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| Illustration by Ai |
A new study by Ida Ayu Gede Oktarini, I Ketut Sutapa, and Saortua Marbun from Universitas Triatma Mulya has found that career development and professional training improve nurse performance only when they successfully increase work motivation. Published in 2026 in the Jurnal Multidisiplin Madani (MUDIMA), the research examined 101 civil-servant nurses at Bali Mandara Eye Hospital and concluded that motivation serves as the critical link between organizational development programs and better healthcare performance. The findings provide valuable guidance for hospital administrators seeking to improve service quality through effective human resource management.
Motivation Emerges as the Missing Link in Nurse Performance
Healthcare systems worldwide continue to face growing demands for high-quality patient care while managing workforce shortages, increasing workloads, and rapid technological changes. In Indonesia, public hospitals also require civil-servant nurses to fulfill administrative responsibilities such as career advancement, competency documentation, Employee Performance Targets (SKP), and digital performance reporting in addition to delivering safe clinical care.
Hospitals have long invested in career development programs and professional education to strengthen employee performance. However, these investments do not always produce measurable improvements in healthcare services. This raises an important question: What transforms career opportunities and training into better nursing performance?
The new research from Universitas Triatma Mulya suggests that the answer lies in work motivation. Rather than directly improving performance, career pathways and education programs first strengthen nurses' professional commitment, confidence, and sense of appreciation, which then lead to better workplace outcomes.
The findings are particularly relevant for specialized hospitals, where patient safety, precision, teamwork, and rapid decision-making are essential.
How the Research Was Conducted
The study was carried out at Bali Mandara Eye Hospital, a provincial government-owned specialized eye hospital in Bali that provides high-volume ophthalmology services.
Researchers surveyed all 101 civil-servant nurses working at the hospital, using a census approach rather than selecting a sample. Participants completed validated questionnaires measuring four key areas:
- Career path opportunities
- Education and professional training
- Work motivation
- Nurse performance
To strengthen the findings, the research team also incorporated semi-structured interviews, workplace observations, and aggregate Employee Performance Target (SKP) documentation.
The data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM), a statistical method commonly used to examine complex relationships among organizational variables.
Key Findings
The study revealed several important insights about what drives nurse performance in public hospitals.
Career development increases motivation
A transparent career system significantly improved nurses' motivation. Opportunities for professional growth, organizational support, promotion transparency, and expanding responsibilities encouraged employees to become more motivated at work.
However, career pathways did not directly improve performance. Nurses performed better only when career advancement increased their enthusiasm, commitment, and professional engagement.
Education and training had the strongest influence on motivation
Among all variables examined, education and training produced the strongest positive effect on work motivation.
Training programs related to patient safety, ophthalmic care, documentation, emergency services, and clinical skills increased nurses' confidence and preparedness.
Yet, similar to career development, training alone did not directly improve performance unless it first strengthened work motivation.
Motivation directly improves nurse performance
The analysis showed that work motivation had a strong and statistically significant influence on nurse performance.
Motivated nurses demonstrated better service quality, stronger professional responsibility, greater teamwork, improved punctuality, and higher consistency in completing clinical documentation.
The researchers concluded that motivation acts as a full mediator, meaning career development and training influence performance only through their ability to inspire and engage employees.
Supporting Evidence Beyond Statistics
The statistical findings were reinforced through interviews and workplace observations.
Hospital staff reported that the existing career system, credit-point requirements, Employee Performance Targets (SKP), and SIKePO reporting had already been implemented. However, nurses also expressed the need for:
- More equitable access to training opportunities
- Better technical guidance
- Greater recognition of professional achievements
- Stronger organizational support
Observations conducted during the study found generally good discipline, teamwork, compliance with standard operating procedures, and application of newly acquired skills.
Nevertheless, researchers identified several areas requiring further improvement, including documentation quality, evidence for professional credit points, and time management in busy clinical units.
Administrative performance also remained relatively strong. Aggregate SKP records showed an average performance achievement score of 80 percent, placing nurse performance in the good category.
Why the Findings Matter
The study carries important implications for healthcare organizations across Indonesia and other countries facing similar workforce challenges.
Many hospitals invest substantial resources in employee training and structured career systems. This research demonstrates that such investments alone may not automatically improve patient care.
Instead, hospital leaders should design career development and education programs that also foster motivation by creating opportunities for recognition, professional growth, meaningful feedback, and organizational support.
According to the researchers, strengthening motivation may generate greater returns than simply increasing the number of training sessions or introducing new administrative career requirements.
The findings also suggest that healthcare policymakers should evaluate human resource programs not only by participation rates but also by their ability to enhance employee engagement and commitment.
Author Profiles
Ida Ayu Gede Oktarini
I Ketut Sutapa
Saortua Marbun
Source
Article Title: Career Path, Education-Training, Motivation, and Nurse Performance
Journal: Jurnal Multidisiplin Madani (MUDIMA)
Publication Year: 2026
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