Predicted positions and qualification mismatch for master of nursing graduates in Croatian hospitals: cross-sectional...

Croatia is producing increasing numbers of Master of Nursing (MN) graduates. However, institutional job classifications, i.e. the rulebooks that define positions, duties, qualifications, and pay grades, may limit their deployment. This study aimed to assess the number of MN-designated posts in public hospitals, the extent to which they are filled, and the degree to which MN graduates are employed in roles that match their qualifications.

This cross-sectional study, conducted from May to June 2025, analysed job classifications from 57 Croatian public hospitals. "Job classification" is an institution's legally required rulebook that defines its internal organization and the classification of all job positions (units, roles, headcount, duties, qualifications, and pay grades). From those documents, we analysed the number of first-category nurse positions, assessed the number of MN graduates employed in these roles, and the number of MN employed in any position.

Data were obtained from 48 of 57 public hospitals (79%), with job classification documents designating 906 first-category positions for MN nurses (specific clinical and coordination posts eligible for MN‑related salary increases). Among 39 hospitals with complete data, 431 of 654 positions of all MN posts were filled, yielding an overall 71% occupancy rate. Several hospitals reported less than 50% occupancy of MN positions. In total, 1,284 MN nurses were employed across 35 hospitals, but many were not placed in positions matching their qualifications.

This study reveals gaps in data transparency, job classification, and employment of MN nurses in Croatian public hospitals. Standardised classifications, exclusive designation of first-category roles for MN nurses, and a transparent national registry of MN nurses, capturing their numbers and positions, are needed to improve workforce planning and strengthen healthcare delivery.