Purpose This study aimed to evaluate the performance of a clinical ladder system in a tertiary hospital by examining how nurses' clinical competence and perceptions of the system affect organizational commitment. Methods The study involved 394 nurses working at a tertiary hospital. Data were collected from May 3 to July 10, 2023, using a self-reported questionnaire. Statistical analyses, including descriptive statistics, independent t-tests, one-way ANOVA, Kruskal-Wallis test, Scheffé post-hoc test, Pearson correlation, and hierarchical regression analysis, were performed using SPSS 27.0. Results Nurses who applied for promotion to the CN III level and current CN III nurses reported higher clinical competence, perceptions of the clinical ladder system, and organizational commitment than those who did not and those at lower levels (p<.001). A positive correlation existed among all independent variables.
Controlling for general characteristics, the effects of clinical competence and perceptions of the clinical ladder system explained 49% of organizational commitment variance (Adjusted R 2 =.49, F=33.43, p<.001). Conclusion Greater clinical competence and positive perceptions of the clinical ladder system are likely to enhance organizational commitment, emphasizing its effectiveness in fostering better organizational outcomes.
PURPOSE This was a correlational study to identify effects of perception of clinical ladder system on job satisfaction and intention to leave in perioperative nurses. METHODS Participants were 154 of perioperative nurses from larger general hospitals in Seoul. Data were collected from April, 16 to 22, 2013 using self-report questionnaires which included items on perception of clinical ladder system, job satisfaction, and intention to leave. Data were analyzed using frequency, t-test, ANOVA, Scheffe? test, Pearson correlation coefficients, and multiple stepwise regression. RESULTS The average mean score for perception of clinical ladder system was midline at 2.69 point out of 4 point. Perception of clinical ladder system correlated positively with job satisfaction (r=.38, p<.01) and negatively with intention to leave (r=-.88, p<.01). Perception of clinical ladder system was the factor which most influenced job satisfaction explaining 17.1% of the variance, also perception of clinical ladder system was the factor which most influenced intention to leave, explaining 12.7% of the variance. CONCLUSION Results of this study suggest that there is a need to enhance the perception of the clinical ladder system and to find ways to fulfill the expected effects for improving perioperative nurses' job satisfaction and reducing the intention to leave.
Citations
Citations to this article as recorded by
Clinical nurses’ experience of participating in a career ladder system: A qualitative study using focus group interviews Myoung-sook Kim, Ae-ju Noh, Young-sun Jung, Hye-jin Lee, Kyoung-eun Lee The Journal of Korean Academic Society of Nursing Education.2025; 31(1): 53. CrossRef
Effect of a Nursing Practice Environment, Nursing Performance on Retention Intention: Focused on the Mediating Effects of Nursing Professional Pride Shin Hee Kim, Mi Sook Oh, Yun Bok Kwak Journal of Korean Academy of Nursing Administration.2025; 31(1): 64. CrossRef
The Impact of Clinical Competence and Perception of Clinical Ladder System on Organizational Commitment among Nurses at a General Tertiary Hospital Yeon Hee Shin, Mi Ra Lee, Sung Nam Kim, Min Jung Kim, Ae Jin Kim, Hyun Ja Kim, Ji Yoon Kang Journal of Korean Academy of Nursing Administration.2025; 31(1): 120. CrossRef
Experience of Nurses Promoted to Clinical Nurse III through the Career Ladder System Bo Kyung Kim, Yeon Hee Kim, Jeong Hye Kim Journal of Korean Association for Qualitative Research.2024; 9(3): 227. CrossRef
Legal and Practical Solutions for the Expanding the Roles of Medical Support Staff Nurses Su Jung Choi, Min Young Kim Journal of Korean Academy of Nursing.2024; 54(3): 300. CrossRef
Nurses' perceptions of career ladder systems, job satisfaction and turnover intention: A cross‐sectional study Young Seon Ahn, Jeong Sil Choi Nursing Open.2023; 10(1): 195. CrossRef
Effect of the Nursing Work Environment on Turnover Intention: Serial Mediation Effects of Career Motivation and Job Satisfaction Young Deok Park, Sun Ju You Journal of Korean Academy of Nursing Administration.2023; 29(5): 529. CrossRef
Perception of Clinical Ladder System, Professional Self-Concept, Self-Efficacy, and Organizational Commitment by the Level of Clinical ladder among Intensive Care Unit Nurses Ji Hyun Lee, Su Jung Choi Journal of Korean Critical Care Nursing.2022; 15(3): 51. CrossRef
Effect of Verbal Violence on the Turnover Intention among Operating Room Nurses: Focusing on the Moderating Effects of Social Support and Coping Ae-Sook Kim, Eun Hee Jang Journal of Korean Academy of Nursing Administration.2021; 27(5): 433. CrossRef
THE RELATIONSHIP BETWEEN CAREER LADDER AND NURSES JOB SATISFACTION AT A HOSPITAL Ekawati Saputri, Syahrir A Pasinringi, Julianus Ake Jurnal Administrasi Kesehatan Indonesia.2021; 9(1): 55. CrossRef
Influences of Workplace Bullying and Job Satisfaction on Happiness among Perioperative Nurses Song I Park, Key Ha Kim Journal of Korean Academy of Nursing Administration.2021; 27(1): 54. CrossRef
A Hierarchical Model of Occupational Burnout in Nurses Associated With Job-Induced Stress, Self-Concept, and Work Environment Ru-Wen LIAO, Mei-Ling YEH, Kuan-Chia LIN, Kwua-Yun WANG Journal of Nursing Research.2020; 28(2): e79. CrossRef
The Impact of Nurse Scheduling Management on Nurses’ Job Satisfaction in Army Hospital: A Cross-Sectional Research Ichsan Rizany, Rr. Tutik Sri Hariyati, Efy Afifah, Rusdiyansyah Sage Open.2019;[Epub] CrossRef
Trends in Turnover Research on Korean Nurses: Based on 8 Journals Published by Member Societies under the Korean Academy of Nursing Science, 2006-2015 Hyo Geun Geun The Open Nursing Journal.2019; 13(1): 92. CrossRef
The impacts of career ladder system for nurses in hospital Bela Pertiwi, Rr. Tutik Sri Hariyati Enfermería Clínica.2019; 29: 106. CrossRef
Nurses’ understanding and perception of career ladder system are related to work motivation: A multicenter cross-sectional study in Aceh, Indonesia Mela Filani, Enie Novieastari, Tuti Nuraini Enfermería Clínica.2019; 29: 434. CrossRef
Factors Affecting on Turnover Intentions among Operating Room Nurses Yeo-Jin Kim, Keum-Sook Park, Eun-Ja Yang Journal of the Korea Academia-Industrial cooperation Society.2016; 17(12): 352. CrossRef
Effect of Career Development and Career Plateau on Career Satisfaction of Nurses Yo Na Kim Journal of Korean Public Health Nursing.2016; 30(1): 83. CrossRef
PURPOSE This methodological study was done to develop a Nursing Competency Measurement Scale based on the clinical ladders of nurses working in wards. METHODS Thirty clinical experts and 501 ward nurses evaluated the content validity of the scale. A survey using the Nursing Competency Measurement Scale was conducted with 114 nurses to evaluate reliability and applicability of the instrument. Data were analyzed using SPSS/WIN 21.0. RESULTS A review of the literature identified 13 components of nursing competencies and 30 core nursing competencies based on each of the 4 grade clinical ladders. Cronbach's alpha coefficient for the total was .92. Cronbach's alpha reliabilities of each clinical ladder grade were .83 for Grade I, .84 for Grade II, .81 for Grade III, and .84 for Grade IV. The Content Validity Index (CVI) of the scale with 120 individual items was 0.976~1.000 for Grade I scale, 0.986~1.000 for Grade II scale, 0.984~1.000 for Grade III scale, and 0.992~1.000 for Grade IV scale. The expert group nurses' average degree of nursing competence measured using the scale was 3.38~3.75 out of 4.0. CONCLUSION Through this process, 120 final questions were confirmed to represent items of the Nursing Competency Measurement Scale based on clinical grade.
Citations
Citations to this article as recorded by
Characteristics of National Competency Standards of Hospital Nursing Departments: An Analytic Hierarchy Process and Multidimensional Scale Analysis Seon‐Nyeo Kim, Sue‐Kyung Sohn Nursing Open.2025;[Epub] CrossRef
The Relationship between Self-Perceived Infection Control Competency Stage and Infection Control Competency in Tertiary General Hospital Nurses Ji Hae Lee, Kyung Mi Kim Journal of Korean Academy of Fundamentals of Nursing.2025; 32(1): 59. CrossRef
User Interface Design and Usability Evaluation of a Mental Health Mobile Application for Healthcare Workers: A Nursing Informatics Perspective Yewon Lee, Eunju Kwak, Mijin Park, Jiyeon Park, Jungjae Kim, Jisan Lee Journal of Health Informatics and Statistics.2024; 49(3): 248. CrossRef
A study on the types of disaster awareness in nursing students: Q methodology Mihyeon Seong, Dajung Ryu, Sohyune Sok BMC Nursing.2023;[Epub] CrossRef
Development of Competencies for New Nurses and Verification of Content Validity through a Delphi Survey Hanna Jung, Yoonjung Lee, Jung Yeon Kim, Minjin Lee, Soo Young Han, Yumie Rhee, Shinki An, Phill Ja Kim Korean Medical Education Review.2023; 25(2): 159. CrossRef
Development and Validation of the Job Competency Scale for Insurance Review Nurses Working in Hospital Song Hwa Nam, Eun A Kim Journal of Korean Academy of Nursing Administration.2023; 29(5): 588. CrossRef
Priority Need Analysis for Career Level-Based Nursing Management Competency Development of Advanced General Hospital Nurses Bo Hyun Yu, Keum Seong Jang Journal of Korean Academy of Nursing Administration.2022; 28(4): 417. CrossRef
Structural Equation Modeling of Person-Centered Nursing in Hospital Nurses Yeon Hee Bae, Hye-Ah Yeom Healthcare.2022; 10(3): 514. CrossRef
Development of a high-risk neonatal infection control competency scale Mi Yu, Hyunju Kang, Jisun Park, Miran Yang Journal of Child Health Care.2021; 25(3): 393. CrossRef
Nursing Students’ Informal Learning of Patient Safety Management Activities Nam-Yi Kim Healthcare.2021; 9(12): 1635. CrossRef
Validity and Reliability of Rehabilitation Nursing Competency Measurement Tools by Clinical Career Stage Chang Hee Kim, Jung Yee Kim The Korean Journal of Rehabilitation Nursing.2020; 23(1): 90. CrossRef
Novice and Advanced Beginner Nurses' Patient Safety Management Activities: Mediating Effects of Informal Learning Nam Yi Kim Journal of Korean Academy of Nursing Administration.2020; 26(5): 542. CrossRef
Importance and Performance Analysis of Competency for Advanced Beginner-stage Nurses of Ward Inhee Hwang, Soyoung Yu Journal of Health Informatics and Statistics.2019; 44(3): 292. CrossRef
Factors Influencing Differences in Turnover Intention according to Work Periods for Newly Graduated Nurses Moon Sook Yoo, Mang Rae Jeong, Kyoungja Kim, Youngjin Lee Journal of Korean Academy of Nursing Administration.2019; 25(5): 489. CrossRef
Core nursing competency assessment tool for graduates of outcome‐based nursing education in South Korea: A validation study YuKyung Ko, Soyoung Yu Japan Journal of Nursing Science.2019; 16(2): 155. CrossRef
Development of Teaching Efficacy Scale to Evaluate Clinical Nursing Instructors Inhee Park, Yeon Ok Suh Korean Journal of Adult Nursing.2018; 30(1): 18. CrossRef
Influences of Interpersonal Problems and Character of Nurses on Quality of Nursing Service Eun-Yi Yeom, Kawoun Seo Journal of Korean Academy of Nursing Administration.2018; 24(5): 445. CrossRef
Developing of a Tool for Ambulatory Care Nurse Competencies Myoungjin Min, Soyoung Yu Journal of Korean Academy of Nursing Administration.2017; 23(1): 90. CrossRef
Rehabilitation Nursing Competencies of Korean Nurses by Type of Health Institute Chang Hee Kim, Eun Sun Lim, Kyung Hee Mun, Min Jeong Park The Korean Journal of Rehabilitation Nursing.2017; 20(2): 89. CrossRef
Development and validation of a nursing professionalism evaluation model in a career ladder system Yeon Hee Kim, Young Sun Jung, Ja Min, Eun Young Song, Jung Hui Ok, Changwon Lim, Kyunghee Kim, Ji-Su Kim, Etsuro Ito PLOS ONE.2017; 12(10): e0186310. CrossRef
Development and Validation of Nurse's Character Scale for Care in Clinical Settings Jeong Hye Park The Journal of Korean Academic Society of Nursing Education.2016; 22(2): 137. CrossRef
A Convergence Study about System of Public Health Nurse Young-Shin Lee Journal of Digital Convergence.2016; 14(3): 13. CrossRef
Recognition for Nursing Competency Importance, Nursing Competency Level, and Their Influencing Factors of Nurses in the Long-term Care Hospitals Eun-Jae Kim, Mee-Ock Gu Journal of the Korea Academia-Industrial cooperation Society.2015; 16(3): 1989. CrossRef
Experiences of Clinical Nurses Aged over 40 as Shift Workers Seonim Choi, Jinhyun Kim Journal of Korean Academy of Nursing Administration.2014; 20(5): 514. CrossRef
PURPOSE This study was done to develop a nursing competency scale according to a clinical ladder system for intensive care nurses. METHODS Index of content validation was done by 20 clinical experts and 80 nurses in Intensive Care Units (ICU). RESULTS The process and results of study are as follows. First, 12 nursing competencies were used in the establishment of the clinical ladder system (Jang, 2000). Second, the first draft of the competency lists was developed. It was based on the clinical nurses' behavioral indicators of nursing competency by Jang (2000), and was modified and supplemented through various literature reviews including competency standards for specialist intensive care nurses in Australia and consultation with 2 clinical nurses with over 10 years experience in the ICU. Third, the draft was examined by 20 clinical experts for content validity. Finally, the final draft was analysed using clinical validity where 20 nurses in each ladder participated. The final number of items was fixed at 309. CONCLUSION The tool represents expected nursing competency of nurses working in ICU. Intensive care nurses can recognize their strengths and weaknesses, and identify directions for their professional growth by analysing results of their competency evaluation using this tool.
Citations
Citations to this article as recorded by
Nursing core competencies for postresuscitation care in Iran: a qualitative study Mahnaz Zali, Azad Rahmani, Kelly Powers, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani BMJ Open.2024; 14(1): e074614. CrossRef
Development and Validation of the Job Competency Scale for Insurance Review Nurses Working in Hospital Song Hwa Nam, Eun A Kim Journal of Korean Academy of Nursing Administration.2023; 29(5): 588. CrossRef
Development of Competencies for New Nurses and Verification of Content Validity through a Delphi Survey Hanna Jung, Yoonjung Lee, Jung Yeon Kim, Minjin Lee, Soo Young Han, Yumie Rhee, Shinki An, Phill Ja Kim Korean Medical Education Review.2023; 25(2): 159. CrossRef
Effects of Emotional Intelligence on Job Satisfaction of Pediatric Nurses: The Mediating Effect of Communication Skills and Pediatric Nurse-Parent Partnership Da Gyeon Lee, Mi-Young Choi Journal of Korean Academy of Nursing.2023; 53(5): 514. CrossRef
Effect of total quality management intervention on nurse commitment and nurse performance: A quasi-experimental study Majdi M. Alzoubi, Hayati KS, Rosliza AM, Khaled M. Al-Zoubi, Khalid AL-Mugheed, Samira A. Alsenany, Islam Oweidat, Sally M.F. Abdelaliem Medicine.2023; 102(40): e35390. CrossRef
The development of nurses’ core competencies and the analysis of validity and importance-performance GyeongAe Seomun, Kyung-Sook Bang, Hee Sook Kim, Cheong Sook Yoo, Woon Kyung Kim, Jin Kyung Park The Journal of Korean Academic Society of Nursing Education.2021; 27(1): 16. CrossRef
The Relationships Between Oncology Nurses’ Attitudes Toward a Dignified Death, Compassion Competence, Resilience, and Occupational Stress in South Korea Sun-A Park, Hee Jung Park Seminars in Oncology Nursing.2021; 37(3): 151147. CrossRef
Comparison of Nursing Performance Competencies and Practical Education Needs Based on Clinical Careers of Operating Room Nurses: A Cross-Sectional Study Ji Hye Jung, Hye Jin Kim, Ji-Su Kim Healthcare.2020; 8(2): 136. CrossRef
Validity and Reliability of Rehabilitation Nursing Competency Measurement Tools by Clinical Career Stage Chang Hee Kim, Jung Yee Kim The Korean Journal of Rehabilitation Nursing.2020; 23(1): 90. CrossRef
Core nursing competency assessment tool for graduates of outcome‐based nursing education in South Korea: A validation study YuKyung Ko, Soyoung Yu Japan Journal of Nursing Science.2019; 16(2): 155. CrossRef
Difficulties in End-of-Life Care and Educational Needs of Intensive Care Unit Nurses: A Mixed Methods Study Hyun Sook Kim, Eun Kyoung Choi, Tae Hee Kim, Hye Young Yun, Eun Ji Kim, Jin Ju Hong, Jeong A Hong, Geon Ah Kim, R.N. Sung Ha Kim The Korean Journal of Hospice and Palliative Care.2019; 22(2): 87. CrossRef
Development and validation of a nursing professionalism evaluation model in a career ladder system Yeon Hee Kim, Young Sun Jung, Ja Min, Eun Young Song, Jung Hui Ok, Changwon Lim, Kyunghee Kim, Ji-Su Kim, Etsuro Ito PLOS ONE.2017; 12(10): e0186310. CrossRef
Recognition for Nursing Competency Importance, Nursing Competency Level, and Their Influencing Factors of Nurses in the Long-term Care Hospitals Eun-Jae Kim, Mee-Ock Gu Journal of the Korea Academia-Industrial cooperation Society.2015; 16(3): 1989. CrossRef
The Impact of Clinical Competence and Perception of Clinical Ladder System on Organizational Commitment among Nurses at a General Tertiary Hospital Yeon Hee Shin, Mi Ra Lee, Sung Nam Kim, Min Jung Kim, Ae Jin Kim, Hyun Ja Kim, Ji Yoon Kang Journal of Korean Academy of Nursing Administration.2025; 31(1): 120. CrossRef
The Professional Self-Concept and Problem-Solving Ability in Different Career Stages Among Jordanian Registered Nurses Tahani R. Al Manaseer, Nidal F. Eshah, Ahmad Rayan, Anas H. Khalifeh Hospital Topics.2025; : 1. CrossRef
Development and Evaluation of Evidence-Based Nursing Protocol for Extracorporeal Membrane Oxygenation to Critically Ill Patients Soomi Kim, Chul-Gyu Kim Journal of Korean Academy of Nursing.2023; 53(3): 275. CrossRef
Factors Related to Professional Self-Concept of Nursing Students and Nurses: A Systematic Review I. Gede Juanamasta, Yupin Aungsuroch, Sunida Preechawong, Joko Gunawan Iranian Journal of Nursing and Midwifery Research.2023; 28(6): 642. CrossRef
The Effects of Pain, Agitation, Delirium, Immobility, and Sleep Disruption Education on Novice Nurses in Adult Intensive Care Units Szu-Ying Lee, Chieh-Yu Liu, Te-Yu Wu Healthcare.2022; 10(8): 1538. CrossRef
Perception of Clinical Ladder System, Professional Self-Concept, Self-Efficacy, and Organizational Commitment by the Level of Clinical ladder among Intensive Care Unit Nurses Ji Hyun Lee, Su Jung Choi Journal of Korean Critical Care Nursing.2022; 15(3): 51. CrossRef
Individual nurse empowerment: A concept analysis Kyla F. Woodward Nursing Forum.2020; 55(2): 136. CrossRef
Effect of Career Development and Career Plateau on Career Satisfaction of Nurses Yo Na Kim Journal of Korean Public Health Nursing.2016; 30(1): 83. CrossRef
Effect of Perception of Career Ladder System on Job Satisfaction, Intention to Leave among Perioperative Nurses Se Na Chae, Il Sun Ko, In Sook Kim, Kye Sook Yoon Journal of Korean Academy of Nursing Administration.2015; 21(3): 233. CrossRef
Treading the clinical pathway: a qualitative study of advanced practice nurses in a local health district in Australia Lauretta Luck, Lesley Wilkes, Jennifer O’Baugh BMC Nursing.2015;[Epub] CrossRef
Influence of Job Stress and Professional Self-concept on Job Satisfaction among Nurses in Rehabilitation Units Jung Ok Ko, Eun Ko The Korean Journal of Rehabilitation Nursing.2014; 17(2): 81. CrossRef
First
Prev
