Association between hospital overcrowding-related stress and self-reported medical errors among nurses in government healthcare facilities.

Abstract

Background: Hospital overcrowding is a patient-safety concern in resource-constrained health systems, where limited bed capacity, staffing shortages, high patient acuity, and weak organizational support increase pressure on nurses. Although international evidence links crowded clinical environments with nurse stress, workload pressure, burnout, and patient-safety risks, limited evidence from Palestine has examined overcrowding-related stress as a distinct factor associated with self-reported medical errors among nurses.

Objective: This study aimed to examine the association between hospital overcrowding-related stress and self-reported medical errors among nurses working in government healthcare facilities in the West Bank, Palestine.

Methods: A descriptive cross-sectional study was conducted between January and March 2025 among nurses working in five West Bank government hospitals. Of 220 distributed questionnaires, 213 were completed and analyzed, yielding a response rate of 96.8%. Data were collected using a structured self-administered questionnaire assessing sociodemographic characteristics, overcrowding-related stress, and self-reported medical errors. Data were analyzed using descriptive statistics, correlation analysis, and binary logistic regression, with significance set at p < 0.05.

Results: The mean age was 31.07 years (SD = 7.77). Most participants were male (68.1%), married (59.2%), held a bachelor's degree in nursing (65.7%), and had 6-10 years of experience (31.9%). Very extreme overcrowding-related stress was reported by 49.3%, followed by extreme stress (27.7%), moderate stress (19.7%), and no stress (3.3%). The mean stress-category score was 3.23 (SD = 0.88). Overcrowding-related stress was weakly but significantly associated with self-reported medical errors (r = 0.326, p < 0.001), explaining 10.6% of the variance. In adjusted regression, marital status and years of experience were significant predictors, although confidence intervals were wide.

Conclusion: Overcrowding-related stress was common and weakly but significantly associated with self-reported medical errors. Findings support staffing review, workload management, early-career nurse support, and non-punitive error reporting.