RELATIONSHIP BETWEEN JOB STRESS AND BURNOUT SYNDROME

IN NURASE AT MEDIKA MULIA HOSPITA

TUBAN

Harry Budi Kusuma

SEKOLAH TINGGI ILMU KESEHATAN NAHDLATUL ULAMA

TUBAN

ABSTRACT

Burnout is a psychological syndrome that consists of three dimensions: emotional exhaustion,

depersonalization, and a decrease in personal achievement and low self-esteem in carrying out
their daily tasks. this syndrome is the result of prolonged work stress and leads to withdrawal
from the organization. This study aims to determine the significance of the relationship between
work stress and burnout syndrome.
The design of this study uses correlational analytics. The time approach is the research is
cross sectional study. The population in this study were some nurses in Medika Mulia Tuban
Hospital totaling 76 people who where determined using simple random sampling techniques
and collecting data using questionnaires. Analysis of research using the spearman test.
From the results of data analysis obtained correlation coeffitient (r) 0.737 which indicates a
strong relationship, with a significance value of 0.000 (P < 0.05) which means there is a
significant positive relationship between work stress and burnout syndrome. This means that
nurses high work stress will be followed by high syndrome burnout.
The results of this study as input to management to improve the quality of hospital
management thereby reducing the level of work stress on nurses to avoid burnout syndrome
which results in a decrease in service quality and hospital quality.

Keyword: Job stress, Burnout syndrome

Introduction is a risk factor for burnout, so work stress
Burnout is a psychological syndrome that and burnout are two things that are
consists of three dimensions, namely susceptible to nurses
emotional exhaustion, depersonalization, Job stress is recognized throughout the
and a decrease in personal achievement and world as a major challenge for nurses.
low self-esteem in carrying out their daily Diindonesia is evidenced by PPNI data in
tasks. (Masclach et al 2001) Prihatini which says that 50.9% of nurses in
Stress and burnout have a large percentage four provinces in Indonesia experience work
of nurses. As many as 50.9% of nurses stress which among others is caused by high
experienced stress (PPNI, 2006) and 43% workload. Work stressors for nurses
experienced burnout (Keiber & Ensman in according to their order are a work load of
Prestiana & Purbandini, 2012), so nurses 82%, unfair wage giving 58%, working
became a profession that was prone to conditions 52%, not involved in 45%
experiencing stress and burnout. Every day decision making (Anoraga, 2009).
nurses meet with many people, this causes According to Maslach (1981) there are
nurses to experience work stress. Job stress three aspects of burnout, namely: emotional
exhaustion, depersonalization, and personal for employees is needed in order to always
achievement. Nurses can be suspected of create a harmonious relationship
experiencing emotional exhaustion that is 4. Career Development
supported by complaints about the service Employees usually have a variety of
system exceeding the time and tasks that are expectations in their working career lives,
increasingly complex, so that eventually which are shown in the achievement and
nurses experience psychological and achievement of the need to actualize
physical exhaustion. The nurse can also be themselves. If the company does not meet
suspected of being depersonalized, which is these needs for example unclear promotion
seen by the nurse's cynical and abusive systems, employees will feel lost hope that
attitude towards clients. In addition nurses can cause symptoms of stressful behavior.
can be expected to experience a decrease in 5. Organizational Structure
personal achievement as indicated by the The organizational structure has the
feeling of being unhappy about themselves potential to cause stress if it is applied
and feeling dissatisfied with their rigidly, the management does not pay
achievements at work. attention to employee initiatives, does not
Sources of work stress, known as job involve employees in the decision making
stressors, are very diverse and their reactions process and there is no support for employee
vary from person to person. The following creativity.
are sources of work stress according to Cary 6. Aatara Relationship between Work and
Cooper, namely (Munandar, 2001): Home
1. Working Conditions The house is a comfortable place that allows
These working conditions include working building and gathering enthusiasm from
conditions for quantitative work overload, within the individual to meet outside needs.
qualitative work overload, assembling line When pressure strikes a person's calm, this
hysteria, decision making, hazardous can strengthen the effects of work stress.
physical conditions, division of work time, Denise Prosseau Sapillover said lack of
and technological progress (tecnostres). support from partners, conflict in the
2. Ambiguity in role household is a factor that can affect stress
Employees sometimes do not know what is and career (Rise, 1992)
actually expected by the company, so he As according to Ivancevich, et al (2007)
works without a clear direction. This states burnout is a psychological process that
condition can be a threat to employees who is produced by stress that is not released and
are in middle-aged careers, because they results in emotional exhaustion, personality
have to deal with uncertainty. As a result it changes, and feelings of self-achievement
can reduce performance, increase tension decline.
and the desire to leave the company where According to Cherniss (in Shaufeli and
he works Buunk, 1996) burnout is a change in attitude
3. Interpersonal Factors and behavior by withdrawing
Interpersonal relationships in work are psychologically, keeping distance from
important factors for achieving job others, cynical with others, often truant,
satisfaction. The existence of social support often late, and has a desire to stop working.
from coworkers, management and family are This is in line with Riggio (2003) saying
believed to be able to reduce the emergence burnout is a syndrome that is the result of
of stress. Thus the management's concern long-standing work stress and leads to
withdrawal from the organization.
 Based on some of the above theories, it personal achievement are lack of attention to
can be concluded that burnout is a form of others, not friendly in providing services
physical, mental and emotional exhaustion with clients and do not have empathy with
experienced by someone due to the demands others. Individuals who experience
of work continuously for a long period of decreased personal achievement feel useless
time so that it causes withdrawal from the and the activities they do not have value or
organizational environment and decreased valuable.
achievement of work performance According to Lee & Ashforth (1996) there
According to Maslach and Jackson (in are several factors that cause burnout,
Enzmann, Schaufeli, and Girault, 1993) namely work pressure and support
divides the burnout aspect into 3 aspects: Job pressures include:
1. Emotional Exhausted 1. Ambiguity, which is a situation where
Emotional fatigue refers to the depletion and employees do not know what to do, become
depletion of emotional resources. There are confused and become unsure because of a
several conditions that state emotional lack of understanding of the rights and
exhaustion such as feelings of frustration, obligations of employees who do work
sadness, hopelessness, empty stress, 2. Role conflict, which is a set of
irritability, feeling overwhelmed by the task expectations or more against each other so
at hand, easily angry without a clear reason that it can be an important pressure for some
that causes a feeling of someone unable to people
provide psychological services. 3. Job stress, if the stress experienced by
2. Depersonalization employees is permanent for a long period of
What is a measure of depersonalization is time, it will cause burnout because the
the development of negative attitudes and condition of the body is not able to rebuild
negative feelings towards service recipients. its ability to deal with stress triggers
Depersonalization is very closely related to 4. Workload, if an employee wins a lot of
negative attitudes, abusive attitudes and work in a relatively short time, it can make
tends to keep distance from others, withdraw the employee depressed and will cause
from the social environment and tend not to burnout
care about the environment and individuals Support includes:
in the environment. Other attitudes that are 1. Social support, which includes the
shown are reduced idealism, reduced contact availability of resources that can be called
with clients, dealing only as needed, having when needed to provide support, so that the
negative opinions and being cynical about person is more confident and healthy
others, and difficult to help others (Edelwich because he believes there are other people
and Brodsky, in Shaufeli, et al 1993). who help when difficulties
3. Reduced Personal Accomplishment 2. Family support, the family has a big hand
Decreased personal achievement of an to relieve the burden experienced even
individual is related to decreased self- though only in the form of emotional
competence, work motivation and work support, namely the behavior of paying
productivity due to feelings of guilt due to attention and listening sympathetically
work goals that are not achieved and have a 3. Support co-workers, supportive
low attitude to give respect to themselves coworkers allow employees to cope with
and feel a lack of self-confidence (Maslach work pressure. The cohesiveness of a group,
Leiter and Shaufeli, 2001). Real attitudes some workers say that a good relationship
that can be shown from a decrease in between several work groups is an important
factor in organizational well-being and threatening one's health. Distress shows high
safety levels of stress that have negative
Burnout can have an impact on both consequences, whereas eustes shows fairly
individuals and organizations. Employees low levels of stress that are needed to move
who experience burnout will be lazy in people in their lives. The experience of
doing tasks and not productive in working general stress or adaptation syndrome
so that the results obtained will also involves a movement that goes through three
decrease. levels, namely: alarm, resistance, and
According to Gray Toft & Anderson fatigue.
(1981), work stress is an internal signal in Stress at work and in everyday life is
the physical, social, or psychological inevitable. Some individuals cannot control
environment that threatens the balance of the over a period of time due to work stress.
individual. Stress can negatively impact a When individuals become tired and feel that
variety of things namely task performance, there is nothing positive to do, they display a
health, desk rage, and burnout (Greenberg & symptom that is often called burnout.
Baron, 2008). Maslach, et al (1981) define Burnout symptoms can be experienced by
burnout as a symptom of emotional everyone or workers. Anger-anger is defined
exhaustion and cynicism that often occurs as a psychological process caused by
between individuals who do some type of continuous work stress that results in fatigue
work. between workers and causes low job
Burnout is not a symptom that comes satisfaction.
suddenly. An individual takes it through With the above opinion, it can be
several stages, a. work involvement is concluded that work stress can affect the
increasing, b. stagnation at work, c. become level of burnout on employees. The higher
separated or withdraw from work and d. the stress level of the employee, the higher
experiencing physical symptoms and the level of the employee will experience
behavior. During this time, burnout research burnout conditions.
has mainly been conducted on professions in RESEARCH METHODS
the service sector, such as teachers or The design of this study uses correlational
lecturers, nurses, doctors, social workers, analytics which is a study to find out the
therapists, and police. Increased (intense) relationship between two or more variables
involvement in each of the professions without any effort to influence these
seems to be a trigger for burnout. From the variables so that there is no manipulation of
burnout organization's point of view, the variables (Faenkel and Wallen, 2008)
most obvious consequence of burnout is a The time approach in this research is
decrease in work performance. If someone cross sectional, which is a study that studies
experiences burnout, the achievement might the dynamics of the relationship or
not be able to continue. However, burnout correlation between risk factors and impacts
involves withdrawal from work. Research carried out by means of observation or data
has also found that individuals who collection at the same time (Notoatmojo,
experience burnout are more absent and 2002)
have higher turnover than other workers. The population in this study were all
Job stress is one of the factors causing permanent nurses working in Medika Mulia
frequent burnout conditions for employees. Tuban Hospital with a total of 94 nurses.
Stress is an adaptation response to a This type of sampling in this study uses
situation that is felt to be challenging or
 "simple random sampling", obtained by 76 Table 5.4 Distribution of Nurse Syndrome
respondents. Burnout Frequency at Medika Mulia
RESEARCH RESULTS AND Hospital in Tuban, August 2019
ANALYSIS No Burnout Syndome Frekuensi Presentase (%)

Characteristics of respondents consisted of:

1 Good 0 0
gender and education 2 Light 0 0
1. Characteristics based on gender 3 Middle 19 25
Table 5.1 Distribution of Frequency 4 Heavy 57 75
of Respondents by Gender August Total 76 100
2019 Source: Researcher Primary Data 2019
No Gender Frekuensi Presentase (%)
From the table above, it is found that the
1 Men 30 39.4 burnout syndrome level of nurses in Medika
2 Women 46 61.6 Mulia Hospital is the Heavy level with 75%
Total 76 100 Relationship between Work Stress and
Burnout Syndrome in Nurses at Medika
Source: Researcher Primary Data
Mulia Hospital in Tuban
2019
Table 5.5 Cross-table Relationship between
From the table above, it was found that
Work Stress and Burnout Syndrome in
respondents with the highest sex were
Nurses at Medika Mulia Hospital in Tuban,
women 61.6%.
August 2019
2. Characteristics based on education Burnout Syndrome
Table 5.2 Distribution of Frequency of Job Total r P
stress value
Respondents by Education in August 2019 Middle Heavy
No Graduate Frekuensi Presentase (%) Middle 18 8 26 0,737 0,000
(94.8%) (14%) (25%)
Heavy 1 49 50
1 D3 56 73.7 (5.2%) (86%) (75%)
2 S1 20 26.3 Total 19 57 76
total 76 100 (25%) (75%) (100%)
Source: Researcher Primary Data 2019
Source: Researcher Primary Data 2019
The table above can be concluded that
From the table above, it was found that
based on the Spearman test with significance
respondents with the highest education level
level α = 0.05, sig values were obtained. (2-
were D3 73.7%
tailed) = 0,000. Where 0,000 <0.05, it is
Job Stress
concluded that H1 is accepted, so there is a
Table 5.3 Distribution of Nurse Work Stress
relationship between work stress and
Frequencies at Medika Mulia Hospital in
burnout syndrome nurses at Medika Mulia
Tuban, August 2019
No Job stress Frekuensi Presentase (%) Hospital in Tuban. The r value obtained is
1 Light 0 0 0.737 and the direction of the correlation is
2 middle 26 34.2 positive which can be interpreted between
3 Heavy 50 65.8 variable 1 and variable 2 having a strong and
Total 76 100
direct relationship which means the greater
Source: Researcher Primary Data 2019 the value of one variable the greater the
From the table above it is found that the value of the other variables.
level of work stress of nurses in Medika Discussion
Mulia Hospital is the Heavy level with 65.8% Job Stress in Nurses
Burnout Syndrome Based on table 5.3 it can be seen that
work stress on nurses at Medika Mulia
Hospital in Tuban is mostly in the weight According to Cherniss (in Shaufeli and
category with a total of 50 people or 65.8% Buunk, 1996) burnout is a change in attitude
of the total 76 respondents studied and as and behavior with psychological
many as 25 people or 34.2% of the total 76 withdrawal, keeping distance from others,
respondents studied . David and Newstrom cynical with others, often truant, often late,
define work stress as a condition that affects and has a desire to stop working. This is in
one's emotions, thought processes, and line with Riggio (2003) saying burnout is a
physical condition. syndrome that is the result of long-standing
According to Cooper (1983) the source work stress and leads to withdrawal from the
of stress consists of the following factors organization. The factors that cause burnout
(Rice, 1992): Work Environment, overload syndrome consist of: personal factors,
(excessive workload), deprivational stress, environmental factors, support and work
high-risk work. While according to pressure. (Lee & Ashford, 1996). Some
Robinsson the factors that influence stress respondents said they experienced burnout
consist of: Demands for the role, demands syndrome due to stress levels in work that
for roles and personal demands. In this was considered heavy.
study, 65.8% of nurses experienced work Respondents said that they experienced
stress in the severe category. burnout due to high work pressure, one of
Nurses who work experience work which was work stress which had an impact
stress, often experience dizziness, fatigue, on decreased work motivation, decreased
lack of friendliness, lack of rest due to work performance. Burnout itself is very
workload that is too high and inadequate influential on the decline in quality of work
income (Russeng, 2007). In this study the characterized by frequent late work,
factors that cause stress are work disobedience to hospital regulations, to the
environment such as poor management of most severe against the boss.
hospital management. Ambigutas in the role Relationship between Work Stress and
often imposes excessive burdens resulting in Burnout Syndrome in Nurses at Medika
increased stress on nurses, nurses play a dual Mulia Hospital in Tuban
role in addition to the main duties as nurses, Data obtained from the characteristics of
also carry out tasks that are given outside the respondents, female gender ranks highest
authority as a nurse. Appreciation is also a with 61.6%, most of which contribute to the
source of stress, when work that has been increase in burnout syndrome due to various
done is not valued which will cause work roles in married life. While the level of
stress. Nurses who experience work stress education, nurses with a D3 education level
will have a bad impact on the services of 73.7% played a role in increasing burnout
provided, thus reducing the quality of syndrome due to their role as implementing
hospital services. nurses.
Burnout Syndrome In Nurses The Relationship between Work Stress
Based on table 5.4 it can be seen that and Burnout Syndrome in Nurses at Medika
burnot syndrome in nurses in Medika Mulia Mulia Hospital in Tuban was analyzed using
Tuban Hospital is mostly in the weight the Spearman test method. The results of
category with a number of 57 people or 75% data analysis of 76 respondents who
of the total 76 respondents studied and as perceived work stress in the weight category
many as 19 people or 25% of the total of more than 50%, as many as 50
number of 76 respondents studied . respondents or 65.8%, while the remaining
26 respondents or 34.2% experienced
moderate work stress. Burnout syndrome Job stress is one of the factors causing
was perceived by 76 respondents in the frequent burnout conditions for employees.
heavy category as many as 57 respondents Stress is an adaptation response to a
or 75%, while 19 respondents experienced situation that is felt to be challenging or
burnout syndrome in the moderate category. threatening one's health.
The results of statistical tests carried out Stress at work and in everyday life is
show the results of the value of p = 0,000 inevitable. Some individuals cannot control
with a significance level of p = 0.05. So H1 over a period of time due to work stress.
is accepted and H0 is rejected, where H0 is When individuals become tired and feel that
rejected if the value of sig (2-tailed) p> 0.05 there is nothing positive to do, they display a
or p> 0.01. The r value obtained is 0.737 symptom that is often called burnout.
and the direction of the correlation is Burnout symptoms can be experienced by
positive which can be interpreted between everyone or workers. Feeling upset is
variable 1 and variable 2 having a strong and defined as a psychological process that is
direct relationship which means the greater caused by continuous work stress which
the value of one variable the greater the results in fatigue between the workers and
value of the other variables. The results of causes low job satisfaction.
the static analysis show that there is a Control (autonomy) owned by nurses to
significant relationship between work stress shape personal values through two aspects,
and burnout syndrome among nurses at namely community and reward. Burnout
Medika Mulia Tuban Hospital. reduction can be done by forming personal
According to Gray Toft & Anderson values and reducing workload which is a
(1981), work stress is an internal signal in source of stress. To reduce burnout can be
the physical, social, or psychological done by reducing workload without ignoring
environment that threatens the balance of the other aspects in the area of work life control,
individual. Stress can have a negative justice, community, values and respect for
impact on various things namely task nurses.
performance, health, desk rage, and burnout The reduction in work stress can be
(Greenberg & Baron, 2008). Burnout is not started by minimizing ambiguity in the role,
a symptom that comes suddenly. An the nurse should only be charged with the
individual takes it through several stages, a. main task as a nurse in providing nursing
work involvement is increasing, b. care and other basic tasks which are still
stagnation at work, c. become separated or within the scope of work at the hospital.
withdraw from work and d. experiencing Reward plays a major role in reducing the
physical symptoms and behavior. During level of stress experienced, for example,
this time, burnout research has mainly been excessive workload and outside the hospital
conducted on professions in the service corridor and does not get a good
sector, such as teachers or lecturers, nurses, appreciation, it will cause rejection in
doctors, social workers, therapists, and carrying out the tasks assigned. Appropriate
police. burnout. From the burnout rewards will also provide great motivation in
organization's point of view, the most carrying out the task.
obvious consequence of burnout is a CONCLUSIONS AND
decrease in work performance. If someone RECOMMENDATION
experiences burnout, the achievement might Conclusion
not be able to continue From the results of this study it can be
concluded that:
1. Job stress on nurses in Medika Mulia Femmy, Lekahena., 2015. Hubungan Antara
Tuban Hospital in the category of heavy Stres Kerja dengan Burnout pada
stress. Perawat di RSUD DR. M. Haulussy
2. Burnout syndrome in nurses at Medika Kota Ambon. Skripsi. Universitas
Mulia Tuban Hospital in the weight Kristen Satya Wacana Salatiga.
category. Fraser. 1997. Sters dan Kepuasan Kerja.
3. There is a significant relationship between Jakarta: PT. Pustaka Binaman
work stress and burnout syndrome among Perssindo.
nurses in Tuban Mulia Medical Hospital Gibson, D., 1996. Organisasi, Perilaku,
RECOMMENDATION Struktur, Proses, Jakarta: Erlangga
1. Theoretical Haryanto, F Rosyid. 1996. Burnout:
2. Practical Penghambat Produktivitas yang
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