Aim: The main purpose of this study is to determine the factors which influences pediatric emergency nurses to report medication errors. Methods: The study utilized descriptive correlation design with 200 conveniently selected pediatric emergency nurses from the tertiary hospitals in Saudi Arabia. SPSS Ver. 17.0 to was used to determine the average weighted mean, standard deviation and rank. Results: The fear towards the consequences, being blamed, and punishment by the organization hinders the nurses from reporting medication errors. However, the nurses will likely report errors when the incidence is potentially or absolutely harmful to their pediatric patients. When the incident is perceived beneficial and without fear of retaliating, it is more likely that errors are reportable. The positive relationship of the nurses to their supervisors also influences the likelihood of reporting the error. Conclusion: Accountability and fear are barriers to pediatric emergency nurses to conceal the errors. The administrative role in education and trainings, utilization of research, and standardization of operating procedures are recommended to create a flawless reporting system. This will make reporting mandatory, or nurses become driven to voluntarily report which will enhance the patients’ safety and ensure delivery of quality health care.