When safety becomes the priority: defensive nursing practice and its associated factors among nurses in Egypt: a cross-sectional study

Background. Defensive nursing practices, which prioritize legal protection over patient care, are becoming increasingly common. This study aims to explore the prevalence and factors associated with defensive nursing practices among nurses in Egypt, considering the impact of workplace violence and legal threats. Methods. A descriptive cross-sectional study was conducted from February to April 2024 using a self-report online questionnaire. The target population included clinical nurses working in various hospitals in Egypt. A sample size of 1,267 nurses was achieved through convenience sampling. The questionnaire assessed demographic data, experiences of workplace violence, legal consequences, and defensive nursing practices, categorized into positive and negative behaviors. Results. The sample consisted of 1,267 nurses, predominantly female (75.9%), with a mean age of 28.57 years. Positive defensive practices, such as detailed documentation (79%) and thorough explanation of procedures (58.5%), were highly prevalent. Negative practices included avoiding high-risk procedures (15.9%) and patients more likely to file lawsuits (13.6%). Older nurses and those with higher educational qualifications were more likely to engage in positive defensive practices. Nurses who experienced workplace violence or legal threats were significantly more likely to avoid high-complication procedures. Conclusion. The study identified a high engagement in both positive and negative defensive practices among nurses in Egypt. These practices are influenced by factors such as age, education level, and experiences of workplace violence and legal threats. The findings underscore the need for strategies to support nurses, reduce reliance on defensive practices, and ensure better patient outcomes.