Adverse events and traumatic moments send shockwaves through the entire care team. As families grieve the loss of a loved one, providers can often suffer from feelings of overwhelming guilt, remorse, or helplessness. When clinicians struggle with the aftermath of a tragic care event, they become known as second victims. Second victim experiences can lead to lapses in safety and care and could be potentially dangerous for future patients.
ONS 43rd Annual Congress presenter Susan Scott, RN, PhD, CPPS, FAAN, manager of patient safety and risk management at the University of Missouri Health Care System in Columbia, has studied the impact of second victims in health care.
“A second victim can be anyone within the healthcare environment,” Scott notes. “It could be nurses, physicians, student learners, volunteers, dietary works, security guards, etc. It’s anyone involved in an unanticipated clinical event with a patient that has an untoward outcome. We often develop relationships with our patients and their families, and when we lose a patient, it can pull at the clinician’s heart strings. It can be a very painful experience.”
Second Victim Effects in Care
Second victims are often afflicted by a number of lingering issues associated with the event. According to the Joint Commission, second victims may face “difficulty sleeping, reduced job satisfaction, guilt and anxiety (including fear of litigation or job loss)—all of which affect medical judgment.”
In a Swiss study of second victims, more than one-third of respondents reported that the emotional reactions they had to a second victim event made their work more difficult. They often relived an adverse event, experiencing disbelief and shock, which was a major source of distraction.
“Unsupported second victims may go back to their practice to try to make sense of what happened. They try to connect the dots,” Scott says. “They often have trouble focusing. Whenever providers are that distracted, the next patient could then be vulnerable to a safety event because of that general inattention.”
The Prevalence of Second Victims
According to Scott, second victim research has yet to focus on oncology populations. However, she notes that oncology nurses may be susceptible to second victim experiences simply because of the nature of the care environment and the bond they form with their patients over time.
“By virtue of the oncology population, I’d imagine that the prevalence of second victim experiences might be higher than general populations,” Scott says. “There are key patient indicators that could evoke a second victim response. A predominant one is when providers connect with and form relationships with their patients.”
Studies suggest that nearly 50% of all healthcare providers have experienced second victim effects at least once in their career. According to Scott, second victims are often faced with three potential outcomes: drop out, survive, or thrive. Clinicians impacted by traumatic events may seek to find employment in different areas of health care, leading them to drop out of their current career paths. Others may simply survive, day to day, without addressing the issues. Finally, healthcare professionals may thrive after a second victim event by learning from the experience and enacting change in their practice or institution.
Supporting Second Victims in Practice
One of the most effective ways to support second victims is by simply being aware of the problem. Starting conversations with colleagues and coworkers can go a long way to helping others explore solutions to second victim experiences.
“Oncology nurses can support their colleagues suffering from second victim experiences by talking with each other about what they’re going through,” Scott notes. “We can get so busy in our work lives, but it’s important to help each other focus on the human responses to difficult events. You can share stories about when you’ve been impacted and the ways you’ve recovered. Listen to your colleagues, care for them, and support their needs. Incorporating self-care strategies and stress management techniques are some of the best ways to conquer the lingering physical and psychosocial symptoms experienced as a second victim.”
For more information and an in-depth conversation about second victim issues, attend Scott’s session on Friday, May 18, from 9:45–11 am at the ONS 43rd Annual Congress. Learn more at congress.ons.org.