Analysis of a nursing workforce policy on the career ladder and pay structure of public sector nurses in the Maldives: a qualitative study

Background International organizations have encouraged countries to adopt policies that ensure adequate pay and career development opportunities for professional advancement and job satisfaction, thereby contributing to organizational effectiveness. The Job Family Standard for Nursing (2018) is a workforce policy on the career ladder and pay structure that aims to improve the career advancement and pay progression of public sector nurses in the Maldives. This study explores the context, process, actors, and content of the policy with regard to the career ladder and pay structure in the Maldives. Methods A qualitative descriptive design was used to collect and analyze data from individuals involved in policymaking. Semi-structured interviews with 26 participants and a document review were used for data collection, and a thematic analysis was conducted. The results were reported via the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and categorized into four major components: context, process, actors, and workforce policy content. The findings indicate that contextual factors, such as the modernization of public administration, political changes, challenges in health system development, and engagement and communication with different actors, influence the process of policy formulation and implementation. Actors such as government elites significantly influence policy content and implementation. Conclusions The findings provide evidence of how contextual factors and the role of actors influence the policy development process so that the content of policies can be finalized and implemented. It is crucial to undertake comprehensive policy analysis to identify contextual factors, engagement and communication with different actors, and these actors' power and influence in shaping policy content and implementation. Nurse leaders and managers should proactively engage relevant actors to contribute to the development of effective policies for nurses' retention and organizational effectiveness.