Clinical Nurses as Second Victims After Patient Safety Incidents: A Meta-Synthesis of Experiences, Coping and Support Needs.

BACKGROUND

In patient safety incidents (PSIs), nurses often act as 'second victims', experiencing multifaceted distress, including psychological, physiological and professional burdens. In recent years, qualitative studies on nurses as second victims have increased; however, the evidence remains fragmented. Existing qualitative meta-syntheses have limitations in terms of contextual diversity, coverage of incident types and exploration of support needs.

AIM: To synthesise qualitative evidence on nurses as second victims after PSIs and provide implications for developing a multilevel support system.

METHODS

A qualitative meta-synthesis approach was employed. Twelve Chinese and English databases were systematically searched from inception to 10 February 2025, with an updated search conducted on 14 October 2025. The 2020 Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research was used to appraise methodological quality. Data were synthesised using the two-stage synthesis approach proposed by Sandelowski and Barroso.

RESULTS

A total of 21 qualitative studies involving 272 nurses across seven countries were included. Three synthesised themes were identified: (1) a state of disequilibrium under multiple shocks; (2) support systems undermined by blame and silence; and (3) reconstructing the self in the aftermath of trauma: multipath coping and recovery mechanisms.

CONCLUSIONS

Nurses' second-victim experiences after PSIs are multidimensional, dynamic and shaped by incident severity, individual appraisal, organisational culture and accessibility of support. A just culture-based support system may help reduce blame and silence, promote psychological safety and facilitate recovery.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should recognise nurses' postincident disequilibrium as a second-victim response and embed structured support into PSI management. Strengthening just culture, psychological safety, peer support, confidential psychological care and protected recovery time may reduce blame, silence and help-seeking barriers, thereby facilitating nurses' recovery and safeguarding patient safety.