Burn Out and Workload on Job Satisfaction and Employees Performance at Arjasa Public Health Center Sumenep Regency

Performance or work performance is the result of a performance appraisal made by his immediate supervisor to be used as material for work improvement, compensation adjustments, placement decisions, development needs and more.The purpose of this study is to analyze the effect of burn out and workload on job satisfaction and employee performance at the Arjasa Public Health Center, Sumenep Regency. The design of this research is an observational quantitative research with a cross sectional approach with the focus of the research being directed at analyzingthe effect of burn out and workload on job satisfaction and employee performance at the Arjasa Public Health Center, Sumenep Regency. The total population is 146 respondents and a sample of 107 respondents is taken by using Simple Random Sampling technique. Based on the results of statistical tests using Path Analysis, it was found that there was an effect of burn out (burn out) on job satisfaction (job satisfaction) of employees at the Arjasa Health Center, Sumenep Regency. There is an effect of workload on employee job satisfaction at the Arjasa Health Center, Sumenep Regency. There is the effect of burn out (burn out) on employee performance at the Arjasa Public Health Center, Sumenep Regency. There is an effect of workload on employee performance at the Arjasa Public Health Center, Sumenep Regency. There is influence burn out through job satisfaction on employee performance at the Arjasa Public Health Center, Sumenep Regency. There isinfluence workload through job satisfaction on employee performance at the Arjasa Public Health Center, Sumenep Regency. It is hoped that health workers are able to pay attention to the importance of maintaining a way of working that prioritizes consumer desires, clarifying again what is the workload that must be completed by employees so that employees are happy to work and can complete their work according to job descriptions, provide clarity on what each part is the goal in working and from what aspect of achievement is measured.


INTRODUCTION
At this time the development of the business world engaged in services shows its development rapidly. This can be influenced by the development of increasingly advanced technology. With these advances, indirectly or directly will be able to influence behavior patterns, mindsets and attitudes when facing a problem because they are required to be able to make a change or innovation in order to realize the existence and success of the company. A company certainly has a target, and in order to be able to realize the target, the company will need a human resource factor that has high performance, this is needed so that the company can achieve its goals well.
Performance is a result of work both in quality and quantity achieved by an employee in carrying out his duties. According to Hasibuan (2016) performance is a work achieved by a person in carrying out the tasks assigned to him based on skills, experience, sincerity and time. Performance can be equated with work performance, and thus employee performance is a work achievement achieved by an employee in carrying out their duties and targets.
Several factors that can affect performance include burn out, workload and job satisfaction. As Mondy (2018) states that burn out can lead to lack of attendance, excessive use of drugs and alcohol, decreased or poor performance, and poor health. Dhania (2015) states that workload affects employee work stress. Altaf and Mohamad Atif (2016) stated that workload has a negative effect on job satisfaction. However, in Rehman, Irum et al. (2017) stated that there is a positive relationship between workload and job satisfaction.  Stress has a negative effect on job satisfaction. Lut (2013) in Dhania (2015) has a different opinion showing that the effect of job stress on employee job satisfaction at PT. SHARP Electronics Indonesia is that work stress does not have a significant effect on employee job satisfaction.
Employees will feel comfortable if when working they get job satisfaction as expected (Koesmono, 2015). There are several ways to express job satisfaction, for example, employees can complain, disobey, steal, etc. An emotional attitude that is pleasant and loves his job is job satisfaction (Hasibuan, 2013). Job satisfaction is an employee's opinion that is pleasant or not about his work, that feeling can be seen from the employee's good behavior towards work and all things experienced in the work environment (Handoko, 2011).
According to the conclusion, Dhania (2015) states that workload is a number of activities that require expertise and must be done within a certain period of time in physical or psychological form. Workloads are work tasks that are a source of stress, such as work that requires working quickly, producing something and concentrating on work stress. According to Hariyono, et al., (2014) is the period of time in carrying out work activities in accordance with the abilities and capacities of employees without showing signs of fatigue. Altaf and Mohamad Atif (2016) found that a high workload has a negative effect on job satisfaction. Mustapha and Ghee (2018) give results, there is a significant negative relationship between workload and job satisfaction. In Mustapha's research (2018), it is stated that job satisfaction is influenced by daily workload, employees are more satisfied when they are given a lower workload. Lower job satisfaction was found at higher workloads in the study of Mansoor et al. (2016). In Tunggareni and Thinni Nurul (2013) found that nursing staff who have a moderate objective workload tend to have a higher level of job satisfaction than a high objective workload.
Putra (2017) found that job satisfaction is negatively affected by job stress. Leila's research (2012) Job stress has a negative effect on job satisfaction. Job stress is a factor that affects job satisfaction. Stress and job satisfaction are negatively related. Research conducted by Brewer and Jama (2013) states that there is a strong relationship between job stress and job satisfaction. Mojaheri and Nelson (2014) suggest that increased stress is associated with decreased job satisfaction. Mostafai et al (2012) stated that there was a significant relationship between stress and job satisfaction. Job stress and job satisfaction have a reciprocal relationship. Khalidi and Wazalify (2013) found that there are many work-related stress factors that lead to decreased satisfaction among pharmacists. Putra (2012) work stress has a negative effect on job satisfaction. Statistically it can be shown that job stressors have a significant negative effect on job satisfaction (Yuhui, 2011).
Based on the above conditions, the authors are interested in researching burn out and workload on job satisfaction and employee performance at the Arjasa Health Center, Sumenep Regency.

METHODS
In this study, the researcher used an observational quantitative design with a cross sectional approach, which is a study to study the dynamics of the correlation between risk factors and effects, by approaching, observing or collecting data all at once (point time approach), that is, each subject The study was observed only once and measurements were made on the status of the character or variable of the subject at the time of examination. This does not mean that all research subjects are observed at the same time (Soekidjo, 2012). This research will analyzethe effect of burn out and workload on job satisfaction and employee performance at the Arjasa Public Health Center, Sumenep Regency. The total population is 146 respondents and a sample of 107 respondents is taken by using Simple Random Sampling technique. Data analysis using Path Analysis test. This research has gone through an ethical test with the number SK: 2371/KEPK/III/2021

a. The Effect of Burn out on Job Satisfaction
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of burn out (burn out) on job satisfaction (job satisfaction) of employees at the Arjasa Health Center, Sumenep Regency b. The Effect of Workload on Job Satisfaction Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of workload on employee job satisfaction at the Arjasa Health Center, Sumenep Regency. c. The Effect of Burn out on Performance Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of burn out (burn out) on employee performance at the Arjasa Public Health Center, Sumenep Regency d. Effect of Workload on Performance Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of workload on employee performance at the Arjasa Public Health Center, Sumenep Regency. e. Influence Burn out Through Job Satisfaction on Performance It is known that the direct effect of burn out on performance is 0.486. While the indirect effect of burn out through job satisfaction on performance is 0.214 x 0.579 = 0.124. Then the total effect of burn out through job satisfaction on performance is 0.486 + 0.124 = 0.610. The total effect value is 0.610, so it can be concluded that there isinfluence burn out through job satisfaction on employee performance at the Arjasa Public Health Center, Sumenep Regency f. Influence Workload through Job Satisfaction on Performance It is known that the direct effect of workload on performance is 0.517. While the indirect effectworkload through job satisfaction on performanceis 0.792 x 0.579 = 0.458. Then the total effectworkload through job satisfaction on performanceis 0.517 + 0.458 = 0.975. The total influence value is 0.975, so it can be concluded that there isinfluence workload through job satisfaction on employee performance at the Arjasa Public Health Center, Sumenep Regency.

A. The Effect of Burn Out (Burn out) on Job Satisfaction (Job Satisfaction) of Employees at Arjasa Health Center, Sumenep Regency
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of burn out (burn out) on job satisfaction (job satisfaction) of employees at the Arjasa Public Health Center, Sumenep Regency. Stress is any influence that interferes with a person's mental and physical health (Wibowo, 2011: 53). Stress is a response to situations that cause pressure, change, emotional tension, and others (Sunaryo, 2004: 215). Stress is pressure that affects physical or psychological conditions, this pressure is a condition that can come from within or from outside a person (Cahyono, 2014). According to the National Safety Council (2003:7) the causes of work stress can be categorized into environmental causes, organizational causes and individual causes. Work stress can occur due to too many tasks, limited time to do work, role ambiguity, differences in values within the company, frustration, family environment. If this factor cannot be controlled, it will affect performance (Pujiastuti, 2013).
According to Wibowo (2011: 54) stress that occurs in the workplace causes the organization to bear the burden: low quality of service, high staff turnover, bad company reputation, bad company image, worker dissatisfaction. The impact of work stress can be grouped into 3 categories according to Robbins (2007:375) are physiological symptoms, psychological symptoms, behavioral symptoms. According to Luthans (2008:298) sources of work stress include sources of stress outside the organization, sources of stress from the organization, sources of group stress, sources of individual stress. Kofoworola and Ajibua (2012) mention some of the causes of stress at work are life changes, hassles, work stress, career development and workload.
Another cause of work stress is a workload that feels very heavy, a little working time, etc. (Mangkunegara, 2008:157). Kumar (2011: 76) found that workload and management style are key factors that affect feelings and create stress among employees. Kawasaki, et al., (2009: 239) stated an investigation conducted by the American Society of Anesthesiolo-GISTs in 1991 showed that stress is caused by heavy workloads. Al- Mohannadi and Capel (2007:70) stated that workload also causes significant stress for elementary school teachers than preschool and secondary teachers, and preparation of secondary school teachers at the beginning of the school year. Workload and deadlines are the two factors that most often cause stress (Bradley and Cartwright, 2002:176).
Putra (2012) found that job satisfaction is negatively affected by job stress. Research Caplan (in Leila, 2002:10) Edi (2009) Job stress has a negative influence on job satisfaction. Alberto (1995) and Praptini (2000) job stress are factors that affect job satisfaction. Leila (2002) stress and job satisfaction are negatively related. Research conducted by Brewer and Jama (2003) states that there is a strong relationship between job stress and job satisfaction. Mojaheri and Nelson (2009) suggest that increased stress is associated with decreased job satisfaction. Mostafai et al (2012) stated that there is a significant relationship between stress and job satisfaction. Hollon (1976) identified that job stress and job satisfaction have a reciprocal relationship. Khalidi and Wazalify (2013) found that there are many work-related stress factors that lead to decreased satisfaction among pharmacists. Putra (2012) work stress has a negative effect on job satisfaction. Statistically it can be shown that job stressors have a significant negative effect on job satisfaction (Yuhui, 2011).

B. The Effect of Workload on Job Satisfaction (Job Satisfaction) of Employees at Arjasa Public Health Center, Sumenep Regency
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of workload on employee job satisfaction at the Arjasa Health Center, Sumenep Regency.
Factors involved in job satisfaction are very important to increase worker happiness (Okpara JO, et al., 2005). One of the most frequently encountered psychological problems in recent years is stress and stress-related illnesses, because the world is constantly changing, everyone is affected by stress regardless of age, gender, profession, social or economic status (Ozkan and Ozdevecioglu, 2012). ). The result of globalization for employees is changes with certain demands, if employees cannot adapt then over time this will be considered a source of stress (Tunjungsari, 2011).
Dhania (2010) states that workload affects employee work stress. Altaf and Mohamad Atif (2011) stated that workload has a negative effect on job satisfaction. However, in Rehman, Irum et al. (2012) stated that there is a positive relationship between workload and job satisfaction.  Stress has a negative effect on job satisfaction. Lut (2008) in Dhania (2010) has a different opinion showing that the effect of job stress on employee job satisfaction at PT. SHARP Electronics Indonesia is that work stress does not have a significant effect on employee job satisfaction.
Employees will feel comfortable if when working they get job satisfaction as expected (Koesmono, 2005). There are several ways to express job satisfaction, for example, employees can complain, disobey, steal, etc. An emotional attitude that is pleasant and loves his job is job satisfaction (Hasibuan, 2003:202). Job satisfaction is an employee's opinion that is pleasant or not about his work, that feeling can be seen from the employee's good behavior towards work and all things experienced in the work environment (Handoko, 2001: 193).
According to Dhania (2010), workload is a number of activities that require expertise and must be done within a certain period of time in physical or psychological form. Riggio (2000: 250) states that workloads are work tasks that are a source of stress, such as work that requires working quickly, producing something and concentrating on work stress. According to Hariyono, et al., (2009) is the period of time in carrying out work activities in accordance with the abilities and capacities of employees without showing signs of fatigue.
Altaf and Mohamad Atif (2011) found that a high workload has a negative effect on job satisfaction. Mustapha and Ghee (2013) show that there is a significant negative relationship between workload and job satisfaction. In the research of Mustapha (2013) stated that job satisfaction is influenced by daily workload, employees are more satisfied when they are given a lower workload. Lower job satisfaction was found at higher workloads in the study of Mansoor et al. (2011). In Tunggareni and Thinni Nurul (2013) found that nursing staff who have a moderate objective workload tend to have a higher level of job satisfaction than a high objective workload.

C. The Effect of Burn Out (Burn out) on Employee Performance at Arjasa Public Health Center, Sumenep Regency
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of burn out (burn out) on employee performance at the Arjasa Public Health Center, Sumenep Regency.
Good performance certainly will not be created if employees experience emotional exhaustion or low self-esteem, or commonly referred to as burnout. The term burnout was first put forward by Freudenberg, a clinical psychologist in 1974. The results of research conducted by Schaufeli (in Eviaty, 2005) showed that a person's profession in the service sector was in the first place with the most burnout, which was around 43 percent. Among professions in the service sector, a person has a higher level of stress than people who work in other fields. Luthans (2011:217) states that the cause of burnout consists of three dimensions, namely emotional exhaustion, depersonalization, and decreased personal achievement. Burnout causes a person to have no goals and not be able to meet the needs at work. The high stress that must be faced by employees is prone to the emergence of burnout symptoms (Berry, in Eka, 2015). Melati and Surya (2015) said that burnout can also occur due to a lack of positive appreciation for the work that has been done so far. Burnout in a company can be measured by the number of employee resignations. Syed (2014) states that there are standards set by the company related to regulations, work deadlines, wages (financial), the environment is even always required to have concentration and physical conditions that are always prime to have a positive and negative impact on employees. The negative impact of burnout can be seen from the decreased work performance of employees due to high stress so that they have the potential to commit violations in the workplace, if stress on individuals continues and cannot be resolved, then there is a trigger for burnout.
Workers who experience burnout have reduced energy and interest in work (Rajan et al., 2015). They experience emotional exhaustion, apathy, depression, irritability, and burn out. They find faults in various aspects, namely their work environment, relationships with coworkers, and react negatively to suggestions shown to them (Syed, 2014). back pain, tension in the neck and shoulder muscles, frequent colds, insomnia, and chronic fatigue (Dita and Muryantinah, 2014). Emotional exhaustion in the form of burn out, irritability, cynicism, anger, anxiety, hopelessness, sadness, depression, helplessness.
The impact of burnout experienced by individuals on others is felt by service recipients and families. Furthermore, the impact of burnout for the organization is the increased frequency of absenteeism, quitting from work or job turnover, which then affects the effectiveness and efficiency of work in the organization (Cherniss, in Hanna, 2015). As a result of burnout itself, it can appear in the form of reduced and worsening employee performance, and low productivity, which causes a lot of conflict within the scope of a person and his family.

D. The Effect of Workload on Employee Performance at Arjasa Public Health Center, Sumenep Regency
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H0 is rejected and H1 is accepted so it can be concluded that there is directly the effect of workload on employee performance at the Arjasa Public Health Center, Sumenep Regency.
At this time the development of the business world engaged in services shows its development rapidly. This can be influenced by the development of increasingly advanced technology. With these advances, indirectly or directly will be able to influence behavior patterns, mindsets and attitudes when facing a problem because they are required to be able to make a change or innovation in order to realize the existence and success of the company. A company certainly has a target, and in order to be able to realize the target, the company will need a human resource factor that has high performance, this is needed so that the company can achieve its goals well.
Performance is a result of work both in quality and quantity achieved by an employee in carrying out his duties. According to Hasibuan (2016) performance is a work achieved by a person in carrying out the tasks assigned to him based on skills, experience, sincerity and time. Performance can be equated with work performance, and thus employee performance is a work achievement achieved by an employee in carrying out their duties and targets.
Dhania (2015) states that workload affects employee work stress. Altaf and Mohamad Atif (2016) stated that workload has a negative effect on job satisfaction. However, in Rehman, Irum et al. (2017) stated that there is a positive relationship between workload and job satisfaction.  Stress has a negative effect on job satisfaction. Lut (2013) in Dhania (2015) has a different opinion showing that the effect of job stress on employee job satisfaction at PT. SHARP Electronics Indonesia is that work stress does not have a significant effect on employee job satisfaction.
According to the conclusion, Dhania (2015) states that workload is a number of activities that require expertise and must be done within a certain period of time in physical or psychological form. Workloads are work tasks that are a source of stress, such as work that requires working quickly, producing something and concentrating on work stress. According to Hariyono, et al., (2014) is the period of time in carrying out work activities in accordance with the abilities and capacities of employees without showing signs of fatigue.

E. The Effect of Burn Out (Burn out) Through Job Satisfaction (Job Satisfaction) on Employee Performance at Arjasa Health Center, Sumenep Regency
It is known that the direct effect of burn out on performance is 0.486. While the indirect effect of burn out through job satisfaction on performance is 0.214 x 0.579 = 0.124. Then the total effect of burn out through job satisfaction on performance is 0.486 + 0.124 = 0.610. The total effect value is 0.610, so it can be concluded that there isinfluence burn out through job satisfaction on employee performance at the Arjasa Public Health Center, Sumenep Regency.
The high workload experienced by employees has an impact on the emergence of burnout. Arie (2015) states that workload is a worker's perception of a set of activities that must be completed within a certain time limit, both in the form of physical and psychological workloads. Excessive workloads can include working hours, the number of tourists to be served (number of full rooms for example), responsibilities that must be borne, routine and non-routine work, and other administrative work that exceeds individual capacity and ability. In addition, excessive workload can include quantitative aspects in the form of the number of jobs and qualitative aspects, namely the level of difficulty of the work that must be handled (Melati and Surya, 2015).
Several studies have stated, where Melati and Surya (2015) workload has a positive influence on burnout in employees. Ari and Dovi (2014) in their research stated that workload has a positive effect on burnout. Arie (2015) states that an excessive workload has a positive influence on triggering burnout behavior in employees. Hanna (2015) states that workload has a positive effect on employee burnout. Jendra and Riana (2015) state that various roles that must be fulfilled by employees are indirectly prone to triggering role stress (work stress) in employees. Continuous work stress has an impact on job saturation and also triggers burnout (Tri, 2005). The workload felt by employees results in work saturation which can consume one's time and energy, causing a feeling of being threatened in a person and negative behavior in their work (Syed, 2014).
The role stress factor (work stress) is one of the causes of burnout in employees. Greenhaus and Beutell (2005: 321) in Johana et al. (2007) define job stress as an individual's response to situations and events that threaten and suppress individuals and reduce their abilities to deal with them. Role work stress is defined as the simultaneous occurrence of two or more forms of stress in the workplace, where the fulfillment of one role makes the fulfillment of another role more difficult to carry out (Sarah et al., 2015). This means that if employees experience stress at work, at that time an employee in carrying out a particular role will find it difficult to meet the expectations of other roles (Syed, 2014). The role of work stress tends to increase when the demands of the workload are carried out as responsibilities. Therefore, each person's level of work stress tends to be different regarding the perceived workload and the role he experiences.
Several studies have stated, where Syed (2014) role stress has a positive influence on workload and burnout on employees. Sarah et al. (2015) in his research stated that role stress was able to mediate the effect of workload on burnout. Jendra and Riana (2015) state that the workload that triggers burnout behavior can be mediated by role stress. John et al. (2007) stated the same thing role stress is able to mediate the effect of workload on burnout.

F. Influence Workload through Job Satisfaction on Employee Performance at Arjasa Health Center, Sumenep Regency
It is known that the direct effect of workload on performance is 0.517. While the indirect effectworkload through job satisfaction on performanceis 0.792 x 0.579 = 0.458. Then the total effectworkload through job satisfaction on performanceis 0.517 + 0.458 = 0.975. The total influence value is 0.975, so it can be concluded that there isinfluence workload through job satisfaction on employee performance at the Arjasa Public Health Center, Sumenep Regency.
Several factors that can affect performance include burn out, workload and job satisfaction. As Mondy (2018) states that burn out can lead to lack of attendance, excessive use of drugs and alcohol, decreased or poor performance, and poor health.
Employees will feel comfortable if when working they get job satisfaction as expected (Koesmono, 2015). There are several ways to express job satisfaction, for example, employees can complain, disobey, steal, etc. An emotional attitude that is pleasant and loves his job is job satisfaction (Hasibuan, 2013). Job satisfaction is an employee's opinion that is pleasant or not about his work, that feeling can be seen from the employee's good behavior towards work and all things experienced in the work environment (Handoko, 2011). Altaf and Mohamad Atif (2016) found that a high workload has a negative effect on job satisfaction. Mustapha and Ghee (2018) give results, there is a significant negative relationship between workload and job satisfaction. In Mustapha's research (2018), it is stated that job satisfaction is influenced by daily workload, employees are more satisfied when they are given a lower workload. Lower job satisfaction was found at higher workloads in the study of Mansoor et al. (2016). In Tunggareni and Thinni Nurul (2013) found that nursing staff who have a moderate objective workload tend to have a higher level of job satisfaction than a high objective workload.
Putra (2017) found that job satisfaction is negatively affected by job stress. Leila's research (2012) Job stress has a negative effect on job satisfaction. Job stress is a factor that affects job satisfaction. Stress and job satisfaction are negatively related. Research conducted by Brewer and Jama (2013) states that there is a strong relationship between job stress and job satisfaction. Mojaheri and Nelson (2014) suggest that increased stress is associated with decreased job satisfaction. Mostafai et al (2012) stated that there was a significant relationship between stress and job satisfaction. Job stress and job satisfaction have a reciprocal relationship. Khalidi and Wazalify (2013) found that there are many work-related stress factors that lead to decreased satisfaction among pharmacists. Putra (2012) work stress has a negative effect on job satisfaction. Statistically it can be shown that job stressors have a significant negative effect on job satisfaction (Yuhui, 2011).