Supporting nurses after adverse events: the second victim phenomenon
What is second victim syndrome?
When a nurse is involved in a medical error or adverse event, they often experience profound emotional distress — guilt, anxiety, difficulty sleeping, decreased confidence in clinical skills, and in severe cases, suicidal ideation. This is second victim syndrome: the clinician who delivers care becomes a secondary casualty of the adverse event.
70-76% of professionals involved in near misses or adverse events report emotional impact. In a study of Italian nurses, 41% presented psychological and physical symptoms as well as intent to leave their job following an adverse event. The scope is wide, the impact is deep, and most organizations have no formal infrastructure to support affected staff.
- PMC, 'Second Victim Syndrome Among Healthcare Professionals,' 2025
- Journal of Advanced Nursing, 'Interventions to support nurses as second victims,' 2024
The connection to safety reporting
Second victim syndrome creates a vicious cycle: the emotional toll of involvement in an adverse event makes nurses less likely to report future events, which means the organization loses the learning opportunity and the systemic issue persists. Fear of punishment compounds this — nurses who anticipate blame are far less likely to disclose.
Leaders who foster collaborative, non-hierarchical cultures promote greater trust and encourage reporting of adverse events. A safety reporting system that supports non-punitive, closed-loop reporting is foundational to breaking this cycle — both because it reduces fear of reporting and because it visibly demonstrates that events are used for learning, not blame.
- PMC, 'Patient Safety Culture and the Second Victim Phenomenon,' 2017
Peer support programs
Peer support programs structured around the Scott Three-Tiered Model are the most commonly implemented intervention and demonstrate consistent short-term benefits — reduced emotional distress and perceived isolation in the immediate aftermath of an adverse event. The BONE Break tool provides a structured hot debrief format for teams immediately after a difficult case.
However, peer support requires organizational infrastructure to sustain: trained peer supporters, protected time to have conversations, leadership endorsement, and clear pathways to professional counseling when peer support isn't sufficient. Without this infrastructure, programs start strong and fade quickly.
- American Journal of Nursing, 'Implementing a Peer Support Program for Second Victims,' September 2024
- AHRQ PSNet, 'BONE break: a hot debrief tool,' 2024
How well-being infrastructure supports second victim recovery
Well-being check-ins integrated into daily workflows can identify nurses experiencing distress after events — without requiring them to self-identify or seek help through a separate system. When distress signals appear in well-being data at the unit level, leaders can act proactively rather than waiting for a resignation.
ImprovementFlow integrates both sides of this equation: safety event reporting that's non-punitive and closed-loop, plus well-being assessment that surfaces distress before it becomes a resignation. The connection between what happened on the unit and how the team is doing afterward is visible in one place.
Start with what you need today
Most customers begin with safety reporting or huddle boards and expand from there. No enterprise commitment required.