Educational Level and Length of Work Experience as Predictors of Adverse-Event Reporting and Patient-Safety Perception Among Nurses in Croatian General and County Hospitals: A National Cross-Sectional Study

Background/Objectives: Two sociodemographic characteristics of the nursing workforce — formal level of education and length of professional experience — are widely assumed to shape both how often nurses report adverse events and how safe they perceive their workplace to be for patients. Empirical evidence on these associations remains uneven, however, and large multicentre data from Central and Eastern European secondary-care systems are scarce. The present study examined whether educational level and length of work experience are independently related to (a) the self-reported frequency of adverse-event reporting and (b) the perceived level of patient safety, in a national sample of nurses working in Croatian general and county hospitals. Methods: We conducted a cross-sectional, multicentre survey in 2023 covering all 22 general and county hospitals in the Republic of Croatia. A 99-item paper questionnaire — including 81 items distributed across six previously validated scales (Cronbach’s α 0.730–0.951) — was distributed proportionally to the eligible nursing workforce (N = 6,661). Of the 1,657 questionnaires distributed, 1,518 were returned fully completed (response rate 91.6%). Two outcomes were examined in parallel: self-reported frequency of adverse-event reporting in the past 12 months, and global perceived level of patient safety on the respondent’s ward. Group differences were tested with Pearson’s chi-square and Kruskal–Wallis H tests; effect sizes were assessed using the φ coefficient and Cramér’s V. The study followed the STROBE reporting guideline. Results: Educational level was associated with the frequency of adverse-event reporting (χ² = 29.873, df = 8, p < 0.001; φ = 0.14) and with safety perception (χ² = 16.084, df = 8, p = 0.041; φ = 0.10). The same monotonic gradient was confirmed by Kruskal–Wallis tests, with mean ranks rising from secondary (SSS) through bachelor (VŠS) to master’s or doctoral (VSS+DR) levels for both reporting (719.40; 772.93; 836.56; H = 15.901, p < 0.001) and safety perception (735.29; 775.89; 844.86; H = 10.539, p = 0.005). Length of total work experience was associated with reporting (χ² = 22.708, df = 12, p = 0.030; φ = 0.12; H = 9.249, p = 0.026): mean ranks were lowest for nurses with ≤ 10 years and ≥ 31 years, and highest for mid-career nurses (11–20 and 21–30 years). For safety perception, the experience gradient ran in the opposite direction — highest in nurses with ≤ 10 years (mean rank 795.08) and lowest in those with ≥ 31 years (718.17; χ² = 35.036, df = 12, p < 0.001; φ = 0.15; H = 8.517, p = 0.036). Conclusions: Educational level and length of work experience are independently related to both the reporting of adverse events and the perception of patient safety among Croatian hospital nurses, but the two characteristics operate in different ways. Higher education is associated with more reporting and more favorable safety perception, whereas longer experience is associated with more reporting at mid-career but with a less favorable view of workplace safety in late-career nurses. Investing in continuing nursing education and in mid-career retention, while remaining attentive to the deteriorating safety perception of the most experienced staff, may be more effective than redesigning reporting forms alone. The findings inform nursing leadership, continuing-education planning, and national patient-safety policy in Central and Eastern European secondary-care systems.