Penelitian ini dilatarbelakangi oleh pemahaman bahwa kinerja perawat berkontribusi bagi mutu pelayanan keperawatan di rumah sakit. Hasil survei menunjukkan ketidakpuasan pelanggan terhadap kinerja perawat pelaksana sebanyak 43,89%, dan penilaian kinerja perawat pelaksana belum optimal. Penelitian ini bertujuan untuk mengetahui hubungan faktor internal dan eksternal dengan kinerja perawat pelaksana di RS X. Sjahranie. Penelitian menggunakan pendekatan cross sectional. Sampel berjumlah 216 perawat pelaksana. Data dikumpulkan dengan menggunakan kuesioner yang disusun peneliti. Analisis data dilakukan secara univariat, bivariat (chi-square dan independent t test) dan multivariat (regresi logistik berganda). Hasil penelitian didapatkan faktor yang berhubungan dengan kinerja adalah: pendidikan (p=0,014), motivasi (p=0,013), persepsi (0,001), kepemimpinan (0,001), dan karier (0,001). Faktor pengembangan karier paling dominan berhubungan dengan kinerja (OR=29,962). Peningkatan kinerja perawat pelaksana harus memperhatikan aspek pendidikan, motivasi, persepsi, kepemimpinan, dan pengembangan karier.Carreer Development as Determinant Factor to Nurses? Working Performance. Nurses? working performance has contributed to the quality of nursing service in hospitals. A survey has shown that unsatisfied customers related to nurses performance is 43.89%. The purpose of this study was to identify the relationship between internal and external factors and nurses performance in a hospital. This was a descriptive study using a cross sectional approach. The sample consisted of 216 nurses. Data were collected using a modified questionnaire and analyzed using univariate, chi-square and independent t test, and double logistics regression. Results shown that factors such as education, motivation, perception, leadership and career were factors that have significant relationship with nurses performance (p<0.05). It is concluded that nurses career development was the most dominant factor related to nurses working performance (OR=29.962). The results of this study suggested that nurses? carreer development should consider factors such as education, motivation, perception, leadership, and career development.