Effect Of Quality Of Work Life On Work Stress, Mental Health, Organizational Citizenship Behavior, And Performance Of Inpatient Nurses In Muhammadiyah Hospitaltype D East Java

Research related to the relationship between QWL, work stress, mental health, OCB and nurse performance in the type D Muhammadiyah Hospital network in East Java. Based on the problems, phenomena that occur in hospitals today as well as literature studies, researchers examine and analyze the effect of the QWL variable on the performance of inpatient nurses in the type D Muhammadiyah Hospital network in East Java. The population of this study were all nurses with the status of nurses in Muhammadiyah hospital type D, East Java. The sampling technique was saturated sample. The sample of this study was the entire population of nurses with the status of nurses who served in the inpatient room. This study was analyzed using the Partial Least Square method. The results of this study are QWL has a significant and positive effect on the performance of inpatient nurses in the Muhammadiyah type D hospital network in East Java; QWL has a significant and negative effect on the work stress of inpatient nurses in the Muhammadiyah type D hospital network in East Java; QWL has a significant and positive effect on the mental health of inpatient nurses in the Muhammadiyah type D hospital network in East Java; Job stress has a significant and negative effect on OCB of inpatient nurses in the Muhammadiyah type D hospital network, East Java; Mental Health has a significant and positive effect on OCB of inpatient nurses in Muhammadiyah type D Hospital, East Java; QWL has a significant and positive effect on OCB of inpatient nurses in the Muhammadiyah type D hospital network in East Java; OCB has a significant and positive effect on the performance of inpatient nurses in the Muhammadiyah type D hospital network in East Java.


INTRODUCTION
Good nurse performance will have an impact on the quality of services in hospitals, have an impact on patient safety and also have an impact on patient and family satisfaction. Conversely, if the performance of nurses in hospitals is not good, it will have a real impact on the quality of hospital services such as poor service quality, low patient safety levels, and will also have an impact on low patient and family satisfaction levels as well. Until now, the performance of nurses still needs to be improved considering that there are still frequent patient complaints related to dissatisfaction with the services received. Complaints related to dissatisfaction with hospital services often occur, including complaints related to nursing services. Complaints that occur related to dissatisfaction with nursing services will give rise to the opinion that hospital services are not good or of poor quality.The factors that cause or affect employee performance are listed in various literatures and research results, including according to Pentury et al., (2010), stating that the factors that affect performance are work ability, work motivation, performance appraisal, compensation, environment work, organizational citizenship behavior, and commitment. Mathis and Jackson (2010: 97), say that the factors that influence performance include the support received, the existence of the work being done, the relationship with the organization, and empowerment. The factors that affect performance according to Pentury and Mathis are summarized in the quality of work life (QWL). Researchers chose the QWL variable as a variable that affects performance because in the hospital environment the indicators that exist in this variable cover all dimensions that employees perceive to be able to meet their work quality needs. Previous studies and studies have not found any differences in the results regarding the effect of QWL on performance, but only differ in the dominance of its dimensions. According to Hijjawi (2017) the dominant dimension is the social dimension, while according to Kumar (2012) the dominant dimension is the wage or salary dimension. QWL was popularized by Cascio (1972) where at that time QWL was carried out to improve performance in automotive companies which resulted in a significant increase in employee performance.QWL is an important factor in creating a work climate in an organizational environment, in this case a hospital. QWL applied in hospitals will create quality of life for individuals in the organization and will increase productivity and good performance within the organization. This is in line with the opinion of Parvar et al., (2003) which states that QWL is an effective program in improving working conditions and organizational effectiveness where QWL has a role in evaluating employees in line with the quality of their work and the quality of their work life as well as the quality of their environmental life. external and internal. QWL has made an important contribution to the hospital and has great concern for the needs of its employees and the quality of their work life. QWL that is implemented properly will greatly affect employee performance, being able to motivate employees to produce optimal performance.In this study, researchers conducted research related to the relationship between QWL, work stress, mental health, OCB and nurse performance in the Muhammadiyah type D hospital network in East Java. Based on the problems and phenomena that occur in hospitals today and referring to previous research studies, the researchers examined and analyzed the effect of the QWL variable on the performance of inpatient nurses in the Muhammadiyah Hospital network type D East Java by placing the QWL variable as an exogenous variable while work stress variables, mental health, OCB and performance variables as endogenous variables.

II. LITERATURE REVIEW Performance
According to Cormick and Tifftin (2010), performance is the quantity, quality and time used in carrying out tasks. Quantity is the result that can be calculated the extent to which a person can successfully achieve the goals that have been set. Quality includes the extent to which a person makes mistakes, discipline and accuracy in carrying out his duties. Time is the extent to which a person works in accordance with the specified time span.

Quality of Work Life (QWL)
According to Idris (2006) states that Quality of Work Life (QWL) refers to a pleasant or unpleasant state in a person's work environment. Its main goal is the development of an excellent working environment for employees as well as for production. The main focus of QWL itself is that the work environment and all work in it must be compatible with people and technology.
Organizational Citizenship Behavior (OCB) OCB according to Organ (2005) is an individual's free behavior that is explicitly or indirectly recognized by the formal system, and in aggregate functions effectively and efficiently in an organization. Aggregate functioning refers to people in a group, department, or organization. If only one person, OCB does not have a significant impact on an organization, but if in an organization, in the aggregate, its members have good OCB, the impact on the organization will be felt significantly.

Work Stress
According to Anwar (1993: 93) work stress is a feeling that suppresses or feels depressed experienced by employees in dealing with their work. Job stress is a pressure due to work that will also affect a person's emotions, thought processes and physical condition, where the pressure comes from the work environment in which the individual is located.

Mental health
According to Daradjat (2013), mental health is the realization of true harmony between the functions of the soul and having the ability to deal with ordinary problems that occur and feel positively about his happiness and abilities.

III. METHODS
The population of this study were all nurses with the status of Nurses in type D Muhammadiyah hospitals who were members of the East Java Muhammadiyah hospital network, totaling 11 hospitals. The sampling technique in this study was a saturated sample. The sample of this study was the entire population of nurses with nurse status on duty in inpatient rooms, so the respondents used in this study were all samples of hospital inpatient nurses. Each hospital was taken by all respondents from inpatient nurses from all Muhammadiyah Hospital tipt D in East Java. The total number of respondents is 100 respondents. This study was analyzed using the Partial Least Square method which was carried out by making a path diagram, converting the path diagram into structural equations and measurement equations, then estimating parameters using Smart PLS software. The hypothesis of this research is 1. QWL has a significant and positive effect on the performance of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 2. QWL has a significant and negative effect on the work stress of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 3. QWL has a significant and positive effect on the mental health of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 4. Work stress has a significant and negative effect on OCB of inpatient nurses in the Muhammadiyah type D hospital network, East Java 5. Mental Health has a significant and positive effect on OCB of inpatient nurses in Muhammadiyah Hospital type D, East Java 6. QWL has a significant and positive effect on OCB of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 7. OCB has a significant and positive effect on the performance of inpatient nurses in the Muhammadiyah type D hospital network in East Java. The following is a research concept framework

IV. RESEARCH RESULTS AND DISCUSSION A. Research Result
Path coefficients and t-statistic values used to test statistical hypotheses on the structural model were obtained through the bootstrapping process. The processing results for the estimation of the inner model parameters can be seen in Table 1  ∑ H1. The QWL variable has a significant and positive effect on Kn, the path coefficient with a positive sign is 0.461 and the t-statistic value is 3.893, the p-value of the results of this test is 0.000 <0.05. So that QWL has a significant and positive effect on Kn. ∑ H2. The QWL variable has a significant and negative effect on SK. The path coefficient value which is negative is -0.379 and the t-statistic value is 2.300, the p-value of the test results is 0.022 <0.05. So that QWL has a significant and negative effect on SK. ∑ H3. The QWL variable has a significant and positive effect on KM. The path coefficient value with a positive sign is 0.751 and the t-statistic value is 11.512, the p-value from the results of this test is 0.000 <0.05. So that QWL has a significant and positive effect on KM. ∑ H4. The SK variable has a significant and negative effect on OCB. The path coefficient value which is negative is -0.414 and the t-statistic value is 8.094, the p-value from the results of this test is 0.000 <0.05. So that SK has a significant and positive effect on OCB. ∑ H5. The KM variable has a significant and positive effect on OCB. The path coefficient value which is positive is 0.237 and the t-statistic value is 3.305, the p-value of the test results is 0.001 <0.05. So that KM has a significant and positive effect on OCB. ∑ H6 The QWL variable has a significant and positive effect on OCB. The path coefficient value with a positive sign is 0.440 and the t-statistic value is 4.970, the p-value of the test results is 0.000 <0.05. So that QWL has a significant and positive effect on OCB. ∑ H7. The OCB variable has a significant and positive effect on Kn. The path coefficient value which is positive is 0.392 and the t-statistic value is 3.417, the p-value of the test results is 0.001 <0.05. So that OCB has a significant and positive effect on Kn.

B. Discussion Quality Work of Life has a significant and positive effect on nurse performance
The results of the hypothesis test show that Quality Work of Life has a significant effect on the performance of nurses, which means that Quality of work of life has a significant effect on improving the performance of nurses, which also means that the increasing efforts to improve the quality of work of life in hospitals will also increase the performance of nurses. The highest perceived QWL indicator by nurses is the salary indicator. This means that salary is the most important indicator in improving the performance of nurses in addition to other factors in the QWL dimension.

Quality Work of Life has a significant and negative effect on nurses' work stress
The results of the hypothesis test show that Quality Work of Life has a significant and negative effect on nurses' work stress, meaning that Quality Work of Life has a significant effect on reducing nurses' stress levels in type D hospitals in East Java, which also means that the better efforts to increase QWL, the lower also nurse stress.

Quality Work of Life has a significant and positive effect on the mental health of nurses
The results of the hypothesis test show that Quality Work of Life has a significant effect on the mental health of nurses. This means that Quality Work of Life has a significant impact on improving the mental health of nurses at Muhammadiyah Hospital type D, East Java, which also means that the better the organization's efforts to improve the Quality of Work of Life, the better the mental health of the nurses.

Job stress has a significant and negative effect on OCB
The results of the hypothesis test show that work stress has a significant and negative effect on OCB. This means that work stress has a significant and negative effect on the performance of nurses in type D hospitals, East Java, which means that the lower the stress level of the nurses, the higher the nurse's performance. The results of this study indicate that the average score of all indicators in the stress variable in the low category is close to number one, which indicates that the stress level of nurses in the Muhammadiyah type D hospital environment in East Java is low.
Mental Health has a significant and positive effect on OCB The results of hypothesis testing indicate that the mental health of nurses has a significant effect on OCB. This means that mental health has a significant influence on improving the OCB behavior of nurses in type D hospitals in East Java. All indicators in mental health were perceived with a value in the high category by nurses. This means that nurses at type D hospitals in East Java have good mental health. Good mental health is characterized by feeling happy, free from envy and envy, being able to adjust to wherever one is, including at work.

QWL has a significant and positive effect on nurses' OCB
The results of the hypothesis test show that Quality Work of Life has a significant effect on OCB, meaning that the quality of work of life has a significant effect on OCB of nurses in type D Muhammadiyah Hospital, East Java. The better the efforts to increase QWL, the better the OCB behavior of nurses in East Java type D hospitals. All QWL indicators are perceived as high by nurses, this shows that the hospital has provided a quality of work life as desired by nurses. All dimensions in QWL provide a guarantee of a good quality of work life for nurses so that it will provide a sense of security, comfort, no discrimination, thus fostering good OCB behavior as well.
OCB has a positive effect on performance The results of hypothesis testing indicate that OCB has a significant effect on performance. This means that OCB has a significant effect on the performance of nurses in Muhammadiyah Hospital type D, East Java. The path coefficient value which is positive is 0.392, so the increase in OCB can improve the performance of the nurses. Vice versa, if OCB decreases, it will be followed by a decrease in the performance of the nurses. The highest value of respondents' responses to the OCB variable is the civie virtue indicator. Civie virtue is a sense of pride from nurses for the hospital where they work and a sense of belonging which is an attitude or behavior inherent in nurses in carrying out their duties. This sense of pride and ownership will spur nurses to carry out their duties with feelings of pleasure and pride, thus providing a good performance according to hospital expectations or even exceeding expectations.

V. CONCLUSION
Based on the results of the analysis and discussion of the research, several conclusions were obtained as follows: 1. QWL has a significant and positive effect on the performance of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 2. QWL has a significant and negative effect on the work stress of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 3. QWL has a significant and positive effect on the mental health of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 4. Work stress has a significant and negative effect on OCB of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 5. Mental Health has a significant and positive effect on OCB of inpatient nurses in Muhammadiyah Hospital type D, East Java. 6. QWL has a significant and positive effect on OCB of inpatient nurses in the Muhammadiyah type D hospital network in East Java. 7. OCB has a significant and positive effect on the performance of inpatient nurses in the Muhammadiyah type D hospital network in East Java. The limitation of this study is that this study is only limited to the network of Muhammadiyah type D hospitals in East Java which is very limited in number. This research was conducted during the COVID-19 pandemic and only used a questionnaire instrument.