The requirements and career stage mapping model
Career stage mapping in Hospital X is categorised by education, experience, work duration and competency evaluation. This career staging has its own unique ways of assessing personal capabilities and self-assessments. Benchmarking results can be combined into personal communications with the nurses’ managers, who apply career stages in some Indonesian hospitals, suggesting that there are many duties to be fulfilled [11]. The career stage has been implemented in some hospitals but is sometimes insufficient for recruitment implementation, rotations, prolonged professional improvement and promotions, which become inseparable components of career stages [12, 13].
National hospitals still have nurses with only high school educations, and career stage regulations have been considered. This will become the role model for other hospitals in Indonesian provinces. A profession should determine the minimum qualification of a profession’s level and no vocations below it [12]. As a recently established profession that has only recently been protected under law in Indonesia through the enactment of Nursing Law no. 38 in 2014, nursing is still very much in need of benchmarking. It needs to learn from other countries that have established regulations for ensuring the quality of their nursing. This quality needs to be established in terms of the nursing services provided and regulations that protect nursing staff; it must also ensure that an adequate nursing education system is established. However, better resources are required to establish a nursing system in Indonesia and strengthen the nursing profession. Benchmarking results in Thailand indicated that no nurses there have a vocational education [14]. This consequence should be addressed by the recognition of a profession [15].
Nurses’ career paths in Japan, Taiwan and Thailand begin with basic nursing education, followed by license issuance with certain qualifications. Specialist nurse development must focus attention on the qualitative aspects of professional experience in services and support the right individual for human resource improvement [16]. Nursing careers in England since 2006 have been directed into five career pathways: society and family heath, emergency and critical care, first contacts, access and emergency care, long-term care support and mental and psychosocial care [11]. Nurses need to improve their competencies [17]; thus self-evaluation becomes one of the strategies to build a nursing practice and proof-based career stage [18].
Competencies are interconnected to education and formal and informal training. Nurses’ competencies need to be clearly understood based on the stages [19]. Higher education is conducted for professional improvement and quality nursing care. Human resource management executes recruitment and retention of skilled employees so that hospitals can provide quality services [20]. Organisations can achieve competitive superiority through their talented, skilled and experienced staffs. One way to ensure that nurses achieve maximum performance is through career stages [21].
Career mapping requires guidelines that cover the implementation of career stage development, competencies that need to be fulfilled and other options for career development [17]. Self-evaluation and assessment verification can become one of the strategies to establish a nursing practice culture and career stage systems that adopt proof-based nursing competencies [18]. Competency assessments at the new hospital are a good starting point for helping management determine the nurses’ capabilities and provide quality nursing care. Early mapping competency assessments are unequivocal because the organisational culture is easily shaped and nurses will gain increased motivation from improvement programmes. Many hospitals have operated for years but still have difficulties developing a competency assessment due to the static attitudes of nurses who are apathetic toward many development programmes [22].
Career stage mapping increases service quality and substantiates nursing professions
Workers who tend to improve themselves are emboldened by the highest basic human necessity, which is the need for self-actualisation [23]. Nurses feel proud of their career level. The career stage effectively supports professional career development, keeping quality nurses working at a hospital, and also serves as a self-actualising vessel [24]. This requires support from leaders and colleagues. The career stage sometimes becomes just a concept without further action. Nurses in Indonesia tend to think of career stage implementation as the promise of additional financial rewards, when in reality, career stages are implemented to guarantee service quality and nurses’ competencies, so they must be interpreted as a medium for motivating professional development [25]. Career stages, according to nurses, are their competency responsibilities.
Career stages can increase work satisfaction, quality care provisions, safety and are cost-effective for patients [26]. Nurses need to understand that the purpose of career stages is to improve service quality and substantiate the nursing profession. Career stages also impact financial rewards and clinical authority, but nurses are also required to exhibit exemplary working conditions [27]. Career stages provide clinical authority, in which nurses who are considered competent will do the work determined by a formal review process by a group of people including professional colleagues and specialists based on their qualifications, education, skills and experience [23]. This process includes the determination of clinical competence [28]. Nurses’ competencies must include a core competence that relates to their specialties.
Nurse managers stated that in Hospital X, the sense of urgency to implement career stages was to gain accreditation. These concepts are not precise, so it needs to be emphasised that four standards exist in accreditation evaluation, but career stages are not a prerequisite. The goal of accreditation is increased quality of service, not achievement of the bare minimum. Career stages must be viewed as a medium for achieving accreditation but not as the final destination.
Nursing synergy elements are involved in career stage mapping
Career mapping involves lower-line to top-line nurses. Human resources are needed by nurse managers to clarify the development process after nurses achieve the roles to plan for education continuance [8]. Nurses’ elements in Hospital X indicate the totality in the process of career stage mapping until the preparation for accreditation. Organisations need leaders’ sustenance for the success of the programme. Top management needs to be active from the beginning of mapping until the nurses’ careers are determined [7]. Competency reviews and goal preparation help employees identify competencies that must be reached [29]. Organisations need to organise work limitations and management performance through competency arrangements and reward mechanisms that touch base with professional aspects to establish achievement motivations. Organisations motivate employees by providing opportunities to express ideas, as making decisions is an important factor for increasing performance [30].
Nurses are individually responsible for improving themselves [23]. Career stages are simply a medium and cannot be relied on to promise career developments. Nurses must conscientiously and purposely plan out their careers in a continuous process [29]. The responsibility of an individual to strategise career development is a difficult concept for Indonesian nurses. It is difficult to plan for self-improvement individually, such as through training programmes, because the people who are assigned to join the training are the same people, and many are managerial nurses. Development programmes are in the leaders’ dominion, and staff are not capable of voicing their development aspirations. Transcendental achievements, overlapping all things that seem to be material advantages, need to become individual motives for self-improvement.
Obstacles of the career stage mapping process and their solutions
Obstacles of implementing career stages are experienced by nurses as well as nurse managers. Nurses feel a lack of support and see it as a problem in the institution’s system as well as direct self-prevention [31]. Some nurses cited an excess of documents to be completed and the difficulties, complications and time consumption associated with applications as obstacles [32]; these obstacles also occur in other countries. Another obstacle is that nurse managers feel the inadequacy of the hospital’s support for nursing. Leaders’ patronage becomes a serious concern because health workers need to feel appreciated to be motivated to work [33]. Nurse managers are blocked by a lack of financial support and understanding about professional development and do not have power at the middle management level to enact professional improvements. Nurses are not considered important contributions to human resources in the planning of professional development [1].
Other obstacles include obscure duties and nursing committee roles. Nurses in the committee include the room master and team leaders, who are responsible for 4–6 patients daily and who execute the committee’s assignments. Structural positions cannot be the reason for swaying the main tasks to provide nursing care. Suggestions include limiting clinical duties and providing manageable nurse-to-patient ratios that are suitable so as not to overload the nurses and allow them to execute their duties optimally, whether in functional or structural fields.
In addition, there are misconceptions about the assessor concept at Hospital X. Nurses who participate in assessor’s training return to the hospital to execute it, and the room master and one team leader from every team in each room must be an assessor. Assessors do not perform nursing duties to reach the target of assessed nurses and believe they are exempt from delivering patient services. Assessors should be nurses who possess credibility and adequate clinical skills to master competencies, especially if the assessed area overlaps with the competencies in a special nursing unit such as the ICU or HCU.
Career stage mapping programme evaluation
Career stages provide clarification about financial rewards [34]. Financial benefit is known as remuneration, which increases motivation to work [35]. The nursing manager’s role is to determine nurses’ remunerations based on performance evaluations [36]. Remuneration implementations are based on the workload, nursing care provided to patients, education level, work duration, responsibilities, attendance and position of each nurse [37].
Competency-based career mapping supports health workers’ collaborations and can increase patients’ safety and ease of access, coordinate effective health services, optimise the health of health service providers, develop mutual respect, share knowledge and skills and escalate roles and communications [38]. Nurses in Hospital X hope for the mentorship process to lay the foundation for professional development. Mentorship promotes self-efficacy by escalating confidence, competencies and pride. Self-efficacy has a positive influence on involvement in professional development and career progress [39, 40].
