Asian
Journal of Healthy and Science
p-ISSN: 2980-4302
e-ISSN: 2980-4310
Vol. 3 No 7. July, 2024
The Effect of Transformational Leadership Style and Conflict Management of the Head of the Room on Job Satisfaction of Executive Nurses at RSABL
Renny Sara Asih Nababan1*, Emiliana Tarigan2, Emiliana Tjitra3
1,2,3Sekolah Tinggi Ilmu Kesehatan SINT Carolus, Central Jakarta, DKI Jakarta, Indonesia
Email: renynababan14@gmail.com1*, emilianatarigan55@gmail.com2, emil.tjitra@gmail.com3
Abstract
The transformational leadership style aims to influence and engage followers through trust and empathy, while conflict management involves utilizing various strategies to resolve conflicts effectively. Training in these areas can enhance job satisfaction among implementing nurses. This study investigates the impact of transformational leadership style and conflict management on job satisfaction among implementing nurses at RSABL, using a quasi-pre-post test design conducted in July 2023 at a private hospital in Bandar Lampung. Nurses with over one year of experience at ABL Hospital participated in training, and data analyzed using SPSS version 22 indicated significant improvements in leadership style, conflict management, and job satisfaction (p < 0.05). Multiple linear regression confirmed the influence of these factors on nurses' job satisfaction (p < 0.05). The study concludes that transformational leadership and effective conflict management significantly affect job satisfaction among implementing nurses, suggesting further qualitative research with control groups to optimize nurse satisfaction.
Keywords: Transformational Leadership Style, Nurse, Conflict Management of the Head of the Room, Job Satisfaction, RSABL.
INTRODUCTION
Global health challenges have driven the role of nurse professionals with a wider scope of duties. Nursingskills are required to have reliable clinical experience so that professional nurses are expected to be able to provide the best nursing services. Nursing services are often a benchmark for the success of achieving the goals of a hospital, and even a determining factor in the image of the hospital in the eyes of the public. This is because the number of nursing staff is the largest in health services in a hospital and nursing staff for 24 hours accompanying patients. For this reason, a leader is needed who will manage a large number of nursing staff so that they are able to provide care according to the expectations of patients and families. This is related to the leadership of nurses in nursing services that in every development and change requires professional management by paying attention to every change that occurs in Indonesia (Susanti et al., 2021). So a leader is needed to achieve this goal.
The leadership role is so important to provide the guidance, direction and sense of stability necessary to ensure the effectiveness and satisfaction of followers, as it embodies commitment and action going forward (Huber, 2018). A transformational leader is defined as a leader who motivates followers to perform to their full potential over time by influencing changing perceptions and by providing direction. Transformational leaders use charisma, individualized consideration and intellectual stimulation for greater results, effectiveness and satisfaction of followers. Transformational leaders grow, develop, and empower the nursing workforce they manage (Bass & Riggio, 2006; Huber, 2018).
Through Karu which applies individual influence, inspirational motivation, individual stimulation and paying attention to the individual. Transformational leadership results in greater effort, effectiveness and satisfaction of nursing staff (Bass et al., 1996; Tun Huseno, 2021). Nursing leaders need to identify the causes of conflict and analyze how to resolve conflicts effectively. When conflict is managed effectively, the result is innovative solutions and better relationships (Morrow & Smith, 2022). Because conflict is a dynamic and will always arise, more precisely conflicts can only be managed. The factors that cause conflicts that occur in organizations can be caused by human factors that can arise from Karu because of his leadership style, negative behavior and individual personality. Organizational factors are competition in the use of resources, differences in goals, values and perceptions, and obstacles in communication (Sudarmanto et al., 2021).
There are five styles of conflict management, namely, accommodating, avoiding, collaborating, competing and compromising (Huber, 2018). Each style of conflict management can be used in different situations. It is a challenge for a nurse leader to know and apply a conflict management style to the right situation. Karu must be able to meet these challenges fully as it involves the critical working relationships for the unit to function effectively and the interaction of nurses who collaborate with members of the health discipline while managing their responsibilities and roles as leaders. Positive conflict management styles can increase employee job satisfaction, develop mutual trust and strengthen the Karu-Nursing relationship (Abane et al., 2021).
In mapping the application of transformational leadership styles and conflict management in this study, the theory of adaptive nursing presented by Hildegard E. Peplau's theory, about interpersonal relationships, explains the ability to understand a person's behavior to help identify perceived difficulties and to apply human principles related to problems arising from all things or events that have been experienced. So that the head of the room can build a working relationship and create a synergistic and conducive work environment atmosphere that has an impact on the satisfaction of nursing staff.
Job satisfaction is a very significant element that directly contributes to the success and failure of the organization. Job satisfaction is one of the most important factors that every institution focuses on developing to obtain an efficient economic position and is very important in improving the efficiency level of their employees (Dugguh & Dennis, 2014; Irani & Scherler, 2002). One of the most important activities for institutional leadership is to ensure employee satisfaction and work commitment. A transformational leader is expected to be able to assess and satisfy individual motives, appreciating each of them and their contribution to the success of their organization.
The head of the room at ABL Hospital is 14 people with a qualification of 100% education level of Nurse graduates and an average working term of 5 five years, the latest is 6 months and the longest is 17 years. Training data 21% of the 14 Karu have participated in ward management training, for transformational leadership training no one has ever participated. ABL Hospital has an average BOR of 69.29%. BTO 82.5/year. LOS 4 days. TOI 1-2 days (Source: Medical Records of ABL. Hospital. 2023). BOR indicator standard (60 – 85 %). BTO (Bed Turn Over) 40 – 50 x/year. LOS (Length of Stay) 6 – 9 days. NIGHT (Turn Over Interval) 1 – 3 days. (Ministry of Health of the Republic of Indonesia, 2005. Ministry of Health, 2011).
The implementing nurse stated that in terms of Karu managing conflicts based on the situation and conditions that occurred, no specific strategy was implemented. However, when given a choice of conflict management strategies: compromise, compete, cooperate, avoid and collaborate, the implementing nurse prefers Karu who implements conflict management with a strategy of compromise, cooperation and collaboration. On the other hand, the implementing nurses do not like the Karu conflict management strategy which uses avoidance and competition strategies. The implementing nurse hopes that Karu will immediately resolve the conflict that occurred. This data is in accordance with the results of the evaluation of the Karu performance assessment every year that one of the factors that has not met the standards is conflict management (Source of HR of ABL Hospital, 2022)
The researcher's personal experience when becoming a Karu, the understanding of leadership style is not well understood because he is less exposed to leadership style knowledge, so the application of the Karu style is only based on work experience and is oriented towards the achievement of targets or programs that have been set previously. Likewise, in conflict management, conflict management is still based on feelings and oriented to the standards of regulations and regulations set in hospitals.
Based on interviews conducted in the HR department, employee satisfaction surveys are conducted quarterly. Based on Satisfaction data taken in the 4th quarter of 2022. Employee job satisfaction in general has been met. Employee job satisfaction in terms of work environment, employment status, giving input according to work capacity, relationships between employees, respect for employees, opportunities for self-development are optimally fulfilled. However, in terms of employee job satisfaction, wage compensation has not been optimally met. Wage compensation if work exceeds office hours or overtime. An interview with Karu "I" said, "that what was given was in accordance with the applicable rules and regulations." The satisfaction survey has not been fully filled by employees, only 20% of the number of employees. The number of surveys filled out from the nursing field was only 2.5% of the total 212 nurses. So that through this survey data, it is not possible to represent the picture of job satisfaction of implementing nurses. Based on the description of the background of the problem above, the researcher is interested in conducting an in-depth analysis of the influence of Karu's leadership style and conflict management on the job satisfaction of implementing nurses at ABL Hospital.
RESEARCH METHODS
Research Design
Creswell & Clark (2007) in Bandur (2021) explained that the research design connects the philosophical framework of research with research methods. This study uses a pre-experimental design in the form of a one-group pretest-posttest, where data is collected before and after the intervention in one intervention group without a comparison group. This study aims to assess change after the intervention, by providing transformational leadership and conflict management training to room heads in the inpatient unit of ABL Hospital. The population of the study was 101 implementing nurses, with samples taken by proportional random sampling and purposive sampling, so that 9 room heads were obtained as subjects. The number of samples was determined using the Slovin Formula with a precision of 10%.
The formula used is the Slovin formula used to determine the sample size in Riyanto (2021) is:
n= N/(1+N〖(∋)〗2 )
Information:
n = Sample size
N = Number of population
∋ = Precision value (precision) margin of error or = Level of significance or error level used.
The study population was 101, with a significance level or error rate of 10%.
The estimate of the sample size calculation is carried out based on the minimum sample size formula above, the following results are obtained:
= (101)/(1+101〖(0.10)〗2 )
= 101/(1+(101 X0.01))
= 101/2.01
= 50.24
= 50
The instruments in this study collected data systematically using questionnaires and modules on transformational leadership training and conflict management based on Bass & Avolio and Peplau (1996) theories. Pre and post tests assess understanding before and after training. The questionnaire consisted of: (1) general data on implementing nurses, (2) assessment of transformational leadership and conflict management, and (3) job satisfaction, using a five-point Likert scale. Validity was tested with Pearson's correlation, showing 11 statements about transformational leadership styles were valid, 1 in 24 conflict management statements were invalid, and 19 statements about job satisfaction were valid. Reliability was tested with Cronbach's alpha, showing all questions that were reliable with an alpha value greater than 0.60. Data analysis included univariate analysis to describe the characteristics of variables, bivariate using Wilcoxon test and paired t-test to compare pre and post-test, and multivariate using multiple linear regression test to describe the influence of independent variables and confounding variables on bound variables.
RESULTS AND DISCUSSION
Univariate Analysis
Identified Sample Characteristics, transformational leadership style, Karu conflict management
1. Characteristics of Implementing Nurses
Table 1. Identification of Characteristics of Nursing Staff in the Inpatient Room of RSABL
|
Characteristic |
n |
% |
|
|
|
Age (years) |
|
|
||
|
23 - 25
|
3 |
5,8
|
||
|
> 25 – 35 |
32 |
61,5 |
|
|
|
>35 |
17 |
32,7 |
|
|
|
Gender |
Man |
1 |
1,9 |
|
|
Woman |
51 |
98,1 |
|
|
|
Education |
2. DIII Kep
|
20 |
38,5
|
|
|
||||
|
2. Nurses 2. |
32 |
61,5
|
|
|
|
Working period (years) |
|
|||
|
2. 1-5 |
19 |
36,5 |
|
|
|
6-10 |
16 |
30,8 |
|
|
|
11- 15
|
6 |
11,5 |
|
|
|
16 – 20
|
4 |
7,7 |
|
|
|
> 20 |
7 |
13,5 |
|
|
|
Marital Status |
Not married |
13 |
25 |
|
|
Marry |
39 |
75 |
|
|
a. Age
Generally, the nursing staff in this study are >25 years old (61.5%). In accordance with the Ministry of Health 2009, the majority of the age of nursing staff is in the early adult category. Hurlock 2017, early adulthood is a period of adjusting to a new way of life, starting to be independent in making decisions. At this stage, social development skills are better. As well as having awareness of problems. However, this period is a period of self-adjustment to new patterns of life and new social expectations. Have a competitive spirit in pursuing the career they want to achieve. Have high creativity according to individual interests and abilities (Ahadiyanto, 2020).
b. Gender
Almost all nursing staff in this study are: 51 people (98.1%) are women and only one is male. Historically, nursing organizations emerged from the role of women, so it is natural that there are more women than men (Putri et al., 2019). Ability, women and men do not have differences in problem-solving skills, analytical skills, competitive drive, motivation, sociability and learning ability (Ilham & Velianto, 2022). Women tend to have a higher commitment to the organization than men. Because women in general have more obstacles in achieving their position in the organization, membership in the organization becomes important for them (Ilham & Velianto, 2022).
c. Education
The education of implementing nurses is: 32 people (61.5%) are nurses. Nurses is a professional academic education program that aims to produce nurses who have the ability to be professional nurses at the first level. Thus, the higher the nurse's education, the more managerial skills and abilities will increase. Nurse Nurses are able to carry out their duties efficiently and have better managerial skills (Suwandi et al., 2023).
d. Working period
Implementing nurses have the most working time of 1-5 years as many as 19 (36.5%) The length of this working time is in the new working time category, namely, the new working time < 6 years (Tulus 1992 in Atika, 2021) The minimum working time is 2 years and the longest is 27 years. The longer a person's working period at work, the more knowledge and experience he has, this can help in improving the performance of a nurse. A long working period of nursing staff will tend to make nursing staff feel at home in an organization, because they have adapted to the environment. So that nurses feel comfortable in their work (Ilham & Velianto, 2022).
e. Marital status
The majority of nursing staff are married, namely 39 people (75%) Robbin, 2003 in Ilham, (2022) stated that marriage encourages increased responsibilities that make a job still valuable and important. This is in accordance with the results of Wati's research (2019), that nurse respondents who were married were more satisfied with their jobs.
Identified Application of transformational leadership style
Table 2. Application of transformational leadership style before and after training
|
Leadership Style |
Before |
After |
|
Transformational |
Frequency-Percentage |
Frequency-Percentage |
|
Less |
0% |
0% |
|
Enough |
22(42%) |
4(8%) |
|
Good |
30(58%) |
48(92%) |
|
Total |
52(100%) |
52(100%) |
Based on the table above, it is known that before the Karu training, out of 52 respondent nurse respondents, 8% of respondents assessed that Karu's transformational leadership style was in the good category. After being given karu training, it was obtained that the tendency of karu's transformational leadership style to be better was 92%. According to Bass & Regio, (2006), a transformational leadership style is a leader who motivates his followers to demonstrate their full potential over time by influencing changing perceptions and by providing direction. Through a transformational leadership style, the role of leadership is so important to provide the guidance, direction, and sense of stability necessary to ensure the effectiveness and satisfaction of followers, as it embodies commitment and forward action (Huber, 2018). Affzhan's research, 2019 stated that a manager who has more transformational characteristics, staff will be more satisfied with their work.
Identified the application of conflict management before and after training was given
Table 3. Implementation of conflict management before and after training
|
Conflict Management |
Before |
After |
|
Frequency-Percentage |
Frequency-Percentage |
|
|
Less |
1(2%) |
0% |
|
Enough |
47(90%) |
4(8%) |
|
Good |
5(10%) |
47(90%) |
|
Total |
52(100%) |
52(100%) |
Based on the table above, it is known that before the karu training, out of 52 respondent nurse respondents, 5% of respondents rated karu conflict management in the good category. After being given karu training, karu conflict management increased to good by 90%. Conflict management is an adaptive approach carried out by a leader to move an organization. members or both in overcoming conflicts so that members can cooperate cooperatively (Huber, 2018).
Identified Job satisfaction of nurses before and after training
Table 4. Job Satisfaction of Nursing Staff before and after
given training
|
Job Satisfaction |
Before |
After |
|
Managing Nurse |
Frequency-Percentage |
Frequency-Percentage |
|
Less |
0% |
0% |
|
Enough |
25(48%) |
5(10%) |
|
Good |
27(52%) |
47(90%) |
|
Total |
52(100%) |
52(100%) |
Based on the table above, it is known that before the training of the nurses, of the 52 respondents, 52% of the respondents assessed that the job satisfaction of the nurses was in the good category. After being given karu training, the job satisfaction of the implementing nurses increased better by 91%. In accordance with Miah M.M.'s research, 2018 that management that supports a satisfactory workplace for employees will get reliable and confident employees, which will have an impact on increasing results and increasing productivity. Because employees who feel satisfied will mostly have a tendency to pay attention to performance and be more dedicated to the workplace. Satisfied employees will make customers satisfied and loyal. So that it can bring higher organizational performance.
Bivariate Analysis
Differences in Transformational Leadership Styles, Conflict Management and Job Satisfaction of Practical Nurses Between Before and After Given Karu Training
a. Differences in understanding transformational leadership styles and conflict management before and after training
This identification can be assessed from a questionnaire of 10 questions in the form of multiple choice. The score is obtained by multiplying the correct number by 10. Thus the lowest value is 10 and the highest is 100. Then the difference in scores before and after the training was given.
a. Karu transformational leadership style
Table 5. Karu's transformational leadership style before and after Karu training
|
Leadership Style Values |
Before (person) |
|
After (person) |
|
|
≤60 |
6 |
|
0 |
|
|
61-79 |
2 |
|
2 |
|
|
≥80 |
1 |
|
7 |
|
|
Average |
57, 8(40-80) |
|
88, 9(70-100) |
|
|
Average increase |
|
31,1 (10 – 40) |
||
|
SD |
12.0 |
|
12.6 |
|
|
t |
|
|
-7.562 |
|
|
Asymp. Sig. (2-tailed) |
|
|
0.00 |
|
The results of the value analysis of 9 karu who were trained in leadership style, only one karu received a standard score of ≥80, before the training with an average score of 57.8 ± 12.0 (40-80), and increased to 7 karu after the training with an average score of 88.9 ± 12.6 (70-100). The average increasein value is 31.1 (10-40). With a value of p = 0.00 < of 0.05. It can be interpreted that before and after the provision of transformational leadership training in karu there is an increase in knowledge in applying transformational leadership styles. Ahmed (2016) reported that the total level of knowledge of nursing managers regarding transformational leadership and conflict management conflict management increased significantly after the educational program. Afzhan's 2019 research proves that if managers have more transformational characteristics, staff will be more satisfied with their work. Elrhama's research, 2018 revealed that the level of knowledge obtained by karu after training was able to improve karu's ability to carry out his duties.
b. Conflict management
Table 6. Conflict management before and after training
|
The value of conflict management |
Before (person) |
After (person) |
|
≤60 |
2 |
0 |
|
61-79 |
2 |
1 |
|
≥80 |
5 |
8 |
|
Average |
72,2 (50-90) |
92,2(70-100) |
|
Average increase |
20 (70-100) |
|
|
SD |
13,9. |
10.9 |
|
t |
|
-2.203 |
|
Asymp. Sig. (2-tailed) |
|
0.01 |
The results of the analysis of the training value, 9 karu trained in conflict management, there were five karu who received a score according to the standard, namely ≥80 before the training with an average score of 72.2 ± 13.9 (50-90), and increased to 8 karu after the training with an average score of 92.2±10.9 (70-100). However, there is 1 karu experiencing a decrease in numbers compared to the post value, namely the pre value of 80 but the post value of 70. However, the average increase in value is 20 (70-100) with a value of p = 0.00 < from 0.05. It can be interpreted that overall before and after the provision of conflict management training in the karu there is an increase in knowledge in implementing conflict management. The role of leaders is very important in fostering conflict management, especially preventing conflicts and creating a conducive work environment (Wulandari et al., 2019). Elrhama, 2018 revealed that hospitals must carry out continuous in-service training programs, namely continuous training programs on policies and guidelines that facilitate collaborative practices and use proactive actions to overcome conflict problems and move towards their resolution. Ahmed and Obied (2016) found that there was an increase in nurses' knowledge in areas related to causes, conflict definitions, conflict management strategies, and consequences of conflicts after the intervention compared to before the educational program. It is very important that conflict management is known by nurses, especially room heads, in order to overcome both task conflicts, communication conflicts, structural conflicts and personal conflicts in their work units (Huber, 2018).
b. Differences in the Implementation of Transformational Leadership Styles Between Before and After Given Karu Training
Table 7. Application of transformational leadership style between before and after Karu training
|
Dimension |
Average±SD (range) |
Ranks (%) |
P value |
|||
|
Pre |
Post |
Positive Increase |
Negative Decreased |
Ties Unchanged |
||
|
Inspirational Motivation |
23.04±2.4 (17-29) |
25,19±2,3
(21-30) |
34(65) |
0 |
18(35) |
0,00 |
|
Paying attention to the individual |
18,17±3,0 (11-25) |
20,29±2,6 (13-25) |
38(73) |
0 |
14(27) |
0,00 |
|
Transformational leadership style |
41,21 |
45,48 |
|
|
|
0,00 |
Based on table 5, Karu has experienced an increase in applying transformational leadership styles in the dimension of paying attention to individuals. (73%) is higher than individual motivation (65%). Juhro, 2020 states that transformational leaders support individuals by listening carefully, acting as coaches and advisors, trying to help individuals to be more actualized. As well as paying special attention to the needs of achievements and the needs of the leaders (Makmuriana, 2021). Based on the condition of the research site, currently medical e-records are being carried out. Karu encourages implementing nurses to be able to develop their abilities in adapting to medical e-records. Each individual has a unique existence and characteristics thatmeans they have different challenges and potential to grow. Therefore, leaders need to pay attention to and treat the implementing nurses individually, train and guide and understand their interpersonal skills so that the goals are achieved.
The application of transformational leadership style in the dimension of inspirational motivation has increased (65%) based on table 5.7 Megawati, 2017 stated that transformational leadership style is a leadership style that is not only limited to working relationships, but rather leads to providing motivation, attention to individual needs, and others that lead to respect for employees as human beings who have human rights. The transformational leadership style applied by leaders accompanied by the motivation of employee achievement can affect employee job satisfaction. In Mushtaq's research, 2021 revealed that transformational leadership interventions carried out by researchers were successful in improving knowledge and skills among head nurses post-intervention compared to before the intervention. As a result of observation, Karu tried to motivate the implementing nurses in daily services, but in the implementation did not use a special time. The implementing nurse stated that she received motivation and praise when completing the morning plus or switching to the plus.
c. Differences in the Implementation of Karu Conflict Management Between Before and After Karu Training
Table 8. Conflict management between before and after
given training
|
Dimension |
Average±SD (range) |
Ranks |
P value |
|||
|
Pre |
Post |
Positive
|
Negative |
Ties |
|
|
|
Collaboration |
19.44±3.2 (8-25) |
20.83±2.1 (15-25) |
25(48,1) |
3(5,8) |
24(46,2) |
0,00 |
|
Accommodation |
14.58±1.9 (9-19) |
16.17±1.6 (12-20) |
37(71,2) |
1(1,9) |
14(26,9) |
0,00 |
|
Compete |
16.27±2.02 (10-21) |
18.06±1.9 (15-23) |
39(75) |
1(0,03) |
12(21) |
0,00 |
|
Dodge |
15.48±1.5 (11-19) |
17.46±2.2 (14-23) |
34(65,4) |
2(3,8) |
16(30,8) |
0,00 |
|
Compromise |
15.15±2.1 (9-20) |
16.08±1.2 (12-20) |
25(48,1) |
4(7,7) |
23(44,2) |
0,00 |
|
Conflict management |
77,65 |
89,13 |
|
|
|
0,00 |
Overall, through table 8, it can be seen that the average value of conflict management has all increased in each dimension and aspect. The average score of the questionnaire of 52 implementing nurses after the training was significantly higher than during the initial data collection or before the training (77.65 vs 89.13) with a value of p= 0.00 (p< 0.05). The selection of the right conflict management can have an impact on job satisfaction, so that it can improve the function of nursing services and the effectiveness of the services provided (Daniyanti & Kamil, 2016; Sriwahyuni & Priscilla, 2019).
The results of Petryshyn's (2012) research emphasized that, there is no right or wrong style in managing conflict, all have advantages and disadvantages. The importance of the way conflict governs to consider the value of relationships. Based on table 5.8, the use of competitive conflict management (75%) used by karu in the first place, is based on service challenges with a limited number of nurses compared to the number of patients served, the target program of BOR, electronic adaptation of SIMRS, cost and quality control in the JKN era. Demanding the use of competitive conflict management so that it is able to control services. Karu not only plays the role of a manager but also functions as a function. It takes a high level of confidence to face these challenges. So that we have to implement a competitive strategy. This is in accordance with Higazee's research, 2015 competitive strategies used by nurses to overcome perceived injustice from the managerial side.
In the second place according to table 8 of the accommodation conflict management strategy (71.2) used by the workers, this finding may be due to the fact that they try to avoid the stress and tension that may arise from the conflict situation and want to stay away from the feeling of discomfort in the struggle. These findings are in line with Abdelazeem (2021) who studied conflict management strategies among nurses and showed that accommodating strategies had the highest average among nurses.
In third place, according to table 5.8 in conflict management, the avoidance strategy (65.4%) is in third place, the background of Karu using this strategy, because of the demand from management that a leader must be able to maintain good relationships with each patient and his family and work staff. As well as the "Zero Complain " effort launched at the hospital. According to the American Sentinel (2012), note that avoidance and withdrawal are the most strategic strategies in conflict resolution most commonly used by nurses. This finding is similar to a study conducted by Kaitlidou (2012), which states that avoidance is the most frequently used method by health workers.
In fourth order based on table 8. On conflict management strategies used by karu in collaborating (48.1%): This implies that the head of the room works together with individuals, alternatives to achieve goals. Vaughn (2009) in Marquis (2015) stated that collaboration can evoke warm feelings in nursing leadership as a mutually beneficial outcome, but it is difficult to implement because it requires high self-awareness and communication skills.
In fifth order based on table 8. Karu uses a compromise strategy (48.1%), this is encouraged by the head of the room to create a comfortable and safe environment among staff, according to Merrit research 2003 in Abdelazeem (2021). Overall, through table 5.8, the results of the questionnaire of 52 nursing staff can be seen that there is an increase in the value of conflict management after training compared to before training (77.65 vs 89.13) with a value of p= 0.00(p<0.05). Karu implements the five conflict management strategies in facing challenges in service so that Karu can provide quality and efficient services and can have an impact on job satisfaction. The selection of the right conflict management has an impact on staff satisfaction and performance, so that it can improve the function of nursing services and the effectiveness of the services provided (Daniyanti & Kamil, 2016; Sriwahyuni & Priscilla, 2019)
d. Difference in job satisfaction of implementing nurses
Table 9. Job satisfaction of implementing nurses between before and after being given karu training
|
Dimension |
Average±SD (range) |
Ranks |
P value |
|||
|
Pre |
Post |
Positive (improve) |
Negative (decreasing) |
Ties (no changes) |
|
|
|
Supervision |
13.10±2.6 (7-18) |
15.81±2.3 (9-20) |
44(84,6) |
1(1,9) |
7(13,5) |
0,00 |
|
Job security |
13.63±2.4 (8-18) |
16.42±1.6 (12-20) |
46(88,5) |
2(3,8) |
4(7,7) |
0,00 |
|
Interpersonal Relationships of Leaders, Colleagues |
23.87±4.0 (16-29) |
28.88±2.7 (23-35) |
48(92,3) |
0 |
4(7,7) |
0,00 |
|
Work Environment |
13.25±2.2 (8-17) |
15.75±1.5 (12-20) |
49(94,2) |
0 |
3(5,8) |
0,00 |
|
Total |
63,85 |
76,87 |
|
|
|
0,00 |
Based on table 9 in the job satisfaction of implementing nurses, the dimension of the work environment in the first place, Karu has a leadership style that supports the job satisfaction of implementing nursing staff in striving for a harmonious work environment both externally and internally, and is supported by management in terms of hospital facilities or regulations. The leader who directs the karu encourages a harmonious and orderly work atmosphere. Through a conducive work environment, it can improve employee performance at work. The work environment is divided into physical environments such as: work equipment, room noise. And non-physical, such as: leadership style, social environment. The more comfortable the working environment, the higher the job satisfaction of the staff. Gurkova, 2021 stated that thework environment has a significant effect on nurses' job satisfaction means that the better the work environment in the hospital, the better the nurses' job satisfaction. In accordance with Jamalina's research, 2018 Satisfaction of implementing nursing staff with the work environment carried out after the intervention,
Based on table 9 in the dimension of interpersonal relationships, leaders are in second place. An environment that is driven by mutual respect and support for each other among the implementing nurses creates harmony. An environment that always builds harmonious cooperation supports satisfaction in this dimension. Robbins, 2017 stated that interpersonal relationships are interactions between people and others in work situations and in organizations as motivation to work together productively. When a person is not happy with their interpersonal relationships, their work situation usually says that they are not satisfied with their work. There are two things that may cause this, the first is if the person does not get the information needed to carry out his or her job and the second, if the relationship between colleagues is not good in establishing relationships or establishing communication. The more comfortable the working environment, the higher the job satisfaction of the staff. Jamalina, 2018, Gurkova, 2021. A conducive work environment built through interpersonal relationships between leaders and colleagues affects the job satisfaction of implementing nurses, this is supported by research, Muti (2020), there is a relationship between interpersonal relationships and job satisfaction of nurses at Tenriawaru Hospital. That is, the implementing nurse agrees that colleagues recognize the performance of nursing staff. Recognizing the performance of one's special abilities over others, fostering a work atmosphere that respects and supports each other.
Based on table 9 Job satisfaction of implementing nurses in the supervision dimension in the last order. One of the job descriptions of a karu carrying out managerial duties is to carry out control that can be done by means of supervision. The purpose of supervision is to maintain a balance between rights and obligations, as a process of guidance or evaluation of staff. Karu who pays attention to individuals not only in performance progress but also obstacles, as well as problems that do not support staff performance can have an impact on the job satisfaction of nursing staff. Supervision is a fairly important source of satisfaction. The ability of the supervisor to provide technical assistance and behavioral support to the staff, so that the staff feels comfortable with their work. From the results of Febrianita's research, 2017 showed that most of the respondents, namely: 54% were quite satisfied with the supervision/supervision system carried out by the managerial of Petala Bumi Hospital. In this dimension, the implementing nurse agrees that Karu always pays attention to the problems faced by nurses with full sympathy. Nurse satisfaction can be increased through attention and good relationships from leaders and subordinates, so that nurses will feel that they are an important part of the work organization.
Multivariate Analysis
Analyze the influence of transformational leadership style and conflict management, and the characteristics of implementing nursing staff on job satisfaction of implementing nursing staff
1. Characteristics of the implementation care
Table 10. Influence of characteristics on job satisfaction
Implementing nurse
|
Characteristic |
PARTIAL T-TEST |
PERCENTAGE |
SIMULTANEOUS |
|
|
|
B |
Sig |
R.Square |
Sig |
|
Age of respondents |
-0,079 |
0,648 |
0,158 |
0,139 |
|
Gender of respondents |
-2,266 |
0,750 |
||
|
Respondent's education |
-4,810 |
0,015 |
||
|
Working period |
0,41 |
0,824 |
||
|
Marital status |
-3,123 |
0,186 |
||
a. Partial multiple linear regression test based on significance value If the sig value < 0.005 has a partial effect on the dependent variable
Based on the results of the hypothesis test, age has no effect on the job satisfaction of the implementing nurses (p 0.64> 0.05), which means that the elderly and young implementing nurses have the same job satisfaction. A person's emotional maturity is not determined by age. The results of this study are contrary to the results of research by Rizany (2020) and Wati (2019) who stated that there is a meaningful relationship between age and job satisfaction of implementing nurses, the younger the age of nurses, the more satisfied they are. In addition, the results of the hypothesis test showed that gender had no effect on job satisfaction, with men and women having equal abilities in problem-solving, analytical skills, motivation, sociability, and learning ability. The results of this study are in line with Setianingrum (2021), but in contrast to the research of Ilham (2022) and Wati (2019) which states that gender affects job satisfaction.
Furthermore, education has an effect on the job satisfaction of implementing nursing staff (p 0.01 < 0.05). B = -4,810, which indicates that lower job satisfaction correlates with lower education. The majority of the education of implementing nurses in this study are nurses, who are able to carry out their duties efficiently and have better managerial skills (Suwandi et al., 2023). A person's level of education is influential in responding to something that comes from outside, with higher education causing a critical assessment of the services provided (Chrisnawati et al., 2020). Education also shows a person's ability to complete his work (Ilham & Velianto, 2022). The relationship between education and job satisfaction suggests that education levels can help a person understand his or her job. This study is in accordance with Chamariyah (2023), but is in contrast to Rizany (2020) who stated that there is no relationship between education and job satisfaction of implementing nurses. The working period has no effect on the job satisfaction of nursing staff (p 0.82 > 0.05), according to the research of Jumrana (2022) but in contrast to Ilham (2022) who stated that the longer the working period, the more job satisfaction increases. Finally, marital status has no effect on the job satisfaction of implementing nurses (p 0.18 > 0.05), which is supported by the research of Jumrana (2022) but is different from Ilham (2022) and Wati (2019) who stated that married nurses are more satisfied with their jobs.
2. Simultaneous F test (Multiple linear regression) based on significant values.
The significant value in the table above p= 0.139 > of 0.05, it can be concluded simultaneously that the characteristics of nurses do not affect the satisfaction of the implementing nurses. In accordance with the research of Simanjuntak et al, 2021 there is no characteristic relationship with the job satisfaction of implementing nurses. However, contrary to Ismaniar's research, 2021, individual characteristics correlate with job satisfaction.
The influence of transformational leadership style, conflict management on job satisfaction of implementing nurses
Table 11. The influence of transformational leadership style and conflict management on job satisfaction
Managing nurse
|
VARIABLE |
PARTIAL T-TEST |
PERCENTAGE |
SIMULTANEOUS |
|
|
B |
Sig |
R.Square |
Sig |
|
|
Transformational Style |
0,377 |
0,06 |
0.525 |
0.000 |
|
Conflict Management |
0,658 |
0.00 |
||
Partial multiple linear regression test based on significance value
Based on the results of the hypothesis test, transformational leadership style has no effect on the job satisfaction of implementing nursing staff with a value of p 0.06 > 0.05, indicating that this leadership must be accompanied by effective and efficient managerial skills. Alise (2021) research supports that transformational leadership styles need effective conflict management to increase staff satisfaction. On the contrary, karu conflict management had a positive effect on the job satisfaction of nursing staff with a p value of 0.00 < 0.05 and a B value of 0.658, indicating that an increase in karu conflict management of 0.658 units would increase job satisfaction by 0.6583. This emphasizes the importance of the ability of nurse leaders to manage conflicts with the right strategies to create good working relationships and the importance of the role of leaders in fostering conflict management to create a conducive work environment (Wulandari et al., 2019).
Percentage of the influence of transformational leadership style, conflict management on job satisfaction of implementing nursing staff
Based on table 11, the simultaneous influence of transformational leadership style, karu conflict management simultaneously affected the job satisfaction of nursing staff by 52.5%.
Simultaneous F test (Multiple linear regression) based on significant values
The significant value in table 5.11, which is 0.000 < from 0.05, can be concluded simultaneously that transformational leadership style, conflict management has an effect on the job satisfaction of the implementing nursing staff. It can be concluded that the influence of karu's transformational leadership style becomes strong when combined with karu's reliability in conflict management so as to contribute to the job satisfaction of the implementing nursing staff. Previous research by Alise, 2021 conflict management style accounts for more job satisfaction than transformational leadership and that the relationship between transformational leadership and job satisfaction is partly due to conflict management styles.
The influence of characteristics, transformational leadership style, and conflict management on the job satisfaction of implementing nursing staff
Table 12. Simultaneous influence of characteristics, transformational leadership style, and conflict management on job satisfaction of implementing nurses
|
|
Based on the results of the hypothesis test, the significant value showed that the characteristics of nurses, transformational leadership style, and conflict management simultaneously affected the job satisfaction of implementing nurses by 54.6%, while 45.84% were influenced by other factors. Karu must apply transformational leadership, pay attention to individuals, and have managerial skills in managing conflicts to achieve better job satisfaction. Transformational leadership emphasizes the principles of morality, cooperation, and community, aiming to empower and encourage followers. Conflict management involves dispute resolution steps to produce calm and creative solutions. This study shows that the job satisfaction of implementing nurses is influenced by education and transformational leadership style. Job satisfaction is a positive feeling towards work and is an indicator of the quality of the health care system, which contributes to better service quality and patient outcomes. Statistical analysis confirmed the influence of nurse characteristics, transformational leadership style, and conflict management on the job satisfaction of implementing nurses at ABL Hospital.
Research Limitations
This study has various limitations, including: the research design uses a quantitative approach with a quasi-experimental design that involves a pretest before treatment and a posttest after treatment, but only looks at cause and effect in the intervention group without comparison with the control group. The research subjects are nurses who serve in the inpatient with a rotating work schedule (morning, afternoon, night), so that data collection or observation is difficult because the schedules of researchers and research subjects are different. The training provided was about transformational leadership style and conflict management through Peplau's theoretical approach, which was carried out for 2 days with a duration of 3 hours per day, although the busy schedule caused obstacles.
Implications of Research Results
The implications of the results of this study show that in nursing services, leaders need to be trained in leadership and conflict management styles to deal with the complexity and chaos that often occurs. This aims to improve the quality of service and patient safety in the midst of global health challenges. In addition, there are leadership style modules and logbooks that can be used by room heads to achieve these goals. In the field of nursing management science, the training modules on leadership style, conflict management, and Peplau theory are expected to be able to update leadership practices and conflict management, both in general and in the context of specific nursing services. These implications are also relevant for nursing education, where learners are expected to apply the learned leadership and conflict management styles in their educational process.
CONCLUSION
This study identified that the majority of nursing staff in this study are women, aged 25-35 years, educated nurses, and married. After the room head training (karu), there was a significant increase in the understanding and application of transformational leadership styles and conflict management, with transformational leadership styles in the dimension of individual attention increasing 73% higher than inspirational motivation, and competitive conflict management strategies increasing 75% higher than other strategies. The job satisfaction of implementing nurses also increased significantly after the training, especially in the aspect of the work environment which increased by 94.2%. Partially, education and conflict management had an effect of 15.8% and 52.5%, while simultaneously, transformational leadership style and conflict management had an effect of 54.6% on the job satisfaction of implementing nurses. In conclusion, Karu's transformational leadership style becomes strong when combined with Karu's reliability in conflict management and educational characteristics, thus contributing to the job satisfaction of implementing nurses.
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Copyright holders:
Renny Sara Asih Nababan, Emiliana Tarigan, Emiliana Tjitra (2024)
First publication right:
AJHS - Asian Journal of Healthy and Science
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