Background Fire is an unintentional event characterized by the outbreak and spread of flames, which may occur on a small or large scale, causing significant damage and often being difficult to control. Hospitals are among the healthcare facilities at the highest risk of fire due to the extensive use of electrical equipment, medical gases, and the presence of vulnerable patients. The effectiveness of fire emergency mitigation and response in hospitals largely depends on the nurses preparedness as the medical first responders. As frontline healthcare professionals, nurses play a critical role in emergency preparedness and response to fire incidents. Aim of the Research This study aimed to analyze the factors influencing nurses preparedness for fire emergency response at Hospital X in 2026, including knowledge, attitudes, length of employment, fire emergency response training, availability of fire protection facilities and infrastructure, management support, compliance with Standard Operating Procedures (SOPs), safety culture, and nurses preparedness for fire emergencies. Method This study employed a quantitative cross-sectional design. Bivariate analysis was conducted using the Chi-square test with IBM SPSS Statistics version 26. Total sampling was applied, involving 93 nurses as respondents. Data were collected using a validated and reliable questionnaire and were further strengthened through data triangulation using semi-structured interviews and field observations. Results and Conclusions The findings revealed significant associations between nurses preparedness and attitude (p = 0.032; OR = 1.500; 95% CI: 0.674–3.339), fire emergency response training (p = 0.011; OR = 3.980; 95% CI: 0.660–24.080), management support (p = 0.011; OR = 3.980; 95% CI: 0.660–24.080), compliance with Standard Operating Procedures (SOPs) (p = 0.022; OR = 2.000; 95% CI: 0.500–7.997), and the availability of fire protection facilities and infrastructure (p = 0.022; OR = 2.000; 95% CI: 0.500–7.997) with nurses preparedness. Meanwhile, knowledge (p = 1.000; OR = 0.984; 95% CI: 0.952–1.016), length of employment (p = 0.151; OR = 1.077; 95% CI: 0.931–1.245), and safety culture (p = 1.000; OR = 0.987; 95% CI: 0.961–1.013) were not significantly associated with nurses preparedness. The analysis indicated that nurses who had participated in fire emergency response training and received adequate management support were approximately 3.98 times more likely to demonstrate good preparedness. In addition, nurses with positive attitudes were 1.5 times more likely to have good preparedness, while those who perceived the availability of fire protection facilities and infrastructure as adequate and those who complied with Standard Operating Procedures (SOPs) were each twice as likely to demonstrate good preparedness. The main challenges identified at Hospital X included a high risk of electrical hazards due to unsafe practices, such as the use of non-standard extension cords, kitchen appliances, and unattended mobile phone charging, the absence of internal nurse emergency response teams across all units, and a safety culture that remained predominantly oriented towards meeting hospital accreditation standards. Suggestions Hospital X is recommended to strengthen its fire preparedness system by enhancing safety culture, conducting regular inspections and maintenance of fire protection facilities, improving nurses competencies through periodic fire emergency training and evacuation drills, and reinforcing compliance with safety procedures to achieve optimal preparedness through the integration of organisational systems, management commitment, and human resources.