The Wounded Caregiver: Understanding and Supporting the Second Victim

The physical, emotional, and even financial impact of medical errors is well documented among victims and their families. However, another victim—a second victim—often suffers in silence. The second victim is a term used to describe medical providers who, neither intentionally nor maliciously, made the error.

Second victims are remorseful and need help coping with their mistakes, according to Mark Bruce Lents, BSN, RN, CNOR. He describes five rights of the second victim, the six stages of recovery, and how best to respond when a colleague has made an error.

“The term second victim was coined by Dr. Albert Wu. He used it to describe medical providers’ connections with medical errors, and how the events surrounding medical errors affect more than just the victims (patient and patient families) of the incidents,” Lents said. “The term second victim is often a contested term, and many medical professionals believe identifying the perpetrator of the error as a victim is wrong.”

Medication errors, which include the wrong medication, dosage, route, etc., are the most common medical errors. However, there are others, such as the wrong surgical site and patient (sentinel events). Studies show the root cause of most medical errors is miscommunication (up to 70% facility-wide). Depending on the medical error, the first victim may experience extended hospital stays, additional surgeries, permanent impairment, and even death. The consequences can leave life-long emotional scars for the second victim, Lents said.

“No one is infallible. Colleagues need to be empathic and provide an open, listening ear/mind to the second victim,” he said.

The second victim typically goes through six stages of recovery:

  • Chaos and accident response
  • Intrusive reflections
  • Restoring personal integrity
  • Enduring the inquisition
  • Obtaining emotional first aid
  • Moving on

Despite the error, Lents said, the second victim has five rights, which include just treatment, respect, understanding and compassion, supportive care, and transparency.

“A peer support program is the basis of the healing journey,” Lents said. “Most peer support programs include a core team (representation of all needed disciplines/departments who are involved in providing care), executive leadership, peer supporters in individual or group formats, education and training, marketing (spreading the word that help is available), and legal documentation preserving both victims confidentiality.”

Learn more about how to support the second victim in Lent’s education session, The Wounded Caregiver: Understanding and Supporting the Second Victim in the Education Hub.