What type of workplace violence is most commonly underreported in healthcare settings?
The most commonly underreported type of workplace violence in healthcare settings is non-physical violence—especially verbal abuse (including yelling, insults, threats, and intimidation). Studies consistently show that verbal abuse happens far more often than physical assaults, yet it is less likely to be formally reported through hospital incident systems.
Workplace violence (WPV) in healthcare is often described as a spectrum that includes physical assault, threats, verbal abuse, bullying/mobbing, sexual harassment, and other forms of psychological aggression. Across countries and settings, the highest-prevalence category is typically verbal abuse, and the reporting gap is widest for these “everyday” aggressive interactions that staff may normalize as “part of the job.” A large synthesis of observational evidence found verbal abuse to be the most prevalent form of WPV against healthcare professionals. This matters because what gets measured gets managed: if the most frequent violence is also the least documented, organizations underestimate risk, under-resource prevention, and fail to protect staff—especially nurses and frontline clinicians who experience the bulk of patient- and visitor-perpetrated aggression.
Why verbal abuse is underreported more than physical assault
Multiple studies show a clear pattern: physical assault tends to be reported at higher rates than verbal abuse, even when verbal abuse is more common. For example, one hospital-based study examining reporting barriers found that verbal abuse had a markedly lower formal reporting rate compared with physical assault. Another study similarly concluded that underreporting is more common for verbal abuse than for physical violence, despite frequent experiences of verbal aggression from patients or visitors.
Several practical and cultural reasons drive this imbalance:
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Normalization and minimization
Verbal abuse can be dismissed as “venting,” “stress,” or “not serious enough.” Over time, repeated exposure can create a workplace culture where staff only report incidents that cause visible injury. When violence is normalized, reporting feels unnecessary—or even naïve—especially for experienced nurses who have seen the same behaviors go unaddressed. -
Ambiguity about what “counts”
Physical assault is easier to define (“hit,” “kicked,” “bit”). Verbal abuse and threats can be subjective in the moment: Was that a threat or just anger? Was it harassment or a rude comment? When definitions feel fuzzy, staff may choose not to report to avoid being challenged or having to “prove” harm. Research on WPV reporting behaviors emphasizes that classification and perception of severity influence whether a clinician reports formally. -
Perceived futility and lack of follow-through
A recurring barrier is the belief that nothing will happen after reporting—no consequences for the perpetrator, no changes to security, no staffing support, and no feedback loop. When staff do not see outcomes from prior reports, they understandably stop spending time on documentation. Studies of underreporting highlight organizational response as a major determinant of whether workers continue reporting. -
Time burden and workflow friction
Reporting systems can be lengthy, hard to access, or not integrated into clinical workflow. In fast-paced environments (ED, inpatient units), clinicians may prioritize patient care tasks, charting, and medication administration over completing an incident report—especially when the incident is “only” verbal. -
Fear of blame, stigma, or being seen as “not resilient”
Some staff avoid reporting because they worry about being judged (e.g., “You escalated the patient,” “You should have de-escalated better,” or “This is just part of the job.”). This is especially relevant to verbal abuse, because it’s sometimes framed as a communication problem rather than violence.
Underreporting is not just a documentation issue—it’s a safety and quality issue
When verbal abuse and threats go unreported, organizations lose the opportunity to identify patterns (repeat offenders, high-risk times/locations, staffing triggers) and to design prevention strategies. Underreporting also distorts risk assessments: leadership may conclude WPV is “rare,” then underinvest in training, security measures, environmental controls, or staffing supports. Research on systematic violence monitoring shows that strengthening surveillance and reporting can reveal hidden burdens of WPV and improve prevention planning.
Importantly, verbal abuse is not “harmless.” Repeated exposure is associated with burnout, psychological distress, reduced job satisfaction, intent to leave, and impaired team communication—all of which can affect patient safety. Reviews of WPV in healthcare describe wide-ranging harms to worker wellbeing and organizational functioning, even when incidents are non-physical.
What healthcare organizations can do to improve reporting of verbal abuse
If verbal abuse is the most underreported, improving reporting requires making it easy, expected, and worthwhile:
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Make definitions explicit and visible: Provide clear examples of verbal abuse, threats, harassment, and bullying; emphasize that these are reportable safety events (not “behavior problems” staff must tolerate).
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Reduce friction: One-click reporting links in the EHR, brief structured forms, mobile-accessible options, and the ability to file quick initial reports with follow-up later.
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Close the loop: Share outcomes and trends (unit dashboards, monthly feedback). When staff see action—security changes, visitor restrictions, behavioral care plans—they report more.
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Adopt a just culture approach: Emphasize safety and learning rather than blame. Protect staff from retaliation or ridicule.
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Train leaders: Frontline managers must respond consistently, document appropriately, and support employees after incidents.
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Use multiple data streams: Combine incident reports with security logs, patient relations complaints, staff surveys, and occupational health visits to reduce “single-system blindness.”
Bottom line
Healthcare workplace violence is frequently underreported overall, but verbal abuse and other non-physical psychological forms of violence are the most commonly underreported. The combination of high frequency, normalization, and low perceived payoff from reporting makes verbal abuse the hardest category to capture—yet addressing it is essential for workforce retention, clinician wellbeing, and patient safety.
References
Arnetz, J. E., Hamblin, L., Ager, J., Aranyos, D., Upfal, M. J., & Luborsky, M. (2015). Underreporting of workplace violence: Comparison of self-report and actual documentation of hospital incidents. Workplace Health & Safety, 63(5), 200–210. https://pmc.ncbi.nlm.nih.gov/articles/PMC5006066/
Kim, S., Chae, W., & Lee, K. (2020). Relationships between nurses’ experiences of workplace violence, emotional labor, and professional quality of life. Journal of Nursing Management. https://pmc.ncbi.nlm.nih.gov/articles/PMC8894792/
Lee, J., Kim, M., & colleagues. (2024). Nurses’ workplace violence reporting behaviours and reasons for not formally reporting. Journal of Nursing Management. https://pmc.ncbi.nlm.nih.gov/articles/PMC12409287/
Lim, M. C., et al. (2022). Workplace violence in healthcare settings: Risk factors and prevention strategies. International Journal of Environmental Research and Public Health, 19(9). https://pmc.ncbi.nlm.nih.gov/articles/PMC9206999/
Song, C., Wang, G., Wu, X., & Li, L. (2020). Frequency and barriers of reporting workplace violence in healthcare workers. BMC Nursing. https://pmc.ncbi.nlm.nih.gov/articles/PMC7859538/
Veronesi, G., et al. (2023). Systematic violence monitoring to reduce underreporting of workplace violence against health care workers. JMIR Public Health and Surveillance, 9, e47377. https://publichealth.jmir.org/2023/1/e47377/
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