Research Article

Indonesian Nursing Journal of Education and

Determinant of Nurses’ Clinic (INJEC)
125-133
Response Time in Emergency Volume 5, Issue 2, December 2020
DOI: 10.24990/injec.v5i2.305
injec.aipni-ainec.org/index.php/INJEC/index
Department When Taking Received : 2020-06-09
Accepted : 2020-07-24
Care of A Patient The Association of Indonesian Nurse
Education Center (AINEC)

Dwi Yanti Rachmasari Tartila1 , Andri Setiya Wahyudi1 , Arina Qona’ah1

Abstract
Introduction: : Response time is the handling speed calculated when the patients arrive at the hospital
until they are treated. It is influenced by several factors according to Gibson Performance Theory. The
research approach aimed to analyze individual factors including: skills, emergency training, gender, age,
length of working, and education, organizational factors: rewards, and psychological factors: nurse
motivation that influences the response time of the nurses in emergency departments at general
hospitals in Madura.
Methods: The research method used was a descriptive-analytic study with a cross-sectional
approach. The sampling technique is total sampling, which is 101 nurses. Independent variables are
skills, emergency training, gender, age, length of working, education, rewards, and motivation.
Dependent variable is response time. Data were collected using a questionnaire and direct
observations on nurses, data were analyzed using the Multiple Regression Logistic test.
Results: The results show that there was no correlation between age (p= 0.996); education (p=
0.913); length of working (p= 0.921); training (p= 0.830); skill factor (p= 0.999); and motivation factors
(p= 0.471) with response time. Whereas gender (p= 0.020); and reward factor (p = 0.020) were
related with response time.
Conclusion: In order to improve patients’ handling procedure, hospitals should give support to
nurses, like promotion or salary. Hospitals are expected to record documentations about the number
of patients according to triage category and how fast nurses handle them because it may be an
evaluation for rooms.

Keywords
gender; motivation; response time; reward; skill

INTRODUCTION functions as the main door in handling

emergency cases (Yumiati, 2017). Services in
Nursing services are an integral part of the ED have the philosophy of Time-Saving it's
health services; one of the places of service in Life-Saving, which means time is the life of the
hospitals is the Emergency Department (ED) patient. Therefore, all emergency measures are
which is a central unit of the hospital that carried out effectively and efficiently. Triage
used in Indonesian hospitals is a color triage
1
Faculty of Nursing, Airlangga University

Corresponding Author:
Andri Setiya Wahyudi, Department of Fundamental Nursing, Faculty of Nursing, Airlangga University, Surabaya, Indonesia
Universitas Airlangga Kampus C, Jl. Mulyorejo, Mulyorejo, Surabaya, Kota SBY, Jawa Timur 60115
Email: andry_remas@yahoo.co.id

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Tartila, et al.

system. Red triage means that emergency (2014) about the factors that affect nurses’
patients need treatment as soon as possible, response time in Prof. Dr. R.D. Kandao
yellow triage is emergency patients, and green Manado’s Hospital in ED and showed that
triage means low levels of emergency and can there were 17 nurses with >5 minutes
still wait for treatment. response time.
Factors affecting response time include Gibson's theory is divided into three
internal and external factors, which may affect factors that can influence nurse performance,
tardiness on handling emergency cases. including individual factors, psychological
Furthermore, response time might also be factors, and organizational factors. Individual
affected by patient’s character, staff positioning, factors consist of ability, skills, education,
stretcher and medical staff availability, patient’s length of work, age, and gender. Psychological
arrival time, implementation of management, as factors consist of perception, attitude,
well as chosen examination and handling personality, learning, and motivation, while
strategy (Wa & Ode, 2012). organizational factors consist of resources,
Response time is the speed of treatment leadership, structure, job design, and rewards.
that is calculated when the patient arrives at The reason of using Gibson’s performance
the hospital until the patient is treated. theory in the research is because it was easy to
Response time is categorized with several understand and Gibson explained factors that
priorities, including P1(Red) for emergency may affect nurses’ performance, which is
patients with a treatment time of 0 minutes, P2 response time. The purpose of this study is to
(Yellow) for emergency patients with a determine the factors that influence
treatment time of less than 30 minutes, and P3 emergency department nurses in handling
(Green) for low emergency patients with a patients based on Gibson's Performance
treatment time of less than 60 minutes Theory.
(Permenkes, 2018).
Based on previous studies that have been MATERIALS AND METHODS
conducted by researchers from 29-30
November, 2019, it was found that there were The research design used was descriptive-
21 nurses in ED of Sumenep Hospital. The analytic with cross-sectional approach. This
lowest level of study is associate degree as research was carried out January to March
many as 16 nurses, Bachelor’s degree as many 2020, in the EDs of Madura General Hospital,
as four nurses, and postgraduate (S2) only one such as Bangkalan General Hospital, Sampang
nurse. The number of ED patient visits in 2018 General Hospital, Mohammad Noer
was 12,000 patients with the number of new Pamekasan General Hospital, and Sumenep
patient visits of 6,961 patients. Whereas in General Hospital. The sampling technique of
2019, from January to November, there were this study was total sampling, that is, all nursing
10,523 patients with a total of 5,893 new staff who served in EDs of Madura General
patients. The average number of patients per Hospital, as many as 101 nurses. Independent
day is 30 patients, so the minimum number of variables are skills, emergency training, gender,
nurses is 25 nurses if calculated based on the age, length of working, education, rewards, and
formula of nurses needed in the emergency motivation. The questionnaire ability has been
room. This shows that the number of nurses in tested in validity and reliability by Yumiati
ED of Sumenep Hospital has not met the (2017) in which questionnaire ability r value
minimum requirements. was between 0.919 to 0.943 and Cronbach’s
Some previous references showed that alpha value was 0.934. The questionnaire uses
tardiness on handling patients was still found at a Likert scale that consists of 10 questions. The
some hospitals in Indonesia. A research by reward questionnaire by Yumiati (2017) shows
Noor (2009) that talked about time response validity test for reward questionnaire gives a
on handling patients in Emergency Department result 0.829 on r value and reliability test
(ED) showed 7.45 minutes of response time, shows Cronbach’s alpha value of 0.860. The
which was the contrary of critical care questionnaire uses Likert scale with indicators
indicators, in which the response time for of financial, interpersonal, and promotion
critical patients, or P1, must be less than 0 divided into 12 questions. On the other hand,
minute. Similar research was done by Vitrise the motivation questionnaire by Yumiati (2017)

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 Indonesian Nursing Journal of Education and Clinic (INJEC)

Table 1. Characteristic Demographic (n=101)

Category
Category Frequency
Frequency (%) (%)
Age
Age
17-25
17-25years
yearsold
old 5 5 5 5
26-35
26-35years
yearsold
old 66 66 65.3 65.3
36-45
36-45years
yearsold
old 28 28 27.7 27.7
46-55
46-55years
yearsold
old 2 2 2 2
Gender
Gender
Male
Male 69 69 68.3 68.3
Female
Female 32 32 31.7 31.7
Education
Education
Diploma
Diploma33 50 50 49.5 49.5
Bachelor
BachelorofofNursing
Nursing 49 49 48.5 48.5
Master
MasterofofNursing
Nursing 2 2 2 2
Length
Lengthofofworking
working
<5
<5years
years 44 44 43.6 43.6
5-10
5-10years
years 47 47 46.5 46.5
>10
>10years
years 10 10 9.9 9.9
Training
Training
Triage
Triage 2 2 2 2
Emergency
Emergency 97 97 96 96
Lain-lain
Lain-lain 2 2 2 2
Ability
Ability
High
High(76-100%)
(76-100%) 98 98 97 97
Medium
Medium(56-75%)
(56-75%) 3 3 3 3
Salary
Salary
High
High(76-100%)
(76-100%) 13 13 12.9 12.9
Medium
Medium(56-75%)
(56-75%) 56 56 55.4 55.4
Low
Low(<55%)
(<55%) 32 32 31.7 31.7
Motivation
Motivation
High
High(75-10%)
(75-10%) 90 90 89.1 89.1
Medium
Medium(56-75%)
(56-75%) 11 11 10.9 10.9
Triage
TriageP1P1
Fast
Fast 68 68 57.3 57.3
Slow
Slow 33 33 32,7 32,7
Triage
TriageP2P2
Fast
Fast 87 87 86.1 86.1
Slow
Slow 14 14 13.9 13.9
Triage
TriageP3P3
Fast
Fast 91 91 90.1 90.1
Slow
Slow 10 10 9.9 9.9

gives a value of 0.803 to 0.852 on r value and patient was handled thoroughly. When patients
Cronbach’s alpha of 0.839. Those 12 questions came, they would be categorized by the triage
include need for achievement aspect, affiliation P1(Red), P2 (Yellow), or P3 (Green). Then,
aspect, and need for power. patients would be sent to cubical curtains that
Other than that, this research instrument had been marked red, yellow, or green. Every
also uses researcher’s direct observation at nurse was only once observed for each triage.
Bangkalan Hospital February 6th – 10th, So, every nurse would be observed on how
2020, Sampang Hospital February 12th – 19th, they handled each triage. The researcher knew
2020, and Sumenep Hospital March 2nd – 9th, the triage category of each patient after they
2020. There was also research at Mohamman had been examined by doctor and nurse, then
Noer Hospital March 16th – 22nd, 2020. The patients would be taken to the cubicle that
researchers did the research on morning shift marked with each color or triage.
at about 07.00am to 2.00pm, except for Furthermore, questionnaire data and
Mohammad Noer Hospital that occurred on observations were collected and analyzed using
afternoon shift at 2.00pm to 8.00pm because the Multiple Regression Logistic test with α =
the decreasing patients during the corona 0.05. This research has been ethically tested by
pandemic. Researchers observed by counting the Health Services Ethics Committee (KEPK)
the time between patient’s arrival time until the

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Tartila, et al.

Table 2. Result of Variables in the Equation

95% C.I for Exp(B)

Variable Sig.
Lower Upper
Correlation between Factors Related to Response Time P1 (Red)
Age 0.996
Gender 0.020 1.228 11.582
Education 0.913
Length of Work 0.921
Training 0.830
Ability 0.999
Reward 0.020
Motivation 0.471
Correlation between Factors Related to Response Time P2 (Yellow)
Age 0.990
Gender 0.702 0.198 0.2978
Education 0.142
Length of Work 0.962
Training 1.000
Ability 0.999 1.642E8 0.000
Reward 0.316
Motivation 0.506 0.194 27.897
Correlation between Factors Related to Response Time P3 (Green)
Age 0.649
Gender 0.597 0.108 3.600
Education 0.741
Length of Work 0.651
Training 0.171
Ability 0.475 0.006 11.134
Reward 0.955
Motivation 0.304 0.036 2.824

of the Faculty of Nursing, Airlangga University. motivation factor category, there were 90
Ethical approval No. 1897-KEPK. nurses. For response time, in the P1 triage
(Red), there were 68 nurses doing fast
RESULTS response times (<60 seconds) and 33
nurses doing slow response times (> 60
Based on Table 1, it can be seen that, seconds). Whereas in the P2 triage
from 101 total number of nurses in ED (Yellow), there were 87 nurses doing fast
from Madura General Hospital, the highest response times, and there were 14 nurses
frequency of nurses is at the age of 26-35 doing slow response times (>30 minutes).
years, as many as 66 nurses. Based on Furthermore, for P3 triage (Green), there
gender, the majority were male with 69 were 91 nurses doing fast response times
nurses. The level of education of nurses (<60 minutes) and 10 nurses doing slow
with Diploma 3 is 50 nurses. Based on the response times (>60 minutes).
length of work, it was found 47 nurses had
worked for 5-10 years. Furthermore, Analysis of the Relationship between Factors
based on the training factor, there were 97 Related to Response Time
nurses in ED who had attended emergency
training. Table 2. Hypothesis Test Results from the
Of the 101 nurses, most of them (98) Relationship of Age, Gender, Education, Length
had a high ability level. In the high of Work, Training, Ability, Salary, and

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 Indonesian Nursing Journal of Education and Clinic (INJEC)

Motivation with the Response Time Nurses in between sex with P1 response time, but
ED Bangkalan Hospital, Sampang Hospital, gender is not related to P2 and P3 response
Mohammad Noer Hospital Pamekasan, and time. These results are consistent with
Sumenep Hospital. Gibson's performance theory which reveals
Based on Table 2, the result of variable in that sex is related to nurses' response time in
the equation table in gender category shows handling patients, especially for P1 triage
the value Sig=0.020. Because the value Sig response time. Most of the respondents' sex is
α<0,05,H0 is rejected and the conclusion is male. This is because the duties of nurses in ED
gender is related to response time P1 (Red). In must have the ability in terms of speed and
the reward factors based on the results accuracy. Gender is related to response time
obtained, Sig=0.020; because Sig α<0.05 the P1. This is because, in the P1 triage, the time
conclusion is the reward factor is related to required in handling patients is <60 seconds, so
response time P1 (Red). more male nurses are needed than females.
Based on the table, it shows the results of Whereas in P2 and P3, the time needed by
correlation between factors related to nurses is quite long, i.e. <45 minutes for P2 and
response time P2 (Yellow) where the value Sig <60 minutes for P3 so that it can be done by
α>0.05 for all factors. So, the conclusion is female nurses.
individual factors, organization, and Based on the results of the study, there
psychological factors do not have significant was no significant relationship between
correlation with response time P2 (Yellow). education and nurse response time in handling
Furthermore, the table shows that the patients. This research contradicts Gibson's
results of the multiple regression for all factors theory which reveals that the education level
to response time P3 (Green) that value Sig of respondents can affect the response time.
α>0.05, so it can be concluded that there is no Research conducted by Yumiati (2017) also
correlation between individual factors, found that there was no relationship between
organizational factors, and psychological education and response time (p = 0.360).
factors with response time P3 (Green). Another study by Vitrise (2014) also found that
there was no relationship between education
DISCUSSIONS and response time (p = 0.084). The education
level of nurses that are low or high will have a
good response time because nursing graduates
Analysis of the Relationship between Individual already have the skills to be able to do nursing
Factors and Response Time care based on nursing ethics and have
mastered nursing during the lectures. In
Based on the results of the study, it was Setiawan (2015), it was stated that health
found that age does not have a significant workers in the Emergency Department (ED)
relationship with the response time. This is must have an element of readiness, including
because nurses must have the ability to handle the readiness of science and skills in handling
patients quickly and appropriately; nurses will patients. Therefore, the higher level of
always update their knowledge by attending education of nurses does not affect the level of
training so that there is no difference between speed in responding time.
young and old. However, this is contrary to Based on the results of the study, there
Gibson's performance theory which reveals was no significant relationship between the
that age is related to nurse performance in length of work with nurses’ response time in
terms of nurse response time. In addition, the handling patients. This is not in accordance
average age of respondents is 25-35 years, with Gibson's performance theory which
which means entering early adulthood. In this revealed that the length of work could be
age range, respondents are familiar with related to the response time of nurses in
carrying out their obligations and duties, so handling patients. This study is also the same as
that at the age of 25-35 years will not Yumiati (2017) that the length of service of
experience in handling serious patients in the nurses has no significant relationship with
ED. response time (p = 0.483). Another study by
Based on the results of statistical tests, it Vitrise (2014) also revealed that there was no
can be concluded that there is a relationship relationship between work duration and

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Tartila, et al.

response time (p = 0.119). Due to the length states that the higher the nurse's reward can
of time, most respondents work in this study is increase the nurse's response time in handling
5-10 years, it can be said that nurses have quite patients in the ED. According to Gibson,
a long experience in handling patients. salaries are divided into two, namely intrinsic
According to Yumiati (2017), there is no and extrinsic salaries. Intrinsic salary is an
difference between nurses' length of work award given by oneself, such as the
because they have been given training. achievements one has achieved. Extrinsic
Therefore, the longer the nurse works cannot salaries are external rewards such as financial
be used as a benchmark to make the response rewards, in the form of money and benefits.
time quickly. Research conducted by Yumiati (2017) also
The training factor is not related to says that there is a relationship between salary
response time. This study is not the same as factors with response time and values (p =
Gibson's performance theory which states that 0.003).
the training followed by nurses is related to the This shows that the higher the salary of
nurse's response time in patient handling. nurses, the faster the handling of patients. This
Research conducted by Vitrise (2014) also is indicated by the burden of nurses in ED that
revealed that there was no relationship is not proportional to the salary earned by
between training and response time (p = nurses. According to Yumiati (2017), low nurse
0.255). This can happen because most nurses salaries have a longer response time than those
have attended emergency training so that it can who get high salaries. Based on the results of
facilitate nurses to provide treatment to the questionnaire with the lowest score,
patients. The training is carried out periodically respondents revealed that respondents did not
a maximum of once every five years so that ED get an award from the leadership for their
nurses can improve their knowledge by work performance, did not get a promotion at
attending the training. the time of achievement, and respondents did
Based on the results of statistical tests, the not get a bonus from the hospital when
ability factor is not related to the nurse's performing. So, there is a need for further
response time. This research contradicts evaluation related to the rewards given by
Gibson's performance theory which reveals nurses in order to improve the performance of
that the ability of respondents can increase nurses in handling patients. Therefore, it can be
response time. According to Gibson, the ability concluded that the higher the rewards or
is one element of maturity related to rewards given, the higher the respondents in
knowledge and skills in handling patients, which completing their work.
can be obtained from education, training and
work experience. This study is the same as Analysis of the Relationship between
Yumiati (2017), whose research results show Psychological Factors and Response Time
that there is no significant relationship between
ability and response time (p = 0.414). Thus, the In psychological factors, motivational
level of ability of respondents is not related to factors, it was found that there was no
the level of speed in carrying out their duties. relationship between motivational factors with
response times P1, P2, or P3. This is because
Analysis of Relationship between room nurses are still reluctant to read books
Organizational Factors and Response Time or look for references. Researchers found that
only a few nurses in each hospital had a desire
On organizational factors, salary factors, to read nursing books in their free time. Based
the results of the research show that there is a on the results of the questionnaire, there are
relationship between the reward factor with still many nurses who do not like looking for
the triage response time P1. If nurses want to books or references on clinical skills to add
be seen as achievers, they must do the work knowledge and insight to nurses. It can explain
quickly and precisely so that they can relate to that respondents still do not have a high
P1 triage because the response time on P1 enthusiasm to renew new skills and knowledge
triage is quite short, i.e. <60 seconds, while for that are developing at this time. This research
P2 and P3 triage, it takes a long time. This is the is contrary to Gibson's performance theory
same as Gibson's performance theory which which reveals that motivational factors can be

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 Indonesian Nursing Journal of Education and Clinic (INJEC)

related to response time. However, this study improve the performance of nurses in
is the same as Yumiati (2017), which states that handling patients.
there is no relationship between motivational
factors and response time (p = 0.320). Acknowledgement
According to Gibson, motivation is a
person's desire to get things done or a desire
The authors wish to express their
to be better at doing work. Motivation has
gratitude to all of staff Bangkalan Hospital,
three main elements, namely, needs,
Sampang Hospital, Mohammad Noer Hospital
encouragement, and goals. Motivation can
Pamekasan, and Sumenep Hospital which
occur if desires are not in accordance with
contributed to assist the research.
reality, so motivation aims to encourage
someone to be able to realize their desires.
This can explain that respondents still do not Conflict of Interest
have a high enthusiasm to renew new skills and
knowledge that are developing at this time. The authors declare no conflict of
According to Ratna (2007 cited in Nursalam, interest.
2015), performance is one's efforts plus the
work of someone so that it can be formulated Research Limitation
as P (performance) = E (effort) + A
(achievement). Therefore, to improve the The authors did not accompany
quality of nursing services also requires nurse respondents to fill the questionnaire, so it’s
motivation and proper appreciation from the possible that the answers were as a result of
hospital. only a few respondents.

CONCLUSION Suggestions

Individual factors, including age, sex, For implementing nurses, in this study
education, length of work, and training in nurses are expected to improve the quality of
this study were only gender factors related treatment in patients without considering the
to response time in P1 triage, while age, salary to be provided by the hospital. For the
education, length of work, and training are research sites, training for nurses, such as
triage and emergency training, is urgently
not related to response time in triage P1
needed to hone nurses' abilities in handling
(Red), P2 (Yellow), or even P3 (Green). patients in the ED. In addition, it is hoped that
This shows that age, education, length of hospitals can increase documentation related
work, and training cannot guarantee to the number of patients in the ED based on
nurses' response time in handling patients the triage and speed category because this can
quickly. The motivational psychological be used as room evaluation material. This
factors of the respondents in this study did research can be developed for further
not have a significant relationship with the research, focusing on variables in psychological
nurses' response time in triage P1 (Red), P2 factors, such as attitudes and perceptions, and
(Yellow), and P3(Green). This proves that organizational factors such as leadership.
the higher level of motivation of nurses
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