Over the past few years, the nursing field has been exposed to a variety of external and internal challenges worldwide, including widespread devastation in healthcare systems (Chhetri and Koirala, 2017). Nurses’ workloads (physical or mental) have also increased because of legislative and ethico-legal issues, as well as new educational requirements that have resulted in increased stress and fatigue among the nursing workforce (Suryavanshi et al., 2020). An individual’s health is significantly impacted by fatigue, which is a complicated phenomenon that causes diminished alertness and makes it difficult to cope with stress and unforeseen circumstances (Çelik et al., 2017).

Fatigue is a subjective experience of extreme physical and mental depletion that impairs the ability of nurses to perform nursing tasks in a regular manner (Billones et al., 2021). Continuous exposure to stressors can lead to secondary trauma syndrome, which is characterized by feelings of guilt, humiliation, and grief, as well as acute and persistent exhaustion. Over time, fatigue also places nurses at higher risk for developing chronic conditions such as obesity, sleep disturbances, irritability, and persistent physical symptoms (Broddadóttir et al., 2021). Fatigue can progress into exhaustion, which is described as burnout in the caregiving role (Dyrbye et al., 2019). Tired nurses may also have a reduced ability to deliver effective, high-quality care (Ruiz-Fernández et al., 2020) and there is an increased risk for patient harm (e.g., errors, near misses, negative events, and poor safety perception) (Kim et al., 2021). Among ICU nurses, who make up a large proportion of the nursing workforce, the issue is even more complicated as these nurses are under continuous pressure of dealing with patients with highly acute, complicated, and thus demanding illnesses. Caring for patients with life-threatening conditions and high mortality rates can be even more psychologically daunting and frustrating for healthcare providers. Fatigue could be a more significant issue among these nurses and within these settings (Broddadóttir et al., 2021).

Reports about patient safety and incidents in ICUs have shown that medication errors, inability to monitor adverse drug reactions, increased fall incidents, and lack of interventions in addition to lack of attentiveness and documentation may all be related to operators (i.e., ICU nurses) and their working conditions or workload (Plutínská and Plevová, 2019, Dionisi et al., 2022).

A clear understanding of the relationships between ICU nurses’ well-being and patient safety may allow nurse managers, administrators, and policymakers to simultaneously manage the two crucial organisational goals of nurses’ health and patient safety (Kim et al., 2021). Decreasing burnout among nurses may offset well-known personal and organisational impacts (e.g., turnover intention, sick leave) and provide a way to positively affect their safety perception (Cho and Steege, 2021). Safety culture and nurses’ perceptions create the values, attitudes, and behaviors that ensure capability for safety practices. Nursing performance can have negative or positive impacts on both patient safety and quality of care. Personal factors, including attitudes, values, perceptions, beliefs, and QoL, directly or indirectly affect qthe quality of care and patient safety (Alayed et al., 2014, Alrasheadi et al., 2022).

Several studies (Kelbiso et al., 2017, Lee and Yusof, 2018, Cho and Steege, 2021, Algamdi, 2022) described QoL as a subjective experience that could be influenced by many different factors, such as the social lifestyle and work context.

The United Arab Emirates (UAE) is heavily dependent on an expatriate nursing workforce (Oakley et al., 2020) as only 3 % of the nursing workforce are Emirati (El-Haddad, 2006). As the majority of nurses, especially in the ICU, are expatriates, they experience various challenges such as being separated from their families, having multiple social roles, and having financial issues that may force them to work extra hours. These challenges may affect their physical, psychological, and emotional QoL. This predominance of expatriate nurses in the UAE means it is necessary to examine the effect of QoL on other variables to better address ICU nurses’ safety perception. In particular, QoL may have an influential role in the relationship between fatigue and nurses’ perception of safety. Understanding the predictors of ICU nurses’ safety perception is important to promote quality and patient safety, as this information can contribute to improving healthcare systems and supporting nursing retention strategies. Therefore, there is a need for reflection on and evaluation of interventions to improve understanding of the relationship between ICU nurses’ fatigue and their perception of safety. This study was unique because we sought to identify a broad set of predictors of nurses’ safety perceptions and test the possible associations between the study variables in the UAE context.

The objective of this study was to explore the association between work fatigue and perception of patient safety among nurses working in Emirati critical care units and clarify whether nurses’ QoL levels mediated this relationship.