Nurse working environment and patient safety: A review

Abstract

Patient safety remains a global priority, and nurses—who deliver most direct patient care—play a pivotal role in preventing errors. The quality of the nursing work environment (e.g. staffing, leadership, teamwork) has been increasingly linked to patient safety outcomes in recent years. However, a comprehensive synthesis of the recent evidence is lacking. To systematically review studies (2019–2024) examining the association between nurses’ work environment and patient safety in hospital settings. We searched PubMed, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library using PICO terms (nurses AND work/practice environment AND patient safety) over the past five years . We included peer?reviewed empirical studies on hospital nurses, published 2019–2024, in English, that measured nurse work environment factors and patient safety outcomes or perceptions. Two reviewers independently screened titles/abstracts and full texts, extracted data, and appraised study quality. Fourteen studies met inclusion. This review of recent evidence confirms that the nurse work environment strongly influences patient safety in hospitals. We organized results into five themes: Staffing and Resource Adequacy; Leadership, Participation, and Professional Commitment; Teamwork, Communication, and Psychological Safety; Occupational Stress and Workload; Missed Nursing Care and Adverse Events. A healthier nurse work environment robustly correlates with safer patient care. These findings suggest that improving staffing, managerial support, teamwork, and reducing nurse stress are likely to enhance patient safety. Health leaders should view nurse work conditions as a critical patient-safety intervention. Future research should test interventions and longitudinal effects to confirm causality.