Modelling the Pathways Between Nurse Work Environment, Emotional Labour, and Patient Safety in Nigerian Tertiary Hospitals

Background: The mechanisms linking nurse work environment conditions to patient safety outcomes are inadequately theorised, particularly regarding the mediating role of emotional labour in the Nigerian tertiary hospital context. Aim: This study modelled the pathways between nurse work environment, emotional labour, and patient safety outcomes across four Nigerian geopolitical zones. Methods: A structural equation modelling study recruited 420 registered nurses from eight tertiary hospitals using stratified random sampling. The Practice Environment Scale of the Nursing Work Index, the Frankfurt Scales of Emotion Work, the Maslach Burnout Inventory, and hospital incident records were integrated in a theoretically specified path model. Results: Emotional labour significantly mediated the relationship between work environment quality and both nurse burnout and patient safety event rates. Work environment directly predicted safety outcomes even after controlling for mediated pathways. The model explained 54% of variance in patient safety events. Conclusion: Emotional labour is a critical but overlooked mechanism linking nursing work conditions to patient safety. Nurse work environment improvements must explicitly address emotional labour burden to achieve meaningful patient safety gains. The study provides a theoretically and empirically grounded advocacy framework for nursing policy reform in Nigeria. Keywords: nurse work environment, emotional labour, patient safety, structural equation modelling, Nigeria.