When Doctors and Nurses Become Second Victims: New Study Maps the Hidden Toll of Medical Errors

When a medical error occurs in a hospital, the first victim is, understandably, the patient. But there is often a second casualty that rarely makes it into incident reports or quality dashboards: the clinician who was involved. A new cross-sectional study from Türkiye, published in BMC Health Services Research, offers a detailed quantitative portrait of this phenomenon—known as second victimhood—among physicians and nurses working at a tertiary university hospital, and it comes with a clear message for health systems worldwide: patient safety programs that focus only on patients are missing half the picture.

The term second victim was coined to describe healthcare professionals who are involved in an adverse patient event and who subsequently experience emotional distress, guilt, and in some cases lasting trauma symptoms. Unlike the patient, the second victim typically continues working, often within the same environment where the event occurred, and often without any structured institutional support. Previous research has linked second victimhood to burnout, sleep disturbances, post-traumatic stress symptoms, and even decisions to leave the profession. Yet, as the authors of the new study note, evidence from Türkiye has remained limited, leaving a gap in understanding how this phenomenon manifests in different health system contexts.

To address that gap, a team of researchers from Zonguldak Bülent Ecevit University Faculty of Medicine, led by corresponding author Bilgehan Açıkgöz from the Department of Public Health, conducted a survey in October 2023 among physicians and nurses at a tertiary university hospital. The study was designed as a census of the target population rather than a convenience sample: the entire group of eligible physicians and nurses was approached, and 366 participants ultimately took part. Of these, 66.9 percent were female, 45.9 percent were nurses, and 42.1 percent were resident physicians—a distribution that reflects the demographic reality of hospital frontline staffing, where women and relatively junior clinicians form the backbone of daily care delivery.

Methodologically, the study relied on two instruments. The first was a sociodemographic questionnaire capturing age, professional title, and length of employment at the current institution. The second was the Turkish version of the Second Victim Experience and Support Tool, abbreviated T-SVEST. The original SVEST was developed to measure both the psychological impact of adverse events on clinicians and the adequacy of the support they receive, and the Turkish adaptation allowed the researchers to apply a validated instrument in their own linguistic and institutional context. The team reported internal consistency analyses to confirm the reliability of the scale in their sample, alongside descriptive statistics, group comparisons, and correlation analyses.

The headline finding is striking in its proportionality. Second victimhood was reported by 15.0 percent of participants—roughly one in seven clinicians surveyed. Among those who reported a second victim experience and provided valid responses on its consequences, 75.9 percent said the experience had negative effects. In other words, when clinicians are caught in the aftermath of an adverse event, the overwhelming majority do not simply shake it off. They carry guilt, anxiety, and professional self-doubt, often while continuing to care for patients. That figure, three out of four affected clinicians reporting harm, is the kind of number that should make hospital administrators pause.

The statistical analysis went beyond simple prevalence. In bivariate comparisons, second victimhood varied significantly according to age group, professional or occupational title, and years of employment at the current institution. But bivariate associations can be confounded, so the researchers built a multivariable binary logistic regression model to identify which factors remained independently associated with second victim experiences. Two variables survived the adjustment. Clinicians aged 46 and older had 5.27 times higher adjusted odds of reporting second victimhood compared with their younger colleagues (95 percent confidence interval: 1.97 to 14.06). And those who had worked at the current institution for two to five years had 2.82 times higher adjusted odds (95 percent confidence interval: 1.43 to 5.56) relative to the reference group.

These two risk profiles are intriguing and, at first glance, somewhat counterintuitive. One might expect the youngest, least experienced clinicians to be most vulnerable to the psychological fallout of an adverse event. Instead, the strongest independent predictor in this cohort was older age. One plausible interpretation, consistent with the broader second victim literature, is that cumulative exposure matters: clinicians in their late forties and beyond have simply had more years—and more adverse events—over the course of their careers, increasing the probability that they have experienced second victimhood at some point. The elevated risk among staff with two to five years of tenure may reflect a similar dynamic: these clinicians are past the initial orientation phase, carry substantial clinical responsibility, and have been embedded in the institution long enough to encounter adverse events, yet may not yet have accumulated the seniority, peer networks, or coping strategies that longer-tenured staff develop.

Just as important as the prevalence data is what the study found about support preferences. Most participants expressed a strong preference for structured institutional support, including peer support programs, managerial support, opportunities for recovery after a distressing event, and access to psychological counseling. This is a critical detail. Second victims frequently report that the informal support they receive—sympathetic colleagues, an understanding supervisor—is inconsistent and unpredictable, and that formal channels are either absent or perceived as punitive. The finding suggests that clinicians are not asking for something exotic; they want organized, reliable systems that activate automatically after an adverse event, much like rapid response teams activate for deteriorating patients.

The implications reach well beyond a single hospital in Türkiye. Patient safety science has matured enormously since the landmark reports of the late 1990s and early 2000s, and the World Health Organization has placed patient safety high on its global agenda. But the second victim literature exposes a structural blind spot: safety cultures built on blame and individual accountability can transform an adverse event into a double injury, harming both the patient and the clinician, and ultimately degrading the safety of the system itself. Clinicians who are anxious, burned out, or emotionally withdrawn are more prone to future errors, creating a vicious cycle. Conversely, institutions that respond to adverse events with confidential, non-punitive, and accessible support mechanisms may protect not only their staff but also their patients—an argument the authors make explicitly in their conclusion, which calls for structured, accessible, confidential, and non-punitive post-event support.

Several practical models already exist in the international literature and could be informed by this study’s findings. Peer support programs, in which trained clinician volunteers provide confidential emotional first aid to colleagues after adverse events, have been implemented at major academic medical centers and are consistently among the most requested and most trusted forms of support. Structured managerial support ensures that supervisors respond with empathy rather than investigation in the immediate aftermath. Dedicated recovery time, psychological counseling pathways, and clear communication about what happens after an event all contribute to what researchers describe as an institutional second victim support infrastructure. The Turkish study adds a valuable data point by quantifying demand for these services in a health system where such evidence was previously scarce.

The study does have limitations worth noting. It was conducted at a single tertiary university hospital, which may limit generalizability to primary care settings, smaller hospitals, or private institutions. Its cross-sectional design captures a snapshot in time and cannot establish causal relationships between demographic factors and second victimhood. The overall response yielded 366 participants from the full target population, but self-reported survey data on sensitive emotional experiences are always subject to underreporting, particularly in workplace cultures where admitting distress may feel risky. The authors also note that the article was shared early as an accepted, citable version subject to further editorial refinement.

Even with those caveats, the study’s core numbers are hard to ignore. One in seven physicians and nurses at this hospital reported having been a second victim, and three quarters of those described negative consequences. The independent risk factors—older age and mid-range institutional tenure—give hospital leaders concrete signals about which staff groups may need proactive outreach. And the near-universal appetite for structured support suggests that the barrier is not clinician reluctance but institutional design. As health systems worldwide grapple with workforce shortages, burnout epidemics, and retention crises, the second victim phenomenon sits at the intersection of all three. Supporting clinicians after adverse events is not a soft perk; it is patient safety policy, workforce policy, and mental health policy rolled into one. This study from Türkiye provides the kind of local, validated evidence that turns that argument from a slogan into an actionable mandate.

Subject of Research: Second victim experiences and support needs among physicians and nurses following adverse patient events

Article Title: Evaluation of second victim experiences and support needs among physicians and nurses

Article References: Evaluation of second victim experiences and support needs among physicians and nurses. (n.d.). https://doi.org/10.1186/s12913-026-15766-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15766-7

Keywords: second victim, medical errors, patient safety, physicians, nurses, occupational stress, burnout, psychological counseling, peer support, health services research, Türkiye, T-SVEST