Every nurse fears making a mistake that harms a patient. When it happens, or when a patient deteriorates or dies unexpectedly in their care, nurses often experience guilt, shame, anxiety, sleeplessness and self-doubt that can last for months. This experience has been called “second victim syndrome”: the patient and family are the first victims; the clinician is the second.
This guide explains what second victim syndrome is, the stages of recovery, warning signs, and practical support for yourself and your colleagues, based on research into how clinicians recover after adverse events.
Imagine you gave a medicine to the wrong patient. You noticed within minutes, escalated immediately, and the patient was monitored and recovered. Your manager was supportive. Still, you replay it every night. You check every medicine three times, slowing down so much that colleagues notice. You wonder whether you should be a nurse at all. You tell no one, because you are ashamed. Many nurses have been exactly here, and many have recovered and become safer, wiser nurses.
What is second victim syndrome?
The term was introduced by physician Albert Wu in 2000 to describe the distress clinicians feel after errors. Today, some prefer terms such as “clinicians affected by adverse events”, because patients and families remain the primary victims and some clinicians dislike being called victims. Whatever the term, the experience is real and common.
Common reactions
| Physical | Emotional | Professional |
|---|---|---|
| Poor sleep, fatigue | Guilt, shame, anxiety | Loss of confidence |
| Headaches, stomach upset | Flashbacks, replaying events | Fear of litigation or losing registration |
| Racing heart | Anger, sadness, isolation | Avoidance of similar situations |
| Changes in appetite | Self-doubt, depression | Thoughts of leaving the profession |
The six stages of recovery
Researchers led by Susan Scott described a recovery trajectory with six stages:
- Chaos and accident response: realising something has gone wrong, while still caring for the patient.
- Intrusive reflections: “what if” thoughts, replaying the event.
- Restoring personal integrity: wondering what colleagues think, fearing judgement.
- Enduring the inquisition: investigations, interviews and documentation.
- Obtaining emotional first aid: seeking support from colleagues, family or professionals.
- Moving on: dropping out of the profession, surviving (coping but still distressed), or thriving (learning and growing from the experience).
The goal of support is to help nurses thrive, not drop out.
What to do immediately after an error
- Make the patient safe and escalate.
- Be honest with your manager; follow your organisation’s duty of candour or open disclosure policy.
- Document factually.
- Complete an incident report.
- Do not stay alone: tell a trusted colleague how you feel.
- If you are too shaken to continue safely, say so.
Looking after yourself afterwards
- Talk about it with someone you trust, a peer supporter or counsellor.
- Remember that most errors involve system factors, not just individuals.
- Look after sleep, food and exercise.
- Use your organisation’s employee assistance programme or occupational health.
- Ask for clear information about any investigation process.
- Seek professional help if distress, sleep problems or low mood persist, or if you have thoughts of harming yourself.
How colleagues and managers can help
- Check in privately and early: “That must have been really hard. How are you doing?”
- Avoid gossip and blame.
- Share your own experiences of mistakes, where appropriate.
- Offer practical help: cover a break, walk them to their car.
- Managers: explain processes clearly, separate learning from blame, and follow a just culture approach.
Peer support programmes
Some health systems have trained peer supporter networks that reach out to staff after adverse events, offering confidential emotional first aid and referral. If your organisation does not have one, consider raising it with your managers.
Just culture and criminalisation
A just culture distinguishes human error (console), at-risk behaviour (coach) and reckless behaviour (sanction). Fear of punishment discourages reporting and makes healthcare less safe. Read our debate on whether nurses should face criminal charges for errors and our medication safety guide.
Frequently asked questions
What is second victim syndrome?
The emotional and physical distress experienced by healthcare workers after an adverse event or error.
How long does it last?
It varies from days to months. Support speeds recovery.
Should I tell my family about an error?
You may share your feelings while protecting patient confidentiality; support from loved ones helps.
Will I lose my job after an error?
Most errors are handled through learning and support. Serious or reckless conduct is treated differently. Ask for clear information and seek union or professional support if needed.
But should nurses who make mistakes be comforted?
Yes, and held accountable in a fair way. Comfort and accountability are not opposites. Nurses who are supported are more likely to report, learn and prevent future harm. Isolated, ashamed nurses help no one.
Your next step: Find out whether your organisation has a peer support or staff wellbeing service for clinicians after adverse events, and save its contact details in your phone today.
Related: Medication safety · Moral injury in nursing · Nurse burnout
Sources: Wu AW. Medical error: the second victim. BMJ (2000); Scott SD et al. The natural history of recovery for the healthcare provider “second victim” (2009); WHO Global Patient Safety Action Plan 2021–2030. If you are in crisis, contact local emergency services or a crisis helpline.
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