Associations of Nurses' Career Attitudes, Career Management Behaviors, and Understanding and Expected Outcomes of The Career Ladder System With Intention to Stay and Career Satisfaction: A Cross-Sectional Study.

Nurses often encounter career plateaus due to limited promotion opportunities and insufficient support for career development, which can decrease career satisfaction and lower their intention to remain. This study explored nurses' career attitudes and management behaviors, and their understanding and expectations of the Career Ladder System (CLS), to examine how these factors are associated with intention to stay and career satisfaction. This study used a descriptive cross-sectional design with a convenience sample of 394 ward nurses with at least 1 year of clinical experience from a tertiary hospital in Seoul, South Korea. Data were collected from May to June 2024, before the CLS was expanded to general ward nurses. The mean score for protean career attitude was 3.60 out of 5; career plateau averaged 2.33 out of 5, with structural career plateau significantly higher than content career plateau (p < 0.001). Career management behavior averaged 3.22 out of 5, understanding of the CLS was 2.86 out of 4, expected CLS outcomes were 2.83 out of 4, intention to stay was 35.57 out of 48, and career satisfaction was 3.25 out of 5. Differences in age and clinical experience were found in value-driven career attitudes and structural career plateaus. Hierarchical multiple regression analysis showed that content career plateau was significantly associated with both intention to stay and career satisfaction. Positive career attitudes were also significantly associated with higher intention to stay and greater career satisfaction. Hospitals may need to strengthen organizational support to create a content-driven career development environment.