ANALYSIS OF NURSE'S JOB SATISFACTION BASED ON INTERNAL SERVICE QUALITY MEASUREMENT

Nurses who are considered by the hospital to be able to provide maximum health services to patients so that they can increase patient satisfaction. This research was conducted to analyze the job satisfaction of nurses based on Internal Service Quality in the inpatient installation of RSI A. Yani Surabaya. The study was conducted with an observational analytic design and cross-sectional approach. The study population was the nurses in the inpatient installation of RSI A. Yani Surabaya, a total of 104 nurses. The sample size was 78 nurses who were spread in each inpatient room of RSI A. Yani Surabaya. The method of sampling using simple random sampling. Data analysis was performed using binary logistic regression test. The results showed that 98.7% of nurses rated internal service quality as good and 64.1% of nurses said they were satisfied. Based on the statistical test, it was found that the value of p=0.999 (> 0.05), which means that internal service quality has no significant effect on job satisfaction of nurses. However, based on the aspect of internal service quality, the aspects of tools and reward and recognition can provide an almost significant effect on job satisfaction of nurses. Provision of tools has 9.23 times less risk of dissatisfying nurses than providing good tools. Likewise, giving rewards and recognition that was less likely to have a 3.34 times risk of making nurses dissatisfied compared to giving good recognition.


Introduction
The hospital is a health service facility that is obliged to meet the Minimum Service Standards, shows appropriate services, and encourages continuous improvement of quality and service quality (Jannah, 2016). The quality of hospital services depends on the management of its resources. One of the main supporting resources in the hospital is the quality of internal services as a form of health service providers. Human resources are a very determining element in providing satisfying services to customers (Zeithaml & Bitner, 2000).
Improving the quality of services in a hospital must be balanced with the human resources needed to support the implementation of health efforts. Various types of health workers with their respective scientific fields interact with each other to provide health services in a hospital, including nurses. Most of the health workers in the hospital are nurses.
Nursing services can be provided effectively to patients and families if managed properly. Efforts to provide quality nursing services will be determined by good cognitive, affective, psychomotor abilities in carrying out management and leadership functions (Sutarni, 2008). The quality of nursing service quality in the hospital depends on the skills, speed, ease, and accuracy in carrying out nursing practice actions (Supriyanto & Wulandari, 2011).
Good and bad services in the hospital are often seen from the knowledge, skills, independent and professional attitude of a nurse.
Workers who have worked will get a reward or compensation following the energy and thoughts issued. Every human being has a desire to fulfil needs which in time form the goals to be achieved and fulfilled (Hidayat, 2015). Therefore, every human being needs a job to make ends meet, one of which is by working in a company.
A hospital cannot be separated from its workforce, because labour is a very important element in a hospital as the executor of health service activities that run in the hospital. Labour in a hospital is always involved in every management and operational process in the hospital, the relationship between compensation and workforce performance is very significant. The higher the workforce satisfaction will increase work motivation in achieving high performance in a workforce (Moeheriono, 2012).
Improved service to patients encourages hospitals to increase employee satisfaction as an effort to motivate to improve employee performance. Good service quality to employees has a great impact on customer satisfaction (Sharma, et al., 2016). Nursing personnel are human resources who play an important role in a hospital because they must provide services 24 hours a day. RSI A. Yani Surabaya is a type B public hospital which has the highest number of personnel with the number of nursing staff, amounting to 183 nurses consisting of 111 permanent employee and 72 contract employees.
Nurses at most and often interact in providing services to patients. Therefore, to assess the performance given by nurses, first, we observe how the level of job satisfaction is felt by nurses. Based on a preliminary study with a questionnaire at RSI A. Yani Surabaya, it was found that most of the nurses (58.7%) were not satisfied. Most dissatisfaction occurred because of their job (56.0%), salary (84.0%), career promotion (56.0%) and co-workers (64.0%). The high level of job dissatisfaction with nurses can cause nurses' motivation declined so that it can affect the quality of health services provided to patients.
Based on the background described, the purpose of this study is to analyze the effect of internal service quality on job satisfaction of nurses in the Inpatient Installation of RSI A. Yani Surabaya.

Method
This study used an observational analytic design using a cross-sectional approach. The population in this study were all functional nurses who served in the inpatient room of RSI A. Yani. The total population of nurses is 104 people. The sample in this study was 78 nurses who served in the Inpatient Installation of RSI A. Yani Surabaya, namely the Shofa-Marwah, Muzdalifah-Tan'im, Multazam, Mina, Hijr Ismail, Makkah, and Madinah rooms with the criteria of being permanent and contract employees, and has been working from ≤ 1 year. The sampling method was using a simple random sampling technique.
The variables in this study consist of internal service quality as an independent variable, which consists of tools, policies and procedures, teamwork, management support, goal alignment, effective training, communication, reward, and recognition. Then the job satisfaction variable as the dependent variable, which consists of the job itself, job promotion, salary, supervision, and co-workers.
Data collection was carried out using a questionnaire. Before the questionnaire is distributed to obtain data, the questionnaire is tested for validity and reliability. How to test the validity by calculating the pearson correlation coefficient. The question item is said to be valid if r count> r Table. The reliability test uses the Cronbach Alpha test which only requires one measurement.
A reliable or consistent measurement scale should have a Cronbach Alpha value of at least 0.7 (Uyanto, 2009). The results of the validity test showed that the internal service quality questions (30 items) and the nurse's satisfaction questions (25 items) had a value of R count> R table (0.396). The value of R table 0.396 is obtained based on the number of respondents 25 people and at a significance level of 5%. The results of the reliability test of the two variables showed a Cronbach Alpha value> 0.7. Meanwhile, to analyze the influence of Internal Service Quality on job satisfaction using linear regression with the help of the SPSS.

Respondent Characteristics
The characteristics of nurses in this study can be seen from the age, sex, length of work, education, employment status, and marital status of nurses at RSI A. Yani Surabaya.
RSI A. Yani Surabaya has human resources, especially nurses, to run health services properly. Each nurse has different individual characteristics. Nurse characteristics can affect performance. According to Robbins (2009), individual characteristics can be seen from age, gender, marital status, work experience, and several dependents. Based on Table 1 above, it can be informed that the nurses in this study were mostly (60.3%) aged 21-27 years. This shows that most of the nurses are still young and in their productive period at work. Almost all nurses (83%) are female. This illustrates that the nurses at RSI A. Yani Surabaya are dominated by women.
Most of the nurses (61.5%) have worked between 0-4 years. This shows that most of the nurses have not been worked at RSI A. Yani Surabaya long. Meanwhile, the level of nursing education consists of Diploma level (50%) and Bachelor level (50%). This shows that the nurses at RSI A. Yani have high education. Health workers require high educational qualifications. The higher the last level of education of a nurse, the higher the quality of the nurse's human resources.
Most of the nurses (53%) employment status are included in contract employees. This is since there are still many new nurses working at RSI A. Yani, so they still have employee status as contract employees. As for marital status, most of the nurses (55%) were married. This is because many nurses are old enough to get married.

Internal Service Quality Measurement
The results of respondents' assessment of internal service quality are measured based on the theory of Hallowell, et al. (1996) which consists of tools, policies and procedures, teamwork, management support, goal alignment, effective training, communication, reward, and recognition. The following is the distribution of internal service quality measurements at RSI A. Yani.  Hallowell, et al. (1996) stated that internal service quality is an activity that aims to make employees get job satisfaction with the services they receive from management. Service quality is important, and the importance of this quality depends on the details of the tasks of the organization and its employees. More specifically, it can be interpreted that before the organization improves the quality of external services to customers, it must first serve the needs of the organization internally, namely employees.
Based on table 2, it can be informed that the overall quality of internal services has received a good assessment from almost all nurses. Meanwhile, if observed in every aspect, the aspects of effective training, communication and reward and recognition received good ratings by most nurses. Meanwhile, the quality of internal services in the aspects of tools, policies and procedures, teamwork, management support and goal alignment received good ratings by almost all nurses.
The results of the interpretation of table 2 above, when referring to the reading of the 20:80 Pareto Principle, can be informed that the quality of internal services in the aspects of tools, effective training, communication and reward and recognition is still in the poor category because the percentage value for good directions has not reached 80%. Thus, the four aspects of the service must be immediately revamped to improve service quality. It can be argued that the Pareto Principle is a very effective way of helping determine areas where agencies need to focus resources and efforts for maximum efficiency. This rule emphasizes agencies to be able to focus on the most important 20% that is responsible for producing the other 80% of the results. The explanation of each aspect is followed:

Tools
Most of the nurses assessed that internal service quality based on the tool's aspect was good. This shows that the existing equipment to support services and activities is adequate. Wang (2012) stated that many scholars believe that organizations should improve the quality of internal services and it is very important for organizations to provide adequate tools to provide good external services.

Policies and Procedures
Almost like a whole, the nurses considered that internal service quality based on the aspects of policies and procedures was good. This shows that the policies and procedures in RSI A. Yani Surabaya are good and can be accepted by nurses. Good work policies and procedures can provide satisfaction to employees so that they can improve the work ability of nurses (Indrayanti, et al., 2012).

Teamwork
Almost as a whole, the nurses rated the internal service quality based on the teamwork aspect as good. This shows that the nurses' cooperation at RSI A. Yani is good. The contribution of every employee in an organization as a team and mutual concern and responsibility for the work to completion is very important to do. One of them is the hospitals. Hospital management can become a facilitator for the establishment of a cooperative relationship between medical personnel by implementing systems or policies that regulate interactions between various health professions, such as integrated recording of patient health data and checking patients together (Malahayati, et al., 2013).

Management Support
Almost overall nurses assessed that internal service quality based on the management support aspect was good. This shows that management support is good for nurses at RSI A. Yani Surabaya. According to Hidayat & Laily (2017), the role of management is very important, such as helping employees when they encounter problems, providing accountable permits or leave, and good communication between leaders and employees. This can make the quality of internal service to employees to develop properly.

Goal Alignment
Almost as a whole, the nurses rated the internal service quality based on the goal alignment aspect as good. This shows that the goals at RSI A. Yani Surabaya are good and in line with nurses. Organizations must provide good internal service, one of which is a consistent goal so that employees can provide good service to customers (Wang, 2012). Every organization must have goals following employees and organizations so that the services provided to customers can be maximized.

Effective Training
Most of the nurses assessed that internal service quality was based on the aspect of effective training as good. This shows that the training at RSI A. Yani Surabaya is quite good. Effective training in every organization needs to be done to improve the quality of employee performance. Each organization can create justice and openness in its work environment, for example by providing training and guaranteed career development for its employees (Malahayati, et al., 2013). Internal service quality has aspects that support internal service quality to develop better and more satisfactorily. One of them is by giving equal opportunities to employees to get education and training according to their field of work (Hidayat & Laily, 2017).

Communication
Most of the nurses assessed that internal service quality based on the communication aspect was good. This shows that the communication between nurses and nurses and their superiors is good enough. Every hospital needs communication to create effective collaboration, this needs to be supported utilizing communication that can provide and compile patient health data comprehensively so that it becomes a source of information for all team members in making health service decisions or actions (Malahayati, et al., 2013). Organizations must consider employees to be customers so that organizations prioritize employee needs by identifying employee expectations, one of which is the development of information communication (Susanti, 2018).

Reward and Recognition
Only half of the nursing staff rated internal service quality based on the aspects of reward and recognition as good. Compensation that employees feel is unfair can reduce the quality of the employee's work so that it affects his service to customers. Organizations must treat their employees fairly, for example by providing a decent salary and following the performance of their employees, and providing rewards for employees (Malahayati, et al., 2013). Organizations can improve the quality of their employees' performance by providing rewards, incentives, and empowering employees to make decisions without assistance from the leadership (Chung, et al., 2012).

Nurse Satisfaction Measurement
The results of the respondent's assessment of nurse job satisfaction are measured based on the theory of Smith, et al. (1969) which consists of the job itself, job promotion, salary, supervision, and co-workers. The following is the distribution of nurses' job satisfaction assessments at RSI A. Yani. Job satisfaction in this study is the feeling of satisfaction or dissatisfaction of nurses with their work including the work itself, promotions, salaries, supervision, and co-workers. Based on table 3, it can be informed that the job satisfaction of nurses on the salary aspect is poorly rated by most of the nurses. Meanwhile, nurses' job satisfaction with the aspects of the job itself, promotion, supervision, and co-workers received good ratings by almost all nurses.
The results of the interpretation of table 3 above, if referring to the reading of the 20:80 Pareto system, can be informed that the overall job satisfaction of nurses is still not good with a percentage of 64.1% (<80% Pareto). Meanwhile, if it is observed from each aspect, the job satisfaction of nurses on the aspects of promotion and salary is still in the poor category because the percentage value for the good direction has not reached 80%. The explanation of each aspect is followed: The work itself Almost overall, the nurses gave a satisfying assessment of the work itself. This shows that the nurses at RSI A. Yani Surabaya feel happy with their work, are quite challenging, do not cause boredom and do not cause frustration. Nurses who are satisfied with their work will love their work and see it as fun. On the other hand, if the nurse is not satisfied with their job, then the nurse will consider their job to be boring (Yayah & Hariyati, 2015).

Promotion
Almost overall, the nurses gave a satisfying assessment of the promotion. This is because the nurses are satisfied with the job promotion they get. However, there are still nurses who are not satisfied with the job promotions they get. Job promotion for nurses has a positive impact on job satisfaction. Opportunities for promotion for employees can make employees feel more valued and cared for so that employees feel more comfortable in the organization (Silaban & Andri, 2018).

Salary
Most of the nurses considered that they were not satisfied with the salary or income they received. This shows that the nurse feels that the salary or income received is not enough to satisfy him. Some argue that the satisfaction made possible by the differences in individual character. Giving fair and proper salaries to employees can increase job satisfaction (Wolo, et al., 2015). The provision of a decent salary can satisfy employees because employees can meet the needs of themselves and their families or dependents. Supervision Almost overall nurses gave a satisfying assessment of supervision. Nurse productivity can be increased through effective supervision through good work implementation, providing real instructions following work standards, and other supports (Wirani, et al., 2017).

Colleagues
Almost overall nurses gave a satisfied assessment of their colleagues. This is because the relationship between colleagues is well established. According to Wuryanto (2010), working people are not only looking for money but also looking for colleagues to meet social interaction needs so that meeting friendly and cooperative colleagues can increase job satisfaction. Friendly and supportive co-workers can increase employee satisfaction. Warm or harmonious relationships or interactions will be able to create employee job satisfaction. This opinion strengthens that RSI A. Yani Surabaya has succeeded in creating a conducive work environment for every employee.
Therefore, several aspects of job satisfaction of nurses who received a poor rating, or it is undeniable that for all aspects of nurse satisfaction, must get attention from the management so that they can be further improved so that they have an impact on improving the quality of nurse performance.
The Influence of Internal Service Quality on Nurse Satisfaction The influence of internal service quality based on aspects of tools, policies and procedures, teamwork, management support, goal alignment, effective training, communication, and reward and recognition on nurse satisfaction was analyzed using binary logistic regression tests. Following are the results of the influence of internal service quality on nurse satisfaction at RSI A. Yani Surabaya. Based on table 4, it can be seen that the overall internal service quality has no significant effect on nurse job satisfaction. The statistical test results obtained p-value=0.999 (p>0.05). Meanwhile, if partially analyzed based on aspects of internal service quality, the provision of tools could have a near significant effect on nurse job satisfaction (p=0.083). Inadequate provision of tools has a 9.23 times risk of making nurses dissatisfied with the provision of good tools. Likewise, the aspect of reward recognition had a near significant effect on nurse job satisfaction (p=0.069). Giving fewer recognition rewards has a 3.34 times risk of making nurses dissatisfied compared to giving good recognition.
The results showed that several aspects of good internal service have a good proportion of satisfaction or it can be said that nurses who are in organizations with good internal service tend to experience high job satisfaction. The results of this study indicate that internal service quality which is assessed from the aspects of tools, policies and procedures, teamwork, management support, goal alignment, effective training, communication, and reward and recognition as a whole is in a good category. This shows that the internal services of the organization which are assessed from several aspects, such as tools and reward and recognition, are quite capable of influencing nurses' job satisfaction. The better the provision of aspects in internal services at the hospital, the higher the level of job satisfaction of nurses.
The results of this study are not following previous research on the effect of internal service quality as a whole with job satisfaction. One of the studies conducted by Wang (2012) shows that there is a significant influence between internal service quality and job satisfaction. Besides, in a study conducted by Sharma, et al. (2016) show that there is a positive influence between internal service quality and job satisfaction. Other studies on the effect of internal service quality on job satisfaction by Safdar, et al. (2014) stated that there is a significant influence between internal service quality and job satisfaction. This shows that one of the factors that influence job satisfaction is internal service quality. However, in this study, overall internal service quality did not have a significant effect on nurses' job satisfaction.
Meanwhile, based on the research results, if analyzed on every aspect of internal service quality, it can be seen that not all aspects of internal service quality affect nurse job satisfaction. Aspects that have almost a significant effect on job satisfaction are the tools, reward and recognition aspects. This research is following research conducted by Indrayanti, et al. (2012), that the aspects of tools and reward and recognition have a positive influence on job satisfaction.
Job satisfaction can be influenced by several factors, including organizational policy factors, leadership, organizational culture, hospital location, competitor hospitals, and family. In this case, internal service quality is one of the factors that influence job satisfaction of nurses at RSI A. Yani Surabaya. Therefore, it is necessary to increase the internal service quality at RSI A. Yani Surabaya because there are still nurses who think that the internal service quality at RSI A. Yani Surabaya is still not good.

Conclusion and Suggestion
The conclusion obtained in this study is that almost all nurses assess the internal service quality at RSI A. Yani Surabaya is good. However, only most nurses expressed satisfaction. Statistically, it shows that the overall internal service quality has no significant effect on nurses's job satisfaction. However, if it is observed from the aspect of internal service quality compilers, only the aspects of tools and reward also recognition have an almost significant effect on job satisfaction on nurses.
Suggestion that can be given are that it is necessary to evaluate regularly and continuously to assess the internal services received by nurses and to periodically evaluate the performance of nurses. Evaluation can be done at least 2 times a year.

Acknowledgments
Our gratitude goes to the S1 Public Health study program, LPPM and Nahdlatul Ulama University Surabaya for the opportunity, support, and motivation in publishing this scientific work. And thanks to the respondents and RSI A. Yani who have given the opportunity and permission to research.