¹ Department of Anesthesiology, Intensive Care Medicine and Pain Management, Sestre milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia, valentina.matic@yahoo.com

² Faculty of Health Sciences, University of Novo Mesto, Na Loko 2, 8000, Novo Mesto, Slovenia

Corresponding author:

Valentina Ješić, Tišina Kaptolska 61, 44000, Sisak, Croatia, valentina.matic@yahoo.com, +385 99 503 4197

Abstract

Introduction: The healthcare sector contributes substantially to environmental pollution, accounting for about 4.5% of global CO₂ emissions, while also generating large amounts of waste and consuming significant energy and water resources. Nurses, as the largest group of healthcare professionals, are well positioned to promote sustainability, but their efforts are often hindered by limited time, resources, and managerial support. This study aimed to examine the level of environmental awareness and the frequency of sustainable practices among nurses in Croatia, and to identify barriers and types of support needed for their more effective implementation.

Methods: A quantitative cross-sectional study was conducted using an online questionnaire among 150 nurses with diverse demographic characteristics. The questionnaire included a scale of environmental awareness, a scale measuring the frequency of sustainable practices, and questions about green audits, participation in sustainability initiatives, barriers, and support needs.

Results: Most participants were women (87%), with a mean age of 35 years and an average of 12 years of work experience. A green audit had been conducted in 20% of institutions. A high level of environmental awareness was observed (mean 4/5), while sustainable practices were moderate (mean 3.6/5). Waste segregation was the most frequent practice, while participation in “green” initiatives was the least common. Higher awareness, the presence of a green audit, and managerial support significantly predicted more frequent implementation of sustainable practices. Key barriers included lack of time, infrastructure, and managerial support.

Conclusion: Nurses in Croatia demonstrate a high level of environmental awareness, but their sustainable actions remain constrained by operational barriers. Institutional measures such as green audits, targeted education, and stronger leadership support are essential for embedding sustainability into everyday nursing practice.