Global prevalence of workplace violence against emergency nurses: a systematic review and meta-analysis

Workplace violence (WPV) of emergency nurses is a widespread work-related risk with far-reaching consequences for clinician safety and long-term sustainability of healthcare delivery. Emergency departments (EDs) are stressful environments with stressors that increase the likelihood of physical and psychological aggression. This systematic review and meta-analysis aimed to estimate WPV prevalence, identify perpetrator profiles, and evaluate the environmental and systemic risk factors driving these hostile encounters to inform targeted organizational interventions and policy reforms. We searched PubMed/MEDLINE, Embase, CINAHL, and Web of Science from the start to April 2026. Included were observational studies reporting the prevalence of violations across the three categories (physical, verbal/psychological, or sexual) against emergency nurses. Two independent reviewers conducted screening, data extraction, and quality assessment using Joanna Briggs Institute (JBI) tools. We used a random-effects meta-analysis to estimate pooled prevalence with 95% confidence intervals (CI). We measured heterogeneity using the I2 statistic and evidence certainty using the GRADE approach. We included 29 studies (20,847 emergency nurses across 17 countries). The pooled global prevalence of any Workplace violence was 77.4% (95% CI: 72.3–82.1%). Verbal/psychological violence was the most frequent form at 77.0% (95% CI: 71.8–81.8%), followed by physical assault at 38.2% (95% CI: 32.1–44.6%) and sexual harassment at 18.5% (95% CI: 14.2–23.7%). The main offenders were patients (52%) and their relatives (27%). The highest prevalence was in Asia (82.1%) and North America (79.3%). ED overcrowding, long wait times, and inadequate security infrastructure were key risk factors. The effects recorded were intense psychological distress, burnout in the profession, and high turnover intention. Three-quarters of emergency nurses in the world have reported workplace violence. The high levels of verbal and physical aggression require immediate adoption of multi-level prevention strategies, such as increased security measures, zero-tolerance policies, and improved reporting systems. It is essential to address the systemic nature of ED violence to support the nursing workforce and quality of emergency care.