This study aims to explore the impact of individual workload and fatigue levels on the sleep quality of operating room (OR) nurses, highlighting a critical aspect of healthcare professionals' well-being that directly affects patient safety and care quality. Operating room nurses face unique challenges due to the high-stress, fast-paced environment of surgical settings, which can lead to increased stress levels, emotional challenges, and a higher incidence of fatigue compared to other nursing specialties. Factors contributing to this fatigue include the demanding nature of surgical procedures, the need for constant vigilance, and the irregular hours associated with shift work, all of which can impair sleep quality.

The literature review suggests that while the relationship between workload, fatigue, and sleep quality has been extensively studied in general nursing populations, there is a lack of specific focus on operating room nurses. These professionals work under distinct conditions that may exacerbate the effects of workload and fatigue on sleep quality, yet comprehensive studies targeting this group are limited. Understanding the nuances of how workload and fatigue specifically impact the sleep quality of OR nurses is crucial for developing targeted interventions aimed at improving their health and job performance, thereby enhancing patient care and safety.

This cross-sectional and correlational study seeks to fill the gap in the literature by examining the specific effects of workload and fatigue on sleep perception among OR nurses. By identifying these relationships, the study aims to contribute valuable insights into strategies for mitigating fatigue and improving sleep among this critical group of healthcare workers, with the ultimate goal of ensuring both nurse well-being and patient safety.

Operating room nurses play a critical role in surgical environments (Aorn 2020). The intense pace of the operating room environment can expose nurses to high workloads, increased stress levels, and emotional challenges (Alrawashdeh H 2021) (Teymoori, E 2022). The continuously changing and complex structure of modern healthcare services can further deepen these effects. Specifically, emergencies or unexpected complications during surgery can expose operating room nurses to different stress factors compared to other nurses (Teymoori, E 2022). The intense work environment of operating room nurses subjects them to high workloads and stressors, leading to stress and fatigue due to various factors (Jang 2021; Yuan SC 2011, Fang 2008, Shahzad, 2021). Fatigue represents a reduction in physical and emotional energy, a lack of motivation, and a general sense of exhaustion. Fatigue in nurses has been associated with factors such as high workloads, inadequate workplace support, challenging physical conditions, and shift work (Khande 2017). Particularly, day and night shifts can lead to increased workloads and consequently to higher rates of anxiety and depression (Warren 2008, Jang 2021 Barker 2011 Smith-Miller 2018 Clendon J 2019 Rathore H 2012 Yang YH 2012 Lee EJ 2014). This situation can lead to acute or chronic fatigue and even negative cycles (Barker LM 2011, Kawano 2008).

Workload is one of the biggest challenges faced by operating room nurses. The perception of workload among nurses can negatively affect their levels of fatigue, which in turn can reduce sleep quality (Cho, H. 2022; Dong 2017; Liu, Y., 2022). High workload can deplete nurses' physical and emotional energies (Akansel 2019)(Fan, 2021; Ghasemi,2019), leading to increased levels of fatigue. It can also negatively affect their decision-making abilities during critical surgical procedures. Moreover, high levels of fatigue can reduce the quality of care provided by nurses to patients, leading to negative effects on patient safety and treatment outcomes (Cho 2022)(Cho, H. 2022) (Dong 2017)(Metthevs 2011) (Liu, Y., 2022) and thus can affect sleep quality (Lin 2014).

Sleep quality is a critical factor for the overall health and job performance of operating room nurses. Generally, among health professionals, the primary causes of fatigue include circadian rhythm sleep disorders and sleep deprivation (Garrubba 2019, Jang 2021) Insomnia not only causes fatigue in nurses but can also negatively affect their psychomotor skills, reduce motivation and job performance, and impair their ability to maintain safe workplace behaviors (Dong 2017, Warren 2008, Choi UE 2016 Seol2018) This situation can lead to errors in procedures performed on patients and even harm to themselves [^8,Huckels-Baumgart, S.,2017) (Jones, T.2014) (Minnick, A 2012) (Pugh, C. 2011). Therefore, fatigue in operating room nurses not only affects them but also directly impacts patient safety and care quality (Garrubba 2019, Jang 2021) Preventing fatigue and eliminating the adverse conditions resulting from fatigue are essential for the safety of both patients and healthcare workers (Warren 2008, Smith-Miller 2014).

The effects of workload and fatigue levels on sleep quality among operating room nurses are significant issues for the nurses' overall health and job performance. The literature extensively examines the relationship between workload, fatigue, and sleep quality (Fan, 2021; Ghasemi,2019). Specifically, understanding the fatigue levels of operating room nurses is vital for the safety and health of both patients and nurses (Yamin 2020; Gurses 2009). The relationship between workload perception and sleep quality is critical for optimizing nurses' clinical performance and patients' health outcomes (Metthevs 2011). It has been indicated that a high perception of workload can have negative effects on fatigue and sleep quality.

The literature generally focuses on the general nurse population and has not sufficiently examined the demographic characteristics of operating room nurses and the potential effects of these characteristics on workload perception, fatigue, and sleep quality. Moreover, comprehensive studies specifically focusing on this topic are limited. The unique working conditions of operating room nurses, and the relationship between workload perception, fatigue, and sleep quality, should be examined more specifically and in detail. The findings obtained will contribute to the development of strategies to reduce fatigue among operating room nurses and improve their perception of sleep. This study will be conducted with the aim of determining the impact of individual workload and fatigue levels on sleep perception among operating room nurses and identifying the relationship between them.](streamdown:incomplete-link)

Inclusion Criteria:

• Nurses who have been working as operating room nurses in the hospitals where the study is conducted for at least one year,
• Nurses who are willing to participate in the study will be included.

Exclusion Criteria:

• Data from nurses who wish to withdraw from the study at any stage will be excluded from the research.

The study focuses on operating room (OR) nurses with at least one year of experience in various hospitals. These participants are chosen for their specialized knowledge in the surgical environment, ensuring they provide insights into workload, fatigue, and sleep quality. Inclusion is based on voluntary consent, aiming to collect data from a group well-versed in the unique challenges and stressors of OR settings. This demographic is particularly valuable for exploring how their demanding roles affect sleep and well-being.

The IPD sharing plan ensures confidentiality and ethical compliance, using a secure, anonymized database for data access by verified researchers post-publication. Key aspects include anonymization, controlled access, a data use agreement, a sharing timeline, supporting documentation, and ethical oversight. This strategy balances scientific advancement with participant privacy.