Barriers to Reporting Workplace Violence Among Emergency Nursing Staff: A Systematic Review and Meta-Analysis

BACKGROUND: Workplace violence (WPV) is highly prevalent in emergency departments and frequently remains unreported, compromising nurse safety and institutional accountability. PURPOSE: The purpose of this study was to identify barriers to emergency departments nurses reporting WPV incidents and the frequency of unreported WPV incidents. METHODS: A systematic review and meta-analysis was conducted, with 4 databases searched through April 2025. Cross-sectional and cohort studies examining reporting behaviors among emergency nurses were included. Random-effects models were applied to estimate pooled prevalence and odds ratios. RESULTS: Ten studies comprising 5812 emergency nurses met inclusion criteria. The pooled prevalence of unreported WPV was 64% (95% CI: 0.57-0.72). Verbal violence was significantly more likely to remain unreported than physical violence (OR 2.51, 95% CI: 1.40-4.49, P =.0019). Major barriers included perceptions of reporting futility, peer pressure, inadequate institutional support, and absence of clear reporting procedures. CONCLUSION: Underreporting of WPV among emergency nurses is substantial and driven by systemic and perceptual barriers, warranting structured institutional reforms to promote safer reporting environments.