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Resilience for Second Victims During and After COVID-19


Laura Evans, MS, RN, alumnus CCRN, hospital surveyor

It will take years or even decades before the full impact of the COVID-19 pandemic on nurses is fully understood.

It’s safe to say that the panic period of the pandemic is passing but the nursing profession will be scarred. Second victim syndrome, or the emotional trauma for a health care provider following an adverse event, will come into play like never before. It’s affected many of my colleagues, as illustrated in this blog post and the toll it may take on nurses in the months following COVID-19 will be immense. Below is a break down of how second victim syndrome could present in the community of nurses responding to COVID-19.

Am I a second victim?

  • Since the onset of the COVID-19 pandemic, have I felt anxiety, depression, dread about going to work, doubt about the ability to do my job, or other negative emotions that seriously impact me emotionally?
  • Have I observed similar distress in a peer or colleague?

If YES, you or your colleague may be second victims.

Three possible trajectories of second victims:

  1. Dropping out: Transferring out, leaving the profession, self-harm
  2. Surviving: “Oh, I’m hanging in there”, absenteeism, presenteeism, decreased work performance
  3. Thriving: Ideal state that indicates positive resilience; mature and balanced perspective on events, equipped to help others cope with traumatic events, and a work/life balance. Evidence-based, timely and ongoing support for second victims improves the chances of thriving and promotes resilience.

Provide Support
During this time, it's crucial to support one another. Some mechanisms include:

  • Self check-ins: How am I feeling right now? Is it time to reach out and ask for help?
  • Peer to peer: identifying distress and initiating the conversation in real time. This can be as simple as saying, “Tell me how you’re feeling, you seem stressed - how are you doing?”
  • Managers and leaders: Follow up with second victims in real time. Again, conversation starters can include:“This has to be difficult for anyone to handle, how are you doing?”
  • Ongoing monitoring for signs of distress during and after events. This may be ongoing for months to years after the events have ended, and after other areas such as operations have already fully recovered.
  • Employee Assistance Program (EAP) referrals are used as adjuncts to the above when professional mental health intervention is needed. However, EAPs are not stand-alone interventions.
  • Evidence-based support programs for second victims have been developed in many organizations across the country. 

Leading Second Victim Support Resources
Below are links to several of the most prominent evidence-based programs, and other resources for second victims. The Joint Commission recognizes that many other organizations also have mature programs in place. 

RISE program at Johns Hopkins, Baltimore, MD

forYOU team at University of Missouri Health, Columbia, MO

The conversation on second victim syndrome in health care is just beginning. We’d love to hear your stories. Please use the comment section to share with our community how YOU’RE doing while working during the pandemic. Stay strong—we’ll get through this together!

Laura Evans, MS, RN, alumnus CCRN is a hospital surveyor at The Joint Commission.