When a Nurse Wants to Quit After an Error, Who Helps?

A 2026 synthesis of 21 studies involving 272 nurses describes what can follow a patient safety incident: shame, silence, damaged confidence and thoughts of leaving nursing. For nurses struggling after an error or a traumatic patient outcome, the findings put a name to an often-hidden experience.

The second victim phenomenon describes the distress healthcare workers can experience after events such as a medical error or unexpected patient death, more commonly referred to as patient safety incidents (PSIs). The World Health Organization reports that more than 3 million deaths worldwide each year are due to unsafe care. Patients and families remain central to the response.

Supporting nurses involved in PSIs raises an essential question: Who helps them recover?

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Published July 30th in the Journal of Nursing Management, the review by Wei Zeng and colleagues combined nurses’ accounts from seven countries. Nurses described self-blame, disrupted sleep, fear and loss of professional confidence. Some considered leaving their work.

The accounts also exposed gaps in support:

• Blame
• Reluctance to speak
• Difficulty accessing psychological help
• Staffing pressures that complicated time off

Colleagues and managers could help, but support was not consistently available.

This was a qualitative synthesis, with most included studies from China. It captures experiences and recurring themes, rather than measuring how many nurses worldwide are affected or proving that an incident caused someone to quit. Three overarching themes emerged:

• A state of disequilibrium under multiple shocks
• Support systems undermined by blame and silence
• Reconstructing the self in the aftermath of trauma: multipath coping and recovery mechanisms

Literature showed that nurses consistently felt anxiety and self-blame after a PSI, especially when the incident was more severe. Nurses felt uncertainty regarding potential legal action and professional accountability. Nurses internalized responsibility and claimed the incident was due to ‘errors in personal judgement’ or ‘insufficient professional competence’. This was despite nurses recognizing there were other factors involved.

The stress after a PSI can also manifest in physical changes, including:

• Tachycardia
• Tachypnea
• Transient mental blankness or confusion
• Insomnia
• Appetite changes
• Weight loss

Nurses in high-intensity settings, like the ICU, were also more likely to consider transferring to another department or leaving the nursing profession.

A separate study published September 30th in BMC Health Services Research, led by Bilgehan Açıkgöz of Zonguldak Bülent Ecevit University in Türkiye, surveyed 366 physicians and nurses at a university hospital in October 2023.

Fifty-five participants reported a second victim experience at their current institution. Among the 54 who answered the impact question, 41 reported negative consequences (75.9%). That percentage applies to affected respondents answering that question, not to all participants or all nurses.

The single-hospital, self-reported survey cannot establish cause and effect or represent every workplace. It also measured preferences for support, which should not be mistaken for proof that particular services were provided or worked.

Still, the authors’ recommendations are concrete: accessible, confidential support pathways, peer and manager support, opportunities for temporary recovery and psychological counseling. They call for further research to evaluate implementation and longer-term effects.

Support does not have to begin with a proven error.

In a published case study of Johns Hopkins Hospital’s RISE program in Baltimore, the majority of calls were for adverse patient events rather than medical errors. A difficult outcome can warrant emotional support even when care was appropriate.

The Johns Hopkins Caring for the Caregiver program offers hospitals a model for training peer responders to listen without judgment and provide psychological first aid. Cheryl Connors, a patient safety specialist at the Armstrong Institute for Patient Safety and Quality, co-developed RISE and co-authored the case study.

For nurses assessing their own workplace, useful questions include:

• How do I reach a trained peer supporter?
• Is help available during my shift?
• What confidentiality rules apply?
• Can someone arrange coverage if I need a break?

These are practical ways to examine whether a structured peer-support program is accessible in daily practice.

Peer support also needs a route to further help. The RISE case study describes responders connecting staff with resources such as employee assistance and counseling, while focusing their conversations on the worker’s emotions.

Preparation can start before a crisis.

A 2026 study by Hanseulgi Lee and Nam-Ju Lee at Seoul National University recommends incorporating preventive support into orientation, training leaders to promote psychological safety and expanding access for nurses working shifts. For nursing leaders, that means making the support process part of how a unit operates.

Nurses and all healthcare professionals know that PSIs are going to happen. Unfortunately, it is part of the job. It is our responsibility as nurses to support one another and to find workplaces that support staff.

If you are struggling after a patient safety incident, you do not have to wait for your hospital to build a program. The following resources are available directly:

• American Nurses Foundation’s Healthy Nurse, Healthy Nation, a free wellness program with resources on stress, burnout, and mental health
• Nurse Well-Being: Building Peer and Leadership Support, a Healthy Nurse, Healthy Nation program with free tools and peer-support training for nurses recovering from stressful clinical events
• Dr. Lorna Breen Heroes’ Foundation, which supports healthcare workers facing burnout, mental health strain, and the aftermath of adverse events
• Emotional PPE Project, free access to licensed mental health professionals for healthcare workers, no insurance required
• Johns Hopkins Armstrong Institute Caring for the Caregiver toolkit, which hospitals and units can use to build their own peer-responder program
• 988 Suicide and Crisis Lifeline, call or text 988, available 24/7

🤔 After an error or a patient death, what support would make the biggest difference on your unit: a trained peer, time away from the floor, counseling or something else?

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