Assessment of Empathy Among Undergraduate and Graduate Nursing Students in Osijek, Croatia: A Cross-Sectional Study

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Abstract
Background/Objectives: Empathy is an important professional attribute in nursing and may be influenced by demographic, educational, and professional characteristics. This study aimed to assess empathy levels and examine demographic, educational, and professional factors associated with empathy among undergraduate and gradu-ate nursing students in Croatia. Methods: A cross-sectional study was conducted in 2025 among 201 nursing students at the Faculty of Dental Medicine and Health Osi-jek. Empathy was assessed using the Jefferson Scale of Empathy–Health Professions Student version (JSE-HPS). Group differences were examined using nonparametric tests. Multiple linear regression with heteroskedasticity-consistent HC3 standard errors was used for the primary multivariable analysis, with sensitivity analyses us-ing alternative model specifications and bootstrap confidence intervals. Results: The total JSE-HPS score was M = 106.82 ± 14.21 and Mdn = 108 (Q1–Q3 = 95–118). Signifi-cant unadjusted differences in empathy were observed according to gender, chrono-logical age, educational level, year of study, employment status, and years of work experience. In the primary HC3 model, female gender remained significantly associ-ated with higher empathy scores (B = 6.12, p = 0.013), whereas employment status was not statistically significant (p = 0.176). The primary model explained 11.5% of the variance according to adjusted R². The association of female gender with higher em-pathy remained consistent in sensitivity analyses; lower scores among employed stu-dents were supported in sensitivity and bootstrap analyses but were not consistent across all model specifications. Conclusions: Female gender showed a consistent asso-ciation with higher empathy scores, whereas the association with employment status was sensitive to model specification. These cross-sectional findings support continued attention to empathy throughout nursing education and warrant further longitudinal and multicenter research.

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