Job Stress Does Not Predict Safety Outcomes But Safety Culture Does: Insights From Emergency Nurses in Iran

Emergency departments are high-stress environments where nursing performance directly impacts patient safety. While job-related stress is assumed to influence safety outcomes, the mediating role of patient safety culture (PSC) remains unclear, especially in resource-limited healthcare systems.

This cross-sectional study surveyed 304 emergency nurses in two teaching hospitals in Iran using validated Persian versions of the Nursing Stress Scale and the Hospital Survey on Patient Safety Culture. Relationships among job-related stress, PSC, and perceived patient safety outcomes (PSOs) were analyzed using partial least squares structural equation modeling (PLS-SEM).

Job-related stress was not significantly associated with PSC (β = -0.339, p = 0.125) or PSO (r = -0.043, p > 0.05), and no mediation effect was observed. However, PSC demonstrated a strong and significant positive correlation with PSO (r = 0.807, p < 0.001), highlighting its potential as a target for safety improvement.

Although the hypothesized mediation model was not supported, the findings underscore the central role of safety culture in promoting better patient outcomes. Reporting null associations contributes to a more balanced understanding of stress-safety dynamics, particularly in middle-income healthcare settings. Future studies should consider organizational context and objective safety indicators.