International Journal of Human Capital Management, Vol. 2 (2), December 2018 International Journal of Human Capital Management, Vol. 6 (1), June 2022 38 | P a g e International Journal of Human Capital Available online at Management http://journal.unj.ac.id/unj/index.php/ijhcm E-ISSN 2580-9164 Vol. 6, No. 1, June 2022, p 38 - 53 THE EFFECT OF ORGANIZATIONAL CULTURE, CAREER DEVELOPMENT, REMUNERATION, AND JOB SATISFACTION ON NURSE PERFORMANCE IN REGIONAL GENERAL HOSPITAL IN BATAM EMBUNG FATIMAH CITY Nelli Roza Human Resource Management Postgraduate Program, State University of Jakarta Email: nelliroza101201@gmail.com Yetty Supriyati Postgraduate Program, State University of Jakarta Email: yetti.supriyati@unj.ac.id Kadir Kadir UIN Syarif Hidayatullah Jakarta Email: kadir@uinjkt.ac.id ABSTRACT The purpose of this study is to develop a model which states that nurse performance is mediated by job satisfaction which is supported by organizational culture, career development and remuneration which also pays attention to the relationship between career development variables and remuneration. This research was conducted at the Embung Fatimah Regional General Hospital, Batam City using a survey method and involving 200 clinical nurses as respondents. Data were collected using a Likert scale and analyzed by using Structural Equation Modelling (SEM) in inferential statistics. The results of the research show that for the model reveal that organizational culture, career development, remuneration and job satisfaction have a direct positive effect on nurse performance. In addition, there was also a positive direct effect of career development and remuneration on job satisfaction, and the dominant direct effect of career development on remuneration (t-value = 12.01 > 1.96), but there was no direct positive effect of organizational culture on job satisfaction (t-value = 1.47 < .96). Therefore, to improve the performance of nurses at the Embung Fatimah Regional General Hospital, Batam more effectively through improving remuneration management, and implementing career development in accordance with applicable regulations compared to organizational culture. Keywords: Organizational Culture, Career Development, Remuneration, Job Satisfaction, Nurse Performance.. Received: 16 February 2022 Accepted: 5 April 2022 Publish: June 2022 http://journal.unj.ac.id/unj/index.php/ mailto:nelliroza101201@gmail.com mailto:yetti.supriyati@unj.ac.id mailto:kadir@uinjkt.ac.id International Journal of Human Capital Management, Vol. 6 (1), June 2022 39 | P a g e How to Cite: Roza, N., et.al. (2022). The Effect of Organizational Culture, Career Development, Remuneration, and Job Satisfaction on Nurse Performance in Regional General Hospital in Batam Embung Fatimah City. International Journal of Human Capital Management, 6 (1), 38 – 53. https://doi.org/10.21009/IJHCM.06.01.4 INTRODUCTION As an institution that produces health care technology products, hospitals are very dependent on the quality of medical and nursing services provided to patients. Seeing this phenomenon, nursing services make a significant contribution to the image of the hospital. The reality in the field is that the performance of nurses is still low. Based on previous research conducted by Jha et al. (2013), provided preliminary evidence that adverse events due to medical care are a major source of morbidity and mortality globally. Research by Kim & Bates (2013) shows that the level of nurse adherence to drug administration guidelines is still low. Likewise, this incident also occurred in Batam City Hospital such as Embung Fatimah Hospital, where according to the 2018 hospital quality PMKP report, there were 148 cases of medication errors and the Batam City RSBP quality PMKP report there were also 5 patients who fell in the service. nursing (Komite Keselamatan Pasien Rumah Sakit, 2011). This low performance can be seen from the assessment. To overcome this problem, it is necessary to measure the performance of nurses through self-assessment, peer assessment, and special assessment. By measuring the performance of nurses can improve the performance of nurses throughout the year, and the results of the evaluation can be used to determine appropriate actions to improve performance (Wibowo, 2016); Sinambela, 2021). The measuring tool used to obtain the expected results from the organization in this case the hospital is to apply a 360-degree assessment process. This process is carried out by evaluating himself and combining all feedback information, both superiors and co-workers (Moeheriono, 2014). According to literature reviews, the factors that effect performance are organizational factors consisting of leadership, compensation, conflict, power, organizational structure, job design, organizational design, and career (Wibowo, 2015). Wirawan (2015) discovered that one of the external factors that effects the performance of human resources is organizational culture. Organizational culture, such as rituals and values, has a significant impact on employee performance. As in the study of Besral, Panjaitan, & Keliat (2014), practice nurses who have good ideas about their organization have been shown to perform better. Nurses' implementation characteristics and their perception of organizational culture are related to performance. Fiori, Bollmann, & Rossier (2015) found that individuals who are more adaptable to work have lower stress levels and higher job satisfaction. To achieve their career, all nurses must complete a Continuing Professional Development (CPD) program. Hariyati, Igarashi, Fujinami, Susilaningsih, & Prayenti (2017), research shows that there is a positive correlation between CPD and nurse satisfaction, where a better perception of CPD will increase nurse satisfaction. Therefore, there are opportunities for improvement in the application of the nursing career system in hospitals in Indonesian. Berliana, Siregar, & Gustian (2018) stated that remuneration compensation has an effect on job satisfaction. Meanwhile, Yani, Hamid, Tutik, & Hariyati (2018) show that improving the remuneration system has positive consequences in terms of nurse performance and subsequent health service quality. As the result of research from Muthmainnah, Hamid, & Hariyati (2018) that an increase in the remuneration system has positive consequences on the performance of nurses and the quality of health services. Similarly, many interesting factors contribute to the formation of nurse satisfaction. A study by Al‐Ahmadi (2009); Lu, Barriball, Zhang, & While (2012) found that job satisfaction is of great concern to healthcare professionals around the world. This study found a strong link between work satisfaction and nursing performance. As such, many International Journal of Human Capital Management, Vol. 6 (1), June 2022 40 | P a g e performance studies have been conducted, but to develop a model that suggests that career development, remuneration, and job satisfaction affect nurse performance. Research on achievements is still interesting. In addition, the relationship between remuneration variables and job satisfaction needs to be considered. Therefore, it is necessary to do research on how the performance of nurses in Embung Fatimah Hospital, Batam City, in terms of organizat ional culture, career development, remuneration, and job satisfaction. This study aims to analyze the nurse's performance model based on career development mediated by remuneration and job satisfaction. LITERATURE REVIEW Nurse Performance Performance is a description of the level of achievement of program or policy implementation in realizing the goals, objectives, vision, and mission of the organization as outlined through the strategic planning of an organization (Moeheriono, 2014). Armstrong (2014), explains performance is the act of performing or doing something successfully, using knowledge or skills as opposed to just possessing it. Then Colquitt, Lepine, & Wesson (2015), a good employee in this case is a clinical nurse, meaning an employee who is good at certain job tasks included in his job description, whether the task is routine, requires adaptability, or creativity. Still according to Colquitt, Lepine, & Wesson (2015) explains that the best performance (good performance) can be seen in three categories consisting of 1) Task Performance, 2) Citizenship Behavior (OCB) and 3) Counter Productive Behavior. Sonnentag & Frese (2005) stated “performance is highly important for an organization as a whole and for the individuals working in it. Performance is very important for an organization as a whole and for the individuals who work in it.Then Greenslade & Jimmieson (2011) introduced that service climate is associated with nurse-directed efforts towards special care and extra-role behaviors. In turn, the effort nurses make to predict their performance, as rated by their supervisor. Finally, task performance was a significant predictor of patient satisfaction. This study shows that hospital management and nurses play a role in increasing patient satisfaction. By focusing on creating a climate for service, health care managers can improve nursing performance and patient satisfaction with care. Nursing performance has been defined as a set of nursing activities or behaviors performed by nurses and directed towards the recovery and well-being of the patients assigned to them to care for the needs and expectations of the patients. Nurse performance was developed based on task performance and contextual performance (Sagherian et al., 2018). The latest development of performance appraisal technique is called 360-degree appraisal. This technique will provide better and more reliable data because it is cross-assessed by oneself, partners, and superiors (Ilyas, 2012). 360-degree feedback assessment is a way to make the performance appraisal process more objective and provide a complete picture of employee competencies and performance levels (Moeheriono, 2014). By the several definitions that have been put forward by the experts above, the researchers synthesized that the performance of clinical nurses is a description of the value of the level of achievement of a series of activities in carrying out nursing care services according to the level and details of clinical services. given authority, compared to the performance targets that have been set. Organizational Culture Each form of organizational culture must be adjusted in advance and managed strategically so that it can be adhered to and supports the creation of an organizational identity. Colquitt, Lepine, & Wesson (2015) stated that organizational culture as shared social knowledge within an organization regarding the rules, norms, and values that shape the attitudes and behavior of its employees. When employees feel that their values and personality match those of the organization, they experience higher levels of job satisfaction. According to Ližbetinová et al., (2016), all organizations should have their own organizational culture, by which they behave and act in public. Robbins & Judge (2017), suggests International Journal of Human Capital Management, Vol. 6 (1), June 2022 41 | P a g e organizational culture is a system of sharing meaning carried out by members that distinguishes an organization from other organizations. How employees perceive the characteristics of organizational culture. Finally, culture acts as a behavioral mechanism that guides, shapes employee attitudes and behavior. Organizational culture represents the perception of the members of the same organization to get a complete picture of the culture of an organization can be done by assessing an organization based on the characteristics of the organizational culture. The study of Hsi Chi et al., (2016) stated that the hospital organizational culture is centered around the idea that, “health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. Denison, Nieminen, & Kotrba, (2014) stated that the last instrument reviewed in the update was the Denison Organizational Culture Survey (DOCS). This instrument has been used in more than 30 published dissertations. The development of DOCS coincided with the development of theories linking four main cultural traits to organizational effectiveness, namely 1) Involvement; 2) Consistency; 3) adaptability; and 4) Mission From several definitions that have been put forward by the experts above, the researcher synthesizes that a organizational culture is a pattern of shared basic values, beliefs and assumptions created by a particular group that can be learned, applied and continuously developed by the organization to motivate and shape the behavior of its members. Career development Career development can be synthesized as an effort made by the organization towards the career planning of its employees, which can be seen as a series of processes that will be passed by an employee with a series of stages, each of which is characterized by several development tasks, formation., succeed, and fulfil one's career (Kaswan, 2014). Career development is accomplished through self-assessment, work environment, job analysis, education, training, job search and acquisition, and self-employment experience. Furthermore, nurse career development in Indonesia is regulated in the Regulation of the Minister of Health of the Republic of Indonesia number 40 of 2017 concerning the Development of Professional Career Paths for Clinical Nurses. Career development is one of the processes to improve one's abilities, both individually and in organizations that have the goal of reaching the peak of the desired career (Mulyadi, 2015). Then, career development can be done personally, supported by the staffing department and supported by managers (Gaol, 2014). Thus, career development is a planning and implementation of a career plan that can be seen as a life process that involves individual employees. Mc Peck states a career plan about exploration, opportunity and change (Marquis, B.L, & Huston, 2010). Every employee really expects career development to motivate them to work better. Sinambela (2021) states that there are four levels of career needs for an employee to be taken in four age categories, through four stages of career development, namely: 1) the initial phase, which is oriented to two indicators, namely the position as a permanent employee or contract, 2) the first phase continuation oriented to the promotion indicator, 3) the retaining phase which is oriented to survival situations, 4) the retirement phase which is oriented to the strategic thinking indicator because everyone ends their job. Furthermore, to measure the career development of nurses developed an instrument. A modified scale called the Nurse Career Growth Scale (CGNS) is acceptable, valid and reliable for evaluating the career growth of nurses in Chinese hospitals (J. Liu et al., 2015). This scale measures three main factors (career goals, career capacity, and career opportunities) and shows that nurses' career growth differs in age, work seniority, and professional title. Career management also seeks to put the right people in the right positions. The implementation of a professional nurse career path is an effort to develop the nursing profession and organize services in a better direction (Suhartati, 2010). Therefore, changes in heterogeneous career patterns result from changes in the nature of work, organizational structure, sociological contracts, workforce demographics, as well as broader economic factors (Baruch & Rousseau, 2019; Biemann et al., 2012). International Journal of Human Capital Management, Vol. 6 (1), June 2022 42 | P a g e From several definitions that have been put forward by the experts above, the researchers synthesize that nurse career development is a series of jobs assigned to nurses through professional career paths with a method designed to reward individual nurses for clinical expertise to improve performance and professionalism in their respective fields. Remuneration In general, A. Noe, R.Hollenbeck, Gerhart & M.Wright (2014) compensation is defined as the provision of remuneration to employees, either directly in the form of financial money or indirectly non-financially. Ivancevich (2007) distinguishes compensation into direct monetary compensation, including wages, salaries, benefits, incentives, health and employment insurance, compensation, pension contributions, and tuition assistance. It is also mentioned that there are non- financial rewards or non-financial rewards such as: praise, a sense of self-worth that can affect satisfaction (Wibowo, 2016). Pora (2011) states that remuneration is a form of remuneration or compensation received by employees/workers from employers for achievements given by workers in order to realize company goals. As is known, several companies have reported the development of the concept of competency-based pay system and performance-based. Fujisawa & Lafortune (2008) stated “The remuneration of GPs and specialists is defined as gross (pre-tax) income from work, including taxes and social security contributions payable by the employee/self-employed worker,2 but excluding practice expenses for selfemployed doctors. Income from work should normally include all types of payments (including bonuses, overtime compensation, "thirteenth month payments", etc.) received by employees”. Based on the description of several descriptions of the concept above, it can be concluded that remuneration is the provision of remuneration received by nurses for the achievements given for their work, in the form of direct financial compensation and indirect or non-financial financial compensation in the form of salaries, performance allowances, remuneration incentives, health insurance and employment, pension contributions. Job satisfaction Colquitt, Lepine, & Wesson (2015) state that job satisfaction is a pleasurable emotional state resulting from the appraisal of one's job or job experiences. This theory is in line with the research of (Puspitawati & Atmaja, 2021), which implies that working conditions can cause stress depending on the condition of the employee. The salaries they earn do not match their workload, especially when working from home, and the working time of other employees reduces their level of satisfaction at work. However, due to the current Covid-19 pandemic, employees feel that job satisfaction does not affect their performance. Lu, Barriball, Zhang, & While (2012) nurse job satisfaction is defined as the extent to which a nurse fulfills herself or herself in the nursing profession. Nurse job satisfaction is effectd by working conditions, organizational environment, job stress, role conflict, role perception and organizational work content and professional commitment. In addition, the working time of other employees reduces their level of job satisfaction. Gibson, Ivancevich, Donelly & Konopaske (2012) describes a reciprocal relationship between performance and job satisfaction. On the one hand, it is said that job satisfaction causes an increase in performance so that satisfied workers will be more productive. On the other hand, job satisfaction can also occur due to performance or work performance so that more productive workers will get job satisfaction. Promoting autonomy, power to make decisions for change, social support, team cohesion, and strategies to reduce job stress can increase the job satisfaction of frontline nurse managers. Innovative solutions such as co-management and targeted electronic and administrative resources require further investigation (Penconek et al., 2021). Promoting prosocial group behaviour, team building, coaching, and implementing wellness programs can increase social support, team cohesion, and well-being. Examining the job satisfaction factors of nurse managers outside the acute care setting may provide further insight into the role that the practice environment plays in nurse manager job satisfaction. Research results (Widyani et al., 2019) International Journal of Human Capital Management, Vol. 6 (1), June 2022 43 | P a g e The Staempfli & Lamarche, (2020) study stated that a review of 161 journal articles revealed 34 articles that met the inclusion criteria were included in the final analysis. Ten dominant factors enabled workplace interventions, including six that did not reach consensus. These ten factors are presented in a practical model for implementation based on Herzberg's two-factor theory and Maslow's hierarchy of needs theory. Conclusion: This model tells health care leaders how to understand job satisfaction pragmatically exclusively for ED nurses. Several studies have used the McCloskey/Mueller Satisfaction Scale (MMSS) to measure nurse job satisfaction. When developing this original scale, McCloskey grouped three categories or domains, namely: 1) safety includes satisfaction with pay, benefits, and work schedules 2) social includes: maternity leave, child care facilities, supervisor support, and peer relations, and social opportunities with colleagues, 3) Psychological includes job satisfaction, opportunities for further education, praise, recognition and superior control (Tourrangeau et al., 2006). Based on several descriptions of the concepts that have been described, it can be concluded that nurse job satisfaction is the extent to which a nurse describes positive feelings towards her work, resulting from the evaluation of characteristics. METHODOLOGY The method used in this research is quantitative approach with survey method, and the technique analysed data using SEM (Structural Equation Modelling). The sampling technique used in this study is a stratified random sampling technique, so the sample in this research were 200 clinical nurses as respondents of the Embung Fatimah Regional General Hospital, Batam. The profile of respondents consists of gender, namely female (77%), the majority had a Diploma in Nursing (71%), and the length of work ranged from 5 -10 years (63%). The data collect in this study using questionnaires with likert scale. RESULT AND DISCUSSION Hypothesis Testing To produce a measurement model from a simplified research model, the five First Order CFAs were combined from each of the research's latent variables. This simplified estimation of the measurement model produces a path diagram of the measurement model, as shown in Figure 1. International Journal of Human Capital Management, Vol. 6 (1), June 2022 44 | P a g e Figure 1 Research Measurement Model Estimation Results (Standard Solution) Figure 1, the estimation results of the research measurement model can be seen from the indicators of the Order 1 measurement model; all research latent variables have SFL > 0.50, meaning that all indicators of career development research variables, remuneration, job satisfaction, and nurse performance are valid indicators. Furthermore, the estimation results of the coefficients of CR and VE show that the CR price is 0.70 and VE is 0.50. These results mean that all items are consistent and reliable in measuring each indicator of the research variables. From the print output and path diagram in Figure 1, it can be seen that the Goodness of Fit Indices (GOFI), the results of the fit model test obtained p-value 1.0000 > 0.05, RMSEA = 0.000 < 0.08. This means having a good overall model fit or based on data. Structural Model Hypothesis Testing Figure 2. Model Estimation Results (Standard) International Journal of Human Capital Management, Vol. 6 (1), June 2022 45 | P a g e Figure 3 Model Estimation Results (t value) Furthermore, the results of the estimation of the path coefficient parameters for direct and indirect effects are presented in table 1. Table 1. Summary path coefficient and hypothesis direct effect test Hypthesis Path Coefficient t-value t-table Decision OC → NSPRF 0.23 4.70 1.96 H0 Rejected CDVLP→ NSPRF 0.34 4.27 1.96 H0 Rejected REMUERA→ NSPRF 0.26 5.09 1.96 H0 Rejected JOBSTFY→ NSPRF 0.23 4.70 1.96 H0 Rejected OC → JOBSTFY 0.10 1.47 1.96 H0 Accepted CDVLP → JOBSTFY 0.42 4.88 1.96 H0 Rejected REMUNERA→ JOBSTFY 0.18 2.78 1.96 H0 Rejected CDVLP →REMUNERA 0.74 12.01 1.96 H0 Rejected Table 1 shows that of the eight research hypotheses, one research hypotheses were accepted, and seven research hypotheses were rejected. In addition, it will also analyse the indirect, and total effects of the latent variables of antecedent exogenous research, namely Career Development, on the performance of endogenous nurses and consequently, based on the printed output, the value of the three types of effects can be obtained, as shown in table 2. Table 2. Summary of indirect effect test Hypthesis Path Coefficient t-value t- table Decision OC → JOBSTFY → NSPRF 0.022 1.4029 1.96 H0 Accepted CDVLP → JOBSTFY → NSPRF 0.0966 3.3852 1.96 H0 Rejected REMUNERA→JOBSTFY→NSPRF 0.0414 2.3927 1.96 H0 Rejected International Journal of Human Capital Management, Vol. 6 (1), June 2022 46 | P a g e Based on table 1, organizational culture indirect effect to job satisfaction. While, for table 2 shows that organizational culture indirect effect on nurse performance trough job satisfaction and its not significant result. Overall, from the results of the study, it is known that the hypothesis has been answered. Discussion Direct effect of Organizational Culture and Nurse Performance The results of this study prove that organizational culture has a direct positive effect on the performance of nurses working at Embung Fatimah Hospital in Batam (t value = 4.70 > 1.96, path coefficient = 0.23), meaning H1 is accepted. The findings of this study support the results of research from Hsi Chi, Hsiao, Chang, Ya Ling, & Tu, (2016) which shows that a good hospital culture leads to better individual performance than conventional training and also research from Winasih et al., (2015) stated the strong organizational culture, which can improve the performance of nurses in Dr. Soetomo Hospital. This finding is also in line with the results of research or concepts from Colquitt, Lepine, & Wesson (2015) and (Wibowo, 2016), although somewhat different from the opinion of Kreitner (2014) which states that culture can affect the performance of human resources towards better or bad performance. This finding is similar to previous research from Cha & Sung (2020) and Manojlovich & Ketefian, (2001). Cha & Sung (2020) stated the active culture has a positive effect on performance. Who work in a culture of having greater opportunities to take on greater responsibility for patients, as well as triggering innovative behaviors that improve performance. Manojlovich & Ketefian, (2001) explained that organizational culture predicted over 16% of the variance in nursing professionalism on the performance. A strong culture is the culture of an ideal organization that is widely embraced and clear in its delivery as well as cultural strength, thus affecting the intensity of behavior (Vernadeth et al., 2020). In terms of hospital culture, it is an important factor that helps nurses in the process of learning culture in hospitals because can increase performance. Hospitals should focus on establishing a culture that values, recognizes, and motivates employees to serve the public. Direct effect of Career Development and Nurse Performance The results of this study showed that the career development has a direct positive effect and significant on nurse performance. The t statistical value is 4.27 > 1.96, path coefficient = 0.34 so that the career development life is directly able to increase nurse performance significantly. So, that the hypothesis H2 in this study is accepted. This shows that a good career development will increase the nurse performance of Embung Fatimah Hospital. However, these results contradict research from Pronajaya et al., (2021) stated that career development does not affect nurse performance. Based on these results it can be explained that the higher the career development will affect the performance of nurses. This finding is in line with researches from Saleem & Amin (2013), Nami Nasution et al., (2018) and Manggis et al., (2018). Saleem & Amin (2013) stated that employee performance increases along with better quality of career development which one of the forms of organizational support. Nami Nasution et al., (2018) stated that career development has a positive effect and significant on employee performance, career development can make employees more motivated to improve performance. By carrying out employee career development, the quality will certainly increase. Manggis et al., (2018) also point out that career development has a positive and significant effect on . There are several reasons why career development can impact employee performance. One is the fact that career development programs that companies effectively support evoke awareness of the purpose of work and the reasons for diligence. Career development for nurses is regulated by PMK No. 40 of 2017, and nurses undergo career placement suitable for their abilities through continuous professional development. Direct effect of Remuneration and Nurse Performance International Journal of Human Capital Management, Vol. 6 (1), June 2022 47 | P a g e The results showed that the remuneration has a positive and significant direct effect on nurse performance. The t statistical value is 5.09 > 1.96, path coefficient = 0.26 so that the remuneration is directly able to increase nurse performance significantly. So, that the hypothesis H3 in this study is accepted. This shows that a good remuneration will improve the nurse performance of Embung Fatimah Hospital. Based on these results it can be explained that the higher the career development will affect the performance of nurses. This finding is in line with researches from Novarini & Imbayani, (2019) there is a positive and significant effect between rewards on employee performance. There is a significant relationship between Reward and Punishment on employee performance. Researches of Berliana, Siregar, & Gustian (2018), states that the remuneration given is considered appropriate enough that it can affect employee performance. Because remuneration has a dominant effect on performance, employees need to be given appropriate remuneration by increasing other benefits in order to work more professionally. And also researches Muthmainnah, Hamid & Hariyati (2018) shows that improving the remuneration system has positive consequences in terms of nurse performance and subsequent quality of health services. A well-managed remuneration system has the potential to increase motivation, productivity, nurse satisfaction, and even increase retention. Direct effect of Job Satisfaction and Nurse Performance The results showed that the job satisfaction has impact direct effect on nurse performance. The t statistical value is 4.70 > 1.96, path coefficient = 0.23, which indicates there is a positive and significant direct effect of job satisfaction on nurse performance. So, that the hypothesis H4 in this study is accepted. This shows that a good job satisfaction will increase the nurse performance of Embung Fatimah Hospital. Based on these results it can be explained that the higher the job satisfaction will affect the performance of nurses. Research by Hua (2015) stated that nurses in Chengde City were most satisfied with their co-workers and mostly dissatisfied with the work itself. In second-tier hospitals, nurses were more satisfied with workers, work-family balance and praise/recognition, while less satisfied with salary than those in third-tier hospitals. In addition, this study also supports research (Kvist et al., 2012), which identifies seven subscales of job satisfaction: leadership, factors that require work, work environment, sense of community, work well-being, work motivation factors and participation in decision making. Their study showed that the highest levels of job satisfaction stem from factors such as client feedback, having a suitable and challenging job, using one's skills at work, appreciation for one's own work and finding work that attracts teamwork. Direct effect of Organizational Culture and Job Satisfaction The results showed that the organizational culture does not have a significant effect on the job satisfaction because the t statistical value is 1.47 < 1.96, it can be concluded that hypothesis 5 is not fulfilled. The path coefficient was 0.10, so it can be concluded that H1 is rejected. This shows that organizational culture has an indirect and insignifivant effect on job satisfaction. Thus, a stronger organizational culture does not necessarily make the job satisfaction of the nurses better. Sharma (2017), stated that organizational cultural values such as fairness, growth opportunities and organizational reputation have a positive effect on job satisfaction, while organizational traits such as aggressiveness have a negative effect on job satisfaction. Based on these results it can be explained that the higher the career development will not affect the performance of nurses. This finding is in line with researches from This result contradicts research from Winasih et al., (2015) and Hazaveheil et al., (2019). Winasih et al., (2015) stated the strong organizational culture, which can improve the job satisfaction of nurses. The research of Hazaveheil et al., (2019) that the findings show that organizational culture and job satisfaction have an average score in the hospitals studied. Treatment-oriented policies and vertical management in hospitals are important reasons that affect organizational culture and job satisfaction. And also research Swathi, (2014), states that employee satisfaction plays an important role in increasing employee morale. Employee satisfaction has a close relationship with organizational culture because it encourages the workforce to give their opinions and share their ideas regarding work. International Journal of Human Capital Management, Vol. 6 (1), June 2022 48 | P a g e Direct effect of Career Development and Job Satisfaction The results showed that the career development has a positive and significant direct effect on job satisfaction. The t statistical value is 4.88 > 1.96, path coefficient = 0.42 so that the career development is directly able directly to increase job satisfaction significantly. So, that the hypothesis H6 in this study is accepted. This shows that a good career development will increase the nurse job satisfaction of Embung Fatimah Hospital. Based on these results it can be explained that the higher the career development will affect the job satisfaction. This finding is in line with researches from Ismail, Madrah, Aminudin, & Ismail (2013), First, the relationship between career programming (ie, planning and management) and career development has a positive and significant relationship with job satisfaction. Second, the relationship between career programming (ie, planning and management) and career development shows a positive and significant relationship with career commitment. Furthermore, research by Yarbrough, Martin, Alfred, & McNeill, (2017) shows a strong correlation between professional values and career development and job satisfaction. Bela Pertiwi, Sri Hariyati (2019), shows the results of her research that the impact of the career ladder system for nurses in hospitals are: (1) career advancement, (2) guidance development, (3) building an effective reward system, (4) development skills and education, and (5) task awareness. Guidance development and career advancement have been shown to significantly effect the development of nurse competencies. The conclusion of the research is that mentorship and career advancement have the greatest impact on the implementation of the nurse's career ladder. Nurse managers have an important role in increasing the application of career paths to increase nurse satisfaction. And also, Shujaat, Sana, Aftab, & Ahmed (2013) research in the banking sector is in line with this study they state that employee job satisfaction depends on career development opportunities in their respective organizations. In generals concluded that the banking sector in Karachi provides career development opportunities. Direct effect of Remuneration and Job Satisfaction The results showed that the remuneration has a positive and significant direct effect on job satisfaction. The t statistical value is 2.78 > 1.96, path coefficient = 0.13, so that the renumeratin is directly able to increase job satisfaction significantly. So, that the hypothesis H7 in this study is accepted. This shows that a good remuneration will increase the job satisfaction of Embung Fatimah Hospital. Based on these results it can be explained that the higher the remuneration will affect the job satisfaction. This finding is in line with researches from Putra et al., (2017) proves that career development has a positive and significant effect on nurse job satisfaction. work goals have a positive and significant effect on the performance of nurses. Muthmainnah, Hamid & Hariyati (2018) shows that improving the remuneration system has positive consequences in terms of improving nurse performance and subsequent quality of health services. A well-managed remuneration system has the potential to increase nurses' motivation, productivity, job satisfaction, and even increase retention. Muthmainnah, Yetti, Gayatri, & Kuntarti (2019) has found a significant correlation between remuneration, work motivation and job satisfaction. Nurses who are satisfied with the remuneration have 3 times the opportunity to display high work motivation. This study recommends hospitals to implement a remuneration system based on the Decree of the Minister of Health No. 652 of 2010. Mendes, Lunkes, Flach & Kruger (2017), analyzed employee perceptions of the remuneration system in two large Brazilian hospitals, one managed by the government and the other by private investors. Their research findings indicate that the effect of fixed wages is different not only for employees in the two fields, but also in relation to public and private hospital management so as to increase job satisfaction. Direct effect of Career Development and Remuneration The results showed that the career development has a positive and significant direct effect on nurse performance. The t statistical value is 12.01 > 1.96, path coefficient = 0,74, so that the career development life is directly able to increase significantly. So, that the hypothesis H8 in this International Journal of Human Capital Management, Vol. 6 (1), June 2022 49 | P a g e study is accepted. This shows that a good career development will increase the nurse performance of Embung Fatimah Hospital. Based on these results it can be explained that the higher the career development will affect the remuneration. This finding is in line with researches from the results of this study indicate that the better the career development by the company as well as compensation system implemented, the higher the employee's performance. Furthermore, research by B. Panjaitan et al., (2020) stated the result of this research showed that career development and conpensation influence the employee performance. The influence of career development and compensation toward employee performance is positive it means that the higher career development and compensation the higher the employee performance and it has mean Indirect effect of Organizational Culture and Nurse Performance through Job Satisfaction The results this study showed that there was an indirect effect of the organizational culture on nurse performance through job satisfaction. The t statistical value is 1,40 < 1.96 means that the hypothesis H9 in this study is declared rejected. This shows that organizational culture can’t improve the nurse performance through job satisfaction of Embung Fatimah Hospital. Based on the analysis that has been done, This finding contradicts the results of the study of Alotaibi et al. (2015), showed that organizational culture, leadership behaviour and job satisfaction are important determinants of teacher performance in junior high schools in Sukabumi. This finding also contradicts research from Farooqui & Nagendra (2014) which shows that there is a relationship between organizational fit and job satisfaction and performance. Indirect effect of Career Development and Nurse Performance through Job Satisfaction The results this study showed that there was an indirect effect of the career development on nurse performance through job satisfaction. The t statistical value is 1,40 < 1.96, which means that the hypothesis H10 in this study is declared accepted. The results of the analysis show that there is no significant effect between career development and nurse performance through job satisfaction Embung Fatimah Hospital Based on the analysis that has been done, this finding contradicts by Onyishi, Enwereuzor, Ogbonna, Ugwu, & Amazue, (2019), which stated that the results of their research that psychological satisfaction of basic needs are positively related to career satisfaction and career commitment of nurses. Career satisfaction is positively related to career commitment. Career satisfaction mediates the relationship between satisfaction of basic psychological needs and career commitment. This finding also strengthens the research by Shujaat, Sana, Aftab & Ahmed (2013), which determined that there is a positive relationship between career development and job satisfaction of employees in the banking sector. Career development is very important for an organization, because career is a need that must be continuously developed by the employees themselves (Harris et al., 2015). Indirect effect of Remuneration and Nurse Performance through Job Satisfaction The results this study showed that there was a direct effect of the remuneration on nurse performance through job satisfaction. The t statistical value is 3,38 > 1.96 so that the remuneration indirectly affects nurse performance through job satisfaction. So that the hypothesis H11 in this study is declared rejected. The results of the analysis show that there is significant effect between remuneration and nurse performance through job satisfaction Embung Fatimah Hospital. Based on the analysis that has been done, the results of this study are in line with the opinion of Colquitt, Lepine & Wesson (2015), which states that performance is mediated by individual mechanisms such as job satisfaction, stress, motivation, trust, justice & ethics and learning decision making. When viewed from the performance indicators, it can be seen that performance is related to feedback in this case remuneration mediated by job satisfaction. This finding also strengthens the results of research by Muthmainnah, Hamid & Hariyati (2018), which shows that an increase in the remuneration system has positive consequences in terms of nurse International Journal of Human Capital Management, Vol. 6 (1), June 2022 50 | P a g e performance and the quality of subsequent health services. A well-managed remuneration system has the potential to increase nurse motivation, productivity, satisfaction, and even increase retention. In addition, it also strengthens, Muthmainnah, Yetti, Dewi Gayatri, & Kuntarti (2019) whose research results using logistic regression tests reveal that there is a significant interaction between remuneration and job satisfaction. Research limitations There are still a number of variables that affect the performance of the nurses that were not used in this study such as the variables competency, the work environment, leadership style. commitment, training, motivation, and level of education. Due the time and place limitations, the variables of organizational culture, career development, remuneration, job satisfaction and nurse performance. Another limitation in this study is that nurse performance is measured based on the perception of the hospital nurses, the last limitation is the number of variables that must be added. CONCLUSION These findings reveal that nurse career development directly affects nurse performance, job satisfaction, and remuneration. Let's look at three positive direct effects of career development. The dominant effect of career development is on remuneration, which is more than double the effect of career development on performance and job satisfaction at Embung Fatimah Hospital Batam. Implementation of a good nurse career development, based on Permenkes No. 40 of 2017 concerning the Development of Professional Career Paths for Nurses (Ministry of Health, 2017), will encourage high-performing nurses. This finding also shows that remuneration has a direct positive effect on nurse performance and other findings from this study also show that job satisfaction has a direct effect on nurse performance. In addition, it was found that there is no effect of remuneration on job satisfaction. The findings of this study reveal that there are direct and indirect effects through the intervening variable or mediation as for the mediating variables, job satisfaction, and remuneration. So it can be concluded that job satisfaction and remuneration successfully mediate the effect of career development and performance. These findings reveal that nurse career development directly affects nurse performance, job satisfaction, and remuneration. Let's look at three positive direct effects of career development. It was found that the dominant effect of career development is on remuneration, which is more than once the effect of career development on performance and job satisfaction at Embung Fatimah Hospital Batam. Based on Permenkes No. 40 of 2017 concerning the Development of Professional Career Paths for Nurses at the Ministry of Health (2017), This finding also shows that remuneration has a direct positive effect on nurse performance and other findings from this study also show that job satisfaction has a direct effect on nurse performance. In addition, it was found that there is no effect of remuneration on job satisfaction. The findings of this study reveal that there are direct and indirect effects through the intervening variable or mediation as for the mediating variables, job satisfaction, and remuneration. So it can be concluded that job satisfaction and remuneration successfully mediate the effect of career development and performance. REFERENCES A.Noe, R., R.Hollenbeck, J., Gerhart, B., & M.Wright, P. (2014). Manajemen Sumber Daya Manusia mencapai keunggulan bersaing. Salemba Empat. Al‐Ahmadi, H. (2009). 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