The Effect of Work-Life Balance and Workload on Job Satisfaction to Affect Nurse Performance

In the process of providing service, nurses are the most interactive healthcare personnel with patients. Nurses in public hospitals have a huge responsibility for providing quality health care. The study aims to confirm and re-test the impact of work-life balance and workload on job satisfaction and the performance of nurses. The sample determination uses the nonprobability sampling method with the technique of taking saturated samples (sensus), so that the entire population of 32 people is the sample. Path analysis is used to test hypotheses in research using SmartPLS version 3.2.9. The study revealed that work-life balance showed a significant positive impact on job satisfaction but no significant impact on nurses’ performance; the workload on an informed nurse’s job satisfaction can have an equally significant positive effect on the performance of the nurse; the satisfaction of the real job does not have a significant effect on the nurse's performance; and job satisfaction cannot affect the impact of work-life balances and workloads on the nurse's performance.

that work life balances has a positive and significant relationship to job satisfaction, while different from research Hafeez & Akbar (2015), which concludes that work life balances do not have much significant impact on job satisfaction.
Other studies also linking work life balance to nursing performance are the studies conducted by Sundari et al (2022), Wijaya & Suwandana (2022), Dousin et al (2019) and Mulinge (2017) which concluded that work life equilibrium support has a significant and positive impact on performance, but unlike the research Thamrin & Riyanto (2020) that concludes that the factor of working life balance does not have a significant impact on employee performance.Another factor that affects the performance of nurses is their workload.According to Sunarso (2010), a workload is a list of tasks that a unit of an organization or office holder must do within a specific amount of time.Excessive workloads can lead to stress, fatigue, anxiety, and even burnout, which can affect a person's satisfaction and performance in the long run.Meanwhile, too mild a workload can lead to boredom and a lack of motivation, which can also affect the performance of nurses.Some studies that associate workload with job satisfaction are the ones conducted by Jermsittiparsert et al (2021), Inegbedion et al (2020), Tentama et al (2019) and Jalal & Zaheer (2017) which concluded that workload balance significantly affects employment satisfaction but differed from the research Rofida Novianti & Roz (2020) and Zaidan & Juariyah (2020) that concluded the workload had a negative and non-significant impact on work satisfaction.
Meanwhile, some studies associating workload with nursing performance are the ones conducted by Ali, 2022), Khairunnisa et al (2021), Rosyidawati et al (2020) and Suryandari et al (2018) which concluded that workload jointly affects the performance of nurses but differed from the research carried out by Susiarty et al (2019) that concluded that workload did not have a significant impact on nurse performance.The private public hospital "X" Denpasar is one of the leading private hospitals located in the city center of Denpasar that is active in the field of health services and has noticed how important it is to have quality human resources.Based on the results of temporary observations, nurses in balancing between the demands of work and personal life can be said to be difficult because the time or schedule of their work is based on three shifts (morning, afternoon, and night), so if there is an urgent need related to personal interests, the nurse should coordinate with colleagues to change their work schedule.While the workload will be felt to be sufficient to give pressure when nurses are faced with a particular situation where the number of patients tends to increase, requiring additional services, the demands of the treatment of the patient must always be guided by the operational standards of the procedure by providing the maximum possible service in order to ensure patient satisfaction.Many studies have previously been conducted related to work-life balance and labor burden on the performance of nurses mediated by job satisfaction, but show different research results.Referring to the phenomena and differences in the results, this study aims to confirm and re-test the impact of work-life balance and workload on job satisfaction and how it affects the performance of nurses.

Literature Review Nurse Performance
According to Suriana (2014), performance nurses are professionals who have both intellectual, technical, interpersonal, and moral capabilities and are responsible and permitted to provide nursing care in compliance with their authority in order to fulfill the tasks of the profession and the goals of the target unit of the health organization without regard to the circumstances and situations of time.According to Kewuan (2013), the performance of nurses is the result of a nurse's work in carrying out good nursing care to patients, which influences the image of hospitals or other health institutions.Indicators of nursing performance in this study are assessment, planning, implementation, evaluation, communication, and expectations.

Job Satisfaction
According to Robbins & Judge (2008), job satisfaction is a favorable sentiment about one's work that arises from an assessment of one's personal traits.Meanwhile, Davis & Newstrom (2008) said that job satisfaction is a group of employee sentiments regarding their level of satisfaction or lack of work.As for the indicators of job satisfaction in this study, they are performance, recognition, responsibility, employment, and prospects for development.

Workload
According to Paramitadewi (2017), a workload is a collection of tasks that a unit of an organization or a job holder must do in a specific amount of time.According to Sitepu (2013), it is argued that the workload is the amount of work that a department or unit of the organization must bear and is the result of the difference between the volume of work and the norm of time.The indicators of the workload in this study include objectives to be achieved, working conditions, work standards, and time usage.

Work-life Balance
According to Delecta (2011), work-life balance is the ability to manage work and family obligations as well as other obligations outside of work and other activities.Kalliath & Brough (2008) describe work-life balance as an individual's prescription where activity in work and personal life can go together and promote personal growth according to individual life priorities.The work-life balance indicators in this study include time balance, engagement balance, and satisfaction balance.

METHODS
The exogenous variable in this study is work-life balance and workload, whereas the endogenous variable is the performance of the nurse, and the mediation variable is job satisfaction.The data utilized in this study is primary data that was retrieved and collected directly from its source using quantitative methodologies.The population studied in this study was all 32 nurses working in the executive hospital room of the private general hospital "X" in Denpasar.With a total sample size of 32 participants drawn from the entire population, the sampling approach employed in this study is the nonprobability sampler method with a saturated (sensus) sampler technique.The data produced by path analysis is the subject of the analysis.Since it can be used with all data scales, doesn't need to be enormous, and can also be used to confirm theories, partial least square (PLS) is a potent analytical technique (Solimun, 2008;Ghozali, 2009;Hair et al., 2006).Using SmartPLS version 3.2.9 to validate the data obtained in this investigation.The decision on the acceptance of the hypothesis in this study was made with the condition that the t-table value of the one-tail test specified in the study is 1,645 for a significance of 0,05 (Ghozali, 2014).After testing the data, interpret the results of the analysis based on theoretical and empirical studies, compile the conclusion, and give some thoughts that can later be used as consideration material and advice on further research.

RESULTS
There are two constructs in this study: job satisfaction (JS) and nurse performance (NP).R 2 values of 0.75, 0.50, and 0.20 describe strong, moderate, and weak (Hair et al., 2010;Henseler et al., 2009).The R 2 value of the construction variable of job satisfaction is 0.873, so that the model of work-life balance (WLB) and workload (WL) impact is strong.The construction value of the variable performance of the nurse (NS) is 0.820, so the model of the influence of job satisfaction (JS), worklife balance (WLB), and workload (WL) is strong.The predictive relevance test (Q 2 ) is used to test the value of the total determination coefficient with the q-square test.(Q 2 ).The criterion for the predictive relevance value of q-square is categorized as predictively relevant if the value of q-square is >0, but the opposite when the value is <0 means that the predictive model is less relevant.Following is the Q 2 calculation: Q 2 = 1 -{(1-R1 2 ) (1-R2 2 )} = 1 -{(1-0.873)(1-0.820)}= 1 -0.0229 = 0.9771 Considering the computation above the Q 2 value, the result is 0.9771, or 97.71%, which indicates that the resulting path analysis model is worthy of being used to predict.A 97.71% value means that a model is capable of describing the information in the data, while 2.29% is explained by errors and other variables not included in this study.
Test results in Table 2 inform us that the work-life balance variable has a significant influence and supports the job satisfaction hypothesis with a t-value of 2.585 and a p-value of 0.005.However, the work-life balance informs us that the results do not support the hypothesis, with a t-value of 1.217 and a p-value of 0.112.The workload substantially supports the job satisfaction hypothesis with a tvalue of 6.104 and a p-value of 0.000.Also, the workload variable significantly supports the hypothesis of nurse performance with a t-value of 1.915 and a p-value of 0.028.The work satisfaction variable shows that it does not support the hypothesis, with a t-value of 0.669 and a p-value of 0.242.

Table 2 Direct Effect Test
Source: Data Processed Testing of the indirect influence between the variables of construction.This test was conducted find out the role of job satisfaction in mediating the impact of work-life balance on the performance of nurses and the influence of workload on nursing performance.Table 3 informs the results that the job satisfaction variable has not been able to mediate the work-life balance and workload against the performance of nurses with a significance value of more than 5 percent where the t-value value of each structure is 0.656 and 0.668 and the p-values of each construction are 0.256 and 0.252, so it can be said that the job satisfaction variant is not included as the mediation variable in this study.

Table 3 Indirect Effect Test
Source: Data Processed Source: Data Processed

The Impact of Work-life Balance on Job Satisfaction
The results of the direct effect test provide information that work-life balance shows a significant positive effect on nurse job satisfaction, where the t-value is 2.585 and the p-value is 0.005.The test findings demonstrate that the hypotheses that have been developed are acceptable and support the findings made by Arief et al (2021), Tirta & Enrika (2020), Sari & Seniati (2020), Murtaza & Khan (2017), Aamir et al (2016) and Fayyazi & Aslani (2015) which concluded that worklife balance has a positive and significant relationship with job satisfaction.The more balanced between work tasks and personal needs, the more likely it will be to increase job satisfaction rather than the nurse itself, so that it can help nurses maintain their quality of life and also improve the quality of their work.

The Impact of Work-Life Balance on Nurse Performance
The results of the direct influence test of the work-life balance variable provide information that there is no discernible influence on the performance of nurses, where the t-value is 1.217 and the p-value is 0.112.The test results that have been carried out in fact cannot support the hypotheses that have been developed, and these outcomes are consistent with the research's conclusions Thamrin & Riyanto (2020) which concluded that the work-life balance factor does not have a significant effect on employee performance.Balancing between work life and private life has little effect in this regard, as nurses need to complete their duties well without compromising the quality of work.

The Impact of Workload on Job Satisfaction
The test results of the direct effect of the workload variable on nurse job satisfaction indicated that it could have a significant positive impact, where the t-value was 6.104 and the p-value was 0.000.The results of the hypothesis testing that have been developed are acceptable and support the findings of research conducted by Jermsittiparsert et al (2021), Inegbedion et al (2020), Tentama et al (2019) and Jalal & Zaheer (2017) which concluded that workload balance significantly affects job satisfaction.Nurses who have a high workload may feel more involved in their work, which can improve their ability to handle complex situations and gain broader experience.However, it is important for hospitals to ensure that nurses have a balanced and well-managed workload to maintain their health and well-being and improve the quality of health services provided.

The Impact of Workload on Nurse Performance
The workload variable's direct effect test results revealed a significantly beneficial impact on nurses' performance, where the t-value was 1.915 and the p-value was 0.028.The test results that have been developed can support the hypotheses that have been developed and are consistent with the results of study done by Ali (2022), Khairunnisa et al (2021), Rosyidawati et al (2020) and Suryandari et al (2018) which concluded that the workload jointly affects the performance of nurses.The greater the workload given to nurses, the higher the nurse's performance.This can happen because the high workload encourages nurses to work harder and focus more on the tasks that must be done.

The Impact of Job Satisfaction on Nurse Performance
The results of the direct effect test of the variable job satisfaction did not significantly affect on the performance of nurses, where the t-value was 0.669 and the p-value was 0.242.The test results that have been developed cannot support the hypothesis, and these outcomes are consistent with those of studies done by Susiarty et al (2019) which concluded that workload does not have a significant effect on nurse performance.Even though nurses are satisfied with their jobs, this does not necessarily mean that they will work more productively or effectively.This does not mean that job satisfaction is not important.

Job Satisfaction Mediation Effects
The findings of the analysis that was performed state that job satisfaction cannot affect the impact of work-life balance and workload on nurse performance, where the t-values of each construct are 0.656 and 0.668 and the p-values of each construct are 0.256 and 0.252.These results indicate that the hypothesis that has been developed cannot be accepted.In fact, based on statistical results, the role of the job satisfaction variable is classified as not mediating.