Understanding the Second Victim Phenomenon

In a well-publicized case, a nurse at Seattle Children’s Hospital mistakenly administered 10 times the prescribed dose of calcium chloride to an eight-month-old baby. The baby died. The nurse immediately reported the error, the only serious medical error she made in her 24-year career. She was escorted from the hospital, placed on administrative leave, and eventually fired. Seven months later, she committed suicide. The incident left many nurses wondering, “Could this happen to me?”

In the high-stress health care work environment, medical errors are always a concern. The patient is the first victim to suffer but there is almost always a second victim: the health care professional who was responsible for the mistake. These second victims may suffer in silence, feeling guilty and ashamed. Their confidence is shattered and they agonize over the incident. Some eventually recover and move on, but others never do―and they are never the same.

Punishment Isn’t the Answer

Health care organizations can, in fact, help prevent second victim phenomenon by instituting programs to support these victims rather than choosing punitive actions, which can deter nurses from reporting errors. Education, supervision, and making reparations to the patient or family are more effective approaches and provide second victims with a sense of control and a belief that they can continue in their career with the ability to prevent such an error from happening again. By stressing confidentiality and emotional support, health care facilities can avoid the “blame game” that does nothing to help second victims or reduce future medical errors for that matter.

Supporting the Second Victim

Although support for second victims is often lacking, some facilities are recognizing the need to help them. In an attempt to gain greater insight, the University of Missouri Health System interviewed 31 professionals identified as having possibly suffered from a second victim experience. The victims described their experiences as life-altering, recalling them as “an emotional tsunami” or “the darkest hour of my professional career.” 

Through an internal culture survey, UMHS learned that nearly one out of seven staff members had been involved in a patient safety incident within the past year that caused them personal problems, including depression, anxiety, and concerns about their job performance. Perhaps most disturbing, 68% of these staff members reported that they had received no institutional support in dealing with the emotional fallout. 

UMHS has subsequently launched a program that provides emotional interventions for health care providers at difficult times. A team of peers listens and supports coworkers when needed. All discussions are completely confidential. The Johns Hopkins Hospital has also established a Second Victims Work Group that is developing support strategies, particularly a peer-support program, for health care professionals within the system.

Recognition and Intervention

Researchers have found that, in many cases, second victims develop their own way of coping, finding that they all went through a similar six-stage recovery process:

  • Chaos and accident response―realizing the error 
  • Intrusive reflections―reevaluating the event and self-isolation
  • Restoration of personal integrity—managing gossip, questioning trust
  • Enduring the inquisition—realizing the seriousness, worrying about repercussions
  • Seeking emotional comfort—where to turn for help?
  • Moving on—dropping out (changing jobs or careers), surviving (coping), or thriving (gaining insight, learning from the event).

Health care organizations can help prevent the second victim phenomenon by:

  • Recognizing the negative impact that medical errors have not only on patient care but also on the health care professional responsible for the mistake.
  • Implementing formal programs to assist health care professionals who are suffering. 
  • Responding swiftly and providing emotional support to second victims when medical errors occur.
  • Advocating a workplace culture of support and trust rather than blame.

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