Effectiveness of supervision on patient safety during nursing students´ clinical practice: A systematic-narrative hybrid literature review

Aim: To synthesize empirical evidence on the effectiveness of supervision on patient safety of nursing students during clinical practice, students’ perceptions and the influencing factors. Background: Patient safety is a key component of nursing education, yet its integration into clinical practice remains inconsistent internationally, with supervision serving as an important determinant of students’ safety learning. Design: A systematic–narrative hybrid review (registered on PROSPERO: CRD42025636289), combining the methodological rigor of systematic reviews with interpretive depth of narrative synthesis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, ten databases were searched (January–August 2025) using SPIDER tool. Thirty-four empirical studies met the inclusion criteria and were critically appraised using the Mixed Methods Appraisal Tool. Qualitative and mixed-method evidence underwent inductive coding; quantitative findings were analyzed using correlation-based effect sizes. Finally, evidence was analyzed through convergent synthesis. Results: Three overarching themes emerged: (1) scope and models of safety supervision; (2) supervision as a determinant of patient safety; and (3) factors influencing safety supervision. Structured and supportive supervision models demonstrated moderate to strong associations with patient safety (r ≈ .30–.60). Key supervisory attributes included competence, authority, continuity and professional coherence in cooperation settings. The emotional aspects experienced by students during supervision are pivotal for their confidence in speaking up and acting safely. Supervisor- and student-related factors, as well as workplace determinants, further shaped the effectiveness of supervision. Conclusion: Supervision has a positive effect on nursing students' patient safety during clinical practice. Structured, supportive and psychologically safe supervision enhances students' competence, confidence and safety-oriented behaviors.