The Influence of Leadership Style and Work Engagement on Job Satisfaction and Its Impact on Nurse Performance in RSUD Dr.

This study aims to determine and analyze the effect of transformational leadership and work culture on nurse performance mediated by job satisfaction at RSUD dr. Abdulaziz. 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 was interviews using a questionnaire accompanied by observation and literature techniques. 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 transformational leadership, work culture, job satisfaction, and nurse performance tended to be less good. There is an influence of transformational leadership and work culture on job satisfaction either partially or simultaneously and job satisfaction affects the performance of nurses in RSUD dr. Abdulaziz.


INTRODUCTION
The Singkawang City Government in carrying out activities is assisted by several SKPDs, one of which is the Regional General Hospital dr. Abdul Aziz who provides special Public Services in the Health sector for the people of Singkawang and the people in the surrounding area. In Singkawang City itself there are 7 hospitals. RSUD dr. Abdul Aziz originally belonged to the Sambas Regency Government and was handed over to the Singkawang City Government in 2004. After becoming one of the Singkawang City SKPDs, the hospital management carried out developments, both facilities, infrastructure and human resources at Abdul Aziz Hospital so that at this time it has shown the increase was mainly due to the number of visits and the interest of the people who chose Abdul Aziz Hospital as a place of referral, treatment and had their health checked, especially from the fractional area of Sambas Regency , and currently RSUD dr. Abdul Aziz Singkawang City is a Class B Non-Educational Hospital.
In line with the increase in the number of community visits to RSUD dr. Abdul Aziz, the need for human resources, especially nursing staff, is getting bigger and management must also always try to develop service activities both in terms of facilities, infrastructure and human resources so that what is expected can be achieved. This is very important because the hospital as a health service institution is an organization that has a high level of complexity due to the work of human resources, consisting of multi-disciplines and various types of expertise.
The hospital is a form of organization whose activities provide services in the form of promotive, preventive, curative and rehabilitative. This is as conveyed in Law no. 44 of 2009 concerning Hospitals, that Hospitals are health service institutions that carry out complete individual health services that provide inpatient, outpatient, and emergency services.
The success of the hospital depends on the various kinds of resources it has, one of which is human resources including nurses. Nurses as one of the health workers in hospitals play an important role in efforts to achieve health development goals. The success of health services depends on the participation of nurses in providing quality nursing care for patients. This is related to the presence of nurses on duty 24 hours a day to serve patients continuously, as well as the number of nurses who dominate health workers in hospitals, which ranges from 40-60%. Therefore, hospitals must have nurses who perform well, are able to provide satisfaction to the patients they serve, and also have a commitment to work ties with the hospital where they work.
Nursing management has been regulated in a number of regulations and laws. Law No. 38 of 2014 concerning Nursing states that Nursing Service is a form of professional service which is an integral part of health services based on nursing knowledge and tips aimed at individuals, families, groups or communities, both healthy and sick. Technically, this is further regulated in the Minister of Health Regulation (PMK) Number 26 of 2019 concerning Regulations for Implementing Law Number 38 of 2014 concerning Nursing. In carrying out its duties as a manager of Nursing Services as referred to in the PMK, it is authorized to: conduct studies and determine problems; plan, implement, and evaluate Nursing Services, and. managing cases.
Performance is a very important factor that is used as an indicator of the success of an organization. As described above, the success and service of nursing in a hospital is largely determined by the performance of the nurses in providing nursing care. Nurse performance is the nurse's activity in implementing as well as possible an authority, duties and responsibilities in order to achieve the objectives of the main duties of the profession and realize the goals and objectives of the organizational unit. To measure whether or not the performance of a nurse can be done by conducting an assessment of her work. Performance appraisal can help anticipate and often prevent employee (nurse) dissatisfaction. Performance appraisal helps find employee (nurse) attitudes towards: diversity, growth, challenges, Nurse performance can be interpreted as anything that has been done by a nurse or works as her job at the hospital. According to Mitchel and Larson (2018: 189), performance can be measured based on indicators: (1) quality of work; (2) timeliness; (3) initiatives/initiatives; (4) abilities; and (5) communications.
Many factors influence the performance of nurses. One of the factors that is thought to influence the performance of nurses is the job satisfaction of nurses who are in charge of providing health services. Job satisfaction is a factor that needs to be considered in efforts to maintain human resources in hospitals. Lack of job satisfaction can be seen, among other things, absenteeism from work, delays in providing nursing services which are marked by the many complaints from patients and families, and resignation from work. The quality of hospital services that are not optimal makes patients dissatisfied as expected by patients, communication between health workers and patients does not go well so that patients are not comfortable with the hospital environment. One of the consequences is human error.
Vroom (Fatimah and Frinaldi, 2016: 137) defines job satisfaction as a reference for the effective orientation of an employee towards their role in the position they currently hold. A positive attitude towards work can conceptually be expressed as job satisfaction and a negative attitude towards work equals dissatisfaction.
The problem that then arises is how to create job satisfaction for nurses in a hospital, so that nurses can produce optimal work. The satisfaction of nurses in carrying out their work will always have a positive impact on the achievement of goals and objectives set by the hospital.
Job satisfaction is basically something that is individual. Satisfaction for each person is different, depending on the value system that applies to him. The higher the assessment of the activity or work that is done and is felt to be in accordance with his wishes, the higher the satisfaction with the work he is doing. In other words, job satisfaction can be translated as a form of evaluation that describes a person's feelings of pleasure or displeasure, satisfaction or dissatisfaction at work.
Nurse job satisfaction does not only have an impact on the progress of the nurse herself, but will also be beneficial for the development and existence of her work in the face of the demands of the times and society. Job satisfaction is very important because nurses can show their abilities to the fullest. That is, if the nurses have high job satisfaction, the results of their work will be considered good. Aspects of job satisfaction include financial, social, physical, and psychological aspects (Triyono, et al., 2020:29).
According to Hasibuan (Yaningsih and Triwahyuni, 2022: 605), job satisfaction is a pleasant attitude and love of work which can be reflected through work messages, obedience, and work results. According to Priyono and Matris (Yaningsih and Triwahyuni, 2022:606) job satisfaction is measured based on the following aspects: (1) there is fair and proper remuneration; (2) placement according to expertise; (3) workloads; (4) work environment; (5) supporting facilities; (6) the attitude of the leader and the attitude towards the leader; and (7) nature of work (monotonous/not).
Nurses who are satisfied with their work will be happy to do their job well and continue to strive to improve their work abilities. On the other hand, nurses who are dissatisfied with their work tend to see their work as boring and boring, so they will do their job compulsorily and haphazardly.
Besides being suspected of influencing job satisfaction, it is also influenced by a number of factors, including: leadership style and work engagement. In the management of an organization or company, the leadership style of its leaders has an important influence in its efforts to achieve the goals of the organization/company. Leaders must be able to apply the right leadership style so that they are able to mobilize all resources, especially human resources to have satisfaction with their work, have a high attachment to their work, and be able to work with good performance.
The leader's ability to lead a hospital is influenced by the leadership style applied in the hospital. According to Thoha (2017: 49), leadership style is a norm in behavior that is inherent and applied by leaders in an effort to influence others as they wish. From this understanding, a leader, for example in a hospital, must have the ability to influence his employees, one of whom is a nurse, so that they can follow what they want. However, it is the way the leader influences the nurses working at the hospital that is very important. If the method used is acceptable to the nurses, then the nurses will gladly follow it.
Leadership style can be interpreted as a collection of traits, characteristics or temperament of leaders in influencing subordinates to achieve organizational goals. Leadership style can also be said that leadership style is a pattern of behavior and strategies that are preferred and often applied by a leader. According to Kartono (2018: 32), leadership style can be measured by indicators: (1) decision 15|T r a n s f o r m a : J u r n a l M a n a j e m e n , V o l . 1 , N o . 1 , F e b r u a r y 2 0 2 3 making, (2) motivating, (3) communicating, (4) controlling subordinates, (5) responsibility; and (6) emotional control.
Research on the effect of leadership style on nurse job satisfaction has been carried out by many previous researchers, such as research by Sari and Fuadati (2022: 43) who examined the effect of leadership style on nurse job satisfaction in a hospital. The results of their research show that the leadership style applied by superiors has an effect on the job satisfaction of nurses in the hospital.
Based on the results of the initial observations that the authors made, there were still complaints from the nurses at RSUD dr. Abdul Aziz Singkawang City related to the way leaders carry out their leadership. This shows that the leadership style applied is inappropriate and not suitable for application in a hospital. A leader must be able to create a pattern of healthy relationships with all employees. The relationship between leaders and employees who are too close, for example, excessive closeness will often be misinterpreted by their subordinates. Leaders are also not maximal in giving trust to their subordinates to develop their abilities or innovate in their work. Another problem is related to the leadership style of superiors at RSUD dr. Abdul Aziz, Singkawang City, is that firm action or strict punishment has not been implemented against nurses who have committed various violations or are unable to complete their duties properly. In the end, these problems are thought to have an impact on job dissatisfaction, and have an impact on the low performance of nurses.
The next factor that is thought to influence job satisfaction and also have an impact on nurse performance is work/employee engagement. One of the successes in optimizing human capital is by increasing employee engagement. This is important because it is assumed that employees who have high work engagement with the place where they work will show the best performance.
Work engagement is a management concept which states that employees who have high engagement are employees who are fully involved and have high enthusiasm for their work and in matters related to longterm organizational activities. In other words, work engagement refers to the involvement, satisfaction and enthusiasm of employees at work. Work engagement has developed from various concepts covering motivation, job satisfaction and organizational commitment (Setiabudhi and Rachmah, 2016: 377).
According to Saks (Supriatna, 2018: 102), work engagement is not an attitude, but a level where individuals have more attention in carrying out roles within the organizational environment. Furthermore, according to the results of a number of studies showing that higher employee engagement will be able to reduce the occurrence of work accidents, employee turnover, employee absenteeism, and so on. In fact, it will foster enthusiasm for work of employees. As one of the important aspects of management, according to Schaufeli et al. (Zamralita, 2017: 339), work engagement can be measured based on dimensions/indicators: (1) Vigor, (2) Dedication; and (3) Absorption.
Regional General Hospital (RSUD) dr. Abdul Aziz is one of the SKPD within the Singkawang City Government, West Kalimantan, which is a supporting element for the implementation of local government in the field of health services. RSUD dr. Abdul Aziz Singkawang City was formed to provide health services to the community based on the principles of efficiency and productivity with the aim of improving the quality of community services, flexibility in financial management which is in line with sound business practices. Based on the results of initial observations at dr. Abdul Aziz Singkawang City obtained a number of problems related to work engagement, namely the perception of nurses who feel that opportunities to develop in the career path are lacking because the quota for appointments as permanent hospital nurses Transforma: Management Journal |16 Copyright© On Author is at least every year. in addition, there are still many nurses who have worked for a long time but have not been appointed as permanent employees. As a result they feel worried about their future which is still in uncertainty.
Another problem regarding the work engagement of nurses at the Singkawang City Hospital is indicated by the many cases of nurse turnover leaving the hospital due to a number of problems, such as job dissatisfaction, workload that is felt to be too heavy, and so on. More and more nurses leaving work can have a negative impact on a hospital, one of which is a decrease in the quality of nursing services, so that it has a direct impact on efforts to achieve hospital goals and targets. This is also an indication of the hospital's inability to maintain its human resources.
The effect of work engagement on nurse performance has been carried out by a number of previous studies, including Pujianto's research (2020). The results of his research show that there is an influence of work engagement on job satisfaction and its impact on nurse performance.
Many studies have examined the influence of leadership style, work engagement, and job satisfaction on performance. Even research that examines the influence of leadership style on job satisfaction and its impact on performance has also been carried out a lot, the results are different from one another, such as research conducted by Sari and Fuadati (2022:43-64) and others studies.
Likewise, research that examines the effect of work engagement on job satisfaction and its impact on performance has also been carried out by previous research, such as research conducted by Pujianto (2020: 6). The results of the research conducted by them found that there were differences from one to another. In addition, no research has been conducted to simultaneously examine the influence of leadership style and work engagement on job satisfaction and its impact on nurse performance. Therefore, these are a number of reasons that cause the authors to be interested in conducting research with the title, "The Influence of Leadership Style and Work Engagement on Job Satisfaction and Their Impact on Nurse Performance at RSUD DR. Abdul Aziz, Singkawang City, West Kalimantan.

IMPLEMENTATION METHOD
The variables used in this study are 4 (four) research variables, namely: leadership style, job satisfaction, work engagement, and nurse performance. The population is a generalized area consisting of objects/subjects that have certain qualities and characteristics determined by researchers to be studied and then conclusions drawn (Sugiyono, 2017:61). Based on the description stated above, the authors can determine that the population in this study are all nurses at RSUD dr. Abdul Aziz Singkawang City which reached 279 nurses. The sample in this study used a random sampling technique with a sample size of 164 respondents.

RESEARCH RESULTS
The hypotheses put forward by the authors in this study are: (1) leadership style has an effect on job satisfaction, (2) work engagement has an effect on job satisfaction, (3) leadership style and work engagement has an effect on job satisfaction , and (4) job satisfaction has an effect on nurse performance.

The Relationship Between Leadership Style Variables and Work Engagement
Results of analysis using SPSS Ver. 20.0 to 164 respondents obtained the magnitude of the correlation coefficient between the independent variables. The magnitude of the correlation coefficient can be seen in Table 1 below: 17|T r a n s f o r m a : J u r n a l M a n a j e m e n , V o l . Based on the calculation of the correlation coefficient, the correlation coefficient value is 0.522. Thus, it can be said that the relationship between the two variables, namely Leadership Style and Work Engagement, has a positive relationship with the criterion of moderate closeness.

The Effect of Leadership Style and Work Engagement on Job Satisfaction Simultaneously
The results of the path analysis of the influence of Leadership Style and Work Engagement on job satisfaction can be explained in the figure below:

The Magnitude of Direct Influence
The Leadership Style (GK) variable has a direct influence on Job Satisfaction (KK) of 13.76%. While the variable Job Engagement (EE) has a direct influence on Job Satisfaction (KK) of 29.16%.

The Magnitude of Indirect Influence
The magnitude of the indirect influence of the Leadership Style (GK) variable through Work Engagement (EE) on Job Satisfaction (KK) and the magnitude of the indirect influence of the Job Engagement variable (EE) through Leadership Style (GK) on Job Satisfaction (KK) is the same, namely by 10.46%.
The total or simultaneous influence of the Leadership Style (GK) and Work Engagement (EE) variables on Job Satisfaction (KK) is 63.84%, while the influence of other variables outside the variable is 36.16%. Other variables not examined by the authors that affect job satisfaction include the work environment, compensation, competence and others.

Partial Effect of Leadership Style and Work Engagement on Job Satisfaction
Based on Table 4.13 above, it can be explained the magnitude of the influence of each Leadership Style (GK) and Work Engagement (EE) variable on Job Satisfaction (KK), as follows: 1. The magnitude of the partial influence of leadership style (GK) on job satisfaction (KK), both direct and indirect influence is 24.22%. 2. The magnitude of the partial effect of work engagement (EE) on job satisfaction (KK), both direct and indirect effects of 39.62%.

Effect of Job Satisfaction on Job Satisfaction
Path analysis of the Job Satisfaction (KK) variable on the Nurse Performance (KP) variable can be described in the image below:

The Effect of Job Satisfaction on Nurse Performance
Based on the picture above, it can be explained that the degree of associative or path coefficient of the job satisfaction

The Influence of Leadership Style and Work Engagement on Job Satisfaction and Its Implications on Nurse Performance
Based on the results of statistical calculations that have been described in the hypothesis, it can be said that each variable, namely Leadership Style and Work Engagement has an effect on job satisfaction both partially and simultaneously and job satisfaction has an effect on nurse performance. The results of the analysis of each variable Leadership Style (GK), Work Engagement (EE), Job Satisfaction (KK) and Nurse Performance (KP) can be seen in Figure 4.4 below:

Figure 2. Full Path Analysis Model
Based on Figure 4.4 above, it can be said that each variable, namely: Leadership Style (GK) and Work Engagement (EE) has an effect on Job Satisfaction (KK) both partially and simultaneously and Job Satisfaction (KK) has an effect on Nurse Performance ( KP) at DR. Abdulaziz.

Hypothesis test
Based on data processing, there are two substructures so that discussion of the interpretation of the results must be carried out in stages based on these substructures. The following is an explanation of each substructure:

Testing the coefficient of Sub-Structure Path 1
Based on data processing can be interpreted as follows: a. Partial Test Partial test to find out which independent variables have a significant effect on the dependent variable with the t test, the criteria for rejection are H0, if tcount is greater than ttable or t0 > ttable, with degrees of freedom = 164 -2 - The magnitude of the GK path coefficient = 0.371, obtained a tcount value of 6.933 by taking the significance levelby 5% degrees of freedom (degree of freedom) = nk-1 or 164 -2 -1 = 161 and the test was carried out with a two-tailed test (2-tailed) obtained ttable of 1.972, because tcount is greater than ttable then Ho is rejected or by In other words, there is a significant influence of Leadership Style on job satisfaction.
Thus it can be concluded that Leadership Style has a positive influence on job satisfaction. This means that Leadership Style makes a positive contribution to job satisfaction of 0.371. Thus, the results of the study indicate that the better the leadership style perceived by nurses, the higher the level of job satisfaction of nurses in dr. Abdul Aziz is also improving (good).

1) Partial Effect of Job Engagement on Job Satisfaction
The partial effect of the Job Engagement (EE) variable on Job Satisfaction (KK) needs to be tested statistically, so the test uses the following statistical hypotheses: Ho :Y. X2= 0 there is no effect of Job Engagement on Job Satisfaction. H1 :Y. X2≠ 0 there is an influence of Job Engagement on Job Satisfaction.
The results of the partial test of Work Engagement (EE) on Job Satisfaction (KK) can be seen in table 4.19 below: 21|T r a n s f o r m a : J u r n a l M a n a j e m e n , V o l . 1 , N o . 1 , F e b r u a r y 2 0 2 3 The simultaneous influence of Leadership Style (GK) and Work Engagement (EE) variables on Job Satisfaction (KK), using the following statistical hypothesis: Ho :Y. X1=Y. X2= 0 there is no effect of Leadership Style and Work Engagement simultaneously on Job Satisfaction. H1 : there is at least oneY. X1≠ 0 (i = 1, 2), there is a simultaneous influence of Leadership Style and Work Engagement on Job Satisfaction Test criteria: reject H0 if Fcount > Ftable. To test this hypothesis, the following table is needed: .144 is greater than 3.04 or Fcount is greater than Ftable then Ho is rejected, meaning that it can be concluded that there is a positive and significant influence simultaneously (together) Leadership Style (GK) and Job Engagement (EE) on Job Satisfaction ( KK). 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.

Sub-Structure Path Coefficient
Testing 2 Testing the path coefficient of Sub-Structure 2 (equation 2) is carried out with the t test, Ho rejection criteria, if tcount is greater than ttable or tcount > ttable, with degrees of freedom = 164 -1 -1 = 162.
The partial effect of the variable Job Satisfaction (KK) on Nurse Performance (KP) needs to be tested statistically, so the test uses the following statistical hypotheses: Ho :ZY= 0 there is no effect of Job Satisfaction on Nurse Performance. H1 :ZY 0 there is an effect of Job Satisfaction on Nurse Performance.
The results of partial testing of job satisfaction (Y) on nurse performance (Z) can be seen in table 4.21 below: The magnitude of the KK path coefficient = 0.931, obtained a tcount value of 33.697 by taking the significance levelby 5% degrees of freedom (degree of freedom) = nk-1 or 164 -1 -1 = 162 and the test was carried out with a two-tailed test (2-tailed) obtained ttable of 1.972, because tcount is greater than ttable then Ho is rejected or by In other words, there is an effect of job satisfaction on the performance of nurses at RSUD dr. Abdulaziz.

Leadership Style
Leadership Style in RSUD dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. This can be seen from the average value of the Leadership Style variable of 2.97, which means the Leadership Style at dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. When compared between dimensions, the idealized influence dimension gives the best description while the individual consideration dimension gives the lowest description. The highest average score is on the indicator regarding the leader having a strong stance, while the lowest average value is on the indicator regarding the leader guiding his subordinates.
Of the 15 indicators studied, there are 3 (three) problems that get the lowest score, namely: leaders are not good at guiding their subordinates, leaders are not good at encouraging employees (nurses) to be creative, and leaders are not good at inviting their subordinates to realize their goals. shared goals.
For problems regarding the lack of good leaders in guiding their subordinates it turns out to be caused by a lack of good communication between superiors and subordinates. This is also related to the lack of good superiors in encouraging employees to be creative and realize their goals. This was reinforced by the information conveyed by a nurse at RSUD dr. Abdul Aziz that it is difficult to communicate with his superiors. The existence of these difficulties can be caused by employees not understanding how to communicate that is preferred by superiors. Another aspect that could be the cause is the existence of unhealthy career competition, causing friction and ultimately favoritism from superiors to subordinates.

Work Engagement
Nurse Work Engagement at RSUD dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. This can be seen from the average value of the Work Engagement variable of 2.95 in the interval value 2.61 -3.40, which means the Nurses' Work Engagement at RSUD dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. When compared between dimensions, the human-oriented dimension that must be achieved gives the best description, while the team-oriented dimension and the stability dimension give the lowest description. The highest average score is on the indicator regarding the nurse's response to management decisions, while the lowest average score is on the indicator of team-organized work activities and the indicator of maintaining what is considered sufficient.
Work Engagement Problems in nurses at RSUD DR. The lowest Abdul Aziz is related to the lack of good teamorganized work activities and the lack of good indicators of maintaining what is considered sufficient. The low teamwork among employees is caused by unhealthy career competition among employees. Employees prefer to be individualistic in carrying out their work. This is also reinforced by the still strong conservative culture, where employees tend to maintain the existing system more, so that employees are less creative and innovative in carrying out their work. In addition, aspects of the quality of human resources can also be one of the contributing factors. Most of the nurses at RSUD dr. Abdul Aziz is educated Diploma III (43.30%). Meanwhile those with Bachelor's degree or Strata-1 education are relatively less, namely only 28.87%.

Job satisfaction
Nurse job satisfaction at RSUD dr. Abdul Aziz in the criteria tends to be less good as seen from the average value of the job satisfaction variable of 2.96, which means the job satisfaction of nurses at RSUD dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. When compared between dimensions, the dimension of work conditions gives the best description while the salary dimension gives the lowest description. The highest average score is on the indicator regarding nurses being satisfied in accepting responsibility, while the lowest average score is on the indicator that nurses have the opportunity to learn from superiors.
Of the 15 indicators studied, there were two indicators that were considered low, namely: the lack of nurses getting the opportunity to learn from their superiors and the indicators that nurses were still dissatisfied with the salary they received. As explained in the leadership aspect above, communication factors that are not smooth make it difficult for nurses to gather information about the experiences of their superiors, so that they find it difficult to learn from their superiors regarding the implementation of work. In addition, they are dissatisfied with the salary they receive because they feel that their hard work is not in line with the salary they receive. This is because as a government hospital, the budget received by dr. Abdul Aziz is still inadequate,

Nurse Performance
The performance of nurses at dr. Abdul Aziz which consists of the dimensions of quality of work, quantity of work, timeliness, effectiveness, independence, and work commitment, which are interpreted in terms of tending to be unfavorable. This can be seen from the average value of the nurse's performance variable of 2.95, which means that the nurse's performance at dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. This can be seen from the percentage value which states that it tends to be unfavorable at 80.28%. When compared between the dimensions, the facilities dimension gives the best description while the salary and wages dimensions give the lowest description. The highest average score is on the indicator regarding identification, while the lowest average score is on the skill indicator in nursing.
Of the 15 indicators studied, there were 3 (three) nurse performance indicators that were rated low, namely: services for many patients, initial medical assessment, and hand hygiene. The low service for many patients is due to the limited number of nurses at RSUD dr. Abdulaziz. With a total of 374 nurses, while relatively many patients have to be served, the nurses are less than optimal in providing services. This condition also has an impact on the poor initial assessment of patients by nurses. The large number of patients who have to be treated makes the nurses less careful in carrying out the initial medical assessment. However, this did not really have an impact on medical treatment, because the doctors also re-checked the patients. Furthermore, what is often found is the problem of adherence to hand washing by nurses. Clean hand washing is a very important aspect for nurses who often interact with patients. Therefore, the compliance of nurses in hand hygiene is very important. This noncompliance is generally caused by the lack of discipline of the nurses themselves. In addition, the management is also lacking in giving sanctions to those who violate it CONCLUSION Leadership Style in RSUD dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. This can be seen from the average value of the Leadership Style variable of 2.97, which means the Leadership Style at dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. When compared between Nurse Work Engagement at RSUD dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. This can be seen from the average value of the Work Engagement variable of 2.95, which means the Nurses' Work Engagement at RSUD dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. When compared between dimensions, the human-oriented dimension that must be achieved gives the best description, while the team-oriented dimension and the stability dimension give the lowest description.
Nurse job satisfaction at RSUD dr. Abdul Aziz in the criteria tended to be unfavorable as seen from the percentage value which stated that it tended to be unfavorable at 2.96. When compared between dimensions, the dimension of work conditions gives the best description while the salary dimension gives the lowest description.
The performance of nurses at dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. This can be seen from the average value of the nurse's performance variable of 2.95, which means that the nurse's performance at dr. Abdul Aziz is interpreted in terms of tending to be unfavorable. This can be seen from the percentage value which states that it tends to be unfavorable at 80.28%. When compared between the dimensions, the facilities dimension gives the best description while the salary and wages dimensions give the lowest description.
Leadership style has a positive and significant effect on nurse job satisfaction at RSUD dr. Abdulaziz. The magnitude of the influence of Leadership Style on Job Satisfaction, both direct and indirect, is 24.22%. Thus it can be concluded that the better the Leadership Style perceived by nurses, the higher the Job Satisfaction of nurses at RSUD dr. Abdulaziz. Work Engagement has a positive and significant effect on job satisfaction of nurses at RSUD dr. Abdulaziz. The magnitude of the influence of Job Engagement on Job Satisfaction, both direct and indirect, is 39.62%. Thus it can be said that the better the Work Engagement shown by the nurses, the higher the Job Satisfaction of nurses at RSUD dr. Abdulaziz. Leadership