Empowerment in Nursing: A Systematic Review of Its Association With Patient Safety Culture

Empowerment in nursing is increasingly recognized as an important determinant of patient safety culture as the primary outcome, with patient safety activities reported as secondary outcomes where applicable. This systematic review and meta-analysis aimed to synthesize the evidence on the association between nursing empowerment and patient safety culture and to examine whether different types of empowerment were associated with variation in effect estimates. A comprehensive search was conducted in Google Scholar, PubMed, and ScienceDirect, with the final search completed on 6th March 2026. Eligible studies included quantitative primary studies of nurses in clinical settings that reported sufficient data for effect-size estimation. Data were pooled using a random-effects meta-analysis, and subgroup, sensitivity, and reporting-bias analyses were performed. Seven studies met the inclusion criteria, comprising six cross-sectional studies and one randomized controlled trial (RCT), with a total of 1,079 participants. The meta-analysis demonstrated a statistically significant and large pooled association between nursing empowerment and patient safety culture (r = 0.721, 95% CI: 0.424 to 0.878, p < 0.001), although heterogeneity was very high (I² = 98.28%, Q(7) = 460.96, p < 0.001), with a wide prediction interval (r = -0.420 to 0.979). Subgroup analysis showed that psychological empowerment had a significant positive effect (β = 1.2385, p = 0.0022), structural empowerment showed a marginal effect (p = 0.0547), and empowerment programs were not statistically significant (p = 0.2292). Sensitivity analysis indicated that the overall finding was robust, although one study contributed disproportionately to heterogeneity. The funnel plot did not indicate asymmetry upon visual inspection, and Egger's test showed no evidence of publication bias (z = -0.03, p = 0.978). Overall, nursing empowerment was associated with better patient safety culture, but the magnitude and consistency of this association varied across empowerment types and study contexts.