Why nursing students do not report workplace bullying during clinical practice: A mixed methods systematic review☆

Background: Workplace bullying in clinical nurse education significantly threatens students' well-being and professional development. Despite its prevalence, many incidents go unreported, exacerbating the issue and compromising the quality of care. A significant gap exists in the literature regarding comprehensive mixedmethods systematic reviews on unreported bullying incidents among nursing students. This review aims to address this knowledge gap and propose effective strategies to tackle this pervasive problem. Aim: This mixed-methods systematic review aimed to explore the factors influencing the non-reporting of workplace bullying incidents among nursing students during clinical practice. Design: Mixed-methods systematic review. Review methods and data sources: An extensive literature search was conducted across ten databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG, from database inception to November 1, 2023. Google Scholar and reference lists of included studies were also searched. Studies were selected based on eligibility criteria regarding population, phenomena of interest, and context. Two researchers independently assessed study quality, with disagreements resolved by a third reviewer. Relevant data were extracted and synthesized using the Joanna Briggs Institute's convergent integrated approach, ensuring a comprehensive integration of qualitative and quantitative findings. Results: Twenty-one studies met the inclusion criteria, comprising six qualitative, twelve quantitative, and three mixed-methods studies. Four integrated themes emerged from nursing students' perspectives on reasons for not reporting workplace bullying during clinical practice: (i) fear and concerns related to reporting, (ii) concerns about professional image, (iii) barriers and challenges in reporting, and (iv) perceived ineffectiveness of reporting. Conclusions: This systematic review provides valuable insights into nursing students' perspectives on the nonreporting of workplace bullying incidents during clinical practice. Understanding these reasons enables stakeholders to collaboratively develop interventions to create a safer and more supportive environment for nursing students, ultimately enhancing quality care and the well-being of healthcare professionals.