The perspectives of critical care nurses regarding the influence of staffing levels and workload on patients’ care quality and safety: a qualitative study from Saudi Arabia

High-pressure environments, such as ICUs and EDs, require optimal staffing levels to ensure patient safety, maintain care quality, and support staff wellbeing. Inadequate staffing and excessive nursing workloads have been consistently linked to poorer patient outcomes. This study explores the perspectives of frontline critical care nurses regarding how staffing levels and workload influence the quality and safety of patient care. A descriptive qualitative study was conducted at a public, government-funded tertiary hospital in Jeddah, Saudi Arabia. Purposive-convenience sampling was used to recruit 12 full-time critical care nurses (7 from the intensive care unit and 5 from the emergency department) for semi-structured interviews. The majority (75%) were female and 66.7% were Saudi. The data were analysed using Braun and Clarke’s reflexive thematic analysis. The analysis identified five major themes, summarized as follows: (i) workload reality: nurses consistently face unsafe nurse-to-patient ratios and physically demanding daily tasks; (ii) patient safety: high workloads force a rushed approach, causing delayed care and increasing the risk of incidents such as falls, self-extubation, and medication errors; (iii) nurse wellbeing: sustained workplace pressure leads to severe physical strain, psychological burnout, and high staff turnover; (iv) coping mechanisms: to manage demands, nurses rely heavily on informal team-based strategies; and (v) organizational improvements: proposed system-level interventions include hiring more registered nurses, utilizing patient care technicians (PCTs) for non-clinical tasks, and implementing automated charting. Staff shortages and high workloads compromise patient safety, the consistency of care, and workforce wellbeing in ICU and ED settings. While teamwork serves as the primary coping mechanism, systemic organizational improvements are critically required, including improved staffing, clearer role delineation, a reduction in non-nursing tasks, and greater support for nurses’ well-being to sustainably manage these high-pressure clinical environments.