The Effect of Job Placement, Workload, and Nurse Work Facilities on Nurse Job Satisfaction at Jombang Hospital

Kaesa Maximimillian Sumarno¹, Mohammad Agung Saryatmo²

Universitas Tarumanagara, Indonesia

Email: [email protected], [email protected]

� Corresponding Author: Kaesa Maximimillian Sumarno

Keywords

Abstract

Job Placement;  Nurse Satisfaction;  SEM-PLS, Work Facilities; Workload

Rapid technological developments have influenced work patterns, employee interactions, and managerial systems in various sectors. The purpose of this study is to analyze the effect of digital technology implementation on employee productivity in manufacturing companies in Indonesia. This study uses a quantitative descriptive cross-sectional design, with a sample of 110 nurses in the Nakula, Sadewa and Abimanyu rooms of Jombang Regional Hospital. Data analysis was carried out using SmartPLS software to see the effect of independent variables on dependent variables using the Structural Equation Modeling-Partial Least Square (SEM-PLS) method. The results of the study indicate that the application of digital technology has a significant positive effect on employee productivity, with digital communication and automation systems as the most influential variables. The implications of this study provide insight for managers and policy makers in designing technology implementation strategies that can improve employee productivity and overall performance. In addition, this study also opens up opportunities for further research on the impact of digital technology in other industrial sectors. � 2024 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY SA) license (https://creativecommons.org/licenses/by-sa/4.0/).

1�� Introduction

Hospitals, as healthcare providers, need to maintain high quality standards to ensure the well-being of patients and other healthcare users. Improving the quality of health services depends on the quality and performance of nurses. Nurses play a crucial role in providing healthcare services and interacting directly with patients. Their performance and motivation are key factors in achieving high-quality services (Purimahua et al., 2020). An increase in the performance of health workers can occur when health workers get job satisfaction. Job satisfaction is influenced by several factors, including job placement, workload and work facilities in hospitals.

Job placement, work facilities, and workload are the three key elements that greatly affect the level of job satisfaction of nurses in hospitals, and understanding each dimension is very important for the management of a hospital that aims to improve the quality of service to patients (Sanjani et al., 2022). Job placement that matches the skills and interests of nurses is very important because it can increase nurses' confidence and motivation at work. When a nurse is placed in a unit or department that matches their expertise, they tend to be more comfortable in carrying out their duties and feel valued by management. Conversely, inappropriate placements can lead to stress, dissatisfaction, and even the desire to leave the job, which in turn can increase turnover rates that will put a strain on the healthcare workforce system at a hospital (Suswati, 2021). In addition, maintaining a clean work environment also has positive benefits for nurses' job satisfaction, such as improving employee health and creating a comfortable and pleasant work atmosphere. An article mentions that cleanliness of the work environment can increase productivity, improve health, and create a comfortable and pleasant working atmosphere (Hayani et al., 2021).

In addition to job placement, work facilities also play a big role in determining the job satisfaction of nurses. Adequate facilities, such as modern medical equipment, a clean work environment, and access to the necessary information technology, not only make it easier for nurses to carry out their duties, but also improve work efficiency and quality of service to patients (Paais, 2022). Good facilities reflect management's support for healthcare workers, which in turn can increase nurses' loyalty and dedication to their work. Conversely, inadequate facilities can lead to frustration as nurses feel hampered in providing optimal care. It can also pose a safety risk to nurses and patients, which can negatively impact nurse morale and performance (Krijgsheld et al., 2022).

Workload is another important factor that directly affects a nurse's job satisfaction. An excessively heavy workload can lead to physical and mental exhaustion, potentially leading to burnout (Kurniawati, 2023). This burnout not only lowers the quality of life of nurses but also reduces the quality of care provided to patients. In the long run, an unbalanced workload can increase the risk of medical errors, which can ultimately harm patients and lower the hospital's reputation (Krijgsheld et al., 2022). Therefore, a balanced distribution of the workload is essential to ensure nurses can work effectively without experiencing excessive fatigue. It is also important to ensure the sustainability of a healthy workforce in hospitals, reduce absenteeism, and increase nurse retention (Gde et al., 2022).

By considering these three factors holistically, hospitals can create a supportive work environment for nurses, which not only improves job satisfaction but also the overall quality of health care (Krijgsheld et al., 2022). This is important because nurses are the backbone of the healthcare system, and their well-being directly affects the quality of care received by patients. Management that is proactive in balancing work placement, providing adequate facilities, and managing workloads well will reap benefits in the form of increased operational efficiency, reduced turnover, and better patient care (Krijgsheld et al., 2022; Leatemia et al., 2023)

The Regional General Hospital (RSUD) is a health service institution owned by the local government and plays a role in health services in Jombang district. Jombang Hospital was established in 1939 and is located on Jl. Dr Soetomo. Now the location has been converted into a high school, to be precise SMA 3 Jombang. Furthermore, in 1955 the Jombang Hospital was moved to its current location on Jl. Wahid Hasyim. Along with the development of the times and the improvement of service quality, Jombang Hospital was appointed as a non-educational Type B Hospital in 2001. This type of appointment is based on the Decree of the Minister of Health and Social Welfare No. 238/Menkes-Kesos/SK/III/2001. Jombang Hospital always improves the quality of its services with 9 specialist services and 7 sub-specialist services. The operational activities of Jombang Hospital are supported by medical equipment that is quite complete and modern, and has a sufficient number of professional medical personnel. Jombang Hospital has a vision to become a trusted and oriented superior hospital with excellent service and patient safety in Jombang Regency and its surroundings.

Hospitals have a very important role in the provision of health services. The Hospital interacts continuously with the environment to achieve a dynamic balance and serve the community in need of health services. Nurses also have an important role to play in the health system and their contribution to global health is undeniable (I Nyoman Swedana, 2023). In an effort to improve hospital services, it is necessary to pay attention to several aspects to increase job satisfaction of health workers in hospitals. Therefore, research was carried out at Jombang Hospital. This study aims to determine the correlation between the dimensions of job placement, workload and work facilities on job satisfaction of nurses. Later, it is hoped that the results of this study can be used as input and evaluation of job placement, workload division and work facilities provided to Jombang Hospital nurses.�

This study aims to see the influence of the dimensions of placement, burden and work facilities on the level of nurse satisfaction at Jombang Hospital.

2�� Materials and Method

Research Type

This study uses a quantitative descriptive research design with a cross-sectional approach. Descriptive research aims to systematically describe the characteristics and conditions of the variables being studied, namely job placement, workload, and nurse work facilities that affect job satisfaction among nurses at Jombang Hospital. The cross-sectional approach is used to collect data at one point in time to analyze the relationships between the existing variables.

Population and Sample

The population in this study consists of all nurses working in the Nakula, Sadewa, and Abimanyu wards at Jombang Hospital. A sample of 110 nurses is selected using simple random sampling to ensure that every nurse has an equal chance of being selected as a respondent. The sample includes nurses who are assigned to these three wards at the time the research is conducted.

Research Location

This study is conducted at Jombang Hospital, located in Jombang Regency, East Java, Indonesia. The research focuses on three inpatient wards, namely Nakula, Sadewa, and Abimanyu, which have different work characteristics and provide a comprehensive overview of the factors influencing nurse job satisfaction.

Data Collection Technique

The data collection technique used in this study is the questionnaire, which will be distributed directly to respondents in the three inpatient wards of Jombang Hospital. The questionnaire consists of closed-ended questions related to job placement, workload, nurse work facilities, and nurse job satisfaction. Respondents are asked to rate their responses on a Likert scale for each question.

Research Instrument

The research instrument is a questionnaire that has been tested for validity and reliability. The questionnaire consists of four sections:

Section I: Demographic data of respondents (age, gender, length of service, and education).

Section II: Questions about job placement, with 5 items.

Section III: Questions about workload, with 6 items.

Section IV: Questions about nurse work facilities, with 5 items.

Section V: Questions about nurse job satisfaction, with 8 items.

Each item uses a Likert scale ranging from 1 to 5, where 1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, and 5 = Strongly Agree.

Data Analysis Technique

The data collected from the questionnaires will be analyzed using quantitative descriptive analysis techniques. The analysis includes the following steps:

Validity and Reliability Testing: Before further analysis, the research instrument will be tested for validity and reliability using construct validity and Cronbach's Alpha coefficient to ensure the questionnaire accurately measures the intended variables and provides consistent results.

Descriptive Analysis: Descriptive statistics will be used to analyze demographic data and provide an overview of the characteristics of the respondents, such as frequency distribution, mean, and standard deviation.

Correlation Analysis: To assess the relationships between job placement, workload, nurse work facilities, and nurse job satisfaction, Pearson correlation analysis will be used. This test will measure the strength and direction of the relationships between the variables.

Multiple Linear Regression Analysis: To determine the extent to which job placement, workload, and nurse work facilities simultaneously affect job satisfaction, multiple linear regression analysis will be performed.

All analyses will be conducted at a significance level of α = 0.05. The results will be presented in tables and graphs to facilitate interpretation and understanding.

3�� Results and Discussions

From the distribution of respondents' answers, it is known that respondents are dominated by women with a percentage of 78% compared to male respondents. The age of nurses is also diverse and dominated by nurses with an age range of 40-45 years with a percentage of 29%. Nurses at Jombang Hospital are included in the loyal category with a percentage of working time dominated by nurses with a working time of 16-20 years with a percentage of 33%.

The analysis of the outer model in this study uses convergent validity, determinants and reliability tests. The test was carried out to see the validity and reliability of the data. The results of the outer model analysis� of the study are described in table 1-3.

Table 1. Results of Convergent Validity Test for Each Dimension

Indicator					Validity
	Workload	Work Facilities	Job Satisfaction	Placement
X1.1				0,885	Valid
X1.2				0,927	Valid
X1.3				0,918	Valid
X1.4				0,901	Valid
X1.5				0,887	Valid
X2.1	0,913				Valid
X2.2	0,919				Valid
X2.3	0,948				Valid
X2.4	0,944				Valid
X2.5	0,931				Valid
X3.1		0,942			Valid
X3.2		0,905			Valid
X3.3		0,915			Valid
X3.4		0,894			Valid
X3.5		0,915			Valid
Y1.1			0,787		Valid
Y1.2			0,823		Valid
Y1.3			0,847		Valid
Y1.4			0,877		Valid
Y1.5			0,837		Valid

Source: Data processed by Researcher (2024)

The convergence validity test serves to ensure that the indicator used in a latent variable actually represents the latent variable. Later indicators that represent a latent variable will have a value outer loadings. A data is said to pass the convergent validity test if it has a value of outer loading >0,7 (Cheung et al., 2023). The results of the convergent validity test of this study can be observed in table 1

From the research that has been carried out, the results of the analysis of the convergent validity test can be observed in table 4.6. In the table, the outer loading values of each latent variable are presented where the X1 indicator symbolizes the work placement dimension, the X2 indicator symbolizes the workload, the X3 indicator symbolizes the work facility and the Y indicator symbolizes the nurse's job satisfaction. From the table, it can be seen that all indicators have passed the convergent validity test so that the next outer model test can be carried out, namely the determinant validity test.

Table 2. Determinant Validity Test Results for Each Dimension

Indicator	Work Placement	Workload	Work Facilities	Job Satisfaction
Work Placement
Workload	0,074
Work Facilities	0,536	0,620
Job Satisfaction	0,167	0,062	0,225

Source: Researcher 2024

Determinant validity tests function to see the relationship between latent variables or determinants compared to other determinants. The commonly used method to test the validity of determinants is analysis Heterotrait-Monotrait (HTMT). The HTMT test has a value range of 0-1 with a value of <0.85 aimed at reducing bias in a research model construct. The HTMT test is carried out to see if the determinant's constituent indicators have redundancy in other determinants. Indicator redundancy on different determinants can create bias so it will be difficult to distinguish between the effects caused by indicators on different latent variables and the effects caused by high correlations between determinants (Henseler et al., 2015).

From the research that has been carried out, it is observed that the validity value of the determinants of each indicator in table 4.7 is still in the range of <0.85 with the highest value at 0.62 observed in the relationship between work facilities and workload and the lowest relationship is observed in the relationship between workload and job satisfaction with a value of 0.062. The results of the validity test in the range of <0.85 indicate that the construct of the determinant/latent variable in this study is worth testing and can be used for the next test, namely the reliability test.

Table 3. Reliability Test Results for Each Dimension

Dimension	Cronbach Alpha Values	Validity
T	0,964	Valid
RB	0,974	Valid
RP	0,973	Valid
AS	0,962	Valid
IN	0,959	Valid
KP	0,901	Valid

Source: Researcher 2024

The data reliability test was carried out using Cronbach's alpha method. The reliability test serves to see the correlation between indicators in a latent variable. With the Cronbach alpha test, it can be seen that indicators that symbolize a latent variable have a correlation with each other, with this researchers can see the consistency of a latent variable. The Cronbach alpha test has a value in the range of 0-1, where a value of <0.7 indicates that the latent variable has indicators that are not related to each other while a value of >0.95 indicates that in a latent variable there are similarities in indicators and potentially can cause bias in research (Tavakol & Dennick, 2011).

From the research that has been carried out, it is known that all latent variables in table 4.8 have a value of >0.7 for the cronbach alpha test. This means that the indicators or questions in the research questionnaire are consistent in measuring the same latent variables, and the measurement results can be trusted if repeated under similar conditions.

Furthermore, the construct of the research model can be observed in figure 1. In the figure,� the outer loading values� of each indicator are presented to the latent variables. In the figure, the r-square value� of this study� is also explained, where the r-square value� is related to how well the construction of a study is seen from the ability to depict the correlation between independent variables and dependent variables.

Figure 1. Research Model Construct and Outer Loading and R-Square Values

Source: Data processed by Researcher (2024)

Valid and reliable data from convergence validity testing, determinants and reliability are then tested by inner model analysis.� The analysis of the inner model in the SEM-PLS method was carried out to see the influence of independent variables on dependent variables. The independent variables in this study are represented by the dimensions of work placement, workload and work facilities. Meanwhile, the dependent variable is represented by the nurse's job satisfaction dimension.� The analysis of the inner model in this study was carried out with several tests such as the r-square test, the q-square test, the f-square test� and the bootstrapping test

Table 4. R-square and q-square values

e	R�	Q�
Nurse Satisfaction	0,669	0,448

Source: Data processed by Researcher (2024)

The first test carried out on the inner model analysis was the R� (r-square) test and the Q� (q-square) test. The R� test serves to describe how good our research model is for the problem being observed with a value range of 0-1. The greater the R� value, the higher the percentage of our research model's ability to explain the events that have been observed in the study. Meanwhile, the Q� value serves to see the predictive ability of the research model used in the research. The Q� test has a value range of <0 - >0 where a negative value indicates that the construct cannot predict endogenous results well, while if the Q� value has a positive value, it indicates that the research model construct can predict endogenous results well.

The R� test value in this study with a range of 0.669 is included in the intermediate category. According to Hair et al., 2013 The interpretation of the R� test is as follows; The value range of 0-0.25 indicates that the research model used has a low value, while the value range of 0.25 to 0.75 indicates that the research model used has a medium value and a value of >0.75 indicates a research model that can explain the interaction between dependent variables and independent variables well. An R� value of 0.669 indicates that the research model used in this study is able to explain 66.9% of the relationship between independent variables and dependent variables. Furthermore, the Q� value of this study ranged from 0.448. This value indicates that the construct used in the study has good endogenous outcome prediction ability.

Tabel 5. Uji Effect Size

Dependent Variables	f�
Work Placement	0,244
Workload	0,912
Work Facilities	1,001

Source: Data processed by Researcher (2024)

From the questionnaire answer data presented in table 4, the highest f� value in the work facility dimension and the lowest f� value in the job placement dimension were obtained. The dimensions of work facilities and workload have a large influence on the job satisfaction of nurses while the dimensions of job placement have a moderate influence on the job satisfaction of nurses.

The dimensions of work facilities have the highest f� value because access to adequate facilities such as modern medical equipment, a comfortable physical environment, and supporting technology directly improve the performance and comfort of nurses. Optimal facilities reduce stress and make it easier for nurses to provide quality services to patients. When nurses feel supported with good infrastructure, they are more likely to feel satisfied and motivated, thus improving the quality of their work. Conversely, the lack of healthcare facilities tends to increase stress and increase the risk of errors, which negatively impacts job satisfaction.

Meanwhile, the job placement dimension has a moderate influence on satisfaction because while appropriate placement is important in creating a match between nurse skills and job demands, the impact may not be as strong as other factors such as workload and facilities. Placement-related dissatisfaction may arise, for example, when a nurse is placed in a unit that does not match her specialty or preferences, but the impact is more long-term or indirect. In these situations, even if job placement is relevant, nurses may feel the immediate impact of facility conditions and unbalanced workloads more quickly

Workload factors also greatly affect nurse satisfaction, as an excessively heavy workload can lead to physical and emotional exhaustion, known as burnout. An unbalanced load can reduce satisfaction and productivity, while a reasonable workload helps nurses maintain a balance between their performance and health. The combination of adequate facilities and a controlled workload significantly plays a role in determining the level of job satisfaction of nurses. The results of this study are expected to provide an overview of the correlation between placement, burden and work facilities on nurses' job satisfaction.

Figure 2. Results of Bootstrapping Analysis

Source: Data processed by Researcher (2024)

From bootstrapping analysis, the t-statistics� value of each latent variable indicator was obtained. In addition, the p-value of each variable is also obtained from each independent variable to the dependent variable. The research structure with the t-statistics value of each indicator against its latent variable can be observed in figure 2.

Table 6. Bootstrapping results with p-value and t-statistics values

Indicator	Original Sample	T Statistics	P Values
Burden > Job Satisfaction	0,557	8,820	0,000
Facilities > Job Satisfaction	0,576	9,759	0,000
Placement -> Job Satisfaction	0,288	4,151	0,000

Source: Data processed by Researcher (2024)

From the research that has been carried out, p-value, t-statistics and original sample values from each dimension are obtained. These values can be described as follows;

1. The work placement dimension had� a p-value of 0.0 and a t-statitistics value� of 4.151 and an original sample value� of 0.288.
2. Meanwhile, the workload dimension has a p-value of 0.0 with a t-statistics value of 8.82 and an original sample value� of 0.557.
3. In the dimension of work facilities, it was found �that the p-value of� this dimension ranged from 0.0 with a t-statistics value� of 9.759 and� an original sample value� of 0.576.

Table 7. Hypothesis Test Results

Indicator	Original Sample	T Statistics	P Values	Test Results
Burden > Job Satisfaction	0,557	8,820	0,000	Accepted
Facilities > Job Satisfaction	0,576	9,759	0,000	Accepted
Placement -> Job Satisfaction	0,288	4,151	0,000	Accepted

Source: Data processed by Researcher (2024)

From the analysis of �the bootstrapping test �, it can be seen that the dimension of job placement has a significant effect on the job satisfaction of Jombang Hospital nurses. This is supported by �the p-value value at 0.0 and the t-statistics value at 4.151. In the analysis, the original sample value of the work placement dimension was also presented with a value of 0.288. This value indicates that the influence of the job placement dimension is positive on the job satisfaction of nurses. From these results, it can be said that the hypothesis in the work placement dimension is accepted.

Job placement has a positive effect on nurses' job satisfaction because the right placement creates a match between Skill and assigned tasks. When nurses are placed in units or departments according to their competence, experience, and interests, the confidence and effectiveness of nurses in carrying out their duties will increase. Appropriate placement will also minimize the level of stress due to unfamiliar or too complex work, which ultimately affects the increase in job satisfaction and work motivation of nurses. Conversely, inappropriate placements can be frustrating and potentially reduce productivity, as nurses feel unable to contribute optimally in an environment that does not support their skills (Campbell et al., 2022).

In table 7, it can be seen� that the p-value of the workload dimension ranges from 0.0 and the t-statistics value at 8.820, these two values indicate that the workload dimension has a significant effect on the satisfaction of nurses at Jombang Hospital. The influence of the workload dimension is also positive which is marked by the original sample value �of 0.556. From this exposure it can be said that the hypothesis of the workload dimension is acceptable.

Workload has a significant influence on nurses' job satisfaction because a balanced load allows nurses to work more productively without experiencing excessive fatigue. The daily duties of nurses often demand excellent physical and emotional condition. When nurses are given a high workload, such as overly busy schedules, excessive administrative tasks, and an exploding number of patients can trigger burnout in nurses. Burnout In nurses, it is generally caused by physical and psychological fatigue. This condition has the potential to reduce the level of satisfaction and work motivation of nurses. Conversely, if the workload is well distributed, nurses can complete tasks effectively. A well-managed workload allows nurses to have time recovery which is enough. A balanced workload between work and personal activities will create a healthy work atmosphere that is important in maintaining the quality of nurse services in the long term. A measured workload also creates a more positive work atmosphere, where nurses can interact with patients in a more qualified way, which can reinforce a sense of meaning in their work. When this balance is achieved, job satisfaction increases, and nurses feel valued and motivated to continue to provide quality services (Maghsoud et al., 2022)

From the research that has been carried out, the p-value and t-statistics of the dimensions of work facilities are in the range of 0.0 and 9.759. This value symbolizes that the dimensions of work facilities affect the job satisfaction of nurses. The influence of the work facility dimension is included in the positive category supported by the original sample� value of 0.576. From this explanation, the hypothesis of the work facility dimension can be accepted because �the p-value and t-statistics values of these dimensions are <0.05 and >1.96.

Work facilities have a positive effect on nurses' job satisfaction because adequate facilities allow them to work more efficiently and comfortably. Access to the right medical equipment, comfortable treatment buildings, and the use of the latest technology in the medical world can help nurses in carrying out their duties efficiently. Good facilities reduce the risk of stress and fatigue due to discomfort or equipment limitations, thereby increasing productivity and quality of service to patients. In addition, adequate work facilities reflect the hospital's professionalism towards employees, so nurses feel valued and supported by management. This strengthens their motivation and involvement in patient care. On the other hand, lack of facilities or poor working conditions can worsen the quality of work, because nurses have to work more to overcome obstacles that should be avoided with adequate means. Therefore, the provision of good facilities not only has a direct impact on performance but also improves can improve mental wellness and nurse job satisfaction (Akpor et al., 2023; Moyimane et al., 2017).

4�� Conclusion

This study shows that factors such as job placement, workload, and work facilities have a significant influence on the job satisfaction of nurses at Jombang Hospital. The results of the analysis showed that work facilities had the greatest influence on job satisfaction, followed by workload, while job placement had a moderate influence. Placements that match nurses' skills can increase their effectiveness and motivation, while a well-managed workload can prevent burnout and improve nurses' well-being. Adequate work facilities, such as well-equipped medical equipment and a comfortable environment, contribute directly to the comfort and work efficiency of nurses, thereby increasing job satisfaction. Therefore, hospitals need to pay attention to these three factors to create a supportive work environment, which will not only increase nurses' job satisfaction but also the quality of service to patients. The suggestion from this study is that hospital management should improve job placement, balance workload, and improve available facilities to maintain nurse satisfaction and loyalty. The implications of this study are important for policies to improve the quality of nurses' work that focus on improving facilities and optimal workload management.

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