Relationship of Internal and External Characteristics of Nurses to the Performance of Nurses in RSUD Sukadana, Lampung Timur Year 2021

The hospital, as one of the public health service agencies

Individual performance in an organization will affect high productivity. Work productivity is directed at getting as much work as possible and getting quality work. Individual productivity can be judged by what has been done by the individual in his work. Individual productivity is also how individuals do their jobs or performance ( jobs ). performance ). Individual work productivity is influenced by several factors, including education, skills, income, nutrition, health, compensation, work climate, work environment, work motivation, work ethic, production facilities, technology, management, and guarantees social work, achievement opportunities, career development and employee discipline (Sedarmayanti 2017) .
Employee discipline is a factor that affects employee performance. Work discipline is behavior that is in accordance with regulations or regulations, as well as existing work procedures. Discipline is also an attitude, behavior, and action in accordance with the written and unwritten rules of an organization. Discipline is a condition or attitude of respect for employees towards company provisions or regulations which, if ignored or violated, it can be said that employees have poor work discipline. On the other hand, if employees comply with stipulations or company regulations, it describes the conditions of work discipline as good. Discipline is also an action taken to correct wrong attitudes and behavior in employees. Employee discipline has a dominant, crucial, and critical role in an effort to improve employee performance. This affects the work productivity of employees in an organization. Employees who ignore work discipline can reduce employee performance and work performance (Siagian 2020) .
In addition to employee discipline, career development is also a factor that affects employee performance. Employees who work will expect career advancement or potential personal development that is beneficial for themselves and the organization. If there is career development, it will trigger a psychological impulse to increase the utilization of potential to increase work productivity. Employees' skills and productivity develop through their work. The skills possessed must always be improved. The mental attitude and skills of employees play a role in increasing productivity, so efforts are needed to establish mental attitudes and improve employee skills in order to realize work productivity (Riyanti and Yulianto, 2020) .
Research on motivation, work discipline, and achievement opportunities on the performance of nurses in the Deli Serdang Regional General Hospital Inpatient Room found a significant influence on the responsibility variable (p = 0.027), status variable (p = 0.041), work performance variable (p = 0.048), salary variable (p=0.035), work result variable (p=0.049) and work procedure variable (p=0.008) on employee performance. The work procedure variable has the greatest effect on the performance of nurses (Susanti, Megawati, and Yuniati 2019) .
Research on the effect of career development, motivation on job satisfaction, and performance of nurses at Dr. Hospital. Soebandi Jember, it was found that motivation had a direct and significant effect on nurse job satisfaction, career development had a direct and significant effect on nurse job satisfaction, motivation had a direct and significant effect on nurse performance, career development had a direct and significant effect on nurse performance, job satisfaction had a direct effect and significant to the performance of nurses (Evanda 2017) .
In order to achieve good performance, companies must make efforts to meet the needs of their employees, for example, through career development for their employees. In achieving a goal for the company, it is necessary to encourage employees to be motivated, such as through awards, career development, promotions, or incentives. The strategy that must be carried out by the management includes planning and career development for employees in the company. Career advancement is important because it can motivate and increase company loyalty (Putri 2018) .
Employee performance includes several things, including quality of work, initiative, promptness, communication, and capability. These five aspects are used as measures in the assessment of employee performance levels. Measurement of performance can be determined that to get a description of a person's performance, it is necessary to study the ability and motivation. The study also found that there was a positive relationship between achievement motivation and achievement s i. This means that managers who have high achievement motivation tend to have high work performance (Robbins and Judge 2015) .
A preliminary study conducted on February 7, 2022, at the Hospital Regional General Hospital (RSUD) Sukadana Lampung East obtained 133 implementing and structural nurses, which include Civil Servants (PNS), Regional Public Service Agencies (BLUD), and Voluntary Workers (TKS). Every year an assessment of the work performance of nurses is carried out. Data on the evaluation of the annual nurse attendance rate in 2020 is described as follows: Based on the table, in the year 2020, the highest employee in January was 86.32% due to the busyness of preparing and submitting annual reports. The lowest attendance was in June at 77.1%. This is in addition to the work discipline problem as described above, from the results of the interview questions other, namely the opportunity for achievement ranging from no appreciation for outstanding employees (exemplary employees), no rewards (study assignments to continue education) for outstanding nurses, only Jamsostek covered by the hospital.
Discipline and achievement opportunities support employee activities. The data on the percentage of work achievement in Sukadana Hospital, East Lampung, is as follows: Based on the description and background of the above problem, so the writer is interested in conducting a study entitled "The Relationship between Internal and External Characteristics of Nurses on Nurse Performance at Sukadana Hospital, East Lampung Regency in 2021 ". The purpose of this study is to determine whether or not there is a relationship between internal and internal characteristics on the performance of nurses at Sukadana Hospital, East Lampung Regency, in 2020. The researcher hopes that the results of this study can be used as a reference source by the government in making policies as well as a source of information for future researchers.

Performance (Work Achievement)
Performance can be defined as the quality or quantity of the achievements made by employees in carrying out various tasks and responsibilities (Mangkunegara 2019) . The performance of each employee will usually be assessed by a manager in order to determine the quality of work to be used as the basis for policy-making. Therefore, performance appraisal is an important thing to be done continuously (Sedarmayanti 2017) .
Performance appraisal refers to several indicators, namely goals to be achieved by an organization, standards as a step to achieve goals, and feedback used as a form of performance reporting to be used as consideration for policy making, tools or facilities, competencies, motives, and opportunities. Hersey, Blanchard, and Johnson (Wibowo 2016) formulate that there are seven factors that influence performance, namely the achieve model, which includes the ability ( knowledge and skill ), clarity ( understanding or role perception ), help ( organizational support ), incentive ( motivation or willingness ). , evaluation ( coaching and performance feedback ), validity ( valid and legal personnel practice ), and environment ( environmental fit ).
After being included in the assessment instrument, the performance will be carefully assessed. Performance appraisal is the process by which individual performance is measured and evaluated. Performance appraisals answer the question of how well workers are performing over a certain period of time. Performance appraisal is a formal method of measuring how well an individual worker performs a job in relation to a given objective. The main purpose of performance appraisal is to communicate personal goals, motivate good performance, provide constructive feedback, and set the stage for an effective development plan (Wibowo 2016) .
Regular job appraisals record measurements of employee performance, potential, and development needs. The assessment is an opportunity to take a thorough look at the work content, load, and volume, review what was achieved during the reporting period, and agree on further goals.
According to Williams (2007) in (Wibowo 2016) , performance appraisal is nothing more than a report card given by superiors to subordinates, a decision about professional adequacy or deficiency. In general, it shows what the weaknesses of subordinates are. Performance appraisal is more directed at the individual assessment of workers. Thus, performance appraisal is a process of assessing how well workers have carried out their duties over a certain period of time.

Work Discipline a. Definition of Work Discipline
Discipline is the sixth operative function of human resource management. Discipline is an important function because the better the employee discipline, the higher the performance achieved. Without employee discipline, it is difficult for organizations to achieve optimal results. Good discipline reflects a person's sense of responsibility for the tasks assigned to him. This encourages work enthusiasm, work enthusiasm, and the realization of company, employee, and community goals. Therefore, every manager always tries to make his subordinates have good discipline.
Discipline is a person's awareness and willingness to obey all company regulations and applicable social norms. Awareness is the attitude of a person who voluntarily obeys all the rules and is aware of his duties and responsibilities. Willingness is the attitude, behavior, and actions of a person in accordance with company regulations, both written and unwritten. Discipline must be enforced in a company organization. Without the support of good employee discipline, it is difficult for the company to achieve its goals (Wibowo 2016) b. Work Discipline Indicator Basically, there are many indicators that affect the level of work discipline of an organization's employees, including (Hasibuan 2021) : 1) Goals and abilities Goals and abilities also affect the level of employee discipline. The goals to be achieved must be clear and ideally defined as well as challenging enough for the abilities of employees. This means that the goals assigned to employees must be in accordance with their abilities so that they can work seriously and be disciplined in doing them.

2) Exemplary leadership
The leadership role plays a very important role in determining employee discipline because the leader is used as an example and role model by his subordinates. Leaders set a good example, are well disciplined, honest, fair, and according to words and deeds. With a good example, the discipline of subordinates will be good.

3) remuneration
The remuneration, in this case, is salary and welfare. This reward will give employees satisfaction and love for the company. A good love for work, the better the discipline will be. In realizing good discipline for employees, companies must provide relatively large remuneration. Employee discipline may not be good if the remuneration received is not satisfactory to meet the needs of life and its family.

4) Justice
Justice contributes to the realization of employee discipline because ego and human nature always feel important and ask to be treated the same as other humans. Justice that is used as the basis of wisdom in providing remuneration (recognition) or punishment will stimulate the creation of good employee discipline.

5) Attached supervision (Waskat)
Inherent supervision is the real and most effective action in realizing the discipline of the company's employees. Supervisors must be active and directly supervise the behavior, morals, attitudes, work passion, and achievements of their subordinates. This means that superiors must always be at work so that they can supervise and provide instructions if there are subordinates who have difficulty completing their work. Waskat is effective in stimulating employee discipline because employees feel they can be guided, directed, and supervised by their superiors.

6) Penalty sanction
Punishment plays an important role in maintaining employee discipline. Severe penalties will make employees more afraid of violating company regulations, thereby reducing disciplinary behavior. The severity or lightness of the punishment that will be applied also affects the good/bad discipline of employees. Punishment sanctions are determined based on logical considerations, make sense, and are clearly informed to employees.

7) Firmness
The firmness of the leadership in taking action will affect the discipline of the company's employees. Leaders must be brave and decisive to act to punish any employee who is not disciplined in accordance with the sanctions that have been set. Leaders who dare to act decisively in applying punishment to employees who are not disciplined will Page | 18 be respected and recognized for their leadership by subordinates. Thus the leadership will be able to maintain employee discipline.

8) Human relations
Harmonious human relations among fellow employees will create good discipline in a company. A good relationship, both vertical and horizontal, should be harmonious. Managers should strive to create an atmosphere of harmonious and binding human relations. The realization of harmonious human relations will create a comfortable working environment and atmosphere. This will motivate good discipline in the company.
c. Factors Affecting Work Discipline Leaders have a direct influence on the habitual attitudes that employees acquire. The habit is determined by the leader, either with the leadership climate or the personal self. According to Singodimejo (2000) (Sutrisno 2020) , the factors that influence employee discipline include: 9) The size of the compensation The size of the compensation can affect the enforcement of discipline. Employees will comply with all applicable regulations if they feel that they are guaranteed a lot of remuneration in accordance with the hard work that has been given to the company. 10) Is there an exemplary leadership in the company?
The role of exemplary leadership in the company is very influential on employee discipline. Employees will imitate the behavior of their superiors in everyday life. If a leader wants to enforce employee discipline, he must set an example for his subordinates. 11) Are there any definite rules that can be used as a guide?
Discipline development will be carried out if there are definite written rules that can be used as a common guide.
Discipline is impossible to enforce if the rules are made only based on verbal instructions that can change according to conditions and situations.

12) Leadership courage in taking action
If there is an employee who violates discipline, then there needs to be courage from the leadership to take action according to the level of the violation made. With action against disciplinary violations, employees will feel protected and will not repeat it. Leaders who do not dare to take action to punish employees who violate it will affect the work atmosphere in the company. 13) Is there leadership supervision? Supervision is carried out by the leadership because the leader knows best and is closest to the employees. This supervision is known as inherent supervision (waskat). At any level, a leader is responsible for carrying out inherent supervision so that the tasks assigned to employees do not deviate from those that have been set. 14) Is there any attention to employees?
Employees are human beings who have different characters from one another. An employee is satisfied when he gets high compensation, a job that is challenging and still requires attention from the leader. Complaints felt by employees want to be heard by the leadership and find a solution. Such leadership will be appreciated by employees, so it will affect the performance, morale, and work morale of employees. 15) Created habits that support the establishment of discipline Positive habits that can be created by leaders include mutual respect, compliments at work, involving employees in meetings, and telling each other when they want to leave the workplace.
d. Work Discipline Assessment Work discipline has an important role in increasing employee productivity. Work discipline must be instilled in every employee. Disciplinary activities are carried out to encourage employees to follow various standards and rules so that violations can be avoided. The main objective is to encourage self-discipline among employees to come to the office on time. That way, they will be able to carry out appropriate tasks and will increase employee work productivity (Sutrisno 2020) .

Career development
Every human resource employee, at the beginning of starting work, will continue to work until he/she enters retirement age; this means that he/she wants to pursue a career in the organization concerned. Departing from this assumption, it is a logical thing if in his work life someone asks about everything related to his career.
Career development ( career development ) is defined as an organized, planned effort comprised of structured activities or processes that result in a mutual career plotting effort between employees and the organization. However good a career plan that has been made by an employee accompanied by a reasonable and realistic career goal will not become a reality without systematic and programmatic career development.
Workers are the people who are most interested in career development because they are the ones who will enjoy the results, and this is one of the very fundamental principles of career development, although the interests of the organization also cannot be ignored.
There are several things that need to be considered in the context of career development, namely: 1) Satisfactory work performance 2) Introduction by the other party 3) Loyalty to the organization 4) Utilization of mentors and sponsors 5) Support from subordinates 6) Take advantage of opportunities to grow 7) Stop at your own request

Framework
Based on the description theory above, it can be assumed that when a nurse has the discipline and the opportunity to achieve high against her job, it will affect the nurse's performance. Therefore there are 4 (four) variables in a study consisting of three variables independent (free) and 1 (one) variable, dependent (bound).

Performance as a variable dependent (Y).
Framework thinking is a conceptual model about how theory relates to various factors defined as important. So could depict a framework thinking as follows:

A. Research Location and Time
This research was carried out at Sukadan A Hospital, East Lampung Regency, and data collection was taken in August 2022 after the SUR session.

B. Research Respondents
Respondents in this study amounted to 138 people who were selected by purposive sampling.

C. Data Collection and Analysis Methods
Data collection used observation, documentation, interviews, and questionnaires with a total of 45 statements with a measurement scale using the Likert scale The data obtained were analyzed in depth through various tests such as validity, reliability, univariate tests, bivariate tests, and regression tests. The results of the research will be presented in a transparent and real manner without any engineering.

D. Research Hypothesis
H hypothesis alternative submitted to study this which are as follows : Ha: 1. There is a relationship between age and the performance of nurses at Sukadana Hospital, East Lampung Regency, in 2021.

2.
There is a relationship between gender and the performance of nurses at Sukadana Hospital, East Lampung Regency, in 2021.

3.
There is a relationship between education and the performance of nurses at Sukadana Hospital, East Lampung Regency, in 2021.

4.
There is a relationship between income and the performance of nurses at Sukadana Hospital, East Lampung Regency, in 2021.

5.
There is a relationship between the length of work and the performance of nurses at the Sukadana Hospital, East Lampung Regency, in 2021.

6.
There is a relationship between work discipline and the performance of nurses at Sukadana Hospital, East Lampung Regency, in 2021.
There is a relationship between career development and the performance of nurses at Sukadana Hospital, East Lampung Regency, in 2021

Research Result
After analyzing the data using SPSS 17, the following results were obtained: Validity test The data above shows that 45 questionnaires have valid criteria and can be used to carry out research. This is because the value of r arithmetic> r table.

Reliability Test
A reliability test was conducted to determine the consistency of an instrument used in a study. If the results are reliable, it means that this instrument can be used in research and will obtain the same results even though they are used at different times. After the analysis, the following data were obtained: The data above shows that Cronbach's Alpha value is 0.995, which indicates that all instruments have a perfect level and can be used in research.

Univariate Test
The univariate test is used to find out information about all the variables used in the study, where this can be observed through frequency (Notoatmofjo, 2018). The following are the results of the univariate test analysis:

Relationship of Internal and External Characteristics of Nurses to the Performance of Nurses in RSUD Sukadana, Lampung Timur Year 2021
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Relationship of Internal and External Characteristics of Nurses to the Performance of Nurses in RSUD Sukadana, Lampung Timur Year 2021
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Relationship of Internal and External Characteristics of Nurses to the Performance of Nurses in RSUD Sukadana, Lampung Timur Year 2021
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Bivariate Test
A bivariate test is a test used to analyze the relationship between two variables presented in the form of a cross table or curve. The bivariate test in this study used the Chi-Square test using a significance limit of 5% or 0.05 and 95% confidence intervals. The results of the bivariate test are as follows: a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 6.41. a. 0 cells (.0%) have an expected count less than 5. The minimum expected count is 6.22.

Relationship of Internal and External Characteristics of Nurses to the Performance of Nurses in RSUD Sukadana, Lampung Timur Year 2021
Page | 28 a. 0 cells (.0%) have an expected count of less than 5. The minimum expected count is 6.41. a. 0 cells (.0%) have an expected count of less than 5. The minimum expected count is 6.41.

Regression Test
A regression test is used to determine whether or not there is an influence between variables, in this case, the variables of motivation, career development, and work discipline, on performance. The results of the study show the following data:   (Hastono 2014) because Cronbach's Alpha was 0.995, where the value was greater than 0.9. 3. The univariate test conducted in this study cannot be used as a conclusion (Notoatmodjo 2018) because it is only used to determine the characteristics of the variables studied. In the univariate test, several things were obtained, namely: a. Gender aspect. Gender in this study consisted of males and females where the percentage of males is denoted by number 1 and the female gender is number 2. Respondents in this study were 138, with 52.2% being male and 47.8% female. b. Age aspect. The results showed that nurses with more productive age than non-productive age with a percentage of 50.7%. c. Educational aspects. In this aspect, it is known that the majority of nurses have D3 nursing education, with a percentage of 62%. d. Income aspect. In this aspect, it is known that nurses with an income of 2,432,000 are more than nurses with an income < 2,432,000, with a percentage of 57.2%. The results of an interview with the head of the Sukadana Hospital, East Lampung Regency, it was found that the salary was adjusted to the weight and lightness of the work carried out, even though they were both nurses, but there were also some nurses who had dual duties or superior performance compared to others. e. In the aspect of the length of service, it is known that the difference between nurses who work more and less than 3 years is only 2%, with the highest percentage obtained by nurses with less than 3 years of work, namely 50.7%. f. Motivation is an urge to do an action; in this case, motivation is encouragement or support from within the individual to provide good performance. The results of the univariate test showed that the average motivation possessed by nurses at Sukadana Hospital was at a value of 70. g. Work discipline is compliance with applicable rules (KBBI, apk). In the aspect of discipline, it is known that nurses at Sukadana Hospital are at an average value of 70. This is evidenced by the lack of discipline scores of nurses from the expected number, which is 100%. Differences in research results can be influenced by several factors, both internal and external because the results of observations show that non -productive age is not always weak in performance, not even a few nonproductive age who still do work with enthusiasm. This is also similar to an interview with the nurse manager at Sukadana Hospital that nurses of an age who are considered unproductive are, in fact, still agile and even more experienced in handling patients. b. In the aspect of gender, it is known that gender has no effect on a person's performance because of the value of Sig>0.05. This is to the results of research conducted by Raden ROK Soepardjo et al., 2017 that gender and performance have no relationship. Researchers are of the view that every human being of any gender can give the best performance in every job. c. In the aspect of education, it is known that the level of education does not affect the quality of performance carried out by nurses. As a result of the observation that whatever level of education each nurse at Sukadana Hospital has, they must always provide the best performance so that visitors feel comfortable and safe. d. In terms of income, it is known that this aspect has no effect on the performance of nurses because regardless of the income they receive, they will still be given direction to do the best performance, although this result is different from research conducted by Imas Trimayanti and Elly Herawati that opinion has an influence on employee performance at PT Asia Citra Pratama Karawang because it has a relationship with job satisfaction (Imas Trimayanti and Elly Herawati, 2016) e. The length of work aspect gets the value of Sig. >0.05, then there is no relationship between the length of work with the performance provided by the nurse. In an interview with TY, a nurse who has worked for more than three years, she stated that even though she has been working for a long time, she is still able to provide the best performance, such as discipline in work, responsibility, and so on.
5. The regression test shows that there is a positive and significant influence between motivation, career development, and work discipline on the performance of nurses, with a fairly high percentage of influence, namely 69.2%. This is similar to research conducted by Soepardo et al. that motivation has an influence on the performance of the nurses in RSJ Prof. DR. VL Ratumbysang, North Sulawesi Province (Soepardjo et al., 2017).
With this, it is known that extrinsic and intrinsic characteristics have an influence on the performance of nurses at Sukadana Hospital, West Lampung, with a fairly high percentage of 69.2%. Internal characteristics, such as motivation possessed by employees, while external characteristics, such as discipline culture, where discipline can be built through organizational culture. While the characteristics of age, gender, income, education, and length of work have no relationship or relationship with the performance given by nurses.

Conclusion
The services provided by nurses to all visitors have a close relationship with the value and performance of the hospital in the eyes of the patient. Therefore, nurses must have the ability and good quality to be able to give the best performance so that patients and visitors feel satisfied.
The hospital must also pay attention to various characters that can affect the performance of nurses, such as motivation, opportunities for career development, and work discipline; where this can be created by the existence of an organizational culture that begins with an assessment of the performance of nurses by hospital nurse managers. In contrast, the characteristics of age, salary or income, education, and length of work did not provide a relationship or link with the performance carried out by nurses at Sukadana Hospital, East Lampung.
Therefore, the researcher hopes that the results of this study can be used as a reference to improve the performance of nurses at Sukadana Hospital, which is carried out through various programs as hospital policies.
It does not stop here; the researcher also hopes that all nurses in any hospital can provide the best performance as a service to their place of work as well as service to the country as promised so that people become comfortable and can restore health quickly and accurately.
Funding: This research received no external funding.