Proceedings of the 11th Annual International Conference on Industrial Engineering and Operations Management

Singapore, March 7-11, 2021

Career Development and Motivation for the Quality of

Nursing Services
Yuriska Kuka
Student of Magister Program of Economic Science, STIE AMKOP, Makassar, Indonesia
windawatyhumola@gmail.com

Hasmin Tamsah, Trimaya Cahya Mulat, Iksan Kadir

STIE AMKOP, Makassar, Indonesia
hasmintamsah@gmail.com, trimayacahya@gmail.com, iksankadir@gmail.com

Ryryn Suryaman Prana Putra

STIKES Pelamonia Kesdam VII Wirabuana, Makassar, Indonesia
uyaputra17@gmail.com

Yusriadi Yusriadi
Sekolah Tinggi Ilmu Administrasi Puangrimaggalatung, Makassar, Indonesia
yusriadi.yusriadi@uqconnect.edu.au

Dwi Yogo Budi Prabowo

Akademi Keperawatan Rumkit TK III Manado
dwiyogo250688@gmail.com

Abstract
This study examines and analyses the effect of career development on the quality of nursing services through nurses'
motivation in community health centres at inpatient care. This study used a survey research design with a
quantitative approach with an accidental sampling technique to 100 nurses as respondents. Data analysis used path
analysis through multiple linear regression tests of SPSS version 16. The results showed that career development has
a significant positive effect on nurses' motivation in hospitalization and the quality of nursing services. The reason
has a significant positive impact on service quality. 4) career development has a significant positive effect on the
quality of nursing services through nurse motivation. It means that cause is more dominant in improving nursing
services quality, followed by career development. With the mediation of inspiration, career development will be
better for enhancing the quality of nursing services.

Keywords: career development, motivation, quality of service, Indonesia

1. Introduction
Competition between hospitals, both public and private and foreign, will be even harder to seize an increasingly free
market. Besides, the community demands that the hospital provide one stop service, meaning that all health care
needs and patient-related services must be served by the hospital quickly, accurately, with quality at affordable costs
for all levels of society. Meanwhile, hospital management is different from businesses in other fields because
hospitals are capital-intensive, labour-intensive and technology-intensive enterprises, apart from having to apply
social and ethical values, they also have to take into account the economic aspects (Kuntoro, 2010). The increasing
number of hospitals, whether government, private or foreign, creates competition in seizing the market or improving
the quality and service of hospitals and competition in obtaining the best human resources. Human resources play an
important role in improving the quality of service that each hospital has. Most human resources in hospitals and
those who interact directly with patients are nurses. The quality of service carried out by nurses can be assessed as
an indicator of good or bad service quality in the hospital (Aditama, 2000). The quality of nursing service is a
professional attitude of nurses that provides comfort and protection for every patient who is undergoing the recovery

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Proceedings of the 11th Annual International Conference on Industrial Engineering and Operations Management
Singapore, March 7-11, 2021

process. Good or bad assessments of the quality of health services are very dependent on nurses; this will be a
reference for the community in the quality of service at a hospital (DepkesRI 2009). Nursing is a profession, and
nurses are responsible for increasing the degree of health (Wijayana 2008). The purpose of nursing services is set to
improve and maintain the quality of health services in a hospital by educating nurses to have a professional and
responsible attitude towards their work (Arwani, 2006).

The Community Health Centre (CHC) is first-level individual health and public health service facility focused on
promotive and preventive services to obtain a degree of health in the community. In 2013, there was an increase in
the number of CHC, previously 9,655 units; in 2017, it increased to 9,825 units. This increase does not directly
reflect the fulfilment of primary health care needs in a region (Sawitri et al.; Ansar et al.). Nurses are human
resources who play a role in the scope of health, especially in the community (Usman et al.). Decree of the House of
Representatives of the Republic of Indonesia and the President of the Republic of Indonesia Number 38 states that
nursing services are professional services that are an integral part of health services, focusing on individuals,
families, groups, and communities, healthy and sick (Law of the Republic of Indonesia, 2014).Nursing human
resources are one of the most important assets and components in hospital services that contribute to determining
whether the hospital's image is good or not. Koesmono (2007) explains that hospital nurses are required to have the
willingness and ability to develop skills and knowledge to provide friendly, courteous and quality service to patients.
Quality health services can only result in quality resources, facilities and infrastructure, and a good managerial
system, including hospital human resource managerial (Koesmono 2007).

There are many public demands for CHC health services, one of which is the phenomenon of hospitalization in
Gorontalo District, which has the highest number of inpatient CHC. Patient complaints related to unsatisfactory
services, such as indifference to nurses in providing services (Umar, Amrin, et al.). Sometimes not explaining
procedures before acting, and nurses are considered relaxed in delivering services (less responsive), proving that
there is still a lack of intellectual, interpersonal, and technical, and moral abilities (Hasbi, Tang, et al.). The initial
data survey results were that there were still many nursing staff who did not have the opportunity to take part in
further education, with a lack of enthusiasm to develop knowledge and prefer to depend on the current situation
(Ahdan et al., 2019; Tahir & Rinantanti, 2018; Hasbi et al., 2019). Other conditions are also difficult to divide time
between family, work, education, and lack of appreciation for the performance performed. Nurses generally carry
out work without the desire to compete through performance achievements, which harms the quality of nursing
services. The importance of the quality of nursing service depends on the quality of the performance of human
resources (Yusriadi, Sahid, et al.). Judging from the above problems, the writer formulates the problem that the
career development of nurses is very influential on the quality of nursing services in hospitals.

2. Theoretical Review
According to J Supranto, service quality is a result that must be achieved and carried out with an action. Still, that
action does not materialize and is easily lost, but can be felt and remembered. The impact is that consumers can be
more active in consuming a company's products and services. According to Wyckof, service quality is an expected
level of excellence, and related to that is control measures over this level of excellence to meet consumer
expectations. According to Philip Kotler, service quality is a performance that one can offer to others. This
performance can be in the form of actions that do not materialize and do not result in the ownership of any goods
and to anyone (Mu’adi et al.). Its customers will feel the quality of health services if the delivery is felt to exceed the
expectations of service users. Assessment of service users is aimed at service delivery, service quality, or how the
service is delivered to service users. According to Wyckof, service quality is a level of excellence that is always well
designed and control of excellence is also carried out appropriately to meet customer expectations. Several
marketing experts have developed the dimensions of service product quality. Garvin describes service quality into
eight measurements: the operational characteristics of the main product performance, various additional features
provided to its users, reliability, and service conformity with product specifications, durability, products, or
institutions that produce these services.

3. Research Method
This study used a survey design with a quantitative approach, a parametric analysis tool with path analysis through
multiple linear regression version 16. Path analysis is a form of applying multiple regression using a path diagram to
guide hypothesis testing. The research subject is the CHC nurse in Gorontalo District. The data collection technique
used a questionnaire. Sampling technique with accidental that is random sample or anyone by chance is used as a

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Proceedings of the 11th Annual International Conference on Industrial Engineering and Operations Management
Singapore, March 7-11, 2021

sample (A’yun et al., 2017). Each questionnaire is assigned a respondent number if all questionnaire statements are
filled in completely. Then, the questionnaire statement was tested for validity using the Pearson product-moment
technique α 5% (n = 100, r-table = 0.195) and reliability using Cronbach's Alpha value> 0.6.

4. Results
4.1 Validity and Reliability
The research validity test used Pearson's product-moment technique with 100 respondents. Based on the Pearson
product-moment r-table value with α 5% and n = 100 is r-table = 0.195. If the value of r-count ≥ 0.195, then the
statement item is significant (valid) and suitable for testing the research hypothesis. Conversely, if the r-count score
<0.195, then the statement item is not significant (invalid) and is not suitable for testing the research hypothesis.
Meanwhile, the reliability test results in this study were analysed using techniques from Cronbach's Alpha. If the
Cronbach's Alpha value is> 0.6, then the research variable statement item is declared reliable or consistent/stable
from time to time. Conversely, if it has a Cronbach's Alpha value <0.6, it is declared unreliable. Validity and
reliability tests were tested using SPSS version 16. The test results in this study can be seen in the following table:

Table 1. Validity and Reliability

Validitas Reliabilitas
Item r-hitung r-tabel Ket. Variabel Cronbach’s Alpha Cut of Point (0,6) Ket.
X1.P1 0,215 0,195 Valid
X1.P2 0,284 0,195 Valid
X1.P3 0,448 0,195 Valid
X1.P4 0,527 0,195 Valid
X1.P5 0,442 0,195 Valid
X1 0,690 0,6 Reliabel
X1.P6 0,591 0,195 Valid
X1.P7 0,618 0,195 Valid
X1.P8 0,509 0,195 Valid
X1.P9 0,449 0,195 Valid
X1.P10 0,443 0,195 Valid
X2.P11 0,472 0,195 Valid
X2.P12 0,558 0,195 Valid
X2.P13 0,444 0,195 Valid
X2 0,747 0,6 Reliabel
X2.P14 0,550 0,195 Valid
X2.P15 0,785 0,195 Valid
X2.P16 0,804 0,195 Valid
Y.P17 0,607 0,195 Valid
Y.P18 0,601 0,195 Valid
Y.P19 0,635 0,195 Valid
Y.P20 0,625 0,195 Valid
Y.P21 0,660 0,195 Valid
Y 0,771 0,6 Reliabel
Y.P22 0,611 0,195 Valid
Y.P23 0,624 0,195 Valid
Y.P24 0,654 0,195 Valid
Y.P25 0,667 0,195 Valid
Y.P26 0,515 0,195 Valid
Thus, all variables can be measured by indicators and statements used on these three variables, namely career
development (X1), motivation (X2), and quality of nursing services (Y).

Path Analysis: Path coefficient model I

e1= 0,7829
(0,000)
Career development (X1) P1 =0,387 Motivation (X2)
Figure 1. Structure Model Path Diagram I

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Proceedings of the 11th Annual International Conference on Industrial Engineering and Operations Management
Singapore, March 7-11, 2021

Table 2. The relationship between the variables X1 and X2

Constant
Koefisien jalur I R square S.E. C.R. (Beta) Sig.
(α)
X1–X2 0,387 14,556 0,055 (SP1) 0,387 (P1) 0,000

The result of the path coefficient test for a model I shows that the value of R square for a model I is 0.387, which
means that the contribution of the influence of X1 to X2 is 38.7%, the remaining 61.3% is the contribution of other
variables not included in the study. This. While the value of e1 is obtained through the formula = 0.7829. The α
value of 14.556 indicates that if the career development variable's value is zero, then the motivation is 14.556. The
regression coefficient for the X1 variable is the path value of P1 and indicates that every one-unit increase in the
career development variable will increase motivation with an influence of 0.387. And directly, the growth has a
significant effect of 0.000.
Path coefficient model II
e2 = 0,8378
(0,160)
Career development (X1) P2=0,131 Quality of nursing
Motivation (X2) services (Y)

Figure 2. Structure Model Path Diagram II

Table 3. The relationship between the variables X1 to Y and X2 to Y

Constant
Koefisien jalur I R square S.E. C.R. (Beta) Sig.
(α)
X1–Y 0,067 0,131 (P2) 0,160
0,298 18,998
X2–Y 0,113 (SP3) 0,482 (P3) 0,000

The result of the path coefficient test for model II shows that the R square value for model II is 0.298, which means
that the contribution of the influence of X1 and X2 on Y is 29.8%. In comparison, the remaining 70.2% is the
contribution of other variables not included in this research. Furthermore, the value of e2 is obtained through the
formula = 0.8378. The α value of 18,998 indicates that if the variable value of career development and motivation is
zero, then the nursing service quality is 18,998. The regression coefficient for the X1 variable is the path value of
P2. It indicates that every one-unit increase in the career development variable will increase the quality of nursing
services with an influence of 0.131. However, directly the increase did not have a significant effect of 0.160.

Furthermore, the regression coefficient for the variable X2 is the path value of P3. It indicates that each addition of
one unit of the motivation variable can improve nursing services' quality with an enormous influence of 0.482. And
directly, the increase has a significant effect of 0.000.

Sobel Test
Table 3 shows that the direct effect of X1 on Y (P2) is 0.131. Meanwhile, the indirect effect of X1 on Y through X2
is the result of multiplying the beta value X1-X2 (P1) with the beta value X2-Y (P3): 0.387 × 0.482 = 0.186534
(P4). Then the total effect given by X1 to Y is the direct effect plus the indirect effect: 0.131 + 0.186534 =
0.317534. Furthermore, to determine the indirect significance value of the independent variable (career
development) on the dependent variable (quality of nursing services) through the intervening variable (motivation),
a manual test using the Sobel test was carried out, with the following description.

Indirect Influence
PTL = P1 x P3
PTL = 0.387 x 0.482
PTL = 0.186534

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Proceedings of the 11th Annual International Conference on Industrial Engineering and Operations Management
Singapore, March 7-11, 2021

The effect of mediation, whether significant or not through the multiplication of the coefficient (P1xP3), can be
tested manually with the Sobel Test formula, with the standard error of the indirect effect coefficient as follows:
ST = �(𝑃𝑃3 )2 (𝑆𝑆𝑆𝑆1 )2 + (𝑃𝑃1 )2 (𝑆𝑆𝑆𝑆3 )2 + (𝑆𝑆𝑆𝑆1 )2 (𝑆𝑆𝑆𝑆3 )2
ST =�(0,482)2 (0,055)2 + ( 0,387)2 (0,113)2 + (0,055)2 (0,113)2
ST =�0,0007027801 + 0,001912400361 + 0,000038626225
ST =�0,002653806686
ST = 0,05151511123932

Based on the results of this Sobel Test calculation, then to calculate the t value of the effect of mediation, it can be
seen from the results of the distribution of the indirect impact and the following Sobel Test values:
PTL
thitung =
ST
0,186534
thitung = = 3,620
0,05151511123932

Because the value of t = 3.620 is more significant than the t table with a significance level of 0.05, which is 1.980, it
can be concluded that the mediation coefficient (with the amount of indirect effect) is significant, which means that
there is an indirect effect of X1 on Y through the mediation of X2.
Thus, the overall path analysis diagram is obtained as follows:

e1= 0,7829 e2 = 0,8378

(0,160)
P2=0,131
Career development Qualitye2of=nursing
0,8378
(X1) P4=0,186534 services (Y)
(t=3,620)
P1 =0,387 Motivation (X2) P3=0,482
(0,000) (0,000)

Figure 3. Path Analysis Diagram

The overall results of the above description are described in table 4. below.

Table 4. Direct and Indirect Effects between Variables

Score Total
No Relationship Sig.
Direct Influence Indirect Influence Influence
1 X1- X2 (P1) 0,387 - - 0,000
2 X1- Y (P2) 0,131 - - 0.160
3 X2-Y (P3) 0,482 - - 0,000
4 X1- X2-Y (P4) - 0,186534 0,317534 t=3,620

5. Discussion
Based on the results of the path coefficient test model, show career development as measured by indicators of the
work environment, experience, education and training, achievement/reward, and fate factors influence the
motivation of 0.387, a significance value of 0.000 (<0.05), meaning that career development affects. These results
indicate that the higher the career development factors, namely the work environment, experience, education and
training, achievement/rewards, and luck factors for nurses, the greater the nurses' motivation in the CHC inpatient in
Gorontalo Regency (Gani et al.; Sahabuddin et al.).

The path coefficient of model II shows that career development as measured by indicators of the work environment,
experience, education and training, achievement/reward, and luck factors influence the quality of nursing services of
0.131 with a significance value of 0.160 (<0.05). This means that career development has no significant positive
effect on quality. This result is different from some of the previous research results. There is a direct and

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Proceedings of the 11th Annual International Conference on Industrial Engineering and Operations Management
Singapore, March 7-11, 2021

consequential relationship between career development variables and the quality of nursing services (Awaluddin et
al.; Yusriadi, Farida, et al.; Yusriadi, Sahid, et al.; Nuraini et al.).

Meanwhile, motivation as measured by indicators of a need for achievement, need for affiliation, and need for
power has an influence on the quality of nursing services by 0.482 with a significance value of 0.000 (<0, 05), which
means that motivation has a significant positive effect on the quality of nursing services (Rijal et al.).
These results indicate that motivation's direct influence is more significant than career development on nursing
service quality. The higher the career development factors, namely the work environment, experience, education and
training, achievement/appreciation, and fate factors for nurses, directly have a less significant effect on improving
nursing services quality (Sahid et al.). At the same time, motivation is in the form of the need for achievement, the
need to establish relationships or be affiliated, and The need for power has a significant direct effect, so the higher
the motivation of the nurses, the higher the quality of nursing services in the CHC inpatient in Gorontalo Regency
(Mustafa et al.; Rahawarin et al.).

The test results also show that indirectly career development as measured by indicators of the work environment,
experience, education and training, achievement/appreciation, and luck factors influence the quality of nursing
services through the motivation of 0.186534 with a significance value (Sobel test) count = 3,620 (> t table = 1,980).
The total effect of 0.317534, which means that career development has a significant positive impact on the quality of
nursing services through motivation or hypothesis IV (H4), is accepted. These results indicate that indirectly career
development is measured by indicators of the work environment, experience, education and training,
achievement/reward, and luck factors influence the quality of nursing services through motivation (Umar, Hasbi, et
al.). This means that without a mediating factor in the form of inspiration, career development will not significantly
affect the quality of nursing services (Sahid et al.). Or it can be said that the better the career development of nurses,
the higher the motivation of nurses in performing nursing care performance so that it can improve the quality of
nursing services in Inpatient CHC in Gorontalo District. This is because motivational factors have a more dominant
influence than career development for enhancing the quality of nursing services (Tamsah et al.).

6. Conclusion
Based on this research, several things are of interest to researchers in improving nursing services quality. First,
directly the role of career development is very influential on motivation. Second, cause presently has a more
significant effect on the quality of nursing services. In contrast, career development's role directly has no significant
impact on improving the quality of nursing services. Third, indirectly career development has a substantial effect on
improving nursing services mediated by motivational factors. With motivation, career development will have a
better effect on improving the quality of nursing services.

7. Acknowledgement
Thank you to the Postgraduate Program of STIE Amkop Makassar for giving full support in the preparation of this
research to be carried out well. Thanks to all the nurses at the CHC inpatient in Gorontalo District who have been
willing to fill out this research questionnaire.

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Bibliography
Yuriska Kuka is a student at Magister Program of Economic Science of STIE AMKOP, Indonesia. Her areas of
interest and research include social science and economic. He has published some articles in national journals

Hasmin Tamsah is a lecturer at Economics Department of STIE AMKOP, Indonesia. His areas of interest and
research include economic, management, management human resource. He has published some books and many
articles in national and international journals. He is a reviewer and editor in some local and international journals.

Trimaya Cahya Mulat is a lecture at Economics Department of STIE AMKOP, Indonesia. Her areas of interest and
research include social science, economic and management. She has published some articles in national and
international journals.

Iksan Kadir is a lecture at Economics Department of STIE AMKOP, Indonesia. Her areas of interest and research
include social science, economic and management. She has published some articles in national and international
journals.

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Proceedings of the 11th Annual International Conference on Industrial Engineering and Operations Management
Singapore, March 7-11, 2021

Ryryn Suryaman Prana Putra is a lecturer at Hospital Administration Department of STIKES Pelamonia Kesdam
VII Wirabuana, Indonesia. His areas of interest and research include hospital administration, public health, and
education. He has published some articles in national journals.

Yusriadi Yusriadi is a lecturer at Public Administration Department of Sekolah Tinggi Ilmu Administrasi
Puangrimaggalatung, Indonesia and chancellor on Sekolah Tinggi Ilmu Hukum Pengayoman. His areas of interest
and research include social science, political science, sociology, legal studies, and public administration. He has
published some books and many articles in national and international journals. He is a reviewer and editor in some
local and international journals.

Dwi Yogo Budi Prabowo is a lecturer at tourism Department of Akademi Keperawatan Rumkit TK III Manado,
Indonesia. His areas of interest and research include nursing. He has published some articles in national journals.

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