Objective To construct a network structure based on the social ecological model, to analyze the interactions among individual, interpersonal, and environmental factors related to operating room misscare, and to identify key influencing nodes. Methods A convenience sampling method was adopted to recruit 256 operating room nurses.Data were collected using the Misscare Survey Operating Room Scale.R software was applied for network analysis to evaluate the centrality indicators of each factor and network stability. Results Totally 109 nurses (42.58%) reported at least one misscare. Scores of misscare items were concentrated in the legal and preparation dimensions.The dimension of teamwork scored the highest among all causes, and the item "B11 Insufficient auxiliary nursing staff and poor collaboration" scored the highest.Network analysis revealed that, factor B11 ranked first in strength, closeness and betweenness, functioning as a key cross-level node linking organizational resources, interpersonal collaboration, and individual practice factors. Conclusion Misscare in operating rooms is affected by multi-level factors.Shortage of auxiliary nursing staff and collaboration barriers act as key risk nodes. It is recommended to optimize staffing allocation and introduce standardized communication tools to reduce the incidence of misscare from a systematic perspective.