Objective To systematically synthesize qualitative studies on the influencing factors of nurses′ medication safety management, and to provide evidence-based references for medical institutions to optimize medication safety management strategies and improve nurses′ performance capabilities. Methods A comprehensive search was conducted in PubMed, Embase, CNKI and other Chinese and English databases for qualitative studies on the influencing factors of nurses′ medication safety management, with the search period from the establishment of the databases to July 12, 2025. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research, and the study results were summarized and integrated using the meta-aggregation method.Results A total of 23 articles (8 Chinese, 15 English) involving 435 nurses were included. Eighty-four research findings were distilled into 13 categories, which were consolidated into five integrated results:nurse-related factors (professional medication knowledge and competence, medication safety responsibility attitudes and behaviors, physical and mental state), patient-related factors (physiological characteristics, consciousness state, subjective willingness and cognitive biases), organizational and management factors (team collaboration and communication, management systems and processes, information technology and equipment support, safety culture), work environment and resource allocation factors (environmental distractions, insufficient resource allocation), and medication-related factors (similar packaging and naming). Conclusion Nurses′ medication safety management is jointly influenced by multiple factors at different levels. Medical institutions should strengthen hierarchical training and physical and mental support for nurses, enhance patient medication education and communication, optimize organizational management systems and work environments, promote differentiated design of medication packaging and naming, and implement other synergistic measures to comprehensively improve the level of nurses′ medication safety management.