An Integrative Review of the Reporting and Underreporting of Workplace Aggression in Healthcare Settings

Keywords: Workplace Violence, Healthcare Workers, Verbal Abuse, Physical Aggression, Sexual Abuse, Assaults


Objectives.  Despite the prevalence of workplace aggression, workplace aggression is grossly underreported.  The purpose of this paper is to review the state of the science for the reporting and underreporting of WPA enacted by patients and/or visitors and then make recommendations for increasing the reporting of WPA. 

Design.  An integrative review process was used to select peer-reviewed articles describing the state of the body of evidence for the reporting and underreporting of workplace aggression. 

Data sources.  Articles were extracted from the Scopus database, a robust search engine that simultaneously searches over 20,000 peer-reviewed journals from over 5,000 international publishers.

Review methods.  Article inclusion criteria were publication date between January 1, 2000 and October 24, 2014, healthcare workers as the study population, and dependent variable related to workplace aggression reporting or workplace aggression underreporting.  The initial search yielded 237 citations.  All abstracts were read for direct or indirect relevance At the conclusion of this initial review, 33 articles met inclusion criteria.  The article reference lists were reviewed and seven additional articles were assessed for inclusion.  Twelve articles were retained, read in full, and critiqued. 

Results.  Twelve articles were retained, read in full, and critiqued.  The underreporting of workplace aggression was as high as 95%.  Reasons for not reporting workplace aggression included perceived lack of organizational change after reporting, violence considered part of the job, and aggression not intentional.  Reasons for reporting workplace aggression included workplace aggression that was perceived as intentional, when administrators took action based on incident reports, when the process for reporting was quick, easy, and efficient, when aggression was physical or resulted in an injury. 

Conclusion.  The reporting of workplace aggression is paramount to the future success of prevention interventions.  Any changes made to increase the reporting of workplace aggression will require healthcare worker buy-in as well as organizational and administrator support to be effective. 

Author Biographies

Gordon Lee Gillespie, University of Cincinnati

Dr. Gordon Gillespie is an Associate Professor and Robert Wood Johnson Foundation Nurse Faculty Scholar from the University of Cincinnati College of Nursing.  His research is focused on the prevention and mitigation of workplace violence.  His research is supported by the CDC-National Institute for Occupational Safety and Health and several private foundations.

Susie Leming-Lee, Vanderbilt University

Dr. Leming-Lee is an Assistant Professor at the Vanderbilt University School of Nursing.  

Terri Crutcher, Vanderbilt University

Dr. Crutcheris the Assistant Dean of Clinical Community Partnerships at the Vanderbilt University School of Nursing.


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How to Cite
Gillespie, G. L., Leming-Lee, S., & Crutcher, T. (2019). An Integrative Review of the Reporting and Underreporting of Workplace Aggression in Healthcare Settings. International Journal of Nursing, 5(1). Retrieved from
Nursing Administration