{'fraction_non_alphanumeric': 0.031275833562965004, 'fraction_numerical': 0.017222375310002754, 'mean_word_length': 5.2465576592082614, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 1, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
THE RELATIONSHIP OF EMOTIONAL INTELLIGENCE, WORKPLACE CULTURE, AND NURSE PERFORMANCE IN A PRIVATE HOSPITAL IN MEDAN INDONESIA

DOI: https://doi.org/10.33546/bnj.1063 Abstract Background: Nurse performance plays an important role in ensuring high quality care to achieve patient outcomes in hospitals. Therefore, factors related to the performance warrant investigation. Emotional intelligence and workplace culture are assumed to be related to nurse performance. Objective: To determine the relationship of emotional intelligence, workplace culture, and nurse performance at one of private hospitals in Medan Indonesia. Methods: This study employed a cross-sectional design with 126 associate nurses who were selected using a simple random sampling technique. Emotional intelligence, workplace culture, and nurse performance were measured using valid questionnaires. Spearman-Rank correlation test was used for data analysis. Results: Majority of nurses had high performance, emotional intelligence and workplace culture. There were significant relationships between emotional intelligence, workplace culture, and nurse performance, with a strong (r= .68; p= .01) and medium level (r= .30; p= .01), respectively. Conclusion: Nurses with high emotional intelligence and good workplace culture would show good performance in providing professional nursing care to patients. It is recommended for the hospital managers and nurse managers to improve emotional intelligence of nurses and create better workplace culture in order to improve the nurse performance.


BACKGROUND
Nurse performance is one of the current issues in health service today. It describes a consequence of people's demands on the need for highquality services, which can be achieved by increasing efficiency and effectiveness. Hameed and Waheed (2011) reported that organizational success or failure, particularly in hospitals, depends on nurse performance. Success can be achieved by improving the quality of service and meeting the stipulated requirements by taking into account social values in the community. De Oliveira Toso, Filippon, and Giovanella (2016) conducted a study on the performance of nurses in primary health care centers in the UK. The results reported that nurses performed the tasks following their roles, such as consultation, monitoring chronic conditions of patients, conducting comprehensive communication, and providing care.
Work performance represents the real work of the employees, which can be measured and should be based on the standard of work in an organization (Suroso, Cherntanomwong, Sooraksa, & Takada, 2011).
The standard of nursing practice in Indonesia has been developed by the Indonesian National Nurses Association (INNA) in 2005, which aims to improve nurse performance particularly in hospitals. But, despite the existence of the standard, low nurse performance is still identified. Maimun and Yelina (2016) found that 53.4% of nurse performance at one of hospitals in Indonesia was in a low category.
There have been many factors influencing nurse performance in hospitals, such as salary, human resource management, work culture, emotional intelligence, and others (Gunawan, 2019). However, their relationships remain inconsistent. In this study, we focus on emotional intelligence and work culture that are considered important factors on nurse performance.
Various dynamic situations occurring in the area where nurses work today have a significant influence on the nurses' emotions. Nurses are often encountered with problems in the workplace, such as criminal charges, inability to communicate effectively with patients, and rejection to criticism from others. Such incidents may serve as indicators of low emotional intelligence among the nurses. In fact, Bakr and Safaan (2012) reported that the emotional intelligence of nurses at Shebin El Kam University Hospital in Egypt, on average, was in a low category. Similar with Indonesia, Mangkunegara (2010) reported that the majority of nurses in Indonesia have low emotional intelligence, which will lead to low performance of nurses. This is also described by AlHamdan, Manojlovich, and Tanima (2017) who conducted a study on registered nurses in Jordanian hospitals and reported that there was a relationship between emotional intelligence and nurse performance in hospitals. However, nurses are demanded to have good emotional intelligence, which is the basis of how successful or unsuccessful a person or company is in providing excellent service (Daniel Goleman, 2015).
Similar with emotional intelligence, workplace culture is believed to be related with nurse performance and patient outcomes (Hesselink et al., 2013;Manojlovich & Ketefian, 2016). Culture has been defined in numerous ways. It can be defined as consistent practices, beliefs and attitudes, within a whole group or a specific group (Braithwaite, Herkes, Ludlow, Testa, & Lamprell, 2017). As there is a dearth of study discussed about the relationship between emotional intelligence, workplace culture, and nurse performance in Indonesia, therefore, this study aimed to determine their correlations in the hospital setting in Indonesian context. This study would be benefit for nurse managers to improve the nurse performance in the hospitals beyond Indonesia.

Study Design
This study employed a correlational design, which aims to find out the relationship of two or more variables, in which the collection of data is carried out at one time, and there is no follow-up (Polit & Beck, 2010).

Participants
The population in this study was associate staff nurses at inpatient wards of Mitra Medika Hospital, Medan Indonesia amounted to 196 nurses. The sample was 126 nurses recruited using a simple random sampling technique. The calculation of the ample size based on a study of Farshi, Vahidi, and Jabraeili (2015) using (1-β) = .80, effect size (γ) = .25 and α = .05. The inclusion criteria of the participants were associate nurses who have educational background at least diploma degree in nursing and working at inpatient wards.

Instruments
There are three instruments used in this study: 1. Emotional Intelligent Questionnaire (EIQ) was used to measure emotional intelligent of nurses. It is modified from Schutte, Malouff, and Bhullar (2009). The questionnaire consisted of 32 items and 4 domains (emotional perception, emotional integrity, emotional understanding and emotional regulation). The answer was rated on five-point Likert scale (5=strongly agree, 4=disagree, 3=not agree, 2=agree, 1=strongly disagree). The EIQ was translated from the original English version to an Indonesia version for conceptual equivalence across the languages by using three translators. The EIQ was valid and reliable with good content validity index (.94) and acceptable value of Cronbach's alpha (.81). 2. Work Culture Questionnaire (WCQ) was adopted from Kennerly et al. (2012) which aims to assess the workplace culture of nurses. This questionnaire consisted of four components including behavior, team work, communication, satisfaction and responsibility. There were 30 items in this questionnaire using dichotomous choices. The WCQ was originally developed in the English language and already translated using the back-translation technique. The CVI of the instrument was .94 and the internal consistency was .85. 3. Indonesian version of the Nurse Performance Questionnaire (NPQ) was used to measure the performance of nurses at hospital. It was developed by Ilyas (2002) that consisted of 20 items using dichotomous options. The NPQ includes work achievement, responsibility, obedience, and collaboration. The internal consistency of NPQ was .83 and content validity index of .92.

Data Collection
Data were collected by the researchers using the questionnaires at Mitra Medika Hospital Medan on December 2018. There were no research assistants during data collection.

Data Analysis
To find out the relationship between the variables of this study, the Spearman's rank correlation was used. There would be a relationship between the variables if the p-value was <.05 (Polit & Beck, 2010). The data showed that there was no normal distribution of the variables and the scale level was ordinal.

Ethical Consideration
Ethical clearance was obtained from the Research Ethics Commission of the Faculty of Nursing Universitas Sumatera Utara (No.1601/XII/SP/2018). The researchers explained clearly about the objectives of the study and provided information to each participant that they had the right to choose whether to participate or not in the study. Each participant was asked to sign an informed consent. Table 1 shows that majority of participants aged 21-30 years (80.95%) and female (72.22%). Most of them had work experience of 1-5 years (96.03%), and majority had educational background of Diploma degree in Nursing (69.05%).  Table 2 shows that all participants had high emotional intelligence. Of the total participants, 89.68% had high level of workplace culture and 10.32% had low level of workplace culture. In regards to the nurse performance, 87.30% showed high level of performance in carrying out their duties as staff nurses while 12.70% showed low level of performance.  Table 3 shows that there was a positive and strong relationship between emotional intelligence and nurse work performance (r=.68, p=.001). In addition, there was a positive and medium relationship between workplace culture and nurse work performance (r=.30, p=.001).

DISCUSSION
The aim of this study was to determine the relationship between emotional intelligence, workplace culture, and nurse performance. Findings of this study revealed that there was a significant correlation between emotional intelligence, workplace culture, and nurse performance, with a strong and medium level. These findings were in line with AlHamdan et al. (2017) who revealed the correlation between emotional intelligence and nurse performance, and in line with Hesselink et al. (2013); Manojlovich and Ketefian (2016) in regards to the relationship between workplace culture and nurse performance.
The emotional intelligence of nurses in this study was also in a good category, which is therefore positively related to better nurse performance. The emotional intelligence is very important factor for nurses in their duties because various problems and challenges that they may encounter in the workplace, such as workload, work demands, environment or work atmosphere and problems related to other people. Such problems require good management that does not harm many parties. To be able to deal with those, a nurse is required to have the ability to be aware of self-emotion, control emerging emotions, and motivate themselves (AlHamdan et al., 2017). D. Goleman (2009) stated that good emotional intelligence plays more critical roles than any other intelligence in general as it provides a significant influence to achieve a successful career and performance. A study conducted by Rankin (2013) claims that emotional intelligent would scale up theirs' clinical practice performance. Therefore, it is necessary to have high emotional intelligence so that professional nurse performance can be achieved. Otherwise, low emotional intelligence indicated as unplanned and unanticipated actions, feelings of anger, impatience, less sensitive to others, and unable to appreciate or empathize lead to poor performance of the nurses (Paomey, Mulyadi, & Hamel, 2016).
Besides, workplace culture in our study was also in good category and therefore it had a significant positive relationship with nurse performance. This is in line with Sangadji and Sopiah (2013) said that the better the workplace culture, the better the performance of the members of the organization will be. It is because the purpose of the employees for joining and working in an organization is not only to get financial needs but also to work in a comfortable and good situation. Workplace culture is an organizational value, which interacts and becomes a norm serving as guidelines for achieving the organizational goals. Hence, workplace culture helps unite the organization in making the right standards.
In this study, the workplace culture becomes a norm that guides nurses in carrying out their duties or establishing interactions with other people in the hospital. The creation of the workplace culture which directs nurses into good work ethics and produces good quality work is influenced by several factors. These factors include the integrity of the nurses, namely the socialization skills, discipline in carrying out regulations, ability in promoting the vision and mission of the organization, and honesty in expressing ideas and thoughts. Other factors are professionalism, which includes corrections of work, fair competition, and respect for work outcomes (Simamora, Purba, Bukit, & Nurbaiti, 2019). Support from the management personnel is also an important factor that encourages the creation of work culture, such as paying attention to nurses' welfare, taking care of nurses' needs for the work, and support of inventory vehicle for work outside the office (Simamora et al., 2019). However, these factors should be confirmed in the future studies.
The implications of this study are that the hospital managers and nurse managers should be able to improve emotional intelligence of nurses and create better workplace culture to improve the performance of nurses in implementing their duties. Proper management of emotions makes an individual work better (Paomey et al., 2016). In addition, this study provides the insight of knowledge that the nurse performance in Indonesian context was influenced by their emotional intelligence and workplace culture. The limitation of this study might include the limited setting. Therefore, the results of the study might not be able to generalize in the whole context. Bigger and equal sample size should be used for future studies.

CONCLUSION
Majority of nurses had high performance, in line with high emotional intelligence and better workplace culture. There were significant relationships between emotional intelligence, workplace culture, and nurse performance, with a strong and medium level. The results of this study could be used as an input in the attempts of improving nurse performance through emotional intelligence and workplace culture specifically in hospital settings.

Declaration of Conflicting Interest
There is no conflict of interest.

Funding
None.