The Reality of Under-Reporting Workplace Violence in Healthcare
Workplace violence in healthcare isn’t rare; in today’s environment, unfortunately, it’s routine.
Yet despite its prevalence, most incidents go unreported. And that silence comes at a cost. Reporting shapes everything: how leaders allocate resources, how teams are protected, and how seriously organizations take each threat. When what healthcare workers face each day isn’t fully documented, the data becomes skewed and teams are put at a significant disadvantage. As a result, they may lack essential safety resources because it is not evident that there is a pressing need for them, adding to the pressure on an already stressed team.
The Numbers Tell A Story – But Not the Whole Story
The statistics paint a sobering picture:
As many as 89% of healthcare WPV incidents go unreported.
76% of ER nurses said their decision to report would be based on whether the patient was perceived as being responsible for their action.
Half of verbal and physical assaults by patients against nurses are never reported in writing.
And 64% of ED staff reported that they felt violence was an expected part of their job.
These numbers explain why, even with growing awareness and stronger prevention strategies, the picture of violence that leaders see is still incomplete. The incidents that make headlines or official logs are only a fraction of what frontline staff experience.
Why So Many Incidents Go Unreported
Under-reporting isn’t driven by apathy– it’s driven by structural barriers, cultural norms, and emotional realities that build on each other.
A leading WPV study notes: “Much of the responsibility for entering incidents into the electronic system falls to unit supervisors, who may not have time to file reports, may have other tasks that demand priority, or may not be willing to admit that violence occurs on their units.”
When reporting depends on already stretched supervisors, incidents easily slip through the cracks– not because they aren’t serious, but because the process isn’t built for clinical realities. And once the system falters, the culture does too. Staff see reports disappearing, inconsistent follow-up, and patterns going unaddressed. Silence begins to feel easier, safer, or simply more realistic.
That cycle is clear in frontline experiences. The American Nurses Association has collected thousands of firsthand accounts, including this one:
“I have witnessed multiple incidents of extreme physical harm by patients who have a history of violent assaults or who have dissociated at the time of the attack. I have witnessed and tried to intervene in assaults that have led to several staff concussions and a broken leg. One of my colleagues was nearly choked to death by a teenager.
I have been kicked, punched, and had a chunk of my hair pulled out of my head when I resisted being bitten. Once, I heard one patient say to another, ‘You can do anything you want around here. The staff can’t do anything to you.’ And that person was right.
A few times when staff tried to press charges, the police who responded said this was part of the job– we had ‘signed up for it.’ After a few such calls, the hospital administration discouraged staff from pressing charges and told us we could no longer call the police department during codes.”
When leaders resign themselves to violence or dismiss it outright, employees start to see reporting as something pointless, risky, or emotionally draining.
What Stops Staff From Reporting Violence
From there, the reasons staff stay silent compound:
1. The process feels unclear or cumbersome. If calling for help or filing an incident takes more than a few clicks or steps, it often gets pushed aside– especially during a busy shift.
2. Staff assume nothing will change. When people don’t see action after submitting a report, trust erodes. Over time, silence feels easier than speaking up.
3. Fear of consequences. Some workers fear being blamed, questioned, or seen as “unable to handle it.”
4. Belief that violence is “part of the job.” This mindset, reinforced over the years, discourages people from naming or documenting what they’re enduring.
5. Emotional exhaustion. Reporting takes energy– and after an incident or a long shift, many staff simply want to move on. These are not personal failures– they are symptoms of a system that makes reporting difficult, unrewarding, or emotionally risky.
What Goes Missing When People Stay Silent
When incidents go unreported, the consequences ripple far beyond a single moment. Leaders lose visibility into patterns and root causes, making it challenging to adjust staffing, strengthen training, or allocate resources where they’re truly needed. Units facing repeated aggression may continue without essential support. And, individual staff members carry the emotional weight alone, often questioning whether their safety is truly a priority.
Here’s the reality that often does not make it into discussions about reporting: since violence is frequent and under-reporting is widespread, it is likely that repeat offenders and escalating severity are significantly under-recognized.
This doesn’t just distort the data. It increases risk, accelerates burnout, and drives up organizational costs.
This lack of visibility directly contributes to burnout, turnover, and higher workers’ comp and liability costs, part of the $18.3 billion hospitals lose annually due to violence.
Failing to adequately document and address workplace violence in healthcare creates a toxic cycle that normalizes the issue– quietly shaping culture, morale, and the overall sense of safety across the organization.
What the Data Doesn’t Capture
Statistics help leaders understand the scale of workplace violence, but they can’t capture what it feels like to live through it. They don’t show how a single incident, or more often a series of smaller ones, reshapes a clinician’s sense of safety, confidence, and identity. They don’t show how the fear lingers long after the shift ends.
Consider the story of nurse Gena Deck, whose experience is not an outlier, but a reflection of what countless healthcare workers endure.
In one attack, a patient who did not want to be discharged wrapped cords from an overhead monitor around her neck, choking her while shouting at her. She thought she might die. This assault wasn’t the first she had experienced– years earlier, she had been punched in the face by a teenage patient and later had equipment thrown at her by a distressed parent. Neither of those earlier incidents had been formally reported. She was told to “calm down,” offered little support, and expected to finish her shift.
Her physical injuries faded, but the psychological ones did not. Deck now experiences nightmares, heightened anxiety around large or loud patients, and a persistent sense of vulnerability in environments where she once felt confident. She describes the lasting impact clearly: “It changes who you are as a nurse.”
This is the part of workplace violence no dashboard can quantify– the erosion of trust, the emotional scar tissue, the way clinicians begin to brace themselves for the following incident because previous ones were minimized, ignored, or quietly accepted as part of the job. When these experiences are not acknowledged, validated, or addressed, they shape everything: retention, engagement, compassion fatigue, and whether someone feels they can continue in the profession at all.
What Leaders Can Do to Break the Silence
Fixing under-reporting isn’t about demanding more reports; it’s about creating environments where reporting is safe, simple, and meaningful. Before any solution can work, leaders have to start by listening. The social and cultural dynamics that fuel under-reporting, from fear of retaliation to generational norms to gender and racial power dynamics, vary widely across regions and staff makeup. There is no one-size-fits-all playbook. Leaders need to ask their teams what’s getting in the way, where trust has eroded, and what support actually feels useful before they begin making changes.
Shift the culture.
Violence cannot be accepted as “part of the job,” and teams need to hear that from leadership consistently.
Make reporting effortless.
Clear tools, fast workflows, and multiple ways to ask for help remove barriers.
Provide real-time support tools.
Staff need both the skills and the tools to navigate rising tensions. Regular de-escalation training helps teams recognize early warning signs and respond safely, while rapid, discreet ways to call for help– whether through mobile tools, workstation alerts, or wearables– ensure support arrives the moment it’s needed.
Ensure reporting always leads to action.
Close the feedback loop. Even minor updates rebuild trust.
Protect staff emotionally, not just physically.
Normalize conversations about violence. Reinforce that workers won’t be blamed.
When reporting becomes something that helps, not something to fear, teams begin to speak up. And when they speak up, leaders can finally see the real patterns that need support.
The Path Forward
Under-reporting will not change overnight. But every barrier removed, every expectation clarified, and every tool modernized makes it more likely that staff will raise their hand when something happens.
Because at the heart of this issue is a simple truth: “Without accurate data, the true extent and nature of the problem cannot be assessed."
Tags: “healthcare safety” “ hospital violence” “ workplace violence”
