According to Maslow's needs theory Helmke et al., (2020) everyone has five different levels of needs: physiological, safety, social, reward, and self- actualization needs. Fulfilling these needs can have an impact on employee motivation and performance in an organization. External incentives, ethical systems, and work culture can help employees improve self-actualization and performance. An employee can be more motivated to work if his needs are met (Handayani et al., 2020).

A job is not solely based on quantity results, but also involves quality, timeliness, and teamwork skills. There are several factors that can affect job performance, ranging from personal and leadership abilities to workplace environmental conditions, including organizational culture. In Maslow's hierarchy of needs theory (Helmke et al., 2020) a person in a culture is mostly satisfied in their security needs. According to Riyanto et al., (2021) measuring organizational culture using an organizational culture approach that supports organizational survival. Engagement, consistency, adaptability, and purpose are important elements in this approach. Thus, leaders need to provide a comfortable organizational culture so that it can encourage the performance of each employee and emphasize the importance of organizational goals, this can make each individual perform better.

In order to improve performance, leaders must always maintain control over each behavior of their members, provide support and motivation in all forms, and maintain integration with their subordinates in order to create an organizational culture and a comfortable work environment (Nurmala & Jasin, 2021). Employee behavior is influenced by the workplace atmosphere where they are employed by a particular organization, and it is believed that this organization can increase employee productivity (Putra et al., 2022).

Research conducted by Fahmi, (2021), Putra & Nasution, (2024), Rojak et al., (2024), and Al-Ansi et al., (2023) shows that organizational culture has a positive and significant effect on performance.

H1: Organizational culture has a positive and significant effect on performance

Various approaches have been used to improve performance, including the application of Islamic ethical values in the work environment. Islamic work ethic is a personality attitude that believes that work is not just for yourself, it is one of the good deeds that is worth worship (Candra et al., 2022). It is based on the belief that Islamic principles encourage people to work sincerely, professionally, and responsibly, thereby increasing productivity and work quality. Islamic work ethic can give organizations a source of long- term competitive edge because it is a rare resource that is challenging to duplicate Badar et al., (2023). In Maslow's hierarchy of needs theory, a person will be motivated by his need to develop and actualize his full potential capacity (Helmke et al., 2020).

One of the needs is a social need where each individual is free to work in accordance with the teach he adheres to which comes from the Qur'an and hadith. According to Udin et al., (2022) including religion and spirituality in the work environment can increase morale in employees which can improve performance. Islamic work ethics emphasizes to work together at work and deliberation is considered a method to prevent mistakes. Research conducted by Khotijah & Helmy, (2021), Kurniasari & Bahjahtullah, (2022), Candra et al., (2022), and Purnama et al., (2021) prove that islamic work ethic has a positive and significant effect on performance.

H2: Islamic work ethic has a positive and significant effect on performance Exstrinsic motivation has a positive and significant effect on nurse performance Motivation has been identified as one of the most important

components affecting performance. Thus motivation is a factor that can affect individual satisfaction in achieving goals (Darmawan et al., 2021). Among the various forms of motivation, extrinsic motivation is usually considered as the main driver, especially in target- and result-based organizations. According to Mulyadi & Pancasasti, (2021), motivation is a trigger that directs, and provides support for individual behavior so that they are willing to work diligently and enthusiastically, with the aim of achieving maximum results. in the organizational context, extrinsic motivation is often used as a strategy to encourage employees to work harder and achieve certain targets.

In Maslow's hierarchy of needs theory, extrinsic motivation is an encouragement that comes from factors outside of the individual to do a job (Helmke et al., 2020). Encouragement from these external factors such as awards, praise, social status, and recognition from others. Providing incentives, awards, and additional facilities is often a special attraction for employees to improve their work performance. Employees who feel materially valued tend to have higher morale, more discipline, and focus on achieving results. Extrinsic motivation plays an important role in improving employee productivity (Ravesangar & Fauzi, 2022). Research conducted by Sismanto & Mubarok, (2024), Al Imtinan & Wulandari, (2025), Putri & Yanti, (2025) and T. P. Purnomo & Wardhani, (2023) proved that extrinsic motivation has a positive and significant effect on performance. H3: Extrinsic motivation has a positive and significant effect on performance.

Based on the development of these hypotheses, the research framework can be formulated as shown in the following figure:

Figure 1. Research Framework

Based on table 2, the majority of respondents consisted of women with the classification of female nurses as many as 102 respondents or 74.45%, while male nurses were 35 respondents or 25.55%, indicating unbalanced participation. This is because the general public believes that working as a nurse is exclusively a female occupation. In terms of age, 76 (55.47%) respondents were aged between 20-30 years old, 54 (39.42%) between 31-40 years old, and 7 (5.11%) people between 41-50 years old. None of the respondents were older than 51 years old. There were 93 respondents (67.88%) who were married while the remaining 44 respondents (32.12%) were unmarried. The dominance of married respondents can provide an idea of the existence of family responsibilities that may affect work priorities and behavior.

The majority of respondents have a D III education as many as 86 people or 62.77%, and the others have an S1 education as many as 43 people (31.39%), 2 people (1.46%) for the S2 level, and 6 people (4.38%) for the SMA level. This shows that most respondents have a relatively high level of education, which can affect ability and performance. In terms of working time, 9 respondents (6.57%) less than 1 year, 43 respondents (31.39%) more than 1 year, 30 respondents (21.90%) more than 3 years, 25 respondents (18.25%) more than 5 years, and 30 respondents (21.90%) more than 10 years.

Table 3. Convergent Validity and Realibility

The results of this study indicate that organizational culture has a positive and significant effect on nurse performance. This indicates that corporate culture is very important for performance. Typically, an organization is designed to achieve goals using all of its human resources. However, an organization's performance is strongly influenced by its environment, including its culture. This finding is in line with Abraham Maslow's research which states that a person in a culture is mostly satisfied in his security needs (Helmke et al., 2020). The results of this study are in line with Nurmala & Jasin, (2021) that by implementing a good organizational culture, there will be a comfortable work environment that can increase employee productivity.

The culture of an organization greatly influences the behavior of its members because the culture has a value system that can be used to direct human behavior in the organization to achieve the expected goals or results. In other words, if the organizational culture is good, members of the organization will be good and qualified (Fahmi, 2021). This suggests that corporate culture must be effectively implemented to maintain company values and make the workplace more comfortable for better performance. In addition, this study is in line with the findings of Virgiawan et al., (2021) Shahidi et al., (2024), Nurmala & Jasin, (2021), and Fahmi, (2021) which state that organizational culture affects performance positively and significantly.

The results of this study indicate that islamic work ethic has a positive and significant effect on nurse performance. This means that one of the important elements that affect performance is islamic work ethic. By implementing a good islamic work ethic, employees will act professionally in their workplace, which results in a sense of sincerity and high morale. This research is in line with Abraham Maslow's theory that a person will be motivated by his need to develop and actualize his full potential capacity (Helmke et al., 2020). This finding is in line with Fadhlurrohman & Mas’ud, (2021) that a worker with a high islamic work ethic will have a sense of sincerity and high work enthusiasm at work through work professionalism, so that his performance will increase.

Working with islamic work ethic is important, especially for nurses. This is because nurses labor with more than just worldly ideas, their profession is also regarded as worship, and they work truly to maximize their abilities (Widzayanto et al., 2023). Employees who apply islamic work ethic will have a sense of professionalism and high morale, which results in improved performance (I. Purnomo et al., 2023). This research is also in line with Lestari et al., (2023), Aflah et al., (2021), and Widyarini & Muafi, (2021) which state that islamic work ethic has a positive and significant effect on performance.

The results of this study indicate that extrinsic motivation has a negative and insignificant effect on nurse performance. Extrinsic motivation is not the main factor determining performance in nurses at the RSU Muhammadiyah Siti Aminah Bumiayu. This can occur due to the limited career development paths available, where the highest position is only as head of the nursing division without attractive incentives. When career development prospects are unclear or stagnant in certain positions, nurses tend not to be encouraged to improve performance for the sake of these incentives. In addition, hospital policies that require nurses to serve for a certain period of time if their education is funded make education incentives perceived as a burden or work bond that limits career freedom. As a result, this is no longer an effective performance driver, but rather creates a sense of compulsion that weakens motivation. Previous research by Islami & Adnyana, (2024), Regina, (2023), and Putra et al., (2022) found that extrinsic motivation has a negative and insignificant effect on performance.