The Influence of Knowledge and Work Attitude on Work Motivation and its Impact on The Performance of Nurses at RSUD Dr. Adjidarmo Rangkasbitung, Lebak District

This study aims to determine and analyze the effect of knowledge and work attitudes on work motivation and their impact on the performance of nurses at RSUD Dr. Adjidarmo Rangkasbitung, Lebak Regency. The results of this study are expected to provide input for hospital leaders and nursing managers to use the results of this study to be taken into account in determining and providing appropriate interventions to improve the performance of nurses in providing nursing care services, especially in hospitals. The research method used is descriptive analysis and verification. The data collection used were interviews, questionnaires, and literature studies. The sample was taken using proportionate random sampling. Data collection in the field will be carried out in 2022. The data analysis technique uses Path Analysis. The results showed that in general the knowledge, work attitude, work motivation, and nurse performance tended to be less good. There is an influence of knowledge and work attitude on work motivation either partially or simultaneously and work motivation affects the performance of nurses in RSUD Dr. Adjidarmo Rangkasbitung, Lebak Regency.


INTRODUCTION
For an organization, human resources is an important factor. To be able to achieve its goals, an organization must be able to manage its human resources well, so that it can produce quality human resources to help achieve its goals. This shows that the management of human resources directly impacts the development and growth of the organization.
The same thing also applies to hospitals as one of the organizations engaged in the health sector in dire need of quality human resources. As regulated in Law Number 44 of 2009 concerning Hospitals, Article 4 states that "Hospitals have the task of providing complete individual health services". To be able to provide complete health services, the role of quality human resources is very important. Therefore, in Article 5 point (c) it is explained that the hospital also functions as the organization of human resource education and training in the context of increasing capacity in providing health services. Thus, the goal of the hospital is to provide protection for the safety of patients, the community, hospital environment and human resources in the hospital can be realized. Furthermore, technical arrangements regarding human resources in hospital administration are regulated in Government Regulation Number 47 of 2021 concerning the Implementation of the Hospital Sector, specifically regulated in Article 22.
The above objectives are also in accordance with the opinion put forward by Wibowo (2012: 9) which states that company (organizational) goals can be in the form of service improvement, fulfilling market demand, improving product/service quality, increasing competitiveness, and increasing company performance.
In an effort to achieve these goals required human resources that have good quality. Nurses as an element of human resources who provide health services in hospitals must have the ability, knowledge, and good quality of work. As mandated in Law Number 38 of 2014 concerning Nursing, Article 1 paragraph (2) states that "A nurse is someone who has graduated from higher education in Nursing, both at home and abroad who is recognized by the Government in accordance with the provisions of Laws and Regulations" . Then, technically the regulations regarding nursing management are regulated in the Minister of Health Regulation Number 26 of 2019 concerning Regulations for Implementing Law Number 38 of 2014 concerning Nursing. Based on these rules, Nurses must have knowledge and competence in the field of health services. All of these regulations aim to improve the quality of health services in hospitals with nurses as an important element of human resources, one of which is shown by the performance of the nurses themselves.
The intended performance is the result of work that has a strong relationship with the objectives of the company it manages. Therefore, every company/organization must be able to improve the capabilities of its human resources.
According to Soelaiman (2010: 280), "Performance is as something that is done and produced in the form of products or services, within a certain period and a certain size by a person or group of people through their skills, knowledge and experience." Then he also explained that employee performance is the level at which employees achieve job requirements.
A further opinion was put forward by Sutrisno (2016: 170), that performance is the result of work that has been carried out by a person or group of people in an organization/company, in accordance with their expertise and obligations, with the ultimate goal of achieving the goals of the organization/company concerned with earnestly, do not abuse the law, and comply with ethics and morals.
Good human resource management can be seen from the performance level of these employees. The high or low performance of an employee affects the achievement of the success of the organization/company, so it can be said that the factor that drives performance is the ability of the employees themselves, namely the extent to which employees can carry out or carry out their work/tasks properly and correctly.
Employees who have high work skills/skills will be able to assist the company in achieving company goals. Employee performance will be seen from how much they like the work they are doing. With this provision, they will fully give attention, imagination, and devote all the creativity and expertise they have into their work (Larasati & Gilang, 2014: 2).
Factual conditions are also faced by RSUD Dr. Adjidarmo Rangkasbitung, Lebak Regency from 2019 to 2020 as one of the oldest hospitals in Rangkasbitung, Lebak Regency. This hospital, which is located in Cimahi, was established in 1952 to provide health services to the community, especially the people of Rangkasbitung.
RSUD Dr. Adjidarmo Rangkasbitung is a hospital in Rangkasbitung City, Lebak Regency. Currently RSUD Dr. Adjidarmo Rangkasbitung has a total of 915 employees, of which 317 employees are nurses, consisting of 84 ASN nurses and 233 are non-ASN nurses. With this number of nurses, RSUD Dr. Adjidarmo Rangkasbitung should be able to provide excellent health services. Health services provided by nurses are one of the important factors in describing the performance of a hospital.
Based on the description and problems above, the authors are interested in conducting research with the title, "The Influence of Knowledge and Work Attitudes on Work Motivation and Their Impact on Nurse Performance at RSUD Dr. Adjidarmo Rangkasbitung, Lebak Regency.

IMPLEMENTATION METHOD
The type of research used to analyze research data is quantitative with descriptive and verification methods. According to Noor (2021: 38), "quantitative research is research to test certain theories by examining the relationships between variables. These variables are measured (usually with research instruments) so that data consisting of numbers can be analyzed according to statistical procedures. Then, the descriptive research method according to Traves (Husein, 2015: 22) is defined as a research method that aims to describe the nature of something that was taking place at the time the research was conducted and examine the causes of a particular symptom. With an overview of the problems in the research, the next writer can draw conclusions.
After being described, it is continued with verification research methods. The verification method is a data analysis method by comparing existing data according to research needs for more in-depth analysis.
This research was conducted in several stages, where the method used in this study according to Husein (2015: 32) revealed the various research methods are as follows: 1. Exploratory design is a research method used to test hypotheses based on past data or existing theories. 2. Descriptive design is a design that aims to describe the nature or characteristics of a particular phenomenon and only collects data and describes it thoroughly and examines it according to the problem to be solved, and knows facts about the theory or concept of variables at the location of the researcher. 3. Causal design is a useful method for analyzing the relationships between one variable and another or how a variable affects other variables. Thus it is expected to know whether there is a correlation between knowledge, work attitude, work motivation, and the performance of nurses at RSUD Dr. Adjidarmo Rangkasbitung.
In this study, these three methods were used, because the authors intend to test hypotheses based on existing theories, describe empirically related to each variable, and analyze the causal relationship between variables.
Furthermore, the type of data used uses quantitative data. Quantitative data is statistical data in the form of numbers, either directly extracted from research results or the results of processing quantitative data.
The data source used in this study is secondary data. Secondary data is primary data that has been further processed and presented by primary data collectors or other parties and then reused by researchers for further processing..
According to Sugiyono (2017: 90), "Population is the area of generalization that occurs over: objects/subjects that have certain qualities and characteristics set by researchers to study and then draw conclusions." The population of this research is the nurses of RSUD Dr. Adjidarmo Rangkasbitung which reached 317 nurses with a total sample of 177 nurses. Based on the test results with a significance level of 0.05, where Asymp. The significance obtained from the processing results for knowledge (X1) = 0.463, work attitude (X2) = 0.527, work motivation (M) = 0.274 and nurse performance (Y) = 0.062 is greater than the significance level value, then the data is to measure research variables shows significant results or the sample data comes from a normally distributed population or there is no difference between the sample data that comes from a normally distributed population. Because 786.701 is greater than 3.05 or Fcount is greater than Ftable then Ho is rejected, meaning that it can be concluded that there is a positive and significant effect simultaneously (together) knowledge (X1) and work attitude (X2) on work motivation (Y ). Based on the significance, if the significance < 0.05 then Ho is rejected, and if the significance is > 0.05 then H0 is accepted. Because the significance of the F test is less than 0.05 (0.000 <0.05), then Ho is rejected.

The Effect of Knowledge on Work Motivation
The magnitude of the partial effect of knowledge (X1) on work motivation (M) both direct and indirect influence is 41.14%. Knowledge is influenced by the perceptions of existing members of the organization. If the employee feels that the knowledge of his duties in his place of work is sufficient for him to support himself at work, this will make the employee feel motivated. Strong knowledge will create an extraordinary level of motivation in employees.
According to Flippo quoted by Hasibuan (2017: 14), motivation is a skill in directing employees and organizations to want to work successfully, so that the wishes of employees and organizational goals are simultaneously achieved.
Furthermore, according to Mangkunegara (2017: 113) it is stated that motivation is an encouragement that makes employees do something in a way and to achieve certain goals.
Based on the description and theory above, it can be concluded that there is a strong influence between knowledge on employee motivation. The research results are in line with a number of studies, such as the research by Wahyuningsih and Purnamasari (2016) which concluded that knowledge has a positive and significant effect on work motivation. Likewise, the results of research by Aisyiah, Yarni, and Angginy (2015), stated that work motivation is influenced by the knowledge of nurses in documenting nursing care in the Orchid and Lotus Room, Bekasi City Hospital, West Java Province.
Thus it can be concluded that there is conformity between the results of the research with theory and previous research, it can be understood that knowledge has an influence on work motivation. Meanwhile, in this study it was concluded that the better the perceived knowledge of nurses, then this would further increase the work motivation of nurses at RSUD Dr. Adjidarmo Rangkasbitung.

The Effect of Work Attitudes on Work Motivation
The magnitude of the partial effect of work attitude (X2) on work motivation (M) both direct and indirect influence is 41.89%. Thus it can be said that the better the work attitude shown by the nurse, the higher the work motivation of the nurse in RSUD Dr. Adjidarmo Rangkasbitung.
The effect of work attitude on work motivation, because work attitude is a form of response that is conveyed by an individual or group due to a stimulus or the existence of a certain event or object related to work, then involves the individual's own emotional feelings to increase his motivation at work.
In accordance with the opinion of Sunaryo (2014) that work attitude will affect the internal and external aspects of the nurses themselves which directly affect work motivation. Therefore, work motivation, which in psychology is usually called a morale booster, will only arise if there is a positive work attitude towards work.
Based on research conducted by Porotu'o, et al. (2021) which proves that work attitude has a positive and significant effect on nurse work motivation, meaning that work attitude is really needed by a nurse as a motivator in carrying out her work. Likewise with Husni's research (2018) which states that there is a strong positive relationship between work attitudes and work motivation of nurses at Zahirah Hospital.

The Effect of Knowledge and Work Attitudes on Work Motivation
The total effect or the simultaneous influence of the knowledge variable (X1) and work attitude (X2) on work motivation (M) is 84.03%, while the influence of other variables outside the variable is 15.97%. Other variables not examined by the authors that affect work motivation include work culture, commitment, and others.
According to Maslow in Bangun (2014), a person will have strong motivation due to the need for appreciation (Esteem-need) which is manifested in the form of knowledge, and the need for self-actualization (Self-actualization need) which is shown in his attitude towards the activity or work he does.
The research results of Nirmawati et al. (2020) showed that there is a positive relationship and also a significant influence of work knowledge and attitudes on nurses' work motivation. Likewise Djariah 's research, et al. (2020) who concluded that there is knowledge and work attitude towards the work motivation of nurses. This indicates that high work motivation will grow her nursing duties and also a positive attitude towards her profession as a nurse.
The Effect of Work Motivation on Nurse Performance at RSUD Dr. Adjidarmo Rangkasbitung Work motivation (M) has an influence on nurse performance (Y) of 78.68%. While the remaining 21.32% is explained by other variables not examined in this study. The results of this study are in line with the theory put forward by Nawawi in (Syafira, 2013) which suggests there are 15 factors that affect performance, one of which is work motivation. Likewise the opinion expressed by Sinamora in (Mangkunegara, 2012, that motivation as a psychological element has an influence on nurse performance. This research is in line with a number of studies, including the research of Phinari and Bernarto (2020) which concluded that motivation has a positive effect on nurse performance. Kapantow, Luddin, and Kambey (2020) also concluded the same thing, that work motivation has a significant direct effect on nurse performance.
Work motivation factors are formed from the attitude of an employee in dealing with work situations. The mental attitude itself is a mental state that stimulates employees to try to achieve optimally. The mental attitude of an employee must be a mental attitude that is ready psychophysically (ready mentally, physically, goals and situations). This means that an employee must be mentally and physically prepared to understand the main goals and work targets to be achieved as a manifestation of his performance. Thus it can be concluded that work motivation influences nurse performance CONCLUSION Based on the results of research that has been done to determine "The Influence of Knowledge and Work Attitudes on Work Motivation and Their Impact on Nurse Performance at RSUD Dr. Adjidarmo Rangkasbitung, Lebak Regency", it can be concluded that knowledge in RSUD Dr. Adjidarmo Rangkasbitung is interpreted in terms of tending to be unfavorable. This can be seen from the average score of nurses' knowledge of 2.95. Of the nine indicators regarding knowledge, five indicators score below the average, namely: suitability of educational background, understanding of SOP implementation, calmness of nurses at work, obedience to superiors, and attitude towards work. The work attitude of nurses at RSUD Dr. Adjidarmo Rangkasbitung is interpreted in terms of tending to be unfavorable. This can be seen from the average score of nurses' knowledge of 2.96. Of the 11 indicators regarding work attitudes, there are six indicators that score below the average, namely: comfort at work, attention from superiors, cooperation to achieve work performance, career security, old age security, and peace of mind at work. Work motivation of nurses at RSUD Dr. Adjidarmo Rangkasbiting in the criteria tends to be less good as seen from the average score of nurses' work motivation of 2.97. Of the 10 indicators regarding work motivation, four indicators score below average, namely: recognition, promotion and career development, company regulations, and supervision. The performance of nurses in RSUD Dr. Adjidarmo Rangkasbiting which consists of the dimensions of work quality, work quantity, timeliness, effectiveness, independence, and work commitment, are interpreted in terms of tending to be unfavorable. This can be seen from the average nurse performance score of 2.95. Of the 11 indicators regarding nurse performance, four indicators score below average, namely: quality of work, number of work units produced, maximizing the time allotted to complete work, and minimizing the use of resources to produce large outputs but the results are still of high quality This can be seen from the average nurse Copyright© On the Author performance score of 2.95. Of the 11 indicators regarding nurse performance, four indicators score below average, namely: quality of work, number of work units produced, maximizing the time allotted to complete work, and minimizing the use of resources to produce large outputs but the results are still of high quality This can be seen from the average nurse performance score of 2.95. Of the 11 indicators regarding nurse performance, four indicators score below average, namely: quality of work, number of work units produced, maximizing the time allotted to complete work, and minimizing the use of resources to produce large outputs but the results are still of high quality.