6th Edition In-Depth: Staff Health and Safety – Second Victim

Standards SQE.8.2 The hospital provides a staff health and safety program that addresses staff physical and mental health and safe working conditions.

The health care environment is face-paced, frequently changing, and can be very stressful. Care givers are often faced with many difficult situations that can be both emotionally and physically challenging.1 Despite health care organizations and health care practitioners working hard to improve the safety of patient care, adverse and sentinel events continue to occur. When a patient suffers an adverse event, many people are affected — the patient, his or her family, and the health care practitioner. The patient’s and family’s needs become the priority for the health care organization, however the health care practitioner most directly involved in the event may be emotionally traumatized and experience effects that may last for months or even years. The health care practitioner becomes the “second victim” of the adverse or sentinel event.2,3 

Second victims may initially experience shock and disbelief, that often turns into guilt and anxiety, leading to disturbances in sleep and fear of job loss. A qualitative study of 21 “second victims” by Ullström S, et al. identified that most study participants reported the event affected them both personally and professionally. “The majority of informants reported emotional reactions such as sadness, anxiety and reliving the event (flashbacks). Many said that they had mentally repeated the sequence of events over and over again…”4 Some health care practitioners report recurrent memories of the event, which may contribute to depression and suicidal ideation.5 Contributing to the distress is the potential risk of isolation from coworkers, who may avoid the health care practitioner.6

Often, the feelings of grief, sadness, and emotional distress experienced by the health care practitioner are not acknowledged or addressed. If not treated, a second victim experience can harm the psychosocial and physical health of the individual; potentially affecting the health care practitioner’s clinical judgment and compromising patient safety.7   

Joint Commission International encourages health care organizations to take actions to support second victims as soon as possible after an adverse or sentinel event occurs. Medically Induced Trauma Support Services (MITSS) is one resource for organizations in the process of developing and/or enhancing a program to support second victims. The MITSS website can be accessed via the following link:  


By addressing the traumatized health care worker, organizations can help ensure that other patients are protected from the effects that adverse events can have on health care worker performance. 


  1. Itzhaki M, et al. Caring international research collaborative: A five-country partnership to measure perception of nursing staffs’ compassion fatigue, burnout, and caring for self. Interdisciplinary Journal of Partnership Studies. 2015;2(1):1–22.
  2. Mira JJ, et al. The aftermath of adverse events in Spanish primary care and hospital health professionals. BMC Health Serv Res. 2015 Apr 9;15(151):1–9.
  3. Seys D, et al. Health care professionals as second victims after adverse events: A systematic review. Eval Health Prof. 2013 Jun;36(2):135–162.
  4. Ullström S, et al. Suffering in silence: A qualitative study of second victims of adverse events. BMJ Qual Saf. 2014 Apr;23(4):325–331.
  5. White AA, et al. Risk managers’ descriptions of programs to support second victims after adverse events. Journal of Healthcare Risk Management, 2015;34(4).
  6. Institute for Safe Medication Practices. Too Many Abandon the “Second Victims” of Medical Errors. ISMP Medication Safety Alert! July 14, 2011. Accessed May 8, 2018. https://www.ismp.org/resources/too-many-abandon-second-victims-medical-errors
  7. Quillivan RR, et al. Patient safety culture and the second victim phenomenon: Connecting culture to staff distress in nurses. The Joint Commission Journal of Quality and Patient Safety, 2016;42(8):377-386.