Patterns and Potential Relationships of Organizational Silence Types Among Clinical Nurses: A Qualitative Meta‐Synthesis and Systematic Review
Honghu Chen, Xuan Cheng, Jiayu Liao, Jiayu Hou, Jiayi Liu, Weihong WangABSTRACT
Aims
To synthesize qualitative evidence on organizational silence among clinical nurses and examine relationships among motives, earlier organizational responses, and subsequent communication choices.
Design
A qualitative systematic review and meta‐synthesis.
Review Methods
One reviewer screened titles, abstracts, and full texts. A second reviewer verified extracted data. Two reviewers independently coded findings and appraised quality using the Joanna Briggs Institute qualitative checklist. Thomas and Harden's thematic synthesis was applied, followed by interpretation using social information processing theory.
Data Sources
Scopus, Embase, PubMed, PsycINFO, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Data, and the Chinese Scientific Journals Database were searched from inception to 6 October 2026. Initial searches were completed on 25 April 2026. Grey literature was not systematically searched.
Results
Nineteen reports yielded four analytical themes encompassing 12 subthemes: (1) Motives distinguished forms of organizational silence; (2) Earlier responses informed later expression and participation; (3) Communication route and timing shaped the distinction between expression and withholding; and (4) Organizational conditions constrained expression across motives. Nurses' accounts linked withholding to anticipated adverse consequences, perceived futility, and efforts to preserve working relationships. The synthesis distinguished delayed or indirect communication from continued withholding.
Conclusion
Established silence types describe motives rather than fixed categories of nurses. Shared contexts may inform different motives, but the synthesis does not establish transitions or causal pathways.
Implications for Nursing Practice
Clear escalation pathways, constructive responses from leaders, timely feedback, and a psychologically safe work environment may help nurses offer suggestions and voice work‐related concerns. These pathways should facilitate prompt escalation of urgent patient safety concerns.
Impact
The review addresses the interpretation of nurses' silence and communication choices. Findings clarify motivational boundaries and alternative expression, informing clinical supervision, debriefing, and speaking‐up systems for nurses and clinical leaders.
Reporting Method
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses 2020, supplemented by Enhancing Transparency in Reporting the Synthesis of Qualitative Research.
Patient or Public Contribution
No patients or members of the public were involved in this systematic review and qualitative meta‐synthesis because the study was based exclusively on previously published research.
Trial Registration
International Prospective Register of Systematic Reviews: CRD420261379111