BACKGROUND: Nurses have a crucial role in recognizing potential dangers to patient safety during direct patient care. However, there are occasions when they opt to stay quiet instead of voicing their concerns, ultimately endangering patients. The underlying reasons for this silence pose a significant challenge in the nursing industry. While it's known that workplace conditions contribute to this silence, the specific ways in which this occurs need to be clarified. This research aimed to investigate the factors that lead nurses to remain silent about patient safety, specifically focusing on environmental influences in Ardabil City. METHODS: This descriptive and analytical study examined 630 nurses, including head nurses, from five medical training centers in Ardabil, northwest Iran. The primary instruments used in the research included the Employee Silence about Patient Safety Questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of psychological safety, leader-member exchange (LMX) assessments, and evaluations of professional discrimination. Data analysis was performed using SPSS version 16.0, applying descriptive statistics, t-tests, ANOVA, Pearson's correlation coefficient, and hierarchical regression analysis. RESULTS: The average score for employee silence regarding patient safety was 2.62, with a standard deviation of 0.98. Several factors were found to be significant predictors of employees' silence about patient safety, including nurse participation in hospital affairs (ß = 0.196, p = 0.002), nurse's role in the quality of care (ß = -0.352, p <
0.001), staff and facility adequacy (ß = 0.156, p = 0.001), communication with the physician (ß = -0.105, p = 0.015), LMX (ß = -0.284, p <
0.001), and job position (ß = -0.093, p = 0.018). CONCLUSION: This study has identified several critical factors influencing employee silence regarding patient safety, including nurse involvement in hospital decision-making, the quality of care, communication with physicians, and job positions. To address these challenges, healthcare organizations must implement standardized protocols, improved communication channels, regular safety training, and the integration of advanced technologies. Increasing nurse participation in decision-making processes and strengthening communication between nursing staff and physicians can foster a culture of openness that encourages employees to voice their safety concerns. By creating an environment where staff feel supported and empowered to speak up, healthcare facilities can enhance patient safety and improve overall care quality, ultimately leading to a safer working environment for healthcare professionals.