Patient safety in the operating room depends on far more than surgical technique — it hinges critically on the psychological and physiological state of the nurses managing those environments. A narrative review synthesizing six years of literature reframes OR nurse wellbeing not as a staff welfare issue but as a structural determinant of perioperative outcomes, with implications for hospital administrators, policymakers, and anyone who may one day be a surgical patient.
The review, published in Frontiers in Public Health, drew on literature published primarily between 2020 and 2026, examining how occupational hazards, psychosocial stress, emotional labor, burnout, compassion fatigue, cognitive load, ergonomic strain, and emerging technologies collectively shape OR nurse performance. The synthesis found that unsafe or inadequately supported operating environments expose nursing staff to overlapping physical, psychological, and technological pressures. Specifically, burnout and compassion fatigue were identified as weakening vigilance and procedural reliability, while hierarchical communication patterns and frequent task interruptions further eroded teamwork and patient-safety margins. Conversely, environments that supported nurse wellbeing were associated with improved clinical judgment, attention, emotional regulation, and active participation in safety protocols.
This framing represents a meaningful conceptual shift. Traditionally, OR safety literature has centered on surgical checklists, instrument protocols, and physician decision-making. Positioning nurse wellbeing as a system-level variable — rather than an individual-level concern — aligns with Human Factors science and resilience engineering frameworks that have long argued institutional design shapes outcomes more than individual performance alone. The inclusion of robotic surgery and artificial intelligence as emerging cognitive stressors is particularly timely, as these technologies are being rapidly adopted without standardized readiness protocols. Key limitations include the review's narrative rather than systematic methodology, limiting quantitative effect-size estimation, and its reliance on largely self-reported occupational health data. Still, the synthesis offers a coherent case for integrating nurse wellbeing metrics into routine perioperative quality measurement — an incremental but practically valuable contribution.
