Improving Nurse Productivity Through Professionalism Self-Concept
I Gede Juanamasta
1
, Kusnanto
1
and Slamet Riyadi Yuwono
2
1
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
2
Poltekkes Kemenkes Surabaya, Surabaya,Indonesia
Keywords: Professional Self Concept, Productivity, Literature Review.
Abstract: Nurses are the biggest proportion of hospital staff. Nurses interact directly with patients in the services.
Therefore, it directly affects quality of patient care and satisfaction as well as productivity and improvement
of the hospital's image. Nurses believe that they have primary responsibility in the care and welfare of their
patients. Some problem of nurses in the self-concept is the lack of communication nurses with the public
and the invisible nurses in the media. The nurse's negative self-concept is partly due to the nurse himself.
The positive self-concept of professional nurses can improve nurse self-confidence in appropriate nursing
interventions to improve patient health status thereby increasing hospital productivity.
1 BACKGROUND
Hospitals are healthcare institutions that provide full
range of personal health services providing inpatient,
outpatient and emergency care (UU No.44 / 2009).
Hospitals in Indonesia have challenges in facing
with MEA and community demands related to
service quality. Increasing government bugdet
priority in health sector expected to improve the
productivity of the hospital and the quality of
service.
Data of several hospitals in Indonesia, related
efficiency of service quality still not meet the
standard of Indonesia Health Ministry (2007).
RSUD Raden Mattaher Jambi (2013) patient
satisfaction evaluation of nursing service obtained
results 72%. Dr. M. Djamil Padang (2013), the
incidence of patient fall 0.18% from Minimum
Standard Service (SPM) set 0%, patient satisfaction
rate 79.28% of SPM 90%. In addition, Fatas's (2017)
study at Hidayah Boyolali Hospital found that
patients were less satisfied with doctors and nurses
responsiveness and the attitude of doctors and nurses
in listening to patient complaints.
In complex care systems, the responsibility of
nurses and other professions to meet the demands of
quality healthcare services expectations of health
care consumers. Nurses are the biggest proportion of
hospital staff. Nurses interact directly with patients
in the services. Therefore, it directly affects quality
of patient care and satisfaction as well as
productivity and improvement of the hospital's
image. (KemenkesRI, 2017; Kim, 2011).
2 METHODS
The literature search conducted in some database
such as Gale, the Cochrane Library, EBSCO,
ProQuest and Plos ONE. There were 39 articles that
fulfil the inclusion criteria Strategies ways in search
journal are done by using the keywords nurse
professional self-concept and nurse productivity.
Time limitation was used in January 2001 to August
2017.
3 RESULTS
The concept of productivity defined as the
relationship between output and input (Krugman,
1997). In addition, the Asia Productivity
Organization (APO) define productivity is combined
between efficiency which means doing things right
with the effectiveness of doing the right thing
(Roghanian et al., 2012). The productivity of nurses
implicitly influences the productivity of current and
future nursing work. One's productivity may change
in the future because of education and training, the
intensity of physical capital and other factors. One's
productivity may decline in the future, for example
116
Juanamasta, I., Kusnanto, . and Yuwono, S.
Improving Nurse Productivity Through Professionalism Self-Concept.
DOI: 10.5220/0008321401160120
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 116-120
ISBN: 978-989-758-336-0
Copyright
c
2018 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
if one's skills are not updated with the latest sciences
or work less because of ill health or become
unproductive if retired.
Letvak and Buck (2008) mentioned factors
related to decreasing work productivity are age,
number of years of work as RN, quality of care
given, work stress, work injuries, and health
problems. Conceptually, Kopelman (1986 in
Nursalam 2016) mentions the factors that affect the
productivity of nurses consists of organizational
factors, work factors and individual factors and work
environment.
Individual factors related to the knowledge, skills
and abilities and psychological nurses have a
positive correlation with nurse performance
(Mudallal et al., 2017; Yaghoubi et al., 2013). Brun
et al. (2003) revealed it is important to explore and
fully understand the potential psychological factors
of nurses. High demand for nursing services,
coupled with a lack of support from co-workers and
leaders, reduced autonomy, tense working
relationships between nurses and doctors, lack of
respect from their managers (Brun et al., 2003),
shifting organizational structure, and poor working
climate (Mrayyan and Al-Faouri, 2008).
Psychological nurses related self-concept
professional nurses reflect workers' emotions and
opinions about their own performance and feelings
towards themselves. Cowin et al. (2006) mentions
nurse self-concept is an important point nurses who
affect the career and it is very dependent on the
experience of nurses in their profession. In
particular, nurses with self-concept
Nurse with high professional self-concept give
influence to other nurses. This has the effect of
improving self-image, self-esteem, and other nurse
confidence. In contrast, low professional self-
concept reduce productivity (Chi and Yoo, 2001).
Research Arthur et al. (1999) discloses nurse
professional relationships with their patients build
on sincerity and reverence. Nurses around the world
have a lot in common in terms of caring. Nurses
believe that they have primary responsibility in the
care and welfare of their patients (Dahlborg-
Lyckhage and Pilhammar-Anderson, 2009;
Fagerberg and Kihlgren, 2001). ten Hoeve et al.
(2014) mentions the problem of nurses in the self-
concept is the lack of communication nurses in the
public and moreover they doesn’t appear to be
significant role at hospital in the media. Negative
self-concept is partly due to the himself (Donelan et
al., 2008; Takase et al., 2006). This is also in line
with the research Arumsari et al. (2016) mentions
the nurse's barrier in communicating.
Public does not pay attention to the position of
the nursing field and the lack of dignity of the
nursing field is mostly nurse experience, which leads
to a decrease in self-esteem resulting in low self-
concept (Valizadeh et al., 2016). This has a
stereotypical effect on nurses. Nurses need to
prevent the impact of stereotypes and improve
professional self-concept. An overview of
stereotypes affects the nurses use autonomy. Nurses
have need of inner strength for increasing self
concept (Takase et al., 2002; Tzeng, 2006).
According to Kemmer and Silva (2007), nursing
education create nurses' inability in public mediation
for themselves. They just think to still perform well
in health care and never fix this problem. The nurse's
inability will continue. Nurses need to increase the
range of roles and chances of basic and advanced
nursing practice offered to give more visibility to the
nursing role, so that the community can recognize
the role of the nurse (Kalisch et al., 2007; Kemmer
and Silva, 2007).
The self-concept of professional nurses can
improve the patient's health status through
appropriate interventions thus increasing the
productivity of the hospital. Nurses practitioner have
a significant role related to hospital productivity,
that important to improve nursing care with
sustainable transformation in their workplace (Nam
and Park, 2002). Good hospital productivity has an
effect on customer satisfaction, it also provides more
value in the public's view of the hospital. Research
conducted by Cowin et al. (2008) revealed that
professional status has a strong relationship with
nurse self concept. This is also supported by
research conducted by Randle (2001) suggesting that
organizational and cultural climate have a strong
influence on professional self-concept.
4 DISCUSSION
4.1 Theory of the Nurse Professional
Self Concept
Professional self-concept established by providing
good quality care to patients who are in the process
of efficient and energy resulting in patient
satisfaction (Lee and Yang, 2015).
The concept of a professional self, an attitude
that develops from a professional experience,
evolved from self-concept (Arthur, 1992).
Professional development from nursing students to
professional nurses has produced themes important
for the development of self-identity and self-concept
Improving Nurse Productivity Through Professionalism Self-Concept
117
(Evans, 2001; Godinez et al., 1999; Leathart, 1994;
Whitehead, 2001). Student nurses believe in
professionalism by three different themes
(belonging, knowledge, and affirmation). Other
research results show, answers to questions from
patients and family members, and what they add to
the meaning of nursing professionalism (Secrest et
al., 2003). In addition, general nursing students of
the nursing faculty, clinical preceptor, peers in the
clinical environment, and family influence in
professional development (Heath et al., 2001; Kelly,
1992).
O'Mara et al. (2006) study have found self-
concept capable of improving job satisfaction and
nurse retention plans. The results construction
analysis show self-concept shows strong relationship
to job retention global and job satisfaction, and this
is in construction in the retention analysis. This is a
strategy for improving the self-concept of nurses.
Kovner et al. (2006) note, salary justice is more
important than retention. In this study, nurse feel
better to stay in nursing with self-concept
improvements of general nurses and professional
status.
In the study of Cowin et al. (2008), this study
reveals the potential interrelationships between self-
concept and job satisfaction, in the hope of being
able to. Strong positive correlation between
professional status and general self-concept of nurse
(NSCQ). Changes that like to increase the
professional status of nurses have mutual effect on
nurse self-concept in general and happiness.
Approach to increase the professional status of
nurses in health care and communities with
exceptional plans in nurse retention plans (Takase et
al., 2006). In line of this study, finding by Takase et
al. (2006) relates to self-image and performance and
the retention to stay. Increasing capability and lore
in nursing and professional nurse self-concept may
be can keep experienced staff (Cowin, 2001).
Preparation in education to address gaps between
academia and services, so that the expectations of
health organizations can be met. A better
understanding of nursing experience after graduate
can enable staff of teaching staff and health workers
to improve professional self-concept and improve
nurse retention.
Over the years the media has been instrumental
in building the image of nurses. The nursing
organization needs to provide restrictions on media
and imaging in the media so as to maintain the
image of the nurse. In addition, an equivalent
education program with other health teams for
members of the nursing team may provide an
opportunity for equal professional status. (Williams,
2001).
4.2 Factors of Nurse Productivity
Nayeri points out that the productivity of nurses
depends on the "human resources" factor that acts as
the main variable. These parameters have a direct or
indirectly significant relationship with effectiveness
and efficiency. Management and organizational
factors play a role in shaping a culture of
productivity. Management and leadership styles
affect the productivity, effectiveness and quality of
staff services. In addition, employment status,
employment patterns, organizational methods, nurse
confidence level and a fair payment system based on
individual performance and effectiveness are also
factors affecting productivity. The need for training
to support staff is constantly changing and should
continue to be done in order to improve
organizational performance (Dehghan Nayeri et al.,
2006).
Human characteristics, such as education,
experience, skills, knowledge, and competence are
predictors of work productivity and are all
associated with improved clinical care among nurses
(Dehghan Nayeri et al., 2006). Factors in the nurse
such as fatigue and stress can have a negative impact
on productivity. Minimizing the time spent on non-
maintenance activities is needed to reduce fatigue
and save the required nursing resources (Dehghan
Nayeri et al., 2006). Work security and financial
wealth are other important factors found to be
associated with productivity.
Another aspect of nurse involvement is long
working hours. According to recent research, a
longer shift has been found to contribute to
accidents, illness, absenteeism and increased work-
related errors and ultimately lower productivity
(Dehghan Nayeri et al., 2006).
The balance between work and life has a positive
effect on productivity. This indicates that the
productivity of the nurses is equally related to the
nurse's dignity and respect. Dignity and respect for
work are indications of a respectful environment.
The nurse's experience of respect is linked to
cooperation, recognition, independence, support, and
justice (Dehghan Nayeri et al., 2006).
The performance of managers is a primary factor
that facilitates or inhibits the productivity of nurses.
Characteristics of managers that affect the
productivity of care is to direct the nurse by being
role models, using leadership styles appropriately,
motivating the team, supporting the team by
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
118
providing recognition and rewards, maintaining
good relationships, and providing solutions to staff
problems. (Dehghan Nayeri et al., 2006).
5 CONCLUSION
All aspects of the individual, social and cultural
level for the organization, both in terms of subjective
and objective, should be explored more deeply
(Arthur and Randle, 2007). Therefore, there needs to
be a model from organizational level to individual.
Based on that, the researcher is concerned to conduct
research of self-concept modeling of professional
nurse to the work productivity of the nurse in the
inpatient ward of the hospital.
REFERENCES
2009. Undang-Undang Republik Indonesia No. 44 Tahun
2009, Jakarta.
Arthur, D., 1992. Measuring the professional self-concept
of nurses: a critical review. Joumal of Advanced
Nursing, 17: 9.
Arthur, D. et al., 1999. Caring attributes, professional self
concept and technological in¯uences in a sample of
Registered Nurses in eleven countries. International
Journal of Nursing Studies, 36: 10.
Arthur, D. and Randle, J., 2007. The Professional Self-
Concept of Nurses: A Review of The Literature From
1992-2006. Australian Journal of Advanced Nursing,
24(3): 15.
Arumsari, D.P., Emaliyawati, E. and Sriati, A., 2016.
Hambatan Komunikasi Efektif Perawat Dengan
Keluarga Pasien Dalam Perspektif Perawat. Jurnal
Pendidikan Keperawatan Indonesia, 2(2): 11.
Brun, J.-P., Biron, C., Martel, J. and Ivers, H., 2003.
Evaluation of Mental Health at Work: An Analysis of
Human Resources Management Practices, Institut de
recherche Robert-Sauvé.
Chi, S.A. and Yoo, H.S., 2001. Concept Analysis of
Professional Nurse Autonomy. J Korean Acad Nurs,
31(5): 781-792.
Cowin, L., 2001. Measuring Nurses’ Self-Concept.
Western Journal of Nursing Research, 23(3): 13.
Cowin, L.S., Craven, R.G., Johnson, M. and Marsh, H.W.,
2006. A longitudinal study of student and experienced
nurses’ self-concept. Collegian, 13(3): 7.
Cowin, L.S., Johnson, M., Craven, R.G. and Marsh, H.W.,
2008. Causal modeling of self-concept, job
satisfaction, and retention of nurses. Int J Nurs Stud,
45(10): 1449-59.
Dahlborg-Lyckhage, E. and Pilhammar-Anderson, E.,
2009. Predominant discourses in Swedish nursing.
Policy Polit Nurs Pract, 10(2): 163-71.
Dehghan Nayeri, n., Nazari, a.a., Selsali, m. and Ahmadi,
f., 2006. Viewpoints of Nurses about Productivity and
the Effects of Current Evaluation Process on it.
scientific magazine yafte, 7(4): 91-100.
Donelan, K., Buerhaus, P., DesRoches, C., Dittus, R. and
Dutwin, D., 2008. Public perceptions of nursing
careers: the influence of the media and nursing
shortages. Nurs Econ, 26(3): 143-50, 165.
Evans, K., 2001. Expectations of newly qualified nurses.
Nursing Standard, 15(41): 33-38.
Fagerberg, I. and Kihlgren, M., 2001. Experiencing a
nurse identity: the meaning of identity to Swedish
registered nurses 2 years after graduation. J Adv Nurs,
34(1): 137-45.
Godinez, G., Schweiger, J., Gruver, J. and Ryan, P., 1999.
Role transition from graduate to staff nurse: a
qualitative analysis. Journal for Nurses in Professional
Development, 15(3): 97-110.
Heath, J., Andrews, J. and Graham-Garcia, J., 2001.
Assessment of professional development of critical
care nurses: A descriptive study. American Journal of
Critical Care, 10(1): 17.
Kalisch, B.J., Curley, M. and Stefanov, S., 2007. An
intervention to enhance nursing staff teamwork and
engagement. J Nurs Adm, 37(2): 77-84.
Kelly, B., 1992. The professional self-concepts of nursing
undergraduates and their perceptions of influential
forces. Journal of Nursing Education, 31(3): 121-125.
KemenkesRI, 2017. Situasi Tenaga Keperawatan,
InfoDATIN. Kementrian Kesehatan RI, Jakarta.
Kemmer, L.F. and Silva, M.J.P.d., 2007. Nurses’
Visibility According to The Perceptions of The
Communication Professionals. Rev Latino-am
Enfermagem, 15(1): 8.
Kim, M.S., 2011. Moderating Effects of Self-Esteem and
Self-Efficacy in the Relationship between Professional
Self-Concept and Satisfaction in their Major among
Nursing Students. J Korean Acad Soc Nurs Edu,
17(2): 9.
Kovner, C., Brewer, C., Wu, Y.W., Cheng, Y. and Suzuki,
M., 2006. Factors associated with work satisfaction of
registered nurses. Journal of Nursing Scholarship,
38(1): 71-79.
Krugman, P., 1997. The Age of Diminished
Expectations. U.S. Economic Policy in the
1990s. The MIT Press, Cambridge,
Massachusetts, London, England, 240 pp.
Leathart, A.J., 1994. Communication and
socialisation (2): perceptions of neophyte ITU
nurses. Intensive and Critical Care Nursing,
10(2): 142-154.
Lee, H.K. and Yang, H.J., 2015. Influence of
Professional Self-Concept and Professional
Autonomy on Nursing Performance of Clinic
Nurses. International Journal of Bio-Science and
Bio-Technology, 7(5): 14.
Letvak, S. and Buck, R., 2008. Factors Influencing
Work Productivity and Intent to Stay in Nursing.
Nursing Economic$, 26(3): 7.
Improving Nurse Productivity Through Professionalism Self-Concept
119
Mrayyan, M.T. and Al-Faouri, I., 2008. Predictors of
career commitment and job performance of
Jordanian nurses. Journal of Nursing
Management, 16(3): 246-256.
Mudallal, R.H., Saleh, M.Y.N., Al-Modallal, H.M.
and Abdel-Rahman, R.Y., 2017. Quality of
nursing care: The influence of work conditions,
nurse characteristics and burnout. International
Journal of Africa Nursing Sciences, 7: 24-30.
Nam, K.-H. and Park, J.-H., 2002. A study on the
relationship of empowerment with job
satisfaction and organizational commitment
perceived by nurses. Journal of Korean Academy
of Nursing Administration, 8(1): 137-150.
Nursalam, 2016. Manajemen Keperawatan, Aplikasi
dalam Praktek Keperawatan Profesional.
Salemba Medika, Jakarta.
O'Mara, A.J., Marsh, H.W., Craven, R.G. and
Debus, R.L., 2006. Do self-concept interventions
make a difference? A synergistic blend of
construct validation and meta-analysis.
Educational Psychologist, 41(3): 181-206.
Randle, J., 2001. The effect of a 3-year pre-
registration training course on students' self-
esteem. J Clin Nurs, 10(2): 293-300.
Roghanian, P., Rasli, A. and Gheysari, H., 2012.
Productivity Through Effectiveness and
Efficiency in the Banking Industry. Procedia -
Social and Behavioral Sciences, 40: 550-556.
Secrest, J.A., Norwood, B.R. and Keatley, V.M.,
2003. " I was actually a nurse": The meaning of
professionalism for baccalaureate nursing
students. Journal of Nursing Education, 42(2):
77-82.
Takase, M., Kershaw, E. and Burt, L., 2002. Does
public image of nurses matter? Journal of
Professional Nursing, 18(4): 196-205.
Takase, M., Maude, P. and Manias, E., 2006. Impact
of the perceived public image of nursing on
nurses’ work behaviour. Journal of Advanced
Nursing, 53(3): 11.
ten Hoeve, Y., Jansen, G. and Roodbol, P., 2014.
The nursing profession: public image, self-
concept and professional identity. A discussion
paper. J Adv Nurs, 70(2): 295-309.
Tzeng, H.M., 2006. Testing a conceptual model of
the image of nursing in Taiwan. Int J Nurs Stud,
43(6): 755-65.
Valizadeh, L. et al., 2016. Self-Esteem Challenges
of Nursing Students: An Integrative Review.
Research and Development in Medical
Education, 5(1): 5-11.
Whitehead, J., 2001. Newly qualified staff nurses'
perceptions of the role transition. British Journal
of Nursing, 10(5): 330-339.
Williams, C.A., 2001. The RN shortage: not just
nursing's problem. Academic Medicine, 76(3):
218-220.
Yaghoubi, M., Javadi, M., Rakhsh, F. and Bahadori,
M., 2013. A study of determining factors
affecting the performance of nurses based on the
achieve model in selected hospital of Isfahan
(Iran). J Educ Health Promot, 2: 49.
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
120