Analyzing Performance of Midwifes viewed from: Workload, Work Shift,

Work Stress
Nurmayanti
Master of Management,
Faculty of Economics and Business,
Esa Unggul University
nurma30@gmail.com

Abstract

Midwives not only carry out midwifery services, but also carry out administrative, financial,
marketing, medical supplies and other tasks that drain the energy and mind of a midwife. Heavy
workloads and the division of work shifts, especially night shifts are phenomena that occur on the
ground which can actually trigger work stress levels. With frequent contact with factors that trigger
work stress, it is likely to lead to a decrease in the performance of a midwife. The purpose of this
study is to investigate workload and work shifts whether it influences work stress and midwife
performance.
Respondents in the study were taken using purposive sampling totaling 180 midwives. Data
was processed using Structural Equation Model (SEM). The results of the study showed that workload
could increase the work stress of midwives, the existence of work shifts did not have a positive effect
on midwife work stress, and work stress had a positive effect on midwife's performance. This study
recommends that the workload of midwives be reviewed and analyzed. Recommend to do a job stress
analysis more thoroughly and in accordance with the subject to be studied.
Key words : workload, work shift, work stress, performance.

Introduction
One of profession or health worker who plays an important role in Indonesia is the
Midwife. Midwives mainly play a role in maternal and child health efforts. In addition to
helping with the delivery process, midwives also help monitor the process of pregnancy,
postpartum and the health condition of the baby or child born. Therefore, the adequacy of
Midwife competencies is important (GAY, 2014).

Basically, Midwives have a division of work shifts that are in accordance with the
policies of each institution. According to the Minister of Manpower and Migration on the
Types and Characteristics of Work carried out continuously in article 3 said that work in the
field of health services can employ it on official holidays based on agreements between
workers and employers or owners (Kurniati & Efendi, 2012).

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 Based on Law RI No. 13 of 2003 concerning Manpower in article 77 states that the
division of labor time includes 8 (eight) hours 1 (one) day and 40 (forty) hours 1 (one) week
for 5 (five) working days in 1 (one) week. In accordance with the article, the government
requires workers in any sector to know clearly shift work hours and also workload
calculations.

The influence of a very large workload will translate to lower levels of performance
and in turn contribute to low morale and high employee turnover in the organization
(Vijayan, n.d.).

In the research conducted by Venny marchelia (2014) said that work stress may be
influenced by work shifts with the results of analysis showed that night shift has stress level
higher than morning and daylight shifts. (Kaewanuchit & Sawangdee, 2016) said that work
condiciton, workload, salary, work safety is found as the significant contributor to work stress
for immigrant employees. (Nonose, Yoda, Kanno, & Furuta, 2016) showed that workload in
team performance consists of at least two types of workloads (work task and team
performance), and therefore, it needs to asses the two types to assess the workload in team
performance better. Investigation on workload which is unique for the team is needed to carry
out team workload.
(Susanty, 2017) stated that the more stressors, the higher the stress of employees.
The stress of this research is workload and time availability. The study recommends that the
workload of each employee be reviewed and analyzed. Evidently, the workload must be
compared with the time available to do the work assigned to employees. Makhbul (2009)
suggested that health, work, work shifts and working hours are factors that are significantly
related to work stress. There is a direct correlation between work stress and performance. The
stress experienced by employees can facilitate increased job performance, even though the
experience can also hinder or damage job performance. The effect depends on the level of
stress experienced by the employee (Handoko, 2001).
Based on the author's experience and observations as a midwife, midwives not only
conduct midwifery services, but also carry out administrative, financial, marketing, medical
supplies, and other tasks that drain the energy and mind of a midwife. Heavy workloads and
the division of work shifts, especially night shifts are phenomena that occur on the ground
which can actually trigger work stress levels. With frequent contact with factors that trigger
work stress, it is likely to lead to a decrease in the performance of a midwife. This study aims

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to investigate workload and work shifts whether it influences work stress and midwife
performance.

Literature Review

Workload

Workload is a pressure as a response that is not adaptable, which is influenced by

individual differences or psychological processes, namely a consequence of any external
action (environment, situation, too many psychological or physical demands) on someone
(Gibson and Ivancevich, 1993). Workload is a situation where workers are faced with a task
that must be completed at a certain time (Munandar, 2001).

Work Shift

According to Kroemer, work shift is the presence of an employee at a workplace

regularly on the same time (permanent shift) or with varied periods (rotated shift). Permanent
shift is employees who work permanently during particular shift (Winarsunu, 2008). For
example, employees who work during nigh shift permanently. Whereas rotated shift is a work
system where employees work in shifts by taking turns with others, working during morning
shift, then rotated to daylight shift, then work during night shift (Aamodt, 1999).

Based on Law RI No. 13 of 2003 concerning Manpower in article 77 states that the
division of labor time includes 8 (eight) hours 1 (one) day and 40 (forty) hours 1 (one) week
for 5 (five) working days in 1 (one) week.

Work Stress

Stress is an internal state, caused by physical (body) or environmental demands, and a

potentially damaging and uncontrolled social situation (Morgan & King, in Umam, 2010).
Structures can also mean a response from a person to physical challenges or mentality that
comes from inside or outside itself (Nasrudin, 2010). Stress is a person's response to changes
in the environment perceived as disturbance and results in him being physically and mentally
improved. Every person has a certain level of tolerance on pressure at all times, namely the
ability to overcome or not to overcome it. (Anoraga, 2009).

Stress is the body's reaction to the environment to protect itself, it is a natural

defense mechanism that makes a person live. Lower stress levels make a person think and try

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to answer life's challenges, and even make life colorful. But high and prolonged stress will
cause disruption to the health of the body and soul. Luthans (2007) stated that stress is a
response to adjustment influenced by individual differences and psychological processes as a
consequence of environmental actions, situations that cause too much psychological and
physical demands. Job stress is caused by factors of work conflict, workload, work time, task
characteristics and support groups (Newstrom and Davis, 2002).
Job stress has dimensions, namely time management, things that trigger stress,
professional difficulties, emotional manifestations, fatigue manifestations, cardiovascular
manifestations, natural manifestations, and behavioral manifestations (Fimian, 1988).

Performance

Performance is the quantity or quality of something produced or services provided by

someone who does work (Luthans, 2005). Performance is the result of work both in quality
and quantity achieved by someone in carrying out tasks according to the responsibilities
given (Mangkunegara, 2002).

Hypothesis

Excessive workload has a positive effect on work-related stress and work life
conflicts (Pradana, 2015). The mental workload of managers and supervisors becomes more
complex along with new jobs, and requires more frequent evaluation of mental burdens
(Jazani, et al 2016). Khan et al. (1990) explained that stressors can be ambiguous roles,
excessive workload, or work conflict (role conflict).
Based on the description above, the hypothesis proposed is:
H1 : Workload will have a positive effect on work stress.

Shift work is usually categorized by day, night, or night schedule (Skipper, Jung, &
Coffey, 1990; Wilson, 2002). Negative results do not occur for all employees working shifts;
some workers adapt to this schedule and do not display any adverse effects (Pisarski, Bohle,
& Callan, 2002). There is a correlation between stress perception and physical and
psychological adjustments to stressors (Lazarus & Folkman, 1984; Roesch, Weiner, &
Vaughn, 2002), this indicates that employee perceptions of the work climate contribute to
their perception of health status. In addition, previous research focused on biological factors
that contribute negatively to the health outcomes of shift workers (Bøggild et al., 2001). Peer
collaboration, supervisor support, and opportunities for professional development are
considered less available during shifts roles (Coffey, Skipper, & Jung, 1988; Parkes, 2003;

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Pope, 1993), and, compared to daily staff, some are considered (a ) greater stress from
environmental risk factors, (b) more diverse in physical work, and (c) less control over work
steps for shift workers and night shifts (Sveinsdottir, 2006).
Based on the description above, the hypothesis proposed is:
H2 : Work shift will have a positive effect on work stress.

Khasaweh & Futa (2012) and Mathur, Moschis and Lee 2007 found a significant
positive linear relationship between work stress factors (role conflict, job responsibility and
organizational culture and employee performance. If the stress intensity increases to the
optimal level, then the increase will help employees to maximize all available resources
(Handoko, 2001 ) Stress affects employee performance: Very low stress levels cause
employees to work below their true potential, while people who work at high stress levels
make them unable to concentrate on their work (Crampton et al., 1995). Stress is eustress and
distress stress, Eustress improves worker performance and provides the motivation, energy,
and additional courage needed for administrative tasks (Cloud, 1991).
Based on the description above, the hypothesis proposed is:
H3 : Work stress will have a positive effect on performance.

Workload
H1

Work stress H3 Performance

H2

Work shift

Figure 1.1 Conceptual framework

Source : Theoretical Study (2015)

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Research Method

The research method used is descriptive analytic statistical method and inductive
analysis, the analytical tool used is path analysis, with the object of research of professional
health personnel, namely Midwives in the Jabodetabek area. Respondents in the study were
taken using purposive sampling. The inclusion criteria for the respondents are: midwife
puskesmas, village midwives, independent practice midwives and midwives who work in
hospitals, whether they are still working or have resigned.
This study initially used 62 statements in the form of questionnaires for four
variables, consisting of independent variables, namely workload and work shift, and the
dependent variable were work stress and performance. But after testing the validity and
reliability, the number of revelations became 36. We compiled a questionnaire by adapting
existing measurements used in previous studies adapted to the current research context. The
number of respondents were as many as 180 midwives (36x5).
To determine the level of significance and interrelation between variables, the
method of structural equation modeling (SEM) was used. With this method, it can be seen the
influence and relationship between exogenous variables and endogenous variables related to
the problem studied. In this study data was obtained using a questionnaire. The questionnaire
was designed so that all respondents were expected to answer all statements. The distributed
questionnaire was accompanied by a cover letter to fill out the questionnaire and an
explanation of matters relating to the research. The scale used in the questionnaire is a Likert
scale with answers in 6 categories ranging from very agree to very disagreeing assessment.
Variable of workload used NASA-TLX.

Structural Equation Model (SEM)

Because the conceptual framework used is an unobserved variable model, where data
is tested based on its indicators, namely using the Structural Equation Model (SEM) and
processed with LISREL. Whether or not a SEM model to be used can be known by looking at
the model fit criteria (Schumacher and Lomax, 2004) such as those generated from syntax
running LISREL.

From the results of the processed data obtained value, if the p-value is less than a
significant level (eg 0.05), it can be concluded that the model is fit or matches the theoretical
model, in this case it can be seen that the Chi-Square test statistic has its p-value P = 0.0017.
So it can be concluded that the SEM model is above fit (match) statistically at a significant

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level of 10%. Next is to pay attention to the root-mean-square error of approximation
(RMSEA) value, if the value is between 0.05 - 0.08 then the model is feasible to use. The
results obtained by the value of RMSEA = 0.060. This indicates that the model is fit /
suitable. The value of Goodness of Fit Index (GFI) = 0.84 and Adjusted Goodness of Fit
Index (AGFI) = 0.78 which is between the values 0 and 1 indicating a good index to accept
the suitability of a model.
This shows that the SEM model fits or matches the data. The model is concluded to be fit with the
data if the value of the RMR is less than or equal to 0. The processed data obtained is Root Mean Square
Residual (RMR) = 0.048 so that the model is fit and feasible to use. from 0.90. The output shows the value of
the Normed Fit Index (NFI) = 0.9 and the Non-Normed Fit Index (NNFI) = 0.99, which means the model is
suitable / fit.Comparative Fit Index (CFI) = 0.99. The magnitude of this index is in the range of 0 to 1 and a
value close to 1 indicates the model has a good level of conformity.

Research Results and Discussion

Figure 1.2 Path diagram t-Value

H1 : Workload can affect on Work Stress

On the results of testing the first hypothesis H1, it is obtained the result of t value of
4.61, which means that a heavy workload can increase the work stress of midwives, or means
that the work stress of midwives is influenced by workload. The test results are similar to

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previous studies that excessive workload has a positive effect on work-related stress and
work life conflicts (Pradana, 2015). Excessive workload is a source of stress in the workplace
(Faulkner and Patiar, 1997; Lo and Lamm, 2005) and emotional fatigue (Karatepe, 2013).
The perceived workload is related to the perspective of employees about objective workloads
when they assume they have too many tasks (Leiter and Marie Durup, 1996) or not enough
time to complete the task (Greenglass et al., 2003). Mansour and Commeiras (2015)
investigated the role of family work conflict between workload and work stress with a sample
of 648 employee hotels in France and confirmed that family work conflicts partly mediate the
relationship between workload and work stress.

H2 : Work shift does not affect Work Stress

The results of testing the second hypothesis, namely H2, obtained the results of t
value of 0.78, which means that the division of work shifts, both morning, evening and night
did not affect the work stress level of midwives. This is similar to previous studies which
state that negative results do not occur for all employees who work in shifts; some workers
adapt to this schedule and do not display any adverse effects (Pisarski, Bohle, & Callan,
2002). There is a correlation between stress perception and physical and psychological
adjustments to stressors (Lazarus & Folkman, 1984; Roesch, Weiner, & Vaughn, 2002).

H3 : Work stress can affect Performance

The third test result, namely H3, obtained a t value of 7.58 which means that the
accepted hypothesis is that high work stress has a positive and significant influence on the
performance of midwives. This is similar to previous studies which state that work stress
factors have a significant cross-sectional and longitudinal relationship with job performance
(Jungwee, 2008). The long-term effects of work stress on work performance are examined
using repeated observations over a two-year period. Job stress is defined as a dangerous
physical and emotional response that occurs when job requirements do not match the
abilities, resources, and needs of workers (National Institute of Occupational Safety and
Health 1999). Depressed workers are also more likely to be unhealthy, less motivated, less
productive, and less safe at work.

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Closing

In conclusion, two hypotheses are accepted, while one hypothesis is rejected. First,
the first hypothesis states that the heavier the workload, the higher the work stress.Work
stress from this research is workload and work shift. Second, there is no influence between
work shifts and work stress. These results indicate that the division of work shifts will not
affect the work stress of midwives. Third, Job stress affects performance. These results
indicate that high levels of work stress will affect the performance of midwives.
This study has several limitations that must be recognized. Such as the sample size
that does not meet the intended target. Therefore, the current results can be said to be
unsatisfactory. This can be seen from the results of varied respondent answers which indicate
that the questionnaire used is not correct with the research subjects.
This study recommends that the workload of midwives be reviewed and analyzed.
Evidently, the workload must be compared with the time available to do the appropriate work
assigned to the midwife. In addition, by knowing the main causes of high levels of work
stress, it is possible to improve the performance of midwives. For further research on work
stress, we recommend that a job stress analysis be done to any profession more thoroughly
and in accordance with the subject to be studied, so that the research can provide a solution to
the organization or profession.
We also recommend to future researchers to have good and effective time
management, because it is very useful for everyday life, it can also reduce work stress levels.

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Note :
The appropriate journal in Scimago : International Journal of Productivity and
Performance Management.

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