The Second Victim Experience of Nurses Involved in Medical Mistakes: Systematic Review of Referral Processes, Feasibility, and Effectiveness

Background: The second victim syndrome is the intense emotional and professional damage caused to nurses by medical mistakes, but supporting mechanisms, particularly referral processes, are rudimentary. Aim: This review synthesizes evidence concerning referral processes among second victim nurses, examining their feasibility, limitations, and innovations to inform fair and effective support interventions. Methods: An integrative review was conducted searching PubMed, CINAHL, Scopus, and Web of Science (2000–2025) for peer-reviewed articles on second victim nurses. Forty sources, including qualitative, quantitative, and mixed-methods studies, were reviewed for themes of referral mechanisms, using thematic analysis and Joanna Briggs Institute appraisal instruments. Results: Referral automation happens in a mere 18% of organizations, with low awareness (74.8% unfamiliarity) and stigma as points of hindrance. Active models like MUHC's pager system and coordinated pathways bring rise to uptake, while innovations like the Talk to Me program achieve 100% uptake. Virtual programs externally (e.g., YANA) are 80% possible in under-resourced settings. Conclusion: Proactive, just culture-based referral systems are crucial to enabling second victim nurses, preventing distress, and enhancing patient safety.