Second and Third Victims Tip Sheet

When a patient is harmed, the impact extends beyond the clinical outcome. Patients and families may experience trauma as second victims, and clinicians and staff can suffer significant emotional distress as third victims. This tip sheet helps organizations respond with empathy, clarity, and structure to guide supportive actions after a serious safety event.

Who it’s for

Patient safety, risk, and quality leaders
Nurse leaders, physician leaders, and frontline managers
Peer support teams, employee assistance, and HR partners
Patient relations, experience teams, and social work
Executive leaders overseeing safety culture initiatives

What it can be used for:

Establishing or strengthening peer support and just culture practices
Training leaders on how to respond to staff after difficult events
Reducing burnout risk and supporting retention after traumatic events
Informing policy, playbooks, and escalation pathways for event response

What’s inside:

Situation: Signs a patient/family or staff member may need additional support
Background: Why second/third victim experiences occur and how they show up
Assessment: Risk factors, stress indicators, and points of vulnerability after events
Recommendations: Practical steps for immediate response, follow-up, and resources

Access the Tip Sheet

A systematic review of 18 studies recognized the following symptoms of second victim syndrome: troubling memories, anxiety/concern, anger toward themselves, regret/remorse, distress, fear of future errors, embarrassment, guilt, and sleeping difficulties.