Approximately 32.5% of United States (US) midwives will be involved in a malpractice action at some point in their careers. In addition, it is estimated that over 50% of US health care professionals will experience second victim phenomenon as a result of their involvement in an adverse clinical event.1 Research exploring second victim phenomenon for certified nurse-midwives (CNMs), certified midwives (CMs), and certified professional midwives (CPMs) is limited.1 Second victim phenomenon is defined as trauma experienced by a health care provider involved in health care-related event.2 It occurs when health care workers are present during an event that adversely impacts a patient and often their family. It may include both short and long-term impacts, including:
- Diminished self-confidence,
- Feelings of isolation, and
- Increased vulnerability to errors in clinical judgement.1
Understanding the physical and psychological symptoms that can impact personal and professional lives is an important first step for recognizing and addressing the impact of traumatic adverse events. Psychological symptoms of the second victim phenomenon include:
- Emotional distress,
- Guilt, and
- Self-blame
Involvement in adverse events leads to important questions regarding what constitutes a “safe” environment for debriefing, both from a psychological and professional liability perspective. Some providers may experience loss of trust by professional and inter-professional colleagues and/or administrators. Sequelae can include compromises to patient or inter-professional communication, leading to increased risk of errors and decreased safety.
Midwives need to understand their state statutes regarding discoverability. Providers may or may not be reassured that debriefing conversations are not discoverable by attorneys representing patients and/or their representatives.
Health care organizations that offer support programs in response to traumatic clinical events report success in safety for patients and providers.3. Christoffersen et al describe proactive practices that were found to be beneficial when implemented at the organizational levels.4 These practices include:
- Full debrief for adverse events, and
- Peer support
Debriefing after adverse events combined with transformational leadership behavior, which considers the emotional status of the stakeholders while investigating the incident, is considered best practice.4 Harmful practices include lack of attention to second victim needs, which may lead to provider burnout and attrition.
Midwives interested in sustainable practice need to learn to navigate the second victim phenomenon. Understanding the intersection of second victim phenomenon with compassion fatigue, secondary traumatic stress, post-traumatic stress disorder and burnout is important as primary causes and recommendations for recovery differ. Developing healthy coping mechanisms can mitigate adverse psychological and physical disruptions to personal and professional lives. Midwives in clinical practice could benefit from understanding beneficial strategies and accessing resources for second victim support.
We invite you to join us and learn more about this topic at the upcoming ACNM 66th Annual Meeting, held virtually May 23-25, 2021. A panel including two midwives who have lived through the experience of a traumatic event and malpractice action, one of whom went on to work as a patient safety and quality officer, and a malpractice attorney who specializes in the defense of midwives and the author of a paper on second victimization will speak to their expertise in strategies to prevent, mitigate, and address trauma associated with second victim phenomenon.
References
1 McDaniel LR, Morris C. The second victim phenomenon: how are midwives affected?. Journal of midwifery & women’s health. 2020 Jul;65(4):503-11.
2 Wu AW. Medical error: the second victim. The doctor who makes a
mistake needs help too. BMJ. 2000;320(7237):726–727
3 Tamburri LM. Creating healthy work environments for second victims
of adverse events. AACN Adv Crit Care. 2017;28(4):366–374
4 Christoffersen L, Teigen J, Rønningstad C. Following-up midwives after adverse incidents: How front-line management practices help second victims. Midwifery. 2020 Jun 1;85:102669.
Authors
Michelle Collins, PhD, CNM, MSN, FACNM, FAAN
Erin Farah, CNM
Katie Page, CNM, FACNM
Michelle Palmer, CNM, MSN, FACNM
