Effectiveness Of Nursing Competency Of Service Quality In Installation Of Hospital Buleleng Hospital

Buleleng Regional General Hospital as a health service provider is concerned with the quality of its services. The quality of nurse services is the biggest part of the overall quality of hospital services because of the amount of contact with patients. The quality of service itself is influenced by the satisfaction and expectations and needs of patients being met. To meet the excellent quality of service, nurses need to have superior competence, namely basic knowledge, hard skills, soft skills, work ethics and legal aspects. The purpose of this study is to provide recommendations based on an analysis of the influence of nurse characteristics and competence on service quality. This research is a descriptive observational study, conducted from November. The study population was nurses working in the Inpatient Room, and the number of samples obtained was 80 nurses. The variables analyzed were individual characteristics, nurse competence, hard skills, soft skills, work ethics, and legal aspects. The results of this study indicate that age, length of work and position of head of the family at work have an influence on nurse competence. Length of work, and soft skills also have a positive influence on service quality. Conclusion: there is a significant effect between length of work, and nurses' soft skills on service quality. Variables that need to be improved and improved are registration letters, work licenses, training, and training to improve soft skills and work ethics


INTRODUCTION
The hospital as an institution engaged in the field of health services continues to change. The basic nature of the hospital is the fulfillment of the needs and expectations of patients to solve their health problems at the hospital. Quality service will be achieved if all human resources (hereinafter referred to as HR) have professional competence, understand products in depth, be friendly and friendly, responsive or sensitive to patients, master the work, communicate effectively and be able to respond to patient complaints and look attractive. Patient satisfaction starts from the time of arrival until the patient leaves the hospital. To create patient loyalty to the hospital, patient satisfaction must reach a special stage because the value of satisfaction in the ordinary category is very easy to fall or turn bad, which can easily occur if the quality of service received does not match the needs and expectations of the patient. The presence of ordinary and even poor nurse services is evidence that nurses' competencies need to get attention, especially on the soft competency element because of the decrease in the level of satisfaction with the services provided by nurses on caring elements in providing services to patients. Nurses as service providers must be updated and upgraded to be able to meet the needs and expectations of patients in providing services. Nurse competence is an important aspect in the quality of service that contains the consequences of authority in the task as well as making decisions according to their roles that are relevant to expertise, knowledge and skills. Nurse competence is needed to support the hospital strategy in maintaining and improving the quality of service for patient satisfaction. The purpose of this study is to develop recommendations for improving service quality based on an analysis of the influence of nurse competencies with service quality in Inpatient Installation.

METHODS
This research belongs to the descriptive observational category. The researcher will analyze the effect of the nurse competency variable on the quality of nurse services in the inpatient room of Buleleng Regional Hospital. This study uses a cross sectional design. In this study, researchers conducted a study on the characteristics of individual nurses, nurse competencies in inpatient installations, and conducted an analysis of the quality of nurse services in inpatient installations, as well as testing the effect on both variables. This research was conducted in 8 (eight) Buleleng IRNA treatment rooms, namely: Emerald treatment room (surgical medical), Ruby treatment room (surgical medical), Sapphire treatment room (children), Pyrus treatment room (obstetrics and gynecology), Diamond treatment room (surgical medical), Pearl treatment room (surgical medical), Mirah treatment room (surgical medical), Emerald treatment room (surgical medical). This research was conducted from March to December in 8 (eight) inpatient treatment rooms of Buleleng Regional Hospital. The stages of this research began with the preparation of proposals, preproposal seminars, preparation of research instruments, trial of research instruments, preparation of proposals, data collection, data processing, data analysis, preparation of research reports and completion of final reports. The population in this study were individual nurses in 8 (eight) treatment rooms. The total number of nurses is 120 people. The sample size used in this study used the Correlative Formula with the transformation of the Z value. By using this formula, a sample size of 79.86 was rounded up to 80 nurse samples. Sampling in this study uses a simple random sampling method that is random sampling. Validity measurement is done by comparing the results of the calculation of the value of corrected items -total correlation with the values in table r. Test for normality to see the data that has gathered normal distribution or not. Performed on soft competency variables, work ethics and the quality of nurse services to be tested.

A. Characteristics of individual nurses
1. Age's Nurse's     who worked in the inpatient room of Buleleng Hospital was at the most age range between 26 to 30 years, which was 61.3%. At that age range, usually starting a career, starting a family life and starting caring for children. Changes in lifestyle from one's own family to more or less affect the quality of services provided while working. In Indonesian culture, women are identified with domestic work. Nurses in the inpatient ward of Buleleng Hospital, all of which are women, will certainly experience a change in role in the family, at the same time the obligation as a nurse working in a hospital is also demanded to be able to perform well.

Analysis Individual Characteristic Effect Of Legal Aspect Nurse's In the Inpatient Instalation a. Analysis Individual Characteristic Effect Of Nurses Competence Record
The working period of nurses in the inpatient room of Buleleng Regional Hospital is mostly in the range of less than 5 years, which is 63.7%. In the relatively new working period, the time obtained by new nurses is considered very sufficient time to adjust to the existing work environment. For nurses who first entered work in Buleleng, the orientation period was given three months. After evaluating, it will be decided whether to enter the contract stage or not. The first contract is valid for 1 (one) year. After completion of the first contract period there will be a reevaluation. The nurse in question will be decided to proceed at the second stage of the contract for 1 (one) year or not. After completing the second contract period, it will be decided to be appointed as a permanent employee or dismissed.
All nurses in the Inpatient Installation are female. This is intended so that the nature of caring and tenderness in the female side is more prominent in the care of patients in the Inpatient Installation. Cultural background in Indonesia, that women do not have the full obligation in making a living. The husband or head of the family plays the main role in finding sustenance for the family. Strong financial capacity in the hands of husband or father to unmarried nurses can provide different intrinsic motivation (lower) to nurses in carrying out their nursing duties.
The background of the position of head of the family, as well as extra income, is assumed to change the intrinsic motivation of a nurse at the executive level. The higher the position of head of the family, it is assumed that pride (pride) and a higher level of prestige compared to other nurses. With this background, it is assumed that there is an influence between the head of the family's debate on the quality of services provided. Of the total nurses studied, the status of the position of head of the family at most was at the executive level of 61.3%.
From the multinomial logistic regression test of individual characteristics to nurse competence, the position of head of the family variable has a significant influence on aspects of work ethics. The significance figure obtained was 0,000 with RR 1794880,59. From these results it can be concluded that the higher the position of the head of a nurse's family, the work ethics he has will also be higher. This can be due to the pride of the nurse in question for the position of head of the family. From the results of multinomial regression tests conducted between individual characteristics of service quality, the significance figure shows the results of 0.586. This means that there is no relationship between the position of the head of the nurse's family's work to the quality of services provided inpatient installations. As with extra income, this is possible because the responsibility for services provided to nurses has been absorbed by individual nurses with different levels

Analysis of Nurse Competence and Its Effect on Nurse Service Quality in Inpatient Installations
The nurse competency factors examined in this study are basic knowledge, hard skills, soft skills, work ethics and legal aspects of each. Basic knowledge variables as part of nurse competence consist of 2 sub-variables, namely education that has been taken by the nurse concerned and training that has been undertaken by nurses. The ability of a nurse in completing her daily technical nursing duties is absolutely mastered by the nurse in question. There are 3 (three) types of nursing care in Buleleng inpatient rooms, namely surgical medical care, child care and obstetrics. Every nursing care requires mastery of technical abilities that differ from one another. Buleleng has established a minimum standard of technical mastery ability based on the competency standards of PPNI.
Soft Skill. The mastery of non technical skills is needed by nurses in completing daily work. Non-technical abilities include personal effectiveness, flexibility, leadership, persuasion, goal orientation, decision making, negotiation, analytical problem solving, teamwork, diplomacy, empathy, interpersonal skills and self management (time and priorities). The role of soft skills is important to master in today's work world (Heckman & Kautz, 2; Andrews & Higson, 2008). Employees who have better soft skills tend to be more successful in their jobs. Work Ethics. The work ethic of a nurse is closely related to the quality of services provided (Segall, 2000). The better the work ethic, the better the quality of service provided. Work ethics components in this study include self reliance, morality, leisure, hardwork, centrality of work, wasted time and delay of gratification.
The legal aspect of the competency is based primarily on Law number 36 year 4 concerning Health Workers and Law number 38 year 4 on Nursing. In carrying out professional practice nurses are required to be able to meet the legal aspects of a Practice License (SIP). While one of the requirements to get a SIP is to have a Registration Certificate (STR).

Quality Analysis of Inpatient Installation Nurse Services
Based on the results of the study, the quality of nurses' services in the Inpatient installation was assessed by patients in the poor category, which amounted to 47.5%. Knowledgeability attitude in this study is shown by the attitude and behavior of nurses who are able to answer questions that are relevant to nursing care. Responsive attitude in this study is shown by the attitude and behavior of nurses who are responsive to the needs of patients. The attitude of professionalism referred to in this study is the attitude and behavior shown by maintaining skills, appearance, listening and manners. The attitude of accessibility in this study is shown by the attitudes and behaviors that provide convenience or contact or the meeting of officers. Caring in this study is shown by the attitudes and behaviors of nurses who listen to complaints, and are sensitive to the needs of patients.
The attitude of dignity in this study is shown by the attitudes and behavior of nurses who respect Seeta respecting the dignity of patients in each of their interactions. Emphaty attitude in this study is shown by the attitude and behavior of nurses who are able to position themselves in the patient's condition. The attitude of convenience in this study is shown by the attitudes and behaviors that provide comfort to the patient. The informative attitude referred to in this study is the attitude and behavior of nurses who always provide information without being asked and provide answers in accordance with their nursing duties. Communication attitude in this study is indicated by nurses' attitudes and behavior that convey information both verbally and non verbally clearly about the patient's needs.

CONCLUSION
1. In the soft skill variable, most nurses inpatients in Buleleng Hospital are still categorized as having poor soft skills. All soft skill subvariables, namely, personal effectiveness, flexibility, leadership, persuasion, goal orientation, decision making, negotiation, analytical problem solving, teamwork, diplomacy, empathy, interpersonal skills, and self management (time and priorities) are all poorly categorized. In this soft skill variable statistically influences the quality of nurse services. 2. In the work ethics variable, most of the nurses inpatient in Buleleng General Hospital have bad work ethics. All components of work ethics, namely self reliance, morality, leisure, hardwork, centrality of work, wasted time, and delay of gratification are categorized as poor. Statistically the work ethic of nurses in the inpatient room of Buleleng Hospital does not have an influence on the quality of services provided.