Objective <p>This research evaluated the effectiveness of risk management strategies in enhancing nursing management quality and improving patient satisfaction in the operating room setting.</p> Methods <p>A quasi-experimental design was adopted to compare outcomes between two patient groups in the operating room. The observation group (<i>n</i> = 49) received nursing care guided by structured risk management protocols, while the routine group (<i>n</i> = 42) received conventional nursing management. Outcome indicators included the incidence of nursing-related risk events, comprehensive nursing quality scores (covering basic care, aseptic practices, documentation quality, item management, and safety protocols), nursing staff’s risk management cognition (awareness, attitude, and behavior), and patient satisfaction levels.</p> Results <p>Compared to the routine group, the observation group demonstrated a significantly lower incidence of nursing risk events (<i>P</i> &lt; 0.05). Scores for nursing quality across all domains—including aseptic practices and safety management—were markedly higher in the risk-managed group (<i>P</i> &lt; 0.05). Nursing staff in the observation group also exhibited enhanced risk cognition, more proactive attitudes, and stronger risk management behaviors (<i>P</i> &lt; 0.05). Furthermore, patient satisfaction scores were significantly improved in the risk-managed group.</p> Conclusion <p>Implementation of structured risk management strategies in the operating room leads to measurable improvements in nursing quality, enhances staff risk awareness and practices, and significantly boosts patient satisfaction. These findings support broader integration of risk-based nursing protocols into perioperative care systems to ensure safer and higher-quality patient outcomes.</p>