Relationship Between Work Loads And Working Conditions With Nursing Stress Levels In Intensive Care Unit

Nurse workload is all activities carried out by nurses while on duty in a nursing service unit. Working conditions include physical environment variables such as the distribution of working hours, physical conditions in the form of noise, regulations, and demands. Job stress is a condition of tension that causes an imbalance of physical and psychological conditions in employees sourced from individuals and organizations that affect the physical, psychological, behavior of employees. This research method uses analytic research, with a cross-sectional design. The population in this study were nurses on duty in the ICU. The sample in this study amounted to 36 respondents with a sampling technique using the total sampling method. Data is collected by using a questionnaire sheet. Analysis of the data used by using the Chi-Square test. In this study, the results were obtained that the workload was in the bad category of 20 respondents (55.6%) and the working conditions included in the category did not support as many as 22 respondents (61.1%) and the stress level in the moderate category there were 23 respondents (63, 9%). Based on the analysis that has been done using the Chi-Square test, there is a significant relationship between workload with stress levels with a value of P = 0.000 <0.05 and work conditions with nurses' stress levels with a value of P = 0.011 <0.05. There is a relationship between workload and working conditions with the stress level of nurses in the ICU. It is hoped that this research can be used as additional knowledge for the educational institutions of Stikes Panrita Husada Bulukumba.


INTRODUCTION
In Indonesia, research by the Indonesian National Nurses Association (PPNI) reported that as many as 50.9% of Indonesian nurses had experienced work stress, with symptoms of dizziness, feeling tired, less restful, and less friendly due to workload in 2006. According to data from the Indonesian Ministry of Health in 2014 the number of nurses in Indonesia reached 237,181 people, thus the incidence of work stress on nurses was quite large (Herqutanto, Harsono, Damayanti, 2017). Job stress is caused by not being able to overcome the threats faced by both mental, physical, and emotional that will affect his physical health. The impact of work stress on nurses can reduce nursing performance such as poor decision making, lack of concentration, apathy, fatigue, work accidents so that the provision of nursing care is not optimal which can result in low organizational productivity. The most common effects of work stress are headaches (49%), followed by other symptoms such as anger, decreased brain function, ineffective coping, and relationship problems with coworkers. Based on studies have shown that the inability to cope with environmental situations in the form of threats both mental, physical, emotional, and spiritual can cause work stress (Mutmainna, 2012).
The results of the study said that the nurse profession has a very high risk of stress because nurses have very high duties and responsibilities towards the safety of human lives (Hendrarwati, 2015). Nurses are physically burdened with the implementation of tasks that are not their responsibility, mainly many Doctor work is delegated to nurses which ultimately makes nurses more physically burdened (Yudatama and Haksama, 2014). Excessive workload physically and mentally, that is, having to do too many things, is a possible source of work stress. The element that causes overload is time pressure.
Nurse work stress can occur if the nurse in the task gets a workload that exceeds his ability so that the nurse is unable to fulfill or complete the task, the nurse is said to experience work stress.
This research is related to other studies which say that the influence of the work environment that does not support includes everything that exists in the environment of employees that can affect work stress, including workplace safety, temperature, humidity, ventilation, lighting, and cleanliness (Utami, 2010). Increased progress from intensive care units (ICU) causes strong stress in the work environment of ICU nurses.
Nurses who work in ICU rooms have a heavy responsibility to deal with patients in critical conditions so nurses are required to further improve service and supervision of patient conditions that can result in fatigue and lead to work stress. where there is a struggle for life's struggle against death. Discovering that ethical issues relating to near-death patients constitute work stress for ICU nurses.
From the initial data collection conducted on December 21, 2018, in the ICU room of H. A. Sulthan Daeng Radja Hospital, Bulukumba Regency, against 36 nurses. Three nurses among them after interviewing using a questionnaire sheet found some data, namely nurses who served in the ICU said that the ICU is a nursing unit that has a high workload and this can cause stress. The working conditions of ICU nurses at H.Andi Sultan Daeng Radja Bulukumba Hospital indicate that night shifts are a problem for nurses because they have to leave home and family at night, in addition to the heavier burden or responsibility in connection with critical patient conditions that require observation strict, nurses have a task or demand that must be done every time that is observing patients every hour but this is an obligation that must be done according to one of the nurses on duty at the ICU.
Based on the results of the study found that nurses who work in ICU H.Andi Sulthan Daeng Radja Bulukumba hospital are often complained, due to work demands that are too high or work environment that does not support the effects of air exchange in the room that is not optimal. Then the problem can be formulated The relationship between workload and working conditions with the stress level of nurses in the ICU H.Andi Sulthan Daeng Radja Bulukumba Hospital. The purpose of this study was to determine the relationship between workload and work conditions with stress levels of ICU nurses at H.Andi Sulthan Daeng Radja Bulukumba Hospital in 2019.

MATERIAL AND METHODS
The research design used by researchers is an analytic survey with a cross-sectional approach, which is a research data collection on several research variables carried out at one time. In this study, the researchers did not see the relationship between variables based on time travel (Hidayat, 2014). The population is a generalization area that consists of objects/subjects, which have certain qualities and characteristics determined by researchers to be studied and then drawn conclusions (Sugiyono, 2017). The population in this study were all who served in the ICU room as many as 36 nurses at H.Andi Sulthan Daeng Radja Bulukumba Hospital.
The sample is part of the number and characteristics possessed by the population. If the population is large, and researchers may not study everything in the population, for example, due to limited funds, manpower, and time, then researchers can use samples drawn from that population. What is learned from the sample, the conclusion can be applied to the population. For this reason, samples taken from the population must be truly representative or representative (Sugiyono, 2017 Table 3 shows the distribution of the number of respondents based on workload and working conditions with the stress level of nurses.The workload shows that the average respondent has a bad workload with a percentage of 55.6% and a good workload of 44.4%. For working conditions that the average respondent has unsupportive work conditions with a percentage of 61.1% and working conditions support 38.9%. While the stress level that the average respondent has a moderate stress level with a percentage of 63.9% and a mild stress level of 36.1%.  (2015) which stated that working conditions have a relationship with work stress for nurses because they are required to work more quickly and precisely with a large number of patients every day with limited unsterile air. Unfavorable working conditions can affect nurses so that nurses find it difficult to face the patient's family with increased anxiety, are disturbed by the patient's condition that suddenly worsens, feels that there is no healthy air circulation in the nurse's room. Where sufficient air exchange will increase the physical freshness of the employees because if the ventilation is sufficient, the health of the employees will be guaranteed.

DISCUSSION
In this study, it can be seen that there is a significant relationship between workload and stress levels of nurses in the ICU room at RSUD H. Andi Sulthan Daeng Radja Bulukumba in 2019. From the results of statistical tests using the Chi-Square test, the pvalue = 0.000 is smaller than the value of α = 0.05. So it can be concluded that there is a relationship between workload and stress levels of nurses in the ICU room. The researcher's assumption is related to the research results that found respondents with a bad workload and not experiencing stress because respondents can cope with their stress by doing positive things and increasing the skills of nurses in carrying out nursing care to patients. Because high responsibility is accompanied by the ability to control properly, it will be able to reduce work stress experienced. Meanwhile, respondents with a good workload and experiencing stress because of the lack of workload and the understanding of each respondent is different. From the results of statistical tests using the Chi-Square test, it is obtained that the value of p = 0.011 is smaller than the value of α = 0.05. So it can be concluded that there is a relationship between work conditions and stress levels of nurses in the ICU room.
As for the assumptions of the researchers, the finding of working conditions is not supportive by experiencing work stress because the working conditions in the room do not support workers in carrying out their activities properly, the body reacts in stressful situations, causes emotional changes and has an impact on nurse performance. Based on the theory that the work environment is one of the factors which is quite influential on the work performed by employees so that it can cause work stress due to complex problems arising from working conditions in the ICU room which includes physical and social work environments, namely relationships with coworkers, relationships with superiors and subordinates and a sense of security for the nurse.