance with the standards and principles of its implementation and optimize recording and reporting in supervision activities.


Introduction
According to the Republic of Indonesia's Law No. 44 of 2009 on Hospitals, a hospital is a health care facility charged with the responsibility of delivering comprehensive individual health care. This plenary health program provides prevention, curative, and rehabilitative care.
Nursing programs are critical in hospitals for sustaining and enhancing the efficiency and safety of patient care. This is because nurses are one of the most numerous Human Resources (HR) categories, accounting for 60-70 percent of nurses. The nurse professional who has the longest daily contact with the client would have a significant impact on the quality and consistency of healthcare care in the facility (Nursalam, 2014).
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. Nurses' efficiency is comparable to that of employees in nursing homes. Their success is evaluated against publicly available and communicable objective criteria (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. Inadequate output of nurses or failure to meet the requirements established by the Indonesian Ministry of Health will result in acts that are inconsistent with SOPs and ineffective in delivering nursing services, resulting in sorrow, damages, and grievances from patients and related parties (Yanti, & Warsito, 2013).
Between 2005 and 2007, a research conducted in five hospitals in the metropolitan area of St. Louis, Missouri, and southern Illinois, United States, established this reality. The research evaluated six program components: the admission method, nursing facilities, physician services, personnel services, and food services. The findings indicated that, in comparison to other variables, the facilities offered by staff and nurses had the greatest effect on patient satisfaction (Otani et al., 2011). Nikpeyma et al. (2014) identified four major trends in their analysis of the clinical nurse performance assessment scheme at the Iranian Tahran Hospital. The subject of this theme is topics relating to historical, job layout, and method evaluation, as well as assessment of work results (Nikpeyma et al., 2014).
The current state of affairs demonstrates that there are already many customer concerns concerning substandard service efficiency. According to a 2011 survey undertaken by the Directorate of Nursing Services of the Ministry of Health of the Republic of Indonesia, 72.6 percent of clients believed the standard of nursing services was already inadequate (Depkes Ri 2011). According to Rusmiati (2012), the majority of nurse managers work poorly (50.5 percent). Additionally, Langingi's (2015) study revealed that 60 people (66.7 percent) had excellent nurse performance, whereas 30 people (33.3 percent) had bad nurse performance (Langingi & Grace, 2015). 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.
According to Gibson et al. (1987), there are three types of variables that may affect job behavior: human variables, social variables, and organizational variables. Leadership is the most critical corporate variable (supervision). Supervision is the method of monitoring the execution of operations to ensure that they are carried out in accordance with the organization's objectives and established guidelines (Gibson et al., 1987). Nursing management is performed by the head of the room as the inpatient unit's first floor manager. This person would be willing to oversee nursing personnel by supervision in such a way that staff is always empowered to enhance their efficiency and collaborate with all health care providers to deliver high-quality nursing care that adheres to predetermined expectations (Keliat, 2009).
Effective oversight not only monitors and tracks the nurse as they perform their tasks in accordance with established guidelines, but also assists the nurse in developing professionalism. The efficacy of supervision may be determined by analyzing the nurse's perceptions of the supervisor's monitoring tasks, which include coordinating, preparing, mobilizing, and initiating, as well as supervising, managing, and reviewing.
Langingi's thesis at the Inpatient Institute C in 2013 Prof. dr. R.D Kandou Manado obtained the findings of cross tabulation between the supervision of the head of room and the output of nurses, obtaining a value of p = 0.033, indicating that there was a connection between the implementation of supervision of the head of room and the performance of the nurse in charge (Langingi, 2013). This is in contrast to Badi'ah's (2008) study at RSD Panembahan Senopati Bantul, which found that the supervision subvariable had no meaningful impact (p) = 0.268, greater than 0.05. This demonstrates that the monitoring scheme is effective and that the nurse's efficiency is adequate (Badi'ah et al., 2009). Mulyono's (2013 research at Hospital Level III 16.06.01 Ambon on 32 samples in inpatient rooms established a substantial relationship between supervision and nurse results. The results of this study indicate that there is a relationship and that r: -0.635 indicates that the correlation is strong. Moreover, the results of the regression test for the second stage of supervision indicate that the regression coefficient (B: -0.347) and p value: 0.019 (p0.05) have a strong influence on the regression coefficient (B: -0.347), indicating that the degree of correlation and regression coefficient was negligible. This suggests that increasing nurse monitoring would result in a reduction in nurse efficiency. Supervision practices can have a beneficial impact on performance; if they do not, that is more likely that supervision activities are not founded on supervision standards (Abdullah et al., 2013). Mariana's (2016) research at RSUD dr. Pirngadi Medan City demonstrates that there is a positive impact of monitoring on nurse results with a meaning of (p = 0.023; Beta = 0.373). 67 (63.8 percent) of the 105 respondents reported that the supervision of this situation referred to the head of the room's capacity or system of providing instruction, direction, encouragement, and assessment of the nurse administrators was inadequate (Manurung, 2016).
Medan Hajj General Hospital is a government hospital situated in North Sumatra's Deli Serdang Regency. The supervisory method at the General Hospital of Hajj Medan is deemed inefficient. This is because often the monitoring information that must be followed is vague as a result of the head of the room not receiving instruction, which has an effect on the nurse in charge's performance issues. The actions of nurses demonstrates this issue, as some nurses seem to demonstrate a lack of care for patients, are slower to provide help, and are less polite to patients, with nurses speaking in blunt voices such as reprimanding the patient or the patient's relatives. Occasionally, when performing the tasks of the nurse in charge, many obstacles arise that are classified as human errors. The findings of the initial study at the Hajj Meda General Hospital indicate that the prevalence of plebhitis in the hospital was 1.9 percent in 2018 (Data from the Nursing Sector), above the normal rate of nasocomial infections in hospitals of 1.5 percent (DepKes, 2008).
The ineffectiveness of nurses is also evident in the findings of the researchers' preliminary survey of inpatient satisfaction. The researchers develop a questionnaire with a total of 18 questions covering various aspects of nurses' conduct, communication, and ability. Just four patients expressed satisfaction with the care and results of nurses at RSU Hajj Medan. 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 competence of nurses, who were perceived to be sluggish to provide assistance when necessary.
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 conducted in February 2020, the amount of inpatients served at the Medan Hajj General Hospital in 2017 was 10,129, with a 58 percent Bad Occupation Rate (BOR). In 2018, there were 8,586 hospitalized patients with a Bad Occupation Rate (BOR) of 49%. In 2019, there were 9,160 uninsured patients with a Worse Occupation Rate (46 percent ). This data indicates that the BOR of the Medan Hajj General Hospital has decreased over the last three years.
According to the qualitative study performed by researchers, only four nurses said that the head of their room monitored well, while four nurses said that the head of their room's supervision was not satisfactory in terms of nurses. Implementers lack direction and instruction when doing everyday activities. Inadequate monitoring has a detrimental effect on the success of nurses in the inpatient room. As a result of the above, the researcher felt compelled to undertake research on: The Effect of Head of Room Supervision on the Performance of Implementing Nurses at Hajj Medan General Hospital.

Methods
This is a comprehensive study that incorporates analytic survey analysis to determine the impact of headroom supervision on nurse efficiency. The study's independent variables are preparing, coordinating, controlling, leading, observing, assessing, tracking, and reporting, 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 method or survey protocol used to assess nurse competence is proportional random selection of 86 nurses.

Result and Discussion
Univariate Analysis   According to the table of the incidence distribution of the head of room in the inpatient room of the Medan Hajj General Hospital, as many as 61 people (70.9 percent), and both as many as 25 people (29.1 percent ).       According to the table above, 29 respondents achieve satisfactory results in arranging the head of the room, including 1 respondent (1 percent) whose nurse output is very fine, 23 respondents (27 percent ) whose nurse performance is satisfactory, and 1 respondent (1 percent ) whose nurse performance is extremely satisfactory. The outstanding organisation of the head of the room resulted in 71 patients, including 2 people (2 percent) who had decent nurse performance and 59 people (69 percent) who had really good nurse performance. The Chi Square test findings indicate that the value of p = 0.000 is appropriate, indicating that "there is a connection between the head of the room and the success of the nurses in the inpatient room of the Medan Hajj General Hospital in 2020" or Ha.  According to the table above, 22 respondents received satisfactory results from the head of the room, including 1 individual (1 percent ) who performed very well, 20 people (23 percent ) who performed well, and 1 person (1 percent ). who performs admirably as a nurse. The outcome of effective room head instruction was 28 participants, 5 of whom (6 percent) had decent nurse performance and 23 of whom (27 percent) had really good nurse performance. The outcomes of the head of room's supervision were excellent; there were 36 participants, specifically 36 people (42 percent) whose nurse output was excellent. The Chi square test findings indicate that p = 0.000, indicating that "There is an association between the Head of Room's Guidance and the Nurses' Performance in the Inpatient Room of the Medan Hajj Hospital in 2020" or Ha is acknowledged. According to the table above, of the 86 respondents, the findings of the head of room's direction were very positive; there were 22 participants, with 1 individual (1 percent ) having quite good nurse output, 20 people (23 percent ) having decent nurse performance, and 1 person (1 percent) having quite good nurse performance. The positive guidance given by the head of the room resulted in 48 participants, 5 of whom (6 percent) had good nurse performance and 43 of whom (50 percent) had really good nurse performance. The outcomes of the head of room's guidance were excellent; there were 16 participants, specifically 16 people (19 percent) whose nurse output was excellent. The Chi square statistical test findings indicate that p = 0.000, indicating that "There is an association between the Direction of the Head of the Room and the Performance of the Nurses in the Inpatient Room of the Medan Hajj General Hospital in 2020," or Ha, is acknowledged.  According to the table above, the findings of the head of room's supervision were very positive for 86 respondents; there were 14 participants, namely 1 individual (1%) whose nurse performance was very nice and 13 people (15%) whose nurse performance was quite decent. The findings of the head of room's effective monitoring is 39 participants, with 12 people (14 percent) having decent nurse performance and 27 people (32 percent) having really good nurse performance. The outcomes of the head of room's supervision were excellent; there were 36 participants, specifically 33 people (39 percent) whose nurse output was excellent. According to the Chi square statistical examination, the significance of p = 0.000 indicates that "There is an association between the Supervision of the Head of the Room and the Nurses' Performance in the Inpatient Room of the Medan Hajj General Hospital in 2020" or Ha is acknowledged.  According to the table above, of the 86 respondents, the findings of the assessment of the head of the room were quite positive; there were nine participants, including one individual (1%) with quite good nurse performance and eight people (9%) with good nurse efficiency. The appraisal of a successful head of the room yielded 41 respondents, with 17 respondents (20%) rating their nurse's output as fair and 24 respondents (28%) rating their nurse's performance as really good. The findings of the head of room assessment were excellent; there were 36 participants, specifically 36 people (42 percent) whose nurse output was excellent. The Chi square statistical test findings indicate that p = 0.000, indicating that "there is an association between the Head of the Room Evaluation and the Nurses' Performance in the Inpatient Room of the Medan Hajj General Hospital in 2020," or Ha agreed.  According to the table above, 22 respondents were registered and reported positively, including 1 individual (1 percent) with very good nurse performance, 20 people (23 percent) with good nurse performance, and 1 person ( 1 percent ) with quite good nurse performance. The outcomes of recording and reporting the head of the room were excellent; there were 64 patients, 5 of whom (7 percent) had reasonable nurse output and 59 of whom (68 percent) had really good nurse performance. The Chi square statistical test findings indicate that p = 0,000, indicating that "There is an association between the Head of the Room's tracking and monitoring and the Nurse's performance in implementation at the General Hospital of Hajj Medan in 2020," or Ha, is acknowledged.  According to the table above, the p value 0.05 indicates that the factors preparation (p value = 0.00), leading (p value = 0.045), tracking (p value = 0.00), assessment (p value = 0.02), documenting and reporting (p value = 0.00) all have an impact on the output of nurses. Planning variables have a constant value of 1.645, leading variables have a constant value of -0.716, control variables have a constant value of 1.070, measurement variables have a constant value of 0.869, and tracking and publishing variables have a constant value of 1.674. Of the determining factors, the most influential is documenting and reporting, with a steady value of 1.674, indicating that good recording and reporting by the head of the room has a 1.674-fold likelihood of improving the success of a good nurse.

Conclusion
The following points are drawn from the study's priorities and test findings: The preparation of the head of the room has a major impact on the success of the nurses in the inpatient room at Medan Hajj General Hospital in 2020. In 2020, there is no discernible impact of the head of the room organization on the nurse's success in the inpatient room at Medan Hajj General Hospital. There is a major effect of leading the head of the room on the success of nurses in the Medan Hajj General Hospital's inpatient room in 2020. There is no discernible correlation between the direction of the room's head and the nurse's success in the room. in 2020 at the Medan Hajj General Hospital. The oversight of the head of the room has a direct effect on the success of nurses in the inpatient room at Medan Hajj General Hospital in 2020. There is a strong correlation between the head of the room's assessment and the nurse's results in the hospital. inpatient payments for the Medan Hajj General Hospital in 2020. The appraisal of the head of the room has a direct effect on the success of the nurses in the inpatient room of the Medan Hajj General Hospital in 2020. The factors of tracking and monitoring have the greatest impact on the nurses' success on the hospital. Inpatient at Medan Hajj General Hospital in 2020 with a constant Beta of 1.647.