Unsteady Foundations: The Effects of Environmental Instability on Nurses and Implications for Nursing Management—An Integrative Review

AIM: To determine the state of the science of how instability in the nursing practice environment affects nurses. BACKGROUND: The COVID-19 pandemic, workforce shortages, and an aging population have highlighted the critical need to build and maintain stable nursing practice environments. Factors such as staffing inconsistencies, fluctuating workloads, and workplace violence create instability. While research has explored nursing practice environments broadly, limited research has been conducted on how instability affects nurses. METHODS: An integrative review was conducted using CINAHL, PsycINFO, and PubMed, with search terms related to instability and fluctuations in the nursing practice environment. Articles from 2014 to 2026 were included if they addressed instability in the nursing practice environment and its impact on nurses in hospital settings. Fifteen studies were included in this integrative review. FINDINGS: Instability in the nursing practice environment has many sources. Organizational support plays a significant role in determining the magnitude and management of environmental instability. Adverse nurse outcomes from instability in the nursing practice environment include decreased well-being, increased turnover, and workplace violence. IMPLICATIONS FOR NURSING MANAGEMENT: Effective leadership and management are necessary to create and maintain positive nursing practice environments, manage environmental instability, and improve nurse well-being and retention. Targeted strategies such as collaborating with policymakers, strengthening the nursing workforce pipeline, and supporting nurses in their practice environments can mitigate environmental instability and its adverse effects on nurses. CONCLUSIONS: Instability is a common feature of nursing practice environments. Excessive instability can cause adverse nurse outcomes. Nurse leaders are optimally situated to mitigate environmental instability and provide leadership support to improve nurse outcomes.