Liz Frings

Second Victim Syndrome: When Healthcare Staff Are Affected by Patient Harm

When something goes wrong in healthcare, the first concern is always the patient and their family. They are the people most affected, and that should never be lost. But the people who were caring for them can be deeply affected too, and that is often overlooked.

Doctors, nurses, midwives, paramedics and other healthcare staff can carry an incident with them for months or years. The idea of the "second victim" was introduced by Dr Albert Wu in 2000 to describe this. Not everyone likes the term. Some patient representatives find it uncomfortable, and many staff don't think of themselves as victims. But it has helped people recognise an experience that is very common. I have worked in the NHS myself, and with NHS staff whose distress came from incidents at work.

What it can feel like

People respond in different ways, but some reactions come up again and again.

  • Replaying the incident. Going over what happened, again and again, asking what could have been different.
  • Guilt and shame. Feeling responsible, or feeling that you have let the patient, their family or your team down.
  • Self-doubt. Losing confidence in decisions you would once have made easily, checking and rechecking, or wanting someone else to confirm everything.
  • Anxiety. Dreading similar situations, a particular ward or procedure, or the post.
  • Trauma symptoms. Intrusive images, nightmares, poor sleep and feeling constantly on edge.
  • Isolation. Feeling that you can't talk about it, either because of the process or because you fear what people will think.

These feelings can be just as strong whatever an investigation later finds. They tell us how much you care about your patients and your work. They are not a measure of whether anyone was at fault.

How common it is

Very. Surveys have found that between 45% and 91% of healthcare professionals experience this during their careers (Royal College of Surgeons of Edinburgh). It affects experienced professionals as much as newly qualified ones, and people in non-clinical roles too.

When the process adds to it

After a patient safety incident there is often a review, and sometimes a complaint, an inquest or a referral to a regulator. These processes exist for good reasons, but they can be long and uncertain. Waiting months for an outcome, being asked to go over the incident again, and not being able to talk about it freely can all keep the distress alive.

Research has found that formal support after patient safety incidents is still patchy in the UK. Support often depends on the goodwill of close colleagues, which may not always be there (Godwin and colleagues, Lancaster University, 2023).

Where to find support

  • Second Victim Support. The website secondvictim.co.uk was developed by researchers in Yorkshire and the Humber to help staff recognise what they are going through and find support.
  • Your trust. Ask about peer support, staff psychology, the employee assistance programme or occupational health. Some trusts have trained peer supporters for people affected by incidents.
  • Your professional body or union. The BMA, RCN and others offer counselling and advice, and your defence organisation can support you through any investigation.
  • NHS Practitioner Health and other services. Counselling for NHS staff sets out the options and their limits. If you are a doctor, counselling for doctors covers the services specific to doctors.

How counselling and EMDR can help

Counselling gives you a confidential space to talk about what happened and how it has affected you, without judgement and without it becoming part of any process.

When an incident keeps coming back through intrusive memories, nightmares or intense guilt, EMDR can help. It works on the way a distressing memory is stored, with the aim of helping it feel less vivid and less overwhelming. In my experience, if someone feels an error was made, EMDR can help them process their feelings about it.

You may not be able to talk about the details, perhaps because of an ongoing investigation, or simply because it is too painful. EMDR can still be used. EMDR without talking about the trauma explains how. If you are worried about what stays private, is counselling confidential? covers the limits.

Frequently asked questions

Is being a second victim the same as PTSD?

No, though they can overlap. Many people have a strong reaction that eases with time and support. If symptoms such as flashbacks, nightmares and feeling on edge last more than a month, it is worth speaking to your GP or a therapist about PTSD.

Should I wait until the investigation is over before getting help?

There is no need to wait. Support during the process can make it easier to get through.

Does it only affect doctors and nurses?

No. Paramedics, midwives, pharmacists, healthcare assistants and non-clinical staff can all be affected.

Talking to someone

I'm a BACP registered counsellor and EMDR practitioner offering EMDR therapy and person centred counselling in Nottingham and online. In my work, I don't share anything with your employer, occupational health or your regulator without your agreement, unless there is a serious risk to you or someone else. If you would like to ask whether I might be the right fit, you can get in touch before committing to anything.

Sources

More about EMDR therapy