Because of the nature of nursing practice, nurses faced risk in the workplace [1]. This could result in significant acute and long-term adverse health outcomes for nurses. Hazards commonly observed in hospitals included actual physical and environmental hazards-toxic chemicals, radiation, infectious diseases-and psychosocial hazards such as stress [11213]. In addition, nurses perceived an increase in risk after experiencing physical and psychological demands, such as shift changes, long working hours, and overtime requirements at work [14]. The health risks faced by nurses, including physical demands such as lifting or moving patients, standing for long periods, chemical exposure, and potential exposure to violence, continued for the duration of nurses' employment in hospitals [14]. In addition, nurses were expected to work hard in such situations. Therefore, while dealing with these issues, nurses need to maintain their own health and safety [115]. If a hazardous substance cannot be eliminated, minimization of exposure or perceived risk is required to ensure nurses' health and well-being [16].

The implementation of measures to ensure employees' health and safety in hospital environments was important in the delivery of care in healthcare systems. In addition, as healthcare providers, nurses were required to consider means through which to keep their work environments safe for their patients and colleagues [17]. Healthcare workers' behavior could either increase or reduce the risk of injury [1]. According to Griffith [15], nurses and their employers should work together to ensure the implementation of health and safety measures in the workplace. While safe hospital environments could protect healthcare workers, safety was accomplished through individual efforts to engage in safe practices[13]. In addition, the implementation of measures to ensure staff members' health and safety is a legal requirement in the Occupational Health and Safety Act in Korea, which requires assessment of workplace risk as failure to identify hazards is likely to increase the severity of harm. Therefore, this law stipulates that risks should be reduced so far as is reasonably practicable[3]. In addition, healthcare workers have the right to be protected from harm [17].

Safety culture is an important issue in hospital environments and reduces exposure to risk in the workplace. Some studies reported that organizational culture was associated with all types of injury in nurses [13]. The structure and design of healthcare environments could affect the health and well-being of patients, nurses, and visitors. The back, neck, and leg strain and injury described by nurses was likely to be related to the poor design of work areas, and the results of some studies suggested that unit design contributed to fatigue and back pain in nurses [18]. The American Nurse Association [19] defined "a healthy workplace" as one that is safe and satisfying. In fact, leaders, managers, healthcare workers, and bedside staff could establish a culture of safety. When all of these individuals accepted responsibility as part of a patient-centered team, they performed their duties with consideration of the health and safety of both patients and healthcare workers. A culture of safety protected workers' health and safety and was included in management commitment, communication, safety prioritization, and supported for safe working practices and work environments that were supportive of safety and minimal work-related burden. Nurses' safety could be ensured via a culture of safety in hospitals [1319].

Education and training constituted an important component of nurses' safety [2]. Although nurses could not avoid exposure to toxins in the workplace, knowledge of the dangers of cumulative exposure could allow them to limit their contact with toxins as much as possible [16]. Smith [16] stated that nurses required education to make changes in the workplace. Nurses and other healthcare providers should also receive training in locating information regarding ways to protect their health. A report regarding nurses' safety emphasized the role of education and training in anatomical functioning. Moreover, new models of education were required to foster staff competence, which could lead to a reduction in the number of work-related injuries that occurred in patient care settings [12212223]. Nelson and Baptiste [22] posited that the prevention of injuries resulting from patient handling required not only equipment with which to move patients but also appropriate training in handling the equipment.

Through education, nurses could develop their knowledge regarding toxic substances and limit their exposure as much as possible, ensuring their safety. Furthermore, nurses should educate other nursing staff and be willing to learn from experts [216].

Several factors influenced both nurses' and patients' safety. Legislation could be used to initiate procedures designed to ensure safety for nurses and patients. In addition, nurses could promote their own safety and that of others through the implementation of regulations. Moreover, the interaction between politics, policy, and advocacy could help to create safe working conditions for nurses [1]. Trim and Elliott [20] reported that the provision of activities designed to increase healthcare providers' knowledge, including sharps awareness campaigns and education, was required to reduce their risk of sustaining sharps injuries. In addition, legislation was passed to protect healthcare providers from sharps injuries, and healthcare organizations were required to implement protective devices for employees [20]. The federal Needle Stick Safety and Prevention Act was approved in the United States in late 2000, and specific provisions to ensure healthcare workers' safety were established in public law and took effect on April 18, 2001. Healthcare facilities have since been obliged to eliminate or reduce healthcare workers' exposure to blood-borne infections and provided safer devices for injection and intravenous treatment. Healthcare organizations' implementation of safety regulations for hospital employees was no longer a recommendation and became a matter of law [27].

Nurses' safety should allow them to continue to help patients [9] as they were unable to when they experienced injury, illness, infection, stress, or burnout [11]. Nurses typically focused on the provision of high quality nursing care. However, nurses should take care of themselves to maintain their ability to provide care for patients and preserve the quality of the services that they provide [1]. When nurses' workplaces were safe, they were able to practice without the threat of injury. Additional advantages of safety in the workplace included increased job satisfaction, lack of pain, and sustainability in professional careers. All of these factors allowed nurses to continue to work competently [2].

If nurses were concerned about their safety, this interfered with their ability to deliver high-quality care. Moreover, patients did not receive the standard of care that they deserved while nurses were stressed, overworked, and worried about their own health and safety [119]. Some studies reported that, when nurses were injured or involved in accidents in the workplace, patients were placed at risk because nurses could make mistakes such as those involving medication errors, failure to notice patients' symptoms, and failure to rescue [119]. Nurses and patients shared the same hazards, as they shared the same environments. Therefore, improvement of nurses' well-being enhanced that of patients [111323]. There was a clear link between patients' and nurses' safety, improvement of nurses' safety, comfort, and dignity was shown to benefit patients [12].

In an online survey conducted by the American Nurses Association, 88% of nurses reported that health and safety concerns influenced their decision to remain in the profession [23]. No nurse was protected from risk entirely. In fact, the negative consequences of risks to nurses' health included increased sick leave, absenteeism, conflict, job dissatisfaction, reduced retention rates, and high turnover rates [225]. In addition, stress resulting from working in an unsafe environment could lead to various work-related problems such as staff conflict, high staff turnover rates, and reduced practice effectiveness [2]. The establishment of healthy work environments could increase nurses' job satisfaction and retention rates. When employee safety was considered and valued, employees were felt appreciated [4].

With the essential elements of the concept in mind, nurses' safety was considered to involve the following attributes: the minimization of actual or perceived risk, personal duties and rights, and ensuring within a safe working environment. The antecedents of nurses' safety included the need for nurses to be vigilant and possessed knowledge regarding health and safety, the need for organizations to implement safety measures for nurses, and the need for legislation to protect nurses from risk. Once nurses' safety was established, they were able to continue working competently; in addition, the quality of patient care enhanced, and turnover rates decreased. The attributes, antecedents, and consequences of nurses' safety are shown in Figure 2.