Injury prevention in fatigue-prone nursing environments: a comprehensive review of strategies centered on work design, human factors engineering, and safety culture

Nurse fatigue is a prevalent and multifactorial occupational health risk that increases the likelihood of work-related injuries and safety incidents, with implications for both workforce well-being and patient care. In fatigue-prone nursing environments, injuries such as slips, sharps injuries, and musculoskeletal disorders related to patient handling represent critical yet often underrecognized consequences of sustained physical and cognitive overload. This review synthesizes findings from occupational health, human factors engineering, sleep medicine, and healthcare quality improvement to examine injury prevention strategies targeting nurse fatigue. Shifting beyond individual-level resilience, the review focuses on system-oriented interventions embedded within work design and care delivery processes. Three interrelated domains are examined: (1) organizational and scheduling strategies, including fatigue risk management systems, shift optimization, protected rest, and acuity-responsive staffing; (2) engineering and ergonomic solutions, such as safe patient handling programs, assistive technologies, environmental optimization, and alarm management; and (3) behavioral and team-based practices, including microbreaks, fatigue-aware communication, training for high-risk tasks, and non-punitive fatigue-related reporting. Across healthcare contexts, implementation is constrained by resource limitations, alarm burden, and deficiencies in safety culture. Evaluation commonly relies on injury incidence, near-miss reporting, sleep quality, and workforce retention, though data standardization remains challenging. Overall, preventing fatigue-related injuries in nursing requires integrated, multidisciplinary, and context-sensitive strategies that align organizational design, engineering controls, and behavioral practices. Embedding fatigue management within healthcare safety culture and policy frameworks is essential to protecting nurses' health, sustaining workforce stability, and improving patient safety.