Background Work-related musculoskeletal disorders (MSDs) represent a major occupational health burden among nurses worldwide, with prevalence rates reaching up to 90% in some settings. Despite the recognized importance of ergonomic rules in preventing these disorders, their application in clinical practice remains insufficient, particularly in low- and middle-income countries with constrained resources. This study addresses a critical research gap by providing the first comprehensive assessment of ergonomic knowledge, attitudes, and practices among nurses in Tunisia. Objective To assess the knowledge, attitudes, and practices (KAP) regarding ergonomic rules among nurses and to measure the prevalence and associated factors of MSDs. Methods A descriptive and analytical cross-sectional study was conducted among all eligible nursing staff (exhaustive sampling) in the two university hospital centers of Sfax, Tunisia, from January to March 2026. Data were collected using a sociodemographic and professional questionnaire, the validated Kergosien KAP questionnaire (originally validated by ALHazim et al., 2022, with Cronbach's alpha values of 0.67 for knowledge, 0.78 for attitudes, and 0.81 for practices), the Standardized Nordic Questionnaire for MSDs, and a self-administered REBA questionnaire to assess postural risk. Results Among 209 participating nurses (mean age 33.1 ± 7.9 years; 66.5% female), the mean knowledge score was 4.4 ± 1.6 out of 10 (44.2%), with only 10.5% demonstrating high knowledge. Attitudes were favorable in 85.6% (mean score 67.3 ± 12.3 out of 80). However, only 33.0% exhibited good ergonomic practices, revealing a marked KAP paradox. Self-reported REBA assessment showed high or very high postural risk in 85.6% of nurses. The 12-month MSD prevalence reached 93.8%, with the shoulder (69.9%), neck (67.5%), and lower back (67.0%) being the most affected regions. Bivariate analysis revealed that MSDs were significantly associated with older age, longer professional experience, absence of regular physical activity, poorer perceived health, and lower practice level (all p < 0.05). In contrast, MSDs were not significantly associated with knowledge or attitudes (both p > 0.05). Conclusions Despite favorable attitudes, poor ergonomic practices and very high self-reported postural risk explain the extremely high MSD prevalence. Multifaceted interventions that combine practical training, mechanical aids, work organization, and the promotion of physical activity are urgently needed.
