Nurses’ Rationale for Underreporting of Patient and Visitor Perpetrated Workplace Violence: A Systematic Review

Background: Patient and visitor perpetrated workplace violence is a problem within healthcare and is known to be underreported by nurses and other healthcare workers. However, it is unclear why nurses choose not to report these violent events. This systematic review aimed to investigate nurses’ reasons and rationale related to underreporting of violence that occurs in the workplace and to summarize recommendations to solve this problem. Methods: : Following PRISMA guidelines for systematic review reporting, studies conducted between 2011 and early 2022 were identified from MEDLINE, CINAHL, APA PsychInfo, and Psychological and Behavioral Sciences Collection via EBSCOHost. Quantitative studies related to patient and visitor perpetrated violence containing explanations, reasons, or rationale related to underreporting were included. Results: : After quality appraisals, 19 studies representing 16 countries were included. The resulting themes identified nursing, management, and organizational factors. The most prominent nursing factors included nurses’ fear of consequences after reporting, nurses’ perceptions, and lack of knowledge about the reporting process. Common management factors which contributed to nursing underreporting included lack of visible changes after reporting, non-supportive culture in which to report, and lack of penalties for perpetrators. Organizational factors included the lack of policies/procedures/training for WPV and the reporting of it as well as a lack of an efficient and user-friendly reporting system. Supportive interventions from management, organizations, and community sources were summarized to provide insight to improve nurse reporting of workplace violence events. Conclusion: Underreporting of workplace violence is a complex and multi-faceted problem. An investigation into the rationale for underreporting a workplace violent event illustrates nurses, management, and organizations contribute to the problem. Clear and actionable recommendations such as the development of a clear and concise reporting process and educational support are addressed to encourage staff reporting. Comprehensive reporting processes are needed to help address workplace violence in healthcare.