The Effect of Professionalism and Structural Empowerment on Job Satisfaction of Inpatient Nurses in Type C Hospitals

Nurses are one of the health workers who provide primary health services. Apart from being a large number in hospitals, its presence and role are strongly associated with patient safety and quality of care. Nurse job satisfaction has become one of the benchmarks for the quality of patient care. Research on the effects of professionalism and structural empowerment simultaneously on job satisfaction has never been done before. This study examines the impact of professionalism and structural empowerment on job satisfaction among inpatient nurses. This study is in the form of a cross-sectional survey. As many as 129 nurses from Bengkayang Regional Hospital and Landak Regional Hospital participated in this study. To collect data, Hall Professionalism Scale, Conditions for Work Effectiveness Questionnaire II, and Job Satisfaction Survey were delivered to respondents. Data were then analyzed using multiple linear regression. According to analysis, there is a significant effect of professionalism and structural empowerment on the job satisfaction of inpatient nurses


INTRODUCTION
Nurses are one of the health workers who provide primary health services (Bergey et al., 2019;Stimpfel et al., 2019) Apart from being a large number in hospitals, its presence and role are strongly associated with patient safety and quality of care (Lake et al., 2019;Stimpfel et al., 2019) Nurse job satisfaction has become one of the benchmarks for the quality of patient care (Al-Haroon & Al-Qahtani, 2020;Al-Faouri et al., 2020).Job satisfaction is very important because, job satisfaction helps nurses in improving nursing skills (Clark et al., 2022;Sons et al., 2021), and productivity (Akinwale & George, 2020) Many studies seek to describe models of interaction of various variables to nurse satisfaction.Among the variables that are widely researched and sought for their relationship and influence with job satisfaction are professionalism, structural empowerment.Research that has been carried out includes reviews conducted by Niskala et al. (2020) and Fragkos et al. (2020) which shows the relationship of empowerment to job satisfaction.The relationship between empowerment and job satisfaction was also confirmed by Choi & Kim (2019) and Orgambídez & Almeida (2020) through their mixed method study.On the other hand Labrague et al.(2019) has successfully identified outonomy as one of professionalism dimensions to be predictor of job satisfaction.Barać et al. (2018) also confirmed that professionalism could predict the level of job satisfaction.
Based on the research described above, it can be seen that studies on job satisfaction have been carried out a lot, however, research on the effects of professionalism and structural empowerment simultaneously has never been done before.This gap needs to be explored and examined.This study aims to examined the effect of professionalism and structural empowerment on job satisfaction among impatient nurse

METHODS
This research is in the form of a cross sectional survey conducted at two Type C Hospital in West Kalimantan.The inclusion criteria consist of inpatient nurses, having worked for at least one year, retirement is still two years ahead and more, and not being sick.

Sampling procedures
Sample selection technique was quata sampling.Randomly, two type C hospitals were chosen from 30 type C hospitals in West Kalimantan.The hospitals were Bengkayang Regional Hospital and Landak Regional Hospital.Then from the hospital, 190 nurses met the inclusion criteria and 129 nurses were willing to be respondents each amounting to 60 inpatient nurses from Bengkayang Regional Hospital and a total of 69 inpatient nurses from Landak Regional Hospital.
Completion of the surveys implied consent.This study has received ethical approval from the Health Research Ethics Commission, Faculty of Health Science, Universitas Brawijaya, Malang with the issuance of the Ethical Approval Letter No. 5312/UN10.F17.10/TU/2022.This letter then became a reference for carrying out research in hospitals with the issuance of research permits in bengkayang regional hospitals and Hospital regional hedgehogs with registration numbers 4976/UN10.F17.01/PK.03.02.1/2022 and 892.4/1350/UMPEG respectively.The Ethical Approval Letter, and The Research Permit Letters attached Along with informed consent.was presented to explain the study's purpose, procedures, benefits, safety, confidentiality, and incentives.All of the respondents involved in the study were kept confidential.All data were stored and used for research purposes only.

Sample size, power, and precision
The number of sample involved in this study was calculated through Solvin formula (Tejada & Punzalan, 2012).The calculation of sample size using Solvin formula (1) from 190 perawat yang memenuhi kriteria inclusion dapat dilihat pada (2).The calculation of sample size memperoleh 129 respondents.Researchers designed a demographic questionnaire to collect demographic data from respondents which included questions about age, gender, marital status, education level, professional experience and employment status.Halls Professionalism Scale adopted from Snizek (2013) used to measure nurses' professionalism.This instrument consist of 25 items which divided into 5 dimensions, namely using the professional organization as a major referent (5 items), belief in public service (5 items), belief in self-regulation (5 items), sense of calling to the field (5 items), and autonomy (5 items).This instrument uses a 5-point likert scale ranging from 1 -5 which represents a very poorlyvery well scale.The questionnaire to measure nurses' empowerment was Conditions for Work Effectiveness Questionnaire II (CWEQ II) adopted from Ta 'An et al. (2020).This instruments consist of 12 items which divided into 4 dimensions namely: opportunity (3 items), resources (3 items), information (3 items), and support (3 items).This instrument uses a 5-point likert scale ranging from 1 -5 which represents a nonea lot scale.The questionnaire to measure job satisfaction was the Job Satisfaction Survey (JSS) adopted from Tsounis & Sarafis (2018).This instrument consists of 36 items which divided into 9 dimensions namely: salary (4 items), promotion (4 items), supervision (4 items), fringe benefits (4 items), contingent rewards (4 items), operating procedures (4 items), coworkers (4 items), nature of work (4 items), and communication (4 items).This instrument uses a 6-point likert scale ranging from 1 -6 which represents strongly disagreestrongly agree scale.

Measures and covariates
The questionnaires and inform consent are compiled through google form.Furthermore, the link to access this form was distributed via whatsapp group to all inpatient nurses (N=129).All respondents had been expected to complete the questionnaire 2 weeks after the link was distributed.

Data analysis
After the data were collected, a validity test was conducted.Construct validity was examined through correlation product moment Pearson.All valid items from three questionnaires were then examined for reliability through Cronbach's Alpha test.Frequencies, percentages, mean, U Mann Whitney test and Kruskal Wallis test were performed to describe respondent characteristics.Finally, multiple linear regression was performed to assess the effect of professionalism and structural empowerment on nurses' job satisfaction.The inferential analysis was conducted using an alpha value of 0.05.Semua analysis menggunakan Statistical Package for Social Sciences version 26 (SPSS 26).

RESULTS AND DISCUSSION
This study aims to examine the effect of professionalism structural on job satisfaction of inpatient nurse in type C Hospital.The results of respondent sociodemographics are displayed in Table 1.

Nurse Socio-Demographic Characteristics
Table 1 shows that Most respondents are female 99 respondents (76.74%).The majority of respondents aged 26-35 years were 89 respondents (68.99%).Most of the respondents had D3 education as many as 81 respondents (62.79%).Most respondents had 6-10 years of work experience of 38 respondents (29.46%).The majority of respondents based on marital status were married as many as 99 respondents (76.74%).Most of the respondents based on their employment status were permanent with 67 respondents (51.94%).

Nurse professionalism
Nurses are one of the professionals in the field of health who are in direct contact with patients.Thus, the professionalism of nurses is very influential on the recovery of patients (Aiken et al., 2018;Coelho, 2019;Coster et al., 2018;Ingwell-Spolan, 2018).Nurses are the largest number of health workers so maximizing their contribution is very important in providing health services Based on Table 3, the professionalism of nurses at Type C Hospitals in West Kalimantan is in the high category.Thus, the health services provided by nurses in the hospital can provide a good recovery rate as well.Type C hospitals are the main referrals for health services at the district level in West Kalimantan.
The professionalism studied in this study refers to Hall with five dimensions, namely using the professional organization as a major referent, belief in public service, belief in self-regulation, sense of calling to the field, and autonomy (Rabie, 2019).Based on the dimensions, in Table 2all dimensions fall into the very good category, with the sense of calling to the field being the highest dimension on average.
Professionalism as well as nurses are also determined by their demographic conditions (Rabie, 2021).
From 6 demographic data, namely gender, education, age, work experience, employment status and marital status, there are differences in professionalism in the demographic variables of education and employment status (Table 3).Sibandze & Scafide (2017) and Rabie (2021) state that the level of professionalism of a nurse is related to the level of Education of the nurse.These findings are also in line with research (Tanaka et al., 2014) which states that the level of professionalism of nurses is determined by the length education that nurses receive.The educational curriculum also affects the professionalism of nurses (Poorchangizi et al., 2019).
In addition to the level of Education, the professionalism of nurses is influenced by staffing status.Nurses who have temporary status in type C hospitals have a higher level of professionalism than those with permanent status.This is in line with the research conducted by Kim-Godwin et al. (2010) and Shohani & Zamanzadeh (2017).

Nurse structural empowerment
Based on the results of research in Table 2, the structural empowerment of nurses at Type C Hospitals in West Kalimantan is in the very good category.The Structural Empowerment studied in this study refers to CWEQ-II with four dimensions, namely opportunity, information, support, and resources (Valdez et al., 2019).Based on the dimensions, in Table 2all dimensions fall into the very good category, with the information and support dimensions being the highest average dimensions.
The structural empowerment of nurses is also influenced by their demographic conditions (Valdez et al., 2019)).From 6 demographic data, namely gender, education, age, work experience, employment status and marital status, education influences nurse structural empowerment (Table 3).Tan & Conde (2021) states that the level of structural empowerment is influenced by the level of education of nurses.

Nurse job satisfaction
Based on the results of research in Table 2, the job satisfaction of nurses at type C Hospitals in West Kalimantan is in the very good category.The job satisfaction studied in this study refers to JSS with nine dimensions.The salary dimensions is in fair category and being the lowest among other dimensions.The coworker become the highest score on average.According to Table 3, there is no significant difference in job satisfaction among socio-demographic data.The effect of professionalism and structural empowerment on job satisfaction Based on the data processing in Table 4, it is known that the p value < 0.05 (0.000 < 0.05).Thus partially and simultaneously professionalism, and structural empowerment have a significant effect on nurses' job satisfaction.Error!Reference source not found.
Then partially, professionalism affects job satisfaction and structural empowerment affects job satisfaction with a p value of < 0.05 (0.000 < 0.05).the magnitude of the influence of professionalism and structural empowerment on job satisfaction is 36.8%(R2).The effect of other job satisfaction is determined by predictors outside the independent variables in the regression equation.

LIMITATION OF THE STUDY
This research has such limitations.Small sample size that can reduce the validity of the findings and limit sample representation.A bias that is likely to occur when the respondent selection process is carried out, because nurses with higher professionalism, empowerment, and job satisfaction are more likely to participate in research studies.Another limitation is the possibility of bias, where participants report higher scores than their reality to appear more competent and look more professional, more empowered and more satisfied with their work.A two-way relationship is also possible between the variables of professionalism and job satisfaction and between structural empowerment and job satisfaction.Here the researcher assumes that there is only one-way relationship from professionalism to job satisfaction and structural empowerment to job satisfaction.

CONCLUSIONS AND SUGGESTIONS
There is significance effect of professionalism and structural empowerment on job satisfaction of inpatient nurse in type C Hospitals in West Kalimantan.Professionalism affects nurse job satisfaction, and Structural Empowerment affects nurse job satisfaction partially.Professionalism and structural empowerment affects nurse job satisfaction simultaniously .

Table 1 .
Characteristics of Respondents

Table 2 .
Professionalism, Structural Empowerment, and Job Satisfaction according to Dimensions

Table 3 .
Analysis of Professionalism, Structural Empowerment, and Job Satisfaction according to Socio-Demographic Data of Respondents

Table 4 .
Multiple Linear Regression Analysis