Impact of Burnout on Nurse Performance in the Inpatient Ward: A Literature Review

Introduction: Burnout is a condition of fatigue that is very likely experienced by nurses in giving nursing care services. It will be directly felt by the patient and determine the quality or quality of services. This line of literature aims to analyze the effect of burnout on the performance of the nurse. Method: This literature uses inclusion and exclusion criteria using the data source of the articles obtained and reviewed from the Google Scholar database. Result: The results of the literature review were obtained that overall obtained if burnout had a negative influence on the performance of the nurse which meant the higher the burnout of the nurse, the worse the nurse's performance. Burnout has a significant negative impact on the performance of nurses. Conclusion: The high workload and job dissatisfaction contribute to burnout for nurses. Hospital management can seek programs to improve organizational climate such as improving policies related to nurse performance, communicating any policies related to nurse performance, developing psychological self-development programs such as stress management training, excellent services, providing reward programs, and punishments that are balanced and appropriate, including giving leave, refreshing programs and incentives according to performance and so on.


Introduction
Burnout is a condition of decreased mental or physical energy after a period of prolonged stress, work-related or physical disability (Perry & Potter 2005). Burnout is also a psychological syndrome that involves a prolonged response to chronic interpersonal stressors at work. Burnout has three dimensions, namely fatigue, cynicism and low self-esteem (Maslach, et al. 2001). Fatigue (emotional exhaustion) is the main determinant of burnout quality, because feeling tired causes a person to feel exhausted at work, resulting in feelings of reluctance to do new work and reluctance to interact with others. Cynic (depersonalization) is characterized by the tendency of individuals to minimize his involvement in work even lost his idealism in work.
Performance can be interpreted as work that can be achieved by a person or group of people in the organization, in accordance with their respective authorities and responsibilities in an effort to achieve the goals of the organization concerned legally, not violating the law and in accordance with moral ethics (Sedarmayanti, 2007). The performance of a person plays an important role for an organization, because the performance of each person is a contribution to the achievement of the performance of each organizational function and in turn the performance of organizational functions contributes to the achievement of organizational performance. The low performance of nurses in an organization can cause an organization to be hampered in achieving its goals (Anja et al., 2008). The performance of nurses can be felt by patients, if poor performance causes a decrease in service quality (Melisa, 2014). Work saturation becomes a problem for organizations if it results in decreased performance, in addition to decreased performance, productivity also decreases (Sulis et al, 2011). Saturated states often make our minds feel full and start to lose rationality, this can lead to being overwhelmed with work and eventually causing mental and emotional fatigue, then starting to lose interest in work and motivation to decrease, in the end the quality of work and quality of life also decreases (Valentina et al., 2011).

Method
The method used in this paper is a literature review study using article data sources obtained and reviewed from the Google Scholar, PubMed and Willley library databases. Search articles by collecting the theme of the concept of burnout associated Leni Agustin: Impact of Burnout on Nurse Performance in the Inpatient Ward... with nurse performance. The limitation of the search for articles taken is in the range of 2012 to 2021, after which a simple analysis of the title and abstract according to the inclusion criteria is carried out.

Result
Based on the results of various studies from the literature study obtained, the results of a significant relationship between burnout and nurse performance. The results of the burnout path analysis on the performance of nurses in RSUD dr. Doris Sylvanus obtained the result is a variable that has the greatest influence on the performance of nurses (0.246). -0.246, where t count > t table (3.455 > 1.96), which means that the higher the burnout, the lower the nurse's performance value. The second study at Sanglah Hospital Denpasar obtained significant results from the effect of burnout on employee performance, which was 0.013 which was smaller than 0.05, and the partial test results showed that burnout had a negative effect on nurse performance.
The third study at Kardinah Tegal Hospital, it was known that the burnout level of nurses in the ICU Ward was obtained in the low category, there were 9 nurses (28.6%) and the medium category was 4 nurses (71.4%), while there were no nurses in the high category. For the performance level of nurses as many as 2 nurses (15.4%) in the poor category, as many as 1 nurse (7.7%) in the fairly good category and 10 nurses (76.9%) in the good category. The burnout level of nurses in the ICCU Ward overall respondents (100%) in the low category and overall respondents (100%) had good performance. The burnout level of nurses in the HCU Ward was obtained in the medium category as much as 2 (14.3%), then the low category as many as 12 (85.7%). It can be seen that for the level of performance in the HCU ward as many as 1 nurse (7.1%) in the moderate category, in the fairly good category there are 2 (14.3%), while 11 nurses (78.6%) are in the good category. The burnout level of nurses in the NICU Ward was obtained as many as 9 (100%) in the low category. The performance level of nurses is shown by the highest proportion of 8 nurses (88.9%) in the good category. The burnout level of nurses in the NICU Ward was obtained from 7 (100%) respondents, all of whom experienced burnout in the moderate category and had good performance categories.
Overall, it was found that from 45 respondents with low saturation, 41 (80.4%) respondents showed good performance, while 1 (2%) respondents showed quite good performance and 3 (5.9%) respondents had low performance. Of the respondents with a moderate burnout level of 6, it was found that 1 (2%) of them had a poor level of performance, 2 (3.9%) of respondents had a fairly good performance and 3 (5.9%) of respondents had a good level of performance. Meanwhile, there are no respondents who have a high level of burnout. Spearman test results obtained p-value of 0.004. This shows that there is a significant relationship between burnout and nurse performance in providing nursing services at the Intensive Care Installation.

Discussion
The results of burnout description from the Intensive Care Installation ward, it showed that of 51 respondents consisting of 45 respondents who were included in the low category, 6 respondents experienced moderate saturation. From the results of this study, it is known that the highest proportion in the category of nurses who experience burnout is in the ICU ward as many as 4 nurses. The ICU ward itself is an inpatient ward in a hospital that is equipped with special staff and equipment to treat and treat patients with rapidly deteriorating physiologic changes that have an intensive physiological effect on one organ or affect other organs so that it is a critical condition that can cause death (Dinda, 2015).
Based on the results of research on the effect of burnout on the performance of nurses in intensive care installations, there is an effect of burnout on the performance of nurses. Burnout or work saturation is the impact of fatigue where performance and service quality can decrease (Nursalam, 2013). This explains that there is a significant relationship between the two variables, the direction of the relationship is negative, that is, if the number of burnout events is low, the nurse's performance will be higher. This is in line with Andini's research (2016), that there is a strong relationship between burnout on the performance of nurses in Sumedang Hospital where the increase in burnout, the nurse's performance will decrease. According to Nurhidayah (2018), the work environment as a long-term impact of burnout, when nurses feel boredom, the work environment will go to a non-conducive level, when this situation is allowed to drag on it will cause a shift in performance to decline. Another factor that can lead to an increase in burnout is the presence of overly binding rules and a lack of responsibility for the job. As is known, nurses who work in intensive care installations have a high risk, so each action has certain rules that must be met. As health workers, we are required to be ready in various situations and work risks, but as humans we have a saturation point. This can be the cause of burnout in health workers. A work environment that is always required to be ready at all times can also affect burnout levels in intensive care nurses. From the explanation above, it can be concluded that burnout negatively and significantly affects performance. If burnout increases it will cause performance to decrease. Factors that can cause burnout are individual factors, work environment and years of service. Burnout can be prevented and overcome by determining individual short-term targets, fostering good communication, increasing individual coping in dealing with stress, maintaining a positive attitude, maintaining health and doing refreshing. It is important for individuals who experience burnout symptoms to have time for themselves by taking holidays/leave, besides that the reward system according to performance in the organization is also able to reduce burnout because it increases job satisfaction which directly improves performance (Wilcockson, 2011).

Conclusion
The high workload and job dissatisfaction contribute to burnout for nurses.
Someone with a high commitment to the task will be more adaptive in dealing with the burnout they experience. Hospital management can seek programs to improve organizational climate such as improving policies related to nurse performance, communicating any policies related to nurse performance, developing psychological self-development programs such as stress management training, excellent services, providing reward programs, and punishments that are balanced and appropriate, including giving leave, refreshing programs and incentives according to performance and so on.