Impact of Nurses’ Sleep Quality on Clinical Performance: A Meta-Analysis Across Countries and Healthcare Units (2000–2025)

This study presents the first comprehensive meta-analysis and mixed-methods synthesis on the relationship between nurses’ sleep quality and clinical performance across global healthcare settings. Poor sleep among nurses has long been recognized as a risk to both workforce well-being and patient safety, yet prior evidence remained fragmented across countries, units, and study designs.

Following PRISMA 2020 and ENTREQ guidelines, 35 studies from 18 countries (2000–2025) were systematically reviewed and synthesized. Quantitative data from 27 studies were pooled using a random-effects model, yielding a moderate-to-strong association between poor sleep and reduced performance (Cohen’s d = 0.62; 95% CI: 0.48–0.76; p < 0.001). Subgroup analyses revealed that ICU (d = 0.71) and ER nurses (d = 0.66) were most affected, while general ward nurses experienced lower but still significant impairment (d = 0.49). Publication bias was suspected (Egger’s p = 0.04), but sensitivity analyses confirmed robustness of the pooled effect.

Eight qualitative and mixed-methods studies added depth, highlighting three recurring themes: emotional exhaustion and cognitive lapses, coping strategies influenced by cultural norms, and systemic barriers such as understaffing and rigid schedules. These insights underscore how organizational structures and cultural expectations intersect with individual sleep health.

Importantly, the synthesis identified promising interventions. Cognitive Behavioral Therapy for Insomnia (CBT-I), light therapy, and shift redesign demonstrated consistent improvements in both sleep quality and performance, while sleep hygiene education yielded mixed and short-term benefits.

Taken together, findings emphasize that inadequate sleep is not simply an individual issue but a structural workforce challenge. The study proposes a SMART-framed policy roadmap advocating for protected rest periods, forward-rotating schedules, and institutional recognition of sleep health as a core component of patient safety. This evidence provides critical guidance for policymakers, health administrators, and nurse leaders seeking to strengthen workforce sustainability and clinical outcomes.