Sharing the Load of a Nurse "Second Victim"

Rescuing the Healer After Trauma

December 2008’s RN Magazine’s cover story shares the University of Missouri Healthcare System’s journey toward better understanding and providing support for its nurses on the sharp end of a medical error or unexpected patient decline. (Click here to view the entire text of the article.)

As the authors point out, there were no nursing specific studies found in the literature regarding helpful interventions, so the UMHS began to compile their own data and gathered anecdotal information from their nursing staff through a series of interviews. Upon review of the findings, UMHS has now begun developing an institutional response to formalize three levels of support for its nurses: (1) peer/colleagues; (2) department leader; and, (3) other institutional resources. Ultimately, they came to the conclusion that a comprehensive response plan must be in place for staff who may be suffering as “second victims” either as a result of a medical error or an unexpected patient decline. Second victims need support in timely and predictable ways, and support systems (peers/colleagues as well as leadership) should be anchored throughout the institution. Supportive peers and department leaders must be properly trained, and staff members need to be made aware of the availability of support services before something happens.

The MITSS mission of Supporting Healing and Restoring Hope has always included the emotional impact on the clinician (in this case the nurse) involved in an adverse event. We have consistently recognized the immense psychological (and sometimes physical) suffering of the medical caregiver in these instances. Barriers to open and honest dialogue and providing the necessary supports have included fear of retribution, loss of employment, guilt, shame, and the list goes on. The culture of “sucking it up” and suffering in silence has been slow to change, but programs such as those at UMHS serve to give us hope.

MITSS will continue to advocate for institutions to develop formalized support programs for all of their clinicians. The UMHS program featured in the article appears to focus on the nursing staff, but we know that these events can negatively impact physicians, pharmacists, and other medical caregivers as well. We have been the sole voice calling for emotional support for everyone involved in an adverse event since our inception, and it is gratifying to see that our persistent calls for change are beginning to be heard.