Background <p>Patient safety is a significant concern in healthcare settings, and speaking up for patient safety is essential for promoting the quality of care and preventing harm. However, nurses, including nursing students, often face barriers that hinder their ability to report safety concerns. In this study, we explored the nursing students’ experiences of barriers to speaking up for patient safety in clinical practice settings.</p> Methods <p>The study used an exploratory-descriptive qualitative design. Data were collected through semi-structured interviews with 19 final-year nursing students at the Tabriz Nursing and Midwifery Faculty between April and June 2023. The data were analyzed via conventional content analysis until data saturation was achieved.</p> Results <p>This study revealed the formation of three distinct categories: lack of communication and collaboration between healthcare professionals and students, inadequate preparation for speaking up for patients’ safety, and theory-practice disconnection in nursing education. These categories are composed of eight sub-categories.</p> Conclusion <p>The study found barriers that prevent nursing students from voicing concerns about patient safety in clinical settings. By understanding these obstacles, healthcare professionals can develop strategies to foster a safety culture and empower nursing students to advocate effectively for patient safety.</p> Clinical trial number <p>Not applicable.</p>