Abstract
Background/Objectives: Problematic smartphone use is common among nursing students and has been linked to academic and psychosocial difficulties. This PROSPERO-registered systematic review (CRD42024559668) identified the instruments used to assess smartphone addiction in nursing students and, secondarily, pooled typical addiction levels using the Smartphone Addiction Scale-Short Version (SAS-SV; 10-60) and examined psychosocial correlates. Methods: Following PRISMA 2020, we searched PubMed, Scopus, Web of Science, CINAHL and ScienceDirect from 1 January 2014 to 9 May 2024. Eligible studies assessed problematic smartphone use in undergraduate nursing students with validated instruments, while development-only studies and pandemic-specific contexts were excluded. Methodological quality was appraised using the JBI checklist, and a random-effects meta-analysis was performed to estimate pooled scores and explore cross-study variability. Results: Fifty-three studies met inclusion; eleven contributed to the SAS-SV meta-analysis (N = 5586). The pooled mean score was 29.5 (95% CI 27.7-31.3), with very high heterogeneity (I(2) = 98%). Sensitivity analyses yielded similar results, and no publication bias was detected. Across studies, higher smartphone addiction was correlated with elevated stress and anxiety, sleep disturbance, and poorer academic and clinical performance. Conclusions: Nursing students' SAS-SV scores cluster around ~29/60, with substantial between-study variability. Higher addiction scores were consistently associated with stress, anxiety, poor sleep, and reduced academic and clinical performance. However, interpretation is limited by the cross-sectional nature of the included studies and the very high heterogeneity observed. Standardising measurement is essential, but equally important is developing targeted educational interventions to foster healthier smartphone habits in nursing education. These results may guide nursing educators and institutions to design programs that foster healthier digital habits and support students' academic and clinical performance.