Defensive Nursing Practices Among Nurses Working in Private Hospitals: A Cross-Sectional Study From Türkiye

Defensive medicine affects not only physicians but also other healthcare professionals. Although widely examined among physicians, studies on defensive practices among nurses remain limited. Nurses' responsibilities in direct care, documentation, communication and informed consent may expose them to malpractice-related concerns.

This study aimed to identify defensive nursing practices among nurses working in selected private hospitals in Türkiye and to examine their associated factors.

A descriptive cross-sectional survey was conducted with 394 nurses working in selected private hospitals affiliated with four private healthcare groups in Türkiye. Data were collected in April 2023 using an online structured questionnaire covering sociodemographic and professional characteristics, malpractice-related awareness and 10 defensive nursing practice items. Items were analysed individually rather than as a total score. Descriptive statistics and Pearson's chi-square tests were used.

The most frequently reported practices potentially related to defensive nursing were detailed record-keeping, attention to informed consent forms, detailed explanations and spending more time with patients. Administering unnecessary medications and avoiding patients perceived as legally risky were reported less often. Concern about making mistakes differed by educational level, professional experience, marital status and malpractice-related awareness variables. Perceived malpractice risk was associated with age, marital status, professional experience and institutional experience. Nurses who believed that malpractice lawsuits affect nursing performance more frequently reported some communication- and documentation-oriented behaviours potentially related to defensive nursing practice.

The reported item-level responses suggested that practices potentially related to defensive nursing were more commonly reflected in documentation-, communication- and informed consent-oriented behaviours than in overt avoidance. These findings should be interpreted cautiously, because such behaviours may reflect appropriate professional care when guided by patient safety, patient rights and ethical practice, but may indicate defensive motivation when primarily driven by legal concern or self-protection. Nurse managers should address malpractice-related concerns through clear documentation standards, legal and ethical education, communication training and supportive safety cultures.

Nurse managers should address defensive nursing practices through clear documentation standards, malpractice-related education, communication training and supportive safety cultures that help nurses distinguish safe professional caution from fear-driven self-protection while strengthening patient-centred care.