Upward violence against nurse managers in the workplace: a scoping review of prevalence, influencing factors and coping strategies

Zhiwei Xu¹Li Li²Xiaomei Gan²Wenfang Mu^3*Ying Wu^1*

• ¹Department of Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
• ²Department of Nursing, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
• ³Department of Nursing, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Background Although workplace violence is a well-documented concern in healthcare, most research has focused on vertical and horizontal forms, with limited attention to upward violence. This overlooked phenomenon may undermine nurse managers' occupational well-being and diminish their organizational commitment. To address this gap, this scoping review synthesizes and maps the existing evidence on upward violence against nurse managers. Methods We searched relevant literature available in such academic databases as MEDLINE, Embase, CINAHL, APA PsycINFO, Cochrane Library, PubMed and Web of Science. The retrieval time limit was from the establishment of the database to March 2025. Results A total of 9 articles were included, among which there were 5 quantitative studies, 3 qualitative studies and 1 mixed-methods study. The nurse managers are facing upward violence in the workplace. Its occurrence is affected by leadership styles, role overload, organizational restructuring, hostile emotions, and resource allocation, and it will cause harm to the managers in terms of physical, psychological, financial, work quality and career development. Confrontation, critical conversations, silence, incident reporting, environmental support and leaving or transferring departments are the main coping styles of nurse managers in this review. Conclusion In the future, high-level nursing managers should pay more attention to the problem of upward violence, and at the same time strengthen the manager's awareness of reporting and formulate corresponding intervention strategies according to its characteristics to reduce its negative impact.