Nursing Work Environments and Patient Safety in Older Adults: A Scoping Review of Their Intricate Relationship, Definitions and Theoretical Frameworks.

AIM(S) To identify and map the relationship between nursing work environments and patient safety for older adults ≥ 65.

Design

Scoping review and consultation exercise.

Methods

Systematic searches of five databases were conducted in 2022, 2024 and 2026. Two reviewers independently screened titles/abstracts and subsequently by full-text review. Data was extracted using an extraction form with knowledge users involved throughout.

Results

Eighty-four studies were included. The data were presented with three main categories: (1) study characteristics; (2) core constructs; (3) the relationship between nursing work environments and patient safety, including theoretical frameworks and knowledge users' insights.

Conclusion

The relationship between nursing work environments and patient safety for older adults is intricate. Work environment factors, such as staffing, skill mix and education, influence patient safety, which is defined through outcomes like mortality, readmissions and healthcare-associated complications. IMPLICATIONS Increased awareness of how the work environment influences patient safety can support prioritisation of nursing practice, staffing, skill mix and increase level of education to reduce errors. IMPACT The findings provide an overview of the ways in which work environment factors shape safety for older adults and highlight gaps in measurement and conceptual clarity. The results have implications for healthcare policy, organisational decision-making and clinical practice. The review was conducted in accordance with the EQUATOR guidelines for PRISMA-ScR. CONTRIBUTIONS TO THE WIDER GLOBAL CLINICAL COMMUNITY Emphasises the role of supportive work environments in enhancing care quality globally. Provides insight for policy and improvements to benefit patient safety. Clarifies the scope of research on nursing work environments and patient safety in older adults. PATIENT OR PUBLIC CONTRIBUTION Patients and members of the public were involved in designing the study, collecting data and interpreting the findings. Their contributions included reviewing concepts, co-creating research questions, providing feedback on methodology, inclusion/exclusion, findings and practice implications.