Health care systems are vulnerable to the commission of errors, given that to err is to be human. Studies have investigated the impact of adverse events on patients and family members (first victims), but few have investigated their effects on the health care staff involved (second victims [SV]).1 Second victimhood has a negative impact on the well-being of staff, patient safety, and institutions.2–4

Because of the lack of knowledge of the SV situation in cardiology services, in May, June, and October 2021, we sent out an anonymous survey that included the validated SV Experience and Support Tool (SVEST) questionnaire5 and demographic data to the email addresses of the Young Cardiologists group of the Spanish Society of Cardiology (SEC) and the Spanish Association of Cardiology Nurses (AEEC). The aim was to investigate the experience of these health care providers as SVs and the quality of support resources in cardiology. The study was approved by the corresponding ethics committee (CHUC_2021_13).

The SVEST comprises 29 items grouped into 9 subscales: 7 dimensions and 2 outcome variables (turnover intentions and absenteeism). Respondents indicate their degree of agreement on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Three of the dimensions measure trauma experienced by SVs (psychological distress, physical distress, impact on professional self-efficacy) and the other 4 measure sources of support (colleagues, supervisors, institution, and nonwork-related support). High scores on each dimension are indicative of more psychological distress, more physical distress, lower perceived professional self-efficacy, and perceived inadequate support. High scores on each outcome variable are indicative of more turnover intentions and greater absenteeism. The percentage of agreement for the subscales is represented by an overall mean subscale score of at least 4.0. The relationships between demographic factors and SVEST scores were tested using univariate analysis, and professional categories were studied using analysis of variance with Bonferroni correction.

In total, 198 validated surveys were obtained. Of these, 44% were completed by nurses, 43% by attending physicians, and 13% by residents (75.9%, 55.3%, and 50% were women, respectively). Table 1 shows the mean scores for each item and subscale of the SVEST.

The item with the highest overall score was “Talking about what happened with my coworkers gives me a sense of relief” (4.10 ± 0.8) with 84.3% agreement. Regarding professional categories, nurses gave the highest score to the item “My coworkers have helped me feel that I am still a good health care professional despite the errors” (4.30 ± 0.84), and attending physicians and residents gave the highest score to the item “The love of my closest friends and family helps me overcome these events” (4.12 ± 0.85 and 4.19 ± 0.98, respectively). The item with the lowest score in all 3 professional categories was “I have taken a few days off after one of these cases occurred” (overall mean, 1.58 ± 0.71), with 3% agreement.

The subscales with the highest overall scores and in each professional category were “nonwork-related support” (overall score, 3.94 ± 1), with 78.75% agreement, and “psychological distress” (overall score, 3.46 ± 1.16), with 59.2% agreement. The subscale with the lowest overall score was “absenteeism” (overall score, 1.63 ± 0.76), with 4.05% agreement. In other cultures, scores on “absenteeism” can reach 9.3%.6

Differences were observed between residents and nurses on the 2 items of the outcome variable “turnover intention”; nurses gave the lowest scores and residents gave the highest scores (P < .05). Differences were observed between the 3 professional categories in relation to the first 3 items of the domain “professional self-efficacy”(P < .01); residents gave the highest scores and nurses gave the lowest. A difference was also observed between nurses and consultants on the item “My coworkers have helped me to feel that I am still a good health care professional despite errors” (nurses: 4.3 ± 0.84 and consultants: 3.82 ± 0.9) (P < .01). The results of some of the comparisons may have been affected by the imbalance between the number of residents and the numbers of consultants and nurses, which were similar.

Regarding sex, higher overall SVEST scores were given by women than by men (3.1 vs 2.86; P < .01). When stratified by occupational category, we observed a trend toward more psychological and physical distress among women in all occupational categories. Statistically significant differences were only observed for the subscales professional self-efficacy and turnover intentions and only between residents and nurses (2.84 ± 1.23 vs 2.23 ± 1.1; P < .05; and 3.49 ± 0.81 vs 2.81 ± 0.67, respectively; P < .01). No differences were found in the overall SVEST score by years of work experience (< 5 years vs ≥ 5 years) or by type of hospital (secondary vs tertiary).

The results suggest that cardiology staff experience a significant burden of SV-related psychological distress and seek support from colleagues. We highlight the low level of turnover intention and absenteeism. The women in the sample were more likely to experience SV symptoms.

We believe that actions are needed to prevent and adequately address this phenomenon. To our knowledge, this is the first pilot study to investigate the phenomenon of SV in cardiology. The study highlights the need to implement institutional strategies to provide adequate support for SVs and consequently improve patient care.