Relationship Between Nurses' Second Victim Experience and Professional Identity: The Mediating Role of Psychological...

The second victim phenomenon is increasingly recognized in patient safety, yet the pathways connecting second victim experience to nurses' professional outcomes remain unclear. This study aimed to investigate the relationships among second victim experience, psychological resilience, and professional identity, and to examine the mediating role of psychological resilience.

This study used convenience sampling to recruit nurses who had experienced nursing adverse events at a tertiary Grade-A hospital. Participants were assessed using the Second Victim Experience and Support Tool, the Connor-Davidson Resilience Scale, and a Professional Identity Scale. Data were analyzed using SPSS 25.0, with Pearson/Spearman correlation and mediation analyses performed.

A total of 368 nurses who experienced nursing adverse events were included in the study. Scores for second victim experience, professional identity, and psychological resilience were 55.03 ± 12.42, 113.82 ± 21.42, and 28.04 ± 7.33, respectively. The mean second victim experience distress and support dimension (reverse-scored) scores were 34.33 ± 10.21 and 20.70 ± 6.84, respectively; their correlation was small and non-significant (r = 0.023, p = 0.722). In the total-score model, the indirect effect of second victim experience on professional identity through psychological resilience was significant (indirect effect = -0.308, 95% CI [-0.400, -0.223]), whereas the direct effect was not (direct effect = -0.080, p = 0.158). In the support-dimension model, both the indirect effect (indirect effect = -0.211, 95% CI [-0.290, -0.143]) and the direct effect (direct effect = -0.341, p < 0.001) were significant. In the distress-dimension model, the indirect effect was negative and significant (indirect effect = -0.227, 95% CI [-0.318, -0.138]), whereas the direct effect was positive and significant (direct effect = 0.128, p = 0.012), resulting in a non-significant total effect (total effect = -0.099, 95% CI [-0.222, 0.023]).

The Second Victim Experience and Support Tool composite score reflects multiple facets of the second victim experience, encompassing both distress-related and support-related components. Perceived support deficit was consistently associated with lower professional identity, partly through psychological resilience, whereas distress showed a more complex indirect association through resilience. These findings suggest that psychological resilience may be a potential intervention target and that both distress- and support-related aspects of second victim experience warrant attention. However, because this was a cross-sectional mediation analysis, the findings should be interpreted as statistical associations rather than causal relationships.