Management Support in Implementing A Career Path System for Nurses in Local Government Hospitals

Background: Career ladder systems are an important mechanism in supporting the professional development of nurses and have been implemented in various models in a number of countries. Effective management support is critical to the successful implementation of career ladder systems in Indonesia. Objective: This study aims to determine the description of management support in the implementation of career ladder system in Local Government Hospitals. Method: This research uses descriptive quantitative research methods in May-June 2024. The study population was all nurses who applied for competency assessment and credentialing / recredentialing as many as 76 people who also became samples with total sampling technique. Data were collected using a questionnaire that included respondent characteristics (age, gender, education, length of service, career path level) and management support in implementing career paths. Data were analyzed using descriptive statistics including frequency distribution and percentage. Result: The results showed that the majority of executive nurses were female (92%) with vocational education (84%) and were in early adulthood (26-35 years old). Most of them had between 8 to 15 years of service and almost half of them were at the Pre PK level (43%). Management support in implementing career ladders was mostly categorized as good (54%). Conclusions: This study concludes that management support in the implementation of the career ladder system in Local Government Hospitals is mostly good, but there are still some aspects that need to be improved. Optimal management support includes the provision of adequate resources, structured training programs, and continuous feedback to ensure the successful implementation of the career ladder system.


INTRODUCTION
Nurses are an important component of the healthcare system in hospitals.They play a significant role in providing quality care to patients and ensuring that health service standards are maintained.In an effort to improve the quality of service and professionalism of nurses, the implementation of a career path system is very relevant.The nursing career path system aims to provide a clear career development path for nurses, increase work motivation, and ensure nurses' competencies continue to develop as their careers progress (1).

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Volume 6, Issue 4, July-August 2024 2 However, the implementation of a career ladder system for nurses in local government hospitals does not always go smoothly.Management support is a key factor in the successful implementation of this system.Hospital management is responsible for providing clear policies, ongoing training programs, and a supportive work environment for nurses.Without adequate support from management, the career ladder system will not be effective and nurses may not feel motivated to develop themselves (2).The career path system in nursing is one of the essential mechanisms in supporting the development of nurses' professionalism.This system has been recognized and implemented in various countries with the main objective of improving competence, motivation, and the quality of services provided by nurses.In developed countries such as Australia, the United States, and Japan, career ladder systems in nursing have proven successful in facilitating professional growth and improving the quality of health services (3).In addition, developing countries such as Taiwan and Thailand have also adopted this system with various adaptations to ensure its sustainability in the local context (4).
In Indonesia, the Ministry of Health has established guidelines for nurses' career paths through Minister of Health Regulation No. 40/2017.These guidelines cover various roles of nurses ranging from clinical nurses, managers, educators to researchers.Although this regulation has been implemented in several hospitals, its implementation still faces various obstacles and is not optimal in many places.For example, at Jember Pulmonary Hospital the achievement rate of the career path system only reached 37.1%, while at Mitra Medika Hospital there are significant obstacles that hinder the effective implementation of this system (5,6).Factors influencing the implementation of the nursing career ladder in Indonesia are diverse.Individual factors such as motivation, readiness to take the assessment, and nurses' awareness play an important role in the success of this system (7, 8, 9, 10).In addition, group factors such as effective communication and adequate socialization are also important determinants in ensuring nurses' understanding and acceptance of the career ladder system (9,11).Organizational factors, including support from management and direct supervisors, are also crucial.Effective management support includes not only providing the necessary resources but also ongoing training and constructive feedback to nurses (12,13).
Previous research shows that strong management support can increase nurses' job satisfaction, reduce turnover rates, and improve the quality of patient care (14).Unclear policies, lack of access to training and development, and lack of rewards and recognition of nurses' achievements are some of the obstacles often faced in implementing a career ladder system (15).This study aims to explore more deeply the management support in the implementation of career ladder systems in Regional General Hospitals (Regional Government Hospitals).By understanding the role of management support in this context, it is expected that effective strategies can be found to improve the implementation of the career ladder system so as to significantly improve the quality of nursing services and nurse competence.Optimal management support is expected to create a conducive work environment for nurses' career development which in turn will contribute to improving the quality of health services provided to the community.

OBJECTIVE
This study aims to determine the description of management support in the implementation of career ladder system in Local Government Hospitals.

METHOD
This research uses descriptive quantitative research methods to determine the description of management support in implementing a career ladder system in Local Government Hospitals.The research was conducted in May-June 2024 with a population of all nurses who submitted competency assessments and credentials / re-credentials totaling 76 people.The sample in this study also amounted to 76 with total sampling technique.Ethical approval has been obtained from the Ethics Committee of the Faculty of Nursing, Andalas University.Data were collected using a questionnaire that included respondent characteristics (age, gender, education, length of service, career path level) and management support in implementing career paths.The questionnaire instrument used had been tested for validity and reliability.Data were analyzed using descriptive statistics including frequency distribution and percentages.1 shows that almost all executive nurses are female (92.8%) and male (7.2%).The majority of respondents had vocational education (84.2%) and professional education (15.8%).Most respondents were in early adulthood (72.4%), while those in late adulthood were (27.6%).Based on tenure, 54% had a long tenure, 28.9% had a new tenure, and 17.1% had a long tenure.Almost half of the executive nurses were at the Pre PK level (43.4%), followed by PK 1 (40.8%) and PK II (15.8%).Management Support Good 41 53,95

RESULTS
Table 2 shows that most of the management support (53.95%) was categorized as good and there were (46.05%) categorized as less management support.

DISCUSSION
The results of this study showed that the majority of executive nurses in Local Government Hospitals were female (92%) with vocational education (84.2%) and were in early adulthood (26-35 years old).Most of them had between 8 to 15 years of service and almost half of them were at the Pre PK level (43.4%).This data provides a clear picture of the demographic profile of executive nurses in Local Government Hospitals, most of whom are still in the early stages of their careers.This highlights the need for more strategic interventions to support their career development through a more structured and comprehensive career pathway system (16).One of the important findings of this study is that the management support provided is mostly good (54%).However, there are still some aspects that need to be improved to achieve higher effectiveness.For example, the socialization of the career ladder system is still considered ineffective by most nurses.Many nurses feel that they do not get enough attention regarding the implementation of career pathways, and this may reduce their motivation to participate in career development programs provided by the hospital.The recognition and preparation of positions in accordance with the career ladder also needs more attention to ensure that nurses feel valued and motivated to continue developing their competencies (6).Management support of nurses' career progression in hospitals is essential for their professional development and organizational commitment.Nurse managers play an important role in providing mentoring and support to newly graduated registered nurses ensuring a positive work environment and promoting sustainable practice.Organizational support for nurses' career planning and development was recognized as important, with a focus on structured frameworks, knowledge sharing, and interprofessional collaboration (18,19).During organizational change, nurse managers' practical support significantly impacted nurses' organizational commitment, emphasizing the importance of preparation and personal development at higher career levels (19).Nurse managers also contributed to supporting graduate nurses' work readiness by establishing a supportive environment, encouraging learning, and providing a team of supportive individuals.While peer support programs may not always produce significant results in increasing resilience among nurse managers, they show promise in addressing stress and burnout, highlighting the ongoing need for interventions to support nurse managers' well-being (21,22).Effective management support covers various aspects, including the provision of adequate resources, structured training programs, and continuous feedback.Management needs to ensure that all nurses understand their career development options and the requirements needed to progress.Clear communication and open feedback channels are essential to build nurses' trust and involvement in their career development process.Regular feedback sessions and performance evaluations should also be conducted to monitor progress and address challenges nurses face in achieving higher career ladders (22).In addition, it is important to overcome technical and administrative obstacles that are often encountered in implementing career ladders.For example, providing adequate competency assessment instruments, speeding up the assessment process, and ensuring nurse data is always updated and easily accessible.The implementation of an electronic-based career ladder can be a solution to overcome some of these obstacles so as to improve the efficiency and effectiveness of the assessment process and career mapping of nurses (23).
Previous research has shown that good management support can improve nurse motivation and performance.According to Wahju Hardjanti et al. ( 2016), strong support from management, including the provision of training facilities and recognition of nurses' achievements, can increase nurses' job satisfaction and commitment to the organization (24).This is in line with the findings of this study, which show that good management support contributes positively to the implementation of a career ladder system.In this context, hospitals need to develop strategies to improve management support, including conducting regular training, providing necessary resources, and establishing effective communication between management and nurses.Periodic evaluations and assessments should also be conducted to ensure that the career ladder system is working well and providing maximum benefits to nurses.
As such, this study provides valuable insights into the importance of management support in the implementation of career ladder systems in Local Government Hospitals.Strong and sustained support from management can ensure that nurses have the necessary tools and resources to advance their careers and provide high quality patient care.This study also provides recommendations to improve the implementation of career ladder systems in order to achieve more optimal outcomes, both for nurses and for the hospital as a whole (18).
In an effort to improve management support, hospitals should focus on developing sustainable and structured training programs.These programs should be designed to meet the specific needs of nurses at different career stages, from novice nurses to senior nurses.Quality training can improve nurses' competencies and prepare them to face new challenges in their work.In addition, management should ensure that the competency assessment process is conducted in a fair and transparent manner so that nurses feel valued and motivated to continue developing themselves (25).In addition, it is important to establish a work culture that supports collaboration and effective communication between nurses and management.
Management should provide open communication channels and listen to inputs from nurses regarding the needs and challenges they face in their daily work.By listening and responding to such inputs, management can create policies and programs that are more relevant and effective in supporting nurses' career development.
Technology implementation can also play an important role in improving management support.The use of sophisticated management information systems can assist in the management of nurses' data, performance monitoring, and implementation of training programs.These systems can provide accurate and real-time information regarding nurses' career progress so that management can make more informed and strategic decisions in supporting their career development (26).Ultimately, the main goal of management support in implementing a career ladder system is to create a work environment that is conducive to nurses' professional development.By providing appropriate support, management can help nurses reach their full potential and deliver high-quality healthcare to patients.This study provides evidence that good management support can improve nurses' job satisfaction, motivation, and performance which in turn will contribute to the overall improvement of healthcare quality.

CONCLUSIONS
The conclusion of the research on management support in the implementation of the career ladder system for nurses in local government hospitals shows that management support in the implementation of the career ladder system is mostly categorized as good.Management support plays an important role in the successful implementation of the career ladder system.The results showed that some significant management support factors include clear policies and regulations, training and development, rewards and recognition, financial support and effective communication facilities.Overall, comprehensive and continuous management support is essential to create a conducive work environment for nurses to develop and advance in their careers.Hospital management needs to continuously improve their policies, programs and strategies to ensure that the career ladder system is effective and provides optimal benefits for nurses and the Local Government hospital institution.