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Paediatric medication administration errors (PMAEs) occur frequently, with devastating consequences for children and their families. This study explored the relationship between the nursing work environment and the occurrence of reported PMAEs. In total, 127 potential and 245 actual PMAEs were reported. Workload, distraction, and ineffective communication were identified as significant contributors to the occurrence of PMAEs. Medical/surgical units reported more errors than critical care environments (p=.000) and a 2.9% increase in the frequency of reported PMAEs was noted for each additional bed on units (p=.001). This study supports the awareness that a systems reform is required to reduce PMAEs.