OBJECTIVE This paper is a report of a study to identify what operating room nurses believe influences patient safety and how they see their role in enhancing patient safety. BACKGROUND Research in health care shows that work experience, communication and the organization of work are key factors in patient safety. This study draws on Reason's definitions of active and latent errors to conceptualize the complex issues that affect patient safety in the operating room. METHODS The study reported here is part of an action research project at a university hospital in Iceland. Semi-structured interviews were conducted in 2004 with eight nurses, followed by two focus groups of four nurses each in 2005. Data were analysed using interpretive content analysis. RESULTS Securing patient safety and preventing mistakes were described as key elements in operating room nursing by all survey participants. In the interviews, the nurses identified the existing culture of prevention and protection that characterizes operating room nursing as crucial in enhancing safety. The organization of work into specialty teams was considered essential. Increased speed of work in an environment where enhanced productivity is imperative, as well as imbalance in staffing, was identified as the main threats to safety. CONCLUSIONS Operating room nurses have a common understanding of the core of their work, which is to ensure patient safety during operations. The work environment is increasingly characterized by latent error, i.e. system-based threats to patient safety that can materialize at any time. Interventions to enhance patient safety in operating room nursing are needed.