Nurse Satisfaction in Implementing Activities based on

the N-ABC Mira System

Mira Asmirajanti

, Achir Yani S. Hamid

, Rr. Tutik Sri Hariyati

and Boy S. Sabarguna

Department of Nursing, Faculty of Health and Sciences, Universitas Esa Unggul, Jakarta 11510, Indonesia

Faculty of Nursing, Universitas Indonesia, Depok, West Java 16424, Indonesia

Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia

Keywords: Nurses, Nursing Activities, Nurse Satisfaction.

Abstract: Background: Caring and recording nursing care are activities of every nurse. The main problem is that

nursing activities at the hospital have not been used as a basis for awarding appreciation points. Even

though, in daily lives, nurses are constantly on the patient's side to perform nursing care. The study's

purpose was to evaluate nurse satisfaction in implementing activities based on the N-ABC Mira system.

Methods: The study was conducted at RSDK Semarang, using a quasi-experimental design, repeated

measurements before implementation; trial 1; 2 and 3. This study randomly sampled 226, 199, 161 and 92

practical nurses with a minimum work period of 1 year, also through nursing documentation on 10 most

frequent diseases in July-December 2018, taken incidentally. Data was collected and analyzed using RM

GLM, t-Test, ANOVA, Pearson's Correlation. Results: It showed significant differences between before and

after the N-ABC Mira system to nurse satisfaction with nursing activities (6,657, p=0,0001); decision

making (2,999, p=0,0001) and award points (6,585, p=0,0001), which were influenced by nurse aspects,

management, and technical support. Conclusions: The differences between before and after the

implementation of the N-ABC Mira system can increase nurse and patient satisfaction, so N-ABC Mira is

recommended at the hospital.

1 INTRODUCTION

Nurses as professional service providers in hospitals

are important health workers. The nurse has the

longest and most intense relationship with the client,

from entering the hospital to being discharged.

Nurse activities must focus on resolving issues and

meeting client needs, both independently and

collaboratively (1). Nurses must respect patients by

working continuously and systematically (2)

Nursing activities consist of assessment,

determination of nursing diagnoses, determination of

outcomes, planning, implementation and evaluation

(3) by always paying attention to client safety

according to service standards, (4) so as to provide

satisfaction to nurse (5). Nurse job satisfaction is

considered an important component so that nurses

work according to their objectives. Financial

remuneration is one of the important things that

contribute to nursing satisfaction in the form of

rewards (6).

A study of the implementation of the

remuneration system and service performance stated

that as many as 71.2% of respondents expressed

dissatisfaction and were very dissatisfied with the

implementation of the remuneration system (7).

Nurses feel the amount of remuneration is not

commensurate with their workload and performance.

Improving the remuneration points needs to be

sought to improve the job satisfaction of nurses (8)

and appreciate their performance. Calculation of

awards and professional payments can be made

based on actual workload and nursing care (9).

Calculation of reward points from nursing activities

based on documentation of nursing care can increase

nurse satisfaction (10).

Type A State Hospitals in Semarang and Jakarta

are hospitals that have provided remuneration in

Indonesia, but nursing activities have not yet

become the basis for calculating remuneration. Both

hospitals have used information management and

electronic medical records, however, documentation

of nursing activities is still carried out manually. The

228

Asmirajanti, M., Hamid, A., Hariyati, R. and Sabarguna, B.

Nurse Satisfaction in Implementing Activities based on the N-ABC Mira System.

DOI: 10.5220/0009590202280233

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 228-233

ISBN: 978-989-758-454-1

results of observations and focus group discussions

in September 2016 - January 2017 stated that

nursing activities based on nursing documentation

were not optimal. Less than 80% of nursing

activities do not meet standards. Manual

documentation requires a long filling time, thus

reducing the time of patient visits by nurses. The

incompleteness of nursing documentation results in

difficulty in finding data and calculating nurse

awards.

The information system is one solution to be able

to increase nurse activity and nurse satisfaction in

documentation (13), save time and can reduce the

risk of data loss (14) and facilitate the calculation of

financing. Funding in almost all hospitals in

Indonesia has used hospital management

information systems. A nursing management

information system based on nursing activities has

also been developed in Indonesia. Some nursing

information systems that have been used are the

Generic Open Hospital Management Information

System (SIMRS GOS) prepared by the Directorate

General of Health Business Development (Ditjen

BUK) Ministry of Health of the Republic of

Indonesia (kemkes.go.id, 2015) and the Nursing

Management Information System that has been

developed by Roro (SIMPRO) (15). One of the

hospitals (RS) in Indonesia that has utilized the

Generic Open Hospital Management Information

System (SIMRS GOS) is the RSDK.

Referring to the previous introduction, it is

necessary to reform and develop the award of nurses

based on nursing activities. One of the information

systems for financing based on nursing activities that

have been developed is the Nursing Activity Based

Costing Mira System (N-ABC Mira) which is

suitable for nurses in Indonesia and hospital needs.

The purpose of this study was to determine

differences in nurse satisfaction before and after

using the Nursing Activity Based Costing Mira

System (N-ABC Mira).

2 RESEARCH METHODS

This research uses a quantitative method, a quasi-

experimental study (pre-post without control). This

study was tested before implementation and 3 times

repeated testing after implementation, with

documentation samples following the number of

nurses. Documentation was taken incidentally from

the 10 most diseases in Surgical Medical patients.

Samples of nurses with a minimum of 1-year work

experience criteria were randomly selected before

the study was conducted. There were 226 nurses in

the sample before implementation, 199 in the first

trial, 161 nurses in the second trial, and 92 nurses in

the third trial. Data were collected in July -

December 2018 at Semarang RSDK and analyzed

using the GLM RM, t-Test, ANOVA, Pearson's

Correlation. This research has also passed the ethical

research review (ethical clearance) from the Faculty

of Nursing, University of Indonesia number 2513 /

UN2.F12. D / HKP.02.04 / 2016.

3 RESEARCH RESULT

The N-ABC Mira system is an information system

that automatically calculates award points based on

recording nursing activities. This system makes a

calculation of nurse award points easier and more

precise. Reward points will be recorded

immediately if the nurse clicks on each activity

carried out. Henderson's need theory, a theory of

technological competence as part of caring in the

Locsin nursing profession, Lewin's theory of

change, clinical pathway theory, remuneration

theory, and information systems theory are theories

that underlie the development of N-ABC Mira

system. The N-ABC Mira system is internet-based

and comes with authorization for each user. The

development of this system is tailored to the needs

of users and can be transplanted easily to

information systems that have been used by

hospitals, for example, Hospitals that already

utilize the Generic Open Hospital Management

Information System (SIMRS GOS).

Nursing activities are the activities of nurses in

providing nursing care, starting from the assessment

of each patient who comes to the inpatient room,

determines nursing diagnoses and interventions,

provides information and education, conducts

discharge planning, establishes nursing outcomes

and evaluations and fills N-ABC Mira system

applications. Nursing activities are implemented by

modifying clinical pathways into nursing pathways

that are applied to the N-ABC Mira system. Every

activity that has been carried out will be

automatically captured in the nursing records and

becomes the basis for setting the nurse's award

points.

Nurse Satisfaction in Implementing Activities based on the N-ABC Mira System

229

Figure 1: Differences in nurse satisfaction with nurse

activity between before, the first trial; second and third

after using the N-ABC Mira system in Semarang Hospital

in 2019.

Figure 1. shows the differences in nurse

satisfaction with nursing activities that illustrate

nurses' perceptions regarding feelings when carrying

out and recording nursing activities before and after

using the N-ABC Mira system. ANOVA (post-hoc)

test results were significant between before and the

first try after using the Mira N-ABC system at

6.65761 (p = 0.0001). In the first and second trials,

trials 2 and 3 after using the N-ABC Mira system

there was an increase but it was not significant. It

can be interpreted that before using the N-ABC Mira

system, nurses' satisfaction with the activities of

nurses is not satisfied (range of values between 20-

29) and after using the N-ABC Mira system, nurses'

satisfaction can be interpreted as satisfied (range of

values of 30-39).

Figure 2. shows the differences in nurse

satisfaction with decision making. This illustrates

nurses' perceptions regarding feelings when

determining appropriate activities in inpatient care

before and after using the N-ABC Mira system.

ANOVA (post-hoc) test results were significant

between before and the first trial, after using the N-

ABC Mira system of 2.99924 (p = 0.0001). An

increase was found but was not significant in the

first and second trials, as well as the second and

third trials after using the N-ABC Mira system. It

can be interpreted that there is nurses' dissatisfaction

with decision making before using the N-ABC Mira

system (range of values between 12-17) and there is

satisfaction after using the N-ABC Mira system

(range of values 18-23).

Figure 2: Differences in Nurse Satisfaction with Decision

Making before, first trial; second and third after using the

N-ABC Mira system in Semarang Hospital in 2019.

Figure 3: Differences in Nurse Satisfaction with Award

Points before, first trial; second and third after using the

N-ABC Mira system in Semarang Hospital in 2019.

Figure 3. shows the differences before and after

using the N-ABC Mira system regarding nurse

satisfaction with reward points, which illustrates

nurses' perceptions regarding feelings when getting

appropriate rewards. ANOVA (post-hoc) test results

were very significant (p = 0.0001) between before and

after using the N-ABC Mira system in the first trial,

with a score of 6.58554. There was no significant

increase (p = 0.098) in the first trial and after the

second trial, as well as in the second trial and after the

third trial using the N-ABC Mira system. This can be

interpreted that there is a nurse's dissatisfaction with

the award points, before using the N-ABC Mira

system, (range of values between 12-17), while nurses

were identified as satisfied after using the N-ABC

Mira system (range of values 18-23).

18.647  0.227

ICOH 2019 - 1st International Conference on Health

230

4 DISCUSSION

N-ABC Mira system is a system for calculating

nurse award points based on the recording of nursing

care activities that have been carried out. N-ABC

Mira system is a system that facilitates nurses in

carrying out their activities. Nurse activities at the

hospital are numerous, from the arrival of the patient

to the hospital to being discharged (16). However,

nurses still need time to adapt to changes, so, N-

ABC Mira system training needs to be given. Nurses

must understand how to use the system properly in

order to record the activities of providing nursing

care in the hospital. Training is conducted as an

effort to reduce resistance and support change (17).

Good job satisfaction will improve performance

and patient satisfaction with nursing services (18).

The results showed differences in nurse satisfaction

with nursing activities based on nursing care

documentation between before and after using the

N-ABC Mira system in the first trial, which was

27,498 (68.75%) and 34,155 (85.39%). The analysis

showed a significant difference (p = 0.0001)

between before and after implementation in the first

trial. There was no significant difference between

before and after the implementation of the N-ABC

Mira system in the first trial to the second trial, and

in the second trial to the third trial. This shows that

good planning needs to be done to make changes.

Changes in an organization must be planned

carefully. Central to change is behavior change so

that good reward and punishment must be

considered for successful change (19).

N-ABC Mira system is an information system

that in addition can store nursing care data, it can

also be used for nurses' assessments, through a

complete system, easily and quickly applied, so

nurses can visit patients more often. Computer-based

documentation makes the nurse's work simpler, so

nurses can focus on providing nursing actions (20).

Caring as a major element in nursing care, and

nurses must be able to apply it to patients (21). N-

ABC Mira system can help nurses to nurse activities

in providing nursing care, thereby increasing nurses'

satisfaction.

Nurses' satisfaction with the decision to provide

nursing care will increase if they can provide

nursing care according to the patient's needs. N-

ABC Mira system makes it easy for nurses to choose

menus and items that are in accordance with the

results of the assessment that has been done, making

it easier for nurses in making decisions to determine

appropriate nursing care. The results showed that the

most significant differences in nurse satisfaction

with decision making were between before the first

trial, using the N-ABC Mira system, amounting to

15,214 (63.38%) and after the first trial, amounting

to 18,212 (75.88%). There is no significant

difference after using the N-ABC Mira system,

namely in the first trial to the second trial, as well as

in the second trial to the third trial. These results

illustrate that making nursing care decisions by

nurses to patients requires management support.

This is consistent with the results of the study

(22) that nurses need management support. Quick

access to information enables decisions that are

appropriate to the nursing activity program and

evaluates results effectively and efficiently, thereby

increasing patient safety and reducing risks to the

patient (22). N-ABC Mira system can help nurses to

make decisions in the provision of nursing care.

N-ABC Mira system is a system of recording

every activity of nurses in the provision of nursing

care that has been done and calculation of nurse

award points. According to (6) that nurses have a

high workload and are not comparable with the

remuneration and professional awards received.

Professional remuneration and appreciation must

reflect the activities, education, and skills in

providing daily nursing care. Appropriate

appreciation will give satisfaction to the nurse. The

results of this study indicate that there is a

significant difference (p = 0.0001) in nurse

satisfaction with respect points between before and

after using the N-ABC Mira system in the first trial,

12,783 (53.25%) and 19,364 (80.68%). This is

consistent with what was stated (23) that the

calculation of the financing of nurses' activities in

providing nursing care would be more effective

based on documenting patient nursing care. N-

ABC Mira system as an information system that can

store nursing care documentation data and can be

used as a reference in calculating award points.

N-ABC Mira system was developed to facilitate

better appreciation for nurses. The results showed

there was a difference in mean nurse satisfaction

with reward points of 6.58554, which was very

significant (p = 0.0001) between before intervention

and after the N-ABC Mira system in the first trial,

but in first trial to second trial and from second trial

to third trial after using the N-ABC Mira system the

difference in mean nurse satisfaction was not

significant. Based on these results, nurses need to be

encouraged to make changes. The results of this

study are supported by satisfaction theory (24)

which focuses on satisfaction on 3 relationships,

including the relationship of motivation with

performance; a relationship of performance with

Nurse Satisfaction in Implementing Activities based on the N-ABC Mira System

231

appreciation and relationship of appreciation with

personal goals. Many workers do work because of

obligations, not because they are motivated at work.

This is because there have not been many awards

relating to nursing activities. That caused many

nurses to decide to work abroad. In accordance with

the results of research on the Policy Brief from (25)

that in Indonesia 60% of health workers are nurses.

Nursing has heavy workload, and it is not valued as

a profession and professional staff by other

professions, besides, the scope of work is unclear

due to many non-nursing assignments, also added by

exposure to work risks that are not matched by

adequate work protection and the lack of a proper

reward system to be a push factor for Indonesian

nurses to migrate and meet more global markets.

N-ABC Mira system is expected to reduce

Indonesian nurses from migrating and meet the

global market because this system can help

overcome problems in calculating nurse award

points based on nursing activities. N-ABC Mira

system needs to be properly socialized and informed

in order to get support from PPNI and HPMI

organizations and from policymakers such as BPJS

and PERSI. Nurses are the largest group of

professionals in hospital health services (26). Nurses'

activities in providing nursing care will be of good

quality if managed properly and nurses have good

motivation to carry out so that they require clear

policies related to the management of nursing care.

The use of the N-ABC Mira system in hospitals will

change the order of nursing services and require

good encouragement. According to Lewin, drivers

need to make 3 steps of change. The first step,

analyzing the situation to find out the factors

inhibiting and driving change. The second step,

conduct training and actual changes in nursing

practice. The third step is used to evaluate the

stability and effectiveness of changes that occur in

nursing practice (27). According to (28) that

motivating nurses can be done by managers by

increasing nurse knowledge through formal and

informal education and training, as well as good

career paths.

N-ABC Mira system is a system developed for

nursing activities and calculation of reward points

that requires validation of the head nurse before

being established. The head nurse must assess the

compatibility between the recording and the nursing

care that has been given to the patient. According to

(29) the supervision of the head nurse must be done

regularly and continuously. Providing optimal

nursing care to patients can increase patient

satisfaction and reduce the length of stay in the

hospital (21). The results of N-ABC Mira system

research showed that management support has a

positive direction towards nursing activities based

on nursing care documentation, nurse satisfaction

with nursing activities, decision making, and award

points. This means that the N-ABC Mira system

requires management support in its implementation

so that nursing activities can run better and faster.

5 CONCLUSIONS

N-ABC Mira system is an information system that is

used to calculate award points based on internet-

based nursing activities documentation. There is a

significant difference in nurse satisfaction with

nursing activities, decision making, and reward

points between before and after trial 1 of the N-ABC

Mira system. N-ABC Mira system is influenced by

aspects of nurses, management support and technical

support. Hospitals as an institution of service with

nurses as the most personnel can use the N-ABC

Mira system to support the calculation of reward

points for nurses' activities in providing nursing care

and hospitals that already have information systems

that can transplant N-ABC Mira system. The N-

ABC Mira system application needs to be socialized

to PPNI, HPMI, PERSI, and BPJS as a health

insurance agency to finance nurse activities in order

to get support and be implemented as a basis for

determining nurse award point policy.

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