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Fishbone Analysis sebagai Metode dalam Optimalisasi Penerapan Sistem Jenjang Karir Perawat

Indonesian Journal of Nursing and Health in Tropical Settings · Vol. 1 No. 3 (2026) · pp. 40–52

Published
2026-10-12
Publisher
Indonesian Journal of Nursing and Health in Tropical Settings
Language
eng

Abstract

The nursing career ladder system is an essential component of hospital human resource management aimed at enhancing nurses’ motivation, performance, and professionalism. However, its implementation remains suboptimal due to structural and managerial constraints. This study aimed to analyse factors influencing the optimisation of the nursing career ladder system using fishbone analysis. A qualitative descriptive-analytical design was employed. Participants included nurse managers and staff nurses working in inpatient units, selected through purposive sampling. Data were collected through in-depth interviews, observations, and surveys, and analysed using fishbone analysis to identify root causes across the dimensions of man, method, material and machine, and money. The findings revealed that low motivation for career development, weak evaluation and promotion mechanisms, limited training facilities and technological support, and insufficient budget allocation and incentive systems were the main barriers to optimal implementation. These interrelated factors contributed to uneven clinical career distribution and reduced job satisfaction among nurses. This study concludes that optimising the nursing career ladder system requires a comprehensive and integrated approach, including strengthening nursing governance, enhancing professional development, utilising information technology for competency mapping, and ensuring sustainable financial and incentive support to improve nursing professionalism and quality of care.

Keywords

Collaboration network of the authors

11 authors · 18 co-authorship links

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Co-authorOrganisationJoint articles
Zusana A SasarariAffiliation unknown2
Irwin PalilingAffiliation unknown1
Kharisma NadiaAffiliation unknown1
Diyah Astuti Nurfa’izahAffiliation unknown1
- FitrianiAffiliation unknown1
Elisabet Bre BoliAffiliation unknown1
Martha KadeikotoAffiliation unknown1
Ita Mariana Adolfina GiyaiAffiliation unknown1

Affiliations come from OpenAlex; journal OAI-PMH metadata carries none. Authors without an OpenAlex ID are matched by name, which can merge or split people.

Metadata source: OAI-PMH (metadata jurnal) https://ejournal.uncen.ac.id/index.php/ERAN/oai, first harvested 1 Nov 2026, last seen 1 Nov 2026.
Original metadata (oai_dc) 
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	<dc:title xml:lang="en-US">Fishbone Analysis sebagai Metode dalam Optimalisasi Penerapan Sistem Jenjang Karir Perawat</dc:title>
	<dc:creator>Mendrofa, Hendry Kiswanto</dc:creator>
	<dc:creator>Astuti, Dwi</dc:creator>
	<dc:creator>Nasrah Nasrah</dc:creator>
	<dc:subject xml:lang="en-US">Nursing career ladder</dc:subject>
	<dc:subject xml:lang="en-US">Fishbone analysis</dc:subject>
	<dc:subject xml:lang="en-US"> Nursing management</dc:subject>
	<dc:subject xml:lang="en-US">Nurse professionalism</dc:subject>
	<dc:subject xml:lang="en-US">Quality of care</dc:subject>
	<dc:description xml:lang="en-US">The nursing career ladder system is an essential component of hospital human resource management aimed at enhancing nurses’ motivation, performance, and professionalism. However, its implementation remains suboptimal due to structural and managerial constraints. This study aimed to analyse factors influencing the optimisation of the nursing career ladder system using fishbone analysis. A qualitative descriptive-analytical design was employed. Participants included nurse managers and staff nurses working in inpatient units, selected through purposive sampling. Data were collected through in-depth interviews, observations, and surveys, and analysed using fishbone analysis to identify root causes across the dimensions of man, method, material and machine, and money. The findings revealed that low motivation for career development, weak evaluation and promotion mechanisms, limited training facilities and technological support, and insufficient budget allocation and incentive systems were the main barriers to optimal implementation. These interrelated factors contributed to uneven clinical career distribution and reduced job satisfaction among nurses. This study concludes that optimising the nursing career ladder system requires a comprehensive and integrated approach, including strengthening nursing governance, enhancing professional development, utilising information technology for competency mapping, and ensuring sustainable financial and incentive support to improve nursing professionalism and quality of care.</dc:description>
	<dc:publisher xml:lang="en-US">Indonesian Journal of Nursing and Health in Tropical Settings</dc:publisher>
	<dc:date>2026-10-12</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://ejournal.uncen.ac.id/index.php/ERAN/article/view/6003</dc:identifier>
	<dc:source xml:lang="en-US">Indonesian Journal of Nursing and Health in Tropical Settings; Vol. 1 No. 3 (2026): Indonesian Journal of Nursing and Health in Tropical Settings; 40-52</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>https://ejournal.uncen.ac.id/index.php/ERAN/article/view/6003/3851</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2026 Indonesian Journal of Nursing and Health in Tropical Settings</dc:rights>
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