Nurse Credentialing, Work Motivation, and Performance: A Cross-Sectional Mediation Study
DOI:
https://doi.org/10.55018/janh.v8i1.524Keywords:
Nurse Credentialing, Work Motivation, Nursing Performance, Professional Competence, HospitalsAbstract
Background: Nurse credentialing is intended to ensure professional competence, improve performance, and enhance work motivation. However, despite its widespread implementation, evidence regarding its actual impact on nurses’ motivation and performance remains inconsistent and inconclusive. This inconsistency reflects an unresolved gap in understanding whether credentialing directly influences nurse performance or operates indirectly through work motivation. This study aimed to examine the relationship between credentialing, work motivation, and nurse performance, with work motivation tested as a mediating variable.
Methods: This quantitative cross-sectional study followed the STROBE reporting guideline. The population comprised all inpatient nurses at Dr. Sam Ratulangi Tondano Regional General Hospital (N = 176). Using purposive sampling, 122 nurses were selected based on inclusion criteria of at least one year of work experience and direct involvement in nursing care; nurses on leave were excluded. Credentialing level (PK0–PK3) was the independent variable, nurse performance the dependent variable, and work motivation the mediating variable. Motivation and performance were measured using validated Likert-scale questionnaires, while credentialing data were obtained from institutional records. Structural Equation Modeling–Partial Least Squares (SEM-PLS) was used to test direct and mediating effects.
Results: Credentialing showed a negligible and non-significant effect on nurse performance (β = 0.002; p = 0.979) and work motivation (β = 0.027; p = 0.683). Conversely, nurse performance had a strong and significant effect on work motivation (β = 0.768; p < 0.001). Work motivation did not mediate the credentialing–performance relationship.
Conclusion: Credentialing alone does not significantly influence nurse performance or motivation. Integrating credentialing with performance management and continuous professional development systems is essential to enhance its effectiveness
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References
Agnesia, Y., Sari, S. W., Nu’man, H., Ramadhani, D. W., & Nopianto. (2023). Buku Ajar Metode Penelitian Kesehatan. Penerbit NEM.
Capili, B. (2021). Cross-Sectional Studies. AJN, American Journal of Nursing, 121(10), 59–62. https://doi.org/10.1097/01.NAJ.0000794280.73744.fe
Dresser, S. C., & Elgin, K. W. (2023). Hospital-Based Credentialing and Privileging. Clinical Nurse Specialist, 37(3), 133–138. https://doi.org/10.1097/NUR.0000000000000742
Elisabhet, T., Awaludin, R., Purwanto, I., & Sudrajat, A. (2025). Analysis of the Level of Work Motivation Related to Nurse Performance”. Indonesian Journal of Global Health Research, 7(2), 985–992. https://doi.org/10.37287/ijghr.v7i2.5886
Geerts, J. M. (2024). Maximizing the Impact and ROI of Leadership Development: A Theory- and Evidence-Informed Framework. Behavioral Sciences, 14(10), 955. https://doi.org/10.3390/bs14100955
George, J., Jack, S., Gauld, R., Colbourn, T., & Stokes, T. (2023). Impact of Health System Governance on Income and Healthcare Quality in Low- ¬ Income Countries : A Scoping Review. BMJ Global Health, 13, 1–16. https://doi.org/10.1136/bmjopen-2023-073669
Gershuni, O., Orr, J. M., Vogel, A., Park, K., Leider, J. P., Resnick, B. A., & Czabanowska, K. (2023). A Systematic Review on Professional Regulation and Credentialing of Public Health Workforce. International Journal of Environmental Research and Public Health, 20(5), 4101. https://doi.org/10.3390/ijerph20054101
Hardani, Andriani, H., Utami, E. F., Fardani, R. A., Sukmana, D. J., Auliya, N. H., Ustiawaty, J., & Istiqomah, R. R. (2020). Buku Metode Penelitian Kualitatif dan Kuantitatif (H. Abadi (ed.); Cetakan 1, Issue Maret). CV. Pustaka Ilmu Group Yogyakarta.
Hariaty, S., Dahlia Purba, & Yuni Ramadhani. (2022). Relationship Between Nurse Credentials and Nurse Performance at Mitra Sejati Hospital 2022. Science Midwifery, 10(5), 3841–3845. https://doi.org/10.35335/midwifery.v10i5.947
Huang, H., Huang, X., Zhang, Z., Chen, H., Wei, W., & Lu, W. (2025). Implementing System Dynamics in Hospital Services to Improve Operational Efficiency: An Empirical Research Study. Health Research Policy and Systems, 23(1), 1–15. https://doi.org/10.1186/s12961-025-01394-w
Lee, C.-Y., Yau, S.-Y., Chen, M.-M., & Lai, H.-Y. (2025). Redefining Medical Professionalism in Taiwan: A Qualitative Study of Societal Expectations and Educational Implications. Perspectives on Medical Education, 14(1), 685–698. https://doi.org/10.5334/pme.1828
Li, H., Yuan, B., Yu, Y., Li, J., & Meng, Q. (2022). Work Motivation of Primary Health Workers in China: The Translation of a Measurement Scale and Its Correlation with Turnover Intention. Risk Management and Healthcare Policy, 15, 1369–1381. https://doi.org/10.2147/RMHP.S366389
Liberty, I. A. (2024). Metode Penelitian Kesehatan. Penerbit NEM.
Lubis, M. F. (2022). The Influence of Intrinsic And Extrinsic Motivation on The Performance Nurses in The Impatient Room of Dr. Djoelham Binjai Hospital. Science Midwifery, 10(3), 2406–2413. https://doi.org/10.35335/midwifery.v10i3.667
Lumban Tobing, M. D. S., Tarigan, E., & Kusumaningsih, I. (2024). Application of Nurses’ Clinical Authority at Hospital X Jakarta. Ascarya: Journal of Islamic Science, Culture, and Social Studies, 4(1), 33–42. https://doi.org/10.53754/iscs.v4i1.653
Neti Ariftaningsih, & Susilo, E. (2025). Hubungan Motivasi Kerja dengan Kinerja Perawat di Rumah Sakit Paru Dr. Ario Wirawan Salatiga. Journal of Holistics and Health Sciences, 7(1), 164–172. https://doi.org/10.35473/jhhs.v7i1.583
Patel, R., & Sharma, S. (2022). Credentialing. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519504/
Patrician, P. A., Campbell, C. M., Javed, M., Williams, K. M., Foots, L., Hamilton, W. M., House, S., & Swiger, P. A. (2024). Quality and Safety in Nursing: Recommendations From a Systematic Review. Journal for Healthcare Quality, 46(4), 203–219. https://doi.org/10.1097/JHQ.0000000000000430
Pérez-Guerrero, E. E., Guillén-Medina, M. R., Márquez-Sandoval, F., Vera-Cruz, J. M., Gallegos-Arreola, M. P., Rico-Méndez, M. A., Aguilar-Velázquez, J. A., & Gutiérrez-Hurtado, I. A. (2024). Methodological and Statistical Considerations for Cross-Sectional, Case–Control, and Cohort Studies. Journal of Clinical Medicine, 13(14), 4005. https://doi.org/10.3390/jcm13144005
Puspa Zuleika, & Legiran. (2022). Cross-Sectional Study as Research Design in Medicine. Archives of The Medicine and Case Reports, 3(2), 256–259. https://doi.org/10.37275/amcr.v3i2.193
Saleh, M. O., Eshah, N. F., & Rayan, A. H. (2022). Empowerment Predicting Nurses’ Work Motivation and Occupational Mental Health. SAGE Open Nursing, 8, 1–12. https://doi.org/10.1177/23779608221076811
Sebire, N. J., Adams, A., Arpiainen, L., Celi, L., Charlesworth, A., Gorgens, M., Gorsky, M., Magrabi, F., Nagasawa, Y., Onoka, C., & McKee, M. (2025). The Future Hospital in Global Health Systems: The Future Hospital as an Entity. The International Journal of Health Planning and Management, 40(3), 730–740. https://doi.org/10.1002/hpm.3893
Starbuck, C. (2023). Descriptive Statistics. In The Fundamentals of People Analytics (pp. 97–120). Springer International Publishing. https://doi.org/10.1007/978-3-031-28674-2_7
Susanti, N. P. A., Susanti, N. D., Wahyuningsih, L. G. N. S., & Agustini, K. T. (2024). Optimizing The Implementation of Nursing Credentials: A Literature Review. Babali Nursing Research, 5(3), 576–590. https://doi.org/10.37363/bnr.2024.53375
Tumanggor, L. S., Siallagan, A. M., & Rostari Saragih. (2025). The Relationship Between Motivation and Nurse Performance at Santa Elisabeth Hospital Medan 2024. Jurnal Midwifery, 7(1), 41–49. https://doi.org/10.24252/jmw.v7i1.54943
Vandenbroucke, J. P., Elm, E. Von, Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & Initiative, S. (2014). Strengthening The Reporting of Observational Studies in Epidemiology ( STROBE ): Explanation and Elaboration. International Journal of Surgery, 12(12), 1500–1524. https://doi.org/10.1016/j.ijsu.2014.07.014
Wahyuningsih, L. G. N. S., Susanti, N. D., & Mahardika, I. M. R. (2024). Analysis of Nurse Performance in Improving the Quality of Hospital Services. Babali Nursing Research, 5(1), 188–195. https://doi.org/https://doi.org/10.37363/bnr.2024.51341
Wang, X., & Cheng, Z. (2020). Cross-Sectional Studies. Chest, 158(1), S65–S71. https://doi.org/10.1016/j.chest.2020.03.012
World Health Organization. (2025). Global Strategy on Digital Health. WHO. https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf
Zoromba, M. A., & El-Gazar, H. E. (2021). Nursing Human Resource Practices and Hospitals’ Performance Excellence: The Mediating Role of Nurses’ Performance. Acta Bio-Medica : Atenei Parmensis, 92(S2), e2021022. https://doi.org/10.23750/abm.v92iS2.11247
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