Abstract
Objectives:
To determine the prevalence of second victim experience among OBGYN clinical and nonclinical healthcare workers and compare healthcare workers who did and did not identify as a second victim in the last year.
Methods:
The validated Second Victim Experience and Support Tool and additional questions designed to explore SVE topics specific to OBGYN healthcare workers were administered to a multidisciplinary group.
Results:
Of 571 individuals sent a survey link, 205 completed the survey; 117 worked in obstetrics (OB), 73 in gynecology (GYN), and 15 in both areas. Overall, 44.8% of respondents identified as a SV sometime during their career, 18.8% within the last 12 months. Among nonclinical staff respondents, 26.7% identified as a SV during their career and 13.3% in the last 12 months. Respondents who identified as a SV in the last 12 months reported experiencing significantly more psychological and physical distress, a greater degree to which colleague and institutional support were perceived as inadequate, decreased professional self-efficacy, and increased turnover intentions. The most common events identified as likely triggers for SVE were fetal or neonatal loss (72.7%) and maternal death (68.2%) in obstetrics and patient accusations or complaints (69.3%) in gynecology.
Conclusions:
Among survey respondents there was a high prevalence of SVs in OBGYN staff, distributed equally between OB and GYN. Nonclinical healthcare workers also identified as SVs. OBGYN departments should consider using the SVEST as a tool to screen for potential SV among their healthcare workers in order to provide additional support after events.
Introduction
The term “second victim” (SV) refers to healthcare workers involved in an unanticipated adverse patient event, such as a medical error and/or a patient-related injury or death, that results in emotional trauma for the healthcare worker (1-2). The definition is inclusive to all healthcare workers (clinical and nonclinical staff) and may include any stressful or traumatic clinical event. The term SV is controversial because the term “victim” can be stigmatizing to the involved individuals and some patient advocates believe the term detracts from the experiences of patients and families (1). However, the term for this significant health worker experience has been retained due to the lack of an agreed upon replacement in the medical literature.
Past estimates of the prevalence of second victim experiences (SVEs) vary widely, from 10.4% to 72.5% (3-12). Healthcare workers may experience a wide range of symptomatology including psychological (e.g. anger, extreme sadness, flashbacks, loss of confidence, grief) and physical (e.g. sleep disturbances, rapid heart rate, increased blood pressure) symptoms (2, 4, 6–8, 10–25). Individuals typically progress through six stages of the SVE. The final stage “Moving On” has three possible outcomes: Thriving (growth from the experience), Surviving (constant coping from the experience), or Dropping Out (leaving the profession or committing suicide) (2). A healthcare worker remaining on a surviving or dropping out trajectory may be at risk for burnout, career abandonment, post-traumatic stress disorder, depression/anxiety, substance abuse, or suicide (21, 23, 26-31).
In 2016, a validated survey, the Second Victim Experience and Support Tool (SVEST), was published to assess the experiences of healthcare workers and evaluate healthcare systems and their staff support services (32-33). The 29-item SVEST was developed and validated at a specialized pediatric hospital treating children with catastrophic illnesses using the Hinkin’s guide for developing questionnaires (32). Since publication, the SVEST has been administered and adapted and/or translated in different settings and jurisdictions both within the United States and internationally (34-38).
Obstetrics and gynecology (OBGYN) healthcare workers are not exempt from SVEs (24, 26, 39 - 45). Most existing research in this population has been conducted outside the United States and describes clinical healthcare workers such as obstetricians and midwives. While SVE in OB has received attention given the cultural expectation of maternal and neonatal deaths as “never events” (24) similar attention has not focused on GYN (26, 44, 46) or nonclinical staff in the literature (47, 48). We sought to determine the prevalence and knowledge of SVE among both OBGYN clinical and nonclinical healthcare workers, describe events with potential for development of SVE, and compare SVEST results between healthcare workers who did and did not identify as SV in the last 12 months. We also investigated the types of support utilized and support resources desired.
Methods
Population
Individuals in a clinical or nonclinical role in the care of OBGYN patients at the study institution, a large tertiary referral center were invited to participate in the study during July and August 2019. OBGYN department email distribution lists were used to define the cohort of 571 eligible staff (see Supplemental Table 1for subgroup totals). All currently employed OBGYN staff were invited to participate. Clinical staff were defined as healthcare workers providing direct patient care. This includes physicians, residents and fellows practicing in OBGYN, representing all subspecialties including maternal fetal medicine, reproductive endocrinology and infertility, gynecologic oncology, and urogynecology. Registered nurses and licensed practical nurses from both inpatient and outpatient OBGYN specialties were also categorized as clinical staff. Additional invited clinical staff included advanced practice providers (nurse practitioners, certified physician assistants, and certified nurse midwives), genetic counselors, sonographers, certified surgical assistants, and certified surgical technicians in all OBGYN inpatient units and outpatient clinics. Nonclinical staff were defined as those who do not provide direct patient care, but who may have limited patient contact. Nonclinical staff in all of the aforementioned clinical areas were also invited to participate and included appointment staff, health unit coordinators, desk staff, patient care assistants, embryologists, lab personnel, and research support personnel. This study was deemed exempt by the Institutional Review Board of Mayo Clinic.
Survey
Each eligible individual received an email invitation to participate in the anonymous survey. The email included a description of the survey, an explanation of risks and benefits of participation, and a unique link to the survey questionnaire. Only those invited individuals with a unique link were able to complete the survey. Two reminders were sent to staff that had not completed the survey two and four weeks after the original invitation. The online survey was created and disseminated using Research Electronic Data Capture (REDCap, Rochester MN), a secure, web-based application used to collect and organize data.
The survey included the validated SVEST plus additional questions designed to explore topics specific to OBGYN healthcare workers. The 29-items on the SVEST are organized into seven dimensions (psychological distress, physical distress, colleague support, supervisor support, organization support, non-work-related support and professional self-efficacy) and two outcomes (turnover intentions and absenteeism). Respondents were asked to use a 5-point Likert scale (1=strongly disagree to 5=strongly agree) to indicate the extent they agree with each of the 29 items as they pertain to their personal experiences. Responses to the SVEST were scored according the published instructions (32). For each respondent, each dimension or outcome variable was defined as the mean of 2 to 4 items specific to that variable after converting the reserve-worded item responses; mean scores were only calculated for respondents who answered more than 50% of the items specific to that variable (e.g. ≥3 of 4 items, ≥2 of 3 items, or both of 2 items). Using the mean scores for each respondent, the overall mean and standard deviation was determined for each dimension and outcome variable, as well as the number and percentage of respondents with a mean score of 4 or higher. A higher score for each specific dimension represents experiencing more psychological distress, more physical distress, decreased professional self-efficacy, and a greater degree to which support is perceived as inadequate. A higher score for each specific outcome represents more turnover intensions and more absenteeism.
Separate from the 29 items, the SVEST includes seven questions assessing the desirability of forms of support also using a 5-point Likert scale (1 = strongly do not desire, 5 = strongly desire). The survey was supplemented with additional questions regarding prevalence and knowledge of SVE, events specific to OBGYN with potential for development of SVE, supportive resources utilized, and demographic data such as clinical specialty, job title, and years of experience (<5, 5 - <15, 15 or more) in OBGYN.
Data Analysis
Statistical analysis was performed using the SAS version 9.4 software package (SAS Institute, Inc.; Cary, NC). The data were summarized using standard descriptive statistics with frequency and percentages for categorical variables and means and standard deviations for the scores from the SVEST. Comparisons between any two independent groups were evaluated using the chi-square test for categorical variables and the two-sample t-test for each of the SVEST dimensions and outcomes. All calculated p-values were two-sided and p-values less than 0.05 were considered statistically significant.
Results
The survey was sent to 571 multidisciplinary healthcare workers who care for OBGYN patients; 205 respondents completed the survey for a response rate of 35.9%. Among the 205 respondents, 117 work in OB, 73 in GYN, and 15 in both areas. The majority (115, 56.1 %) of the respondents were registered nurses or licensed practical nurses. The distribution of length of time working in the OBGYN department was similar in both areas (Table 1). Response rates by job title are summarized in Supplemental Table 1.
Table 1.
Characteristics of Survey Respondents
| Characteristic | Total (N=205) |
Gynecology (N=88) |
Obstetrics (N=132) |
|---|---|---|---|
| Specialty | |||
| Gynecology only | 73 (35.6%) | 73 (83.0%) | 0 |
| Obstetrics only | 117 (57.1%) | 0 | 117 (88.6%) |
| Both | 15 (7.3%) | 15 (17.0%) | 15 (11.4%) |
| Job title | |||
| Registered nurse or licensed practical nurse | 115 (56.1%) | 39 (44.3%) | 79 (59.8%) |
| Physician, faculty | 18 (8.8%) | 9 (10.2%) | 10 (7.6%) |
| Appointment staff or health unit coordinator | 15 (7.3%) | 3 (3.4%) | 12 (9.1%) |
| Desk staff or patient care assistant | 13 (6.3%) | 4 (4.5%) | 10 (7.6%) |
| Physician, resident or fellow | 12 (5.9%) | 11 (12.5%) | 9 (6.8%) |
| Advanced practice provider | 11 (5.4%) | 4 (4.5%) | 7 (5.3%) |
| Certified surgical assistant or technologist | 12 (5.9%) | 12 (13.6%) | 0 |
| Sonographer | 4 (2.0%) | 2 (2.3%) | 4 (3.0%) |
| Embryologist, lab personnel, or research support personnel | 3 (1.5%) | 3 (3.4%) | 0 (0.0%) |
| Not specified | 2 (1.0%) | 1 (1.1%) | 1 (0.8%) |
| Years working in the OBGYN department | |||
| Less than 5 years | 76 (37.1%) | 30 (34.1%) | 56 (42.4%) |
| 5 to less than 15 years | 66 (32.2%) | 32 (36.4%) | 38 (28.8%) |
| 15 years or more | 63 (30.7%) | 26 (29.5%) | 38 (28.8%) |
One-third of the respondents noted familiarity with the term SV, but only one was nonclinical staff. Of the 69 subjects who had heard the term, most (45, 65.2%) had learned about the term from peers at work. Overall, 44.8% reported feeling like a SV during their career, including 18.8% reporting this in the last 12 months. The proportion of respondents who identified as SV in the last 12 months were similar among those who worked in OB only (17.4%) and GYN only (19.4%), but slightly higher among the subset who worked in both areas (26.7%) (chi-square test, p=0.68). Among the nonclinical staff respondents, 26.7% (8/30) identified as a SV during their career and 13.3% (4/30) in the last 12 months. Of those who identified as a SV in the last 12 months (N=38), the majority (92%) emotionally processed their symptoms through conversations with their peers. Peer support was the most frequently reported resource for all groups (Table 2). Respondents who worked in the department for 15 years or more were less likely to identify as a SV in the last 12 months versus those who had worked less than 5 years or 5 to 15 years, however this difference did not reach statistical significance (12.9% vs 22.4% vs. 20.3%, respectively; p=0.34).
Table 2.
Prevalence of SVE and Types of Support Mechanisms or Help Used in Processing an Adverse Event, According to Clinical Specialty or Position
| Survey item | All (N=205) |
Clinical specialty† | Position‡ | ||
|---|---|---|---|---|---|
| Gynecology (N=88) |
Obstetrics (N=132) |
Clinical staff (N=174) |
Nonclinical staff (N=31) |
||
| Responded that they had heard the term SV related to adverse events, prior to this survey | 69/203 (34.0%) | 40/88 (45.5%) | 40/130 (30.8%) | 68/173 (39.3%) | 1/30 (3.3%) |
| Responded that they had felt like a SV after an adverse patient safety event, ever in their work experience | 91/203 (44.8%) | 40/87 (46.0%) | 59/131 (45.0%) | 83/173 (48.0%) | 8/30 (26.7%) |
| Responded that they had felt like a SV after an adverse patient safety event, in the past 12 months | 38/202 (18.8%) | 18/87 (20.7%) | 24/130 (18.5%) | 34/172 (19.8%) | 4/30 (13.3%) |
| Support mechanism or help used in processing an adverse event, in the last 12 months (Top 5 are listed) | % of 38 | % of 18 | % of 24 | % of 34 | % of 4 |
| Conversations with peers | 35 (92.1%) | 16 (88.9%) | 23 (95.8%) | 32 (94.1%) | 3 (75.0%) |
| Conversations with family | 25 (65.8%) | 13 (72.2%) | 15 (62.5%) | 23 (67.6%) | 2 (50.0%) |
| Conversations with friends | 16 (42.1%) | 6 (33.3%) | 11 (45.8%) | 14 (41.2%) | 2 (50.0%) |
| Conversations with supervisors/managers | 11 (28.9%) | 6 (33.3%) | 5 (20.8%) | 11 (32.4%) | 0 (0.0%) |
| Patient safety/quality committee members | 5 (13.2%) | 4 (22.2%) | 2 (8.3%) | 5 (14.7%) | 0 (0.0%) |
Abbreviations: SV, second victim; SVE, second victim experience.
Both groups include the 15 respondents who reported that they were in both specialties.
Nonclinical staff includes appointment staff, health unit coordinators, desk staff, patient care assistants, embryologists, lab personnel, and research support personnel. All other respondents were classified as clinical.
As summarized in Table 3, fetal or neonatal loss and maternal death were the most common events endorsed as likely to trigger a SVE by OB healthcare workers. For respondents practicing GYN, events most likely to trigger a SVE were patient accusations or complaints and unexpected complications. Patient accusations or complaints were endorsed as likely to trigger a SVE by 57.6% of those practicing OB and by 69.3% of those practicing GYN.
Table 3:
High Risk Events Endorsed as Likely to Trigger a SVE, as Perceived by Clinical Specialty
| Survey item | Gynecology (N=88) |
Obstetrics (N=132) |
|---|---|---|
| Events endorsed in obstetrics:† | ||
| Fetal or neonatal loss | 96 (72.7%) | |
| Maternal death | 90 (68.2%) | |
| Intrapartum or neonatal death >2500g | 76 (57.6%) | |
| Patient accusations or complaints | 76 (57.6%) | |
| Co-worker complaints | 63 (47.7%) | |
| Birth trauma | 55 (41.7%) | |
| Litigation | 53 (40.2%) | |
| Events endorsed in gynecology:† | ||
| Patient accusations or complaints | 61 (69.3%) | |
| Unexpected complications | 48 (54.5%) | |
| Co-worker complaints | 47 (53.4%) | |
| Litigation | 38 (43.2%) | |
| Missed diagnoses | 37 (42.0%) | |
| Intraoperative death | 35 (39.8%) |
Abbreviations: SVE, second victim experience.
Events endorsed by >40% of respondents are shown in the table.
A comparison of subjects who did and did not identify as SVs in the last 12 months demonstrated statistically significant differences on 5 of the 7 SVEST dimensions as shown in Table 4. Respondents who identified as a SV reported experiencing more psychological distress (P< 0.001) and physical distress (P< 0.001), a greater degree to which both colleague support (P=0.012) and institutional support (P=0.002) were perceived as inadequate, and decreased professional self-efficacy (P<0.001), by having higher mean scores for these dimensions compared to those who didn’t identify as a SV in the last 12 months. For the SVEST outcome of turnover intentions (P = 0.002), there was a higher mean score among those who identified as a SV, indicating increased turnover intentions. When assessing the desirability of support options between those who did and did not identify as a SV in the last 12 months (Table 5), three forms of support were statistically preferred, including: time away from the unit (P=0.004); counseling to discuss the event (P=0.025), and a confidential 24 hour means of getting in contact with someone to discuss the experience (P=0.044).
Table 4.
Comparison of SVEST dimensions and outcomes between respondents who did vs did not report that they felt like a SV after an adverse patient safety event in the past 12 months †
| SVEST measure‡ |
Felt like a SV after an adverse patient safety event in the last 12 months | ||||
|---|---|---|---|---|---|
| No (N=164) | Yes (N=38) | P-value^ | |||
| No. (%) of respondents with a mean score of 4 or higher | Mean (SD) | No. (%) of respondents with a mean score of 4 or higher | Mean (SD) | ||
| SVEST Dimensions* | |||||
| Psychological distress | 14/163 (8.6%) | 2.2 (1.1) | 17/38 (44.7%) | 3.4 (1.2) | <0.001 |
| Physical distress | 9/163 (5.5%) | 1.7 (0.9) | 7/38 (18.4%) | 2.6 (1.1) | <0.001 |
| Colleague support | 0/161 (0.0%) | 2.1 (0.7) | 0/38 (0.0%) | 2.4 (0.7) | 0.012 |
| Supervisor support | 13/160 (8.1%) | 2.0 (1.0) | 4/37 (10.8%) | 2.3 (1.1) | 0.10 |
| Institutional support | 13/160 (8.1%) | 2.7 (0.9) | 11/38 (28.9%) | 3.2 (1.0) | 0.002 |
| Non-work-related support | 10/156 (6.4%) | 3.0 (0.4) | 0/38 (0.0%) | 3.0 (0.3) | 0.40 |
| Professional self-efficacy | 16/163 (9.8%) | 2.5 (0.9) | 12/37 (32.4%) | 3.4 (1.0) | <0.001 |
| SVEST outcomes** | |||||
| Turnover intentions | 18/160 (11.3%) | 2.0 (1.1) | 8/37 (21.6%) | 2.7 (1.2) | 0.002 |
| Absenteeism | 9/159 (5.7%) | 1.5 (0.9) | 3/38 (7.9%) | 1.8 (1.1) | 0.06 |
Abbreviations: SV, second victim; SVEST, Second Victim Experience and Support Tool.
Results based on 202 (of the 205) who answered the question about whether they felt like a SV after an adverse patient safety event in the past 12 months
The respondent’s score for each dimension or outcome was defined as the mean of 2 to 4 items each rated on a 5-point scale of 1=strongly disagree and 5=strongly agree. Results are presented for respondents who answered more than 50% of the items for a specific dimension or outcome (e.g. ≥3 of 4 items, ≥2 of 3 items, or both of 2 items).
Comparisons between the two groups were evaluated using two-sample t-test for each of the SVEST dimensions and outcomes.
A higher score for each specific dimension represents experiencing more psychological distress, more physical distress, decreased professional self-efficacy, and a greater degree to which support is perceived as inadequate.
A higher score for each specific outcome represents more turnover intensions and more absenteeism.
Table 5.
Comparison of desirable support options between respondents who did vs did not report that they felt like a SV after an adverse patient safety event in the past 12 months †
| Support option‡ | Felt like a SV after an adverse patient safety event in the last 12 months | ||||
|---|---|---|---|---|---|
| No (N=164) | Yes (N=38) | P-value^ | |||
| Desired, n (%)‡ | Mean (SD) | Desired, n (%)‡ | Mean (SD) |
||
| The ability to immediately take time away from my unit for a little while. | 92/159 (57.9%) | 3.5 (1.2) | 30/36 (83.3%) | 4.3 (0.9) | 0.004 |
| A specified peaceful location that is available to recover and recompose after one of these types of events. | 93/159 (58.5%) | 3.5 (1.2) | 27/36 (75.0%) | 3.9 (1.0) | 0.07 |
| A respected peer to discuss the details of what happened. | 125/160 (78.1%) | 4.1 (1.0) | 32/36 (88.9%) | 4.3 (0.7) | 0.14 |
| An employee assistance program that can provide free counseling to employees outside of work. | 81/160 (50.6%) | 3.4 (1.3) | 24/37 (64.9%) | 3.8 (1.1) | 0.12 |
| A discussion with my manager or supervisor about the incident. | 96/160 (60.0%) | 3.6 (1.2) | 22/37 (59.5%) | 3.6 (1.0) | 0.95 |
| The opportunity to schedule a time with a counselor at my hospital to discuss the event. | 66/158 (41.8%) | 3.1 (1.3) | 23/37 (62.2%) | 3.5 (1.2) | 0.025 |
| A confidential way to get in touch with someone 24 hours a day to discuss how my experience may be affecting me. | 65/158 (41.1%) | 3.1 (1.3) | 22/37 (59.5%) | 3.4 (1.3) | 0.044 |
Abbreviations: SV, second victim; SVEST, Second Victim Experience and Support Tool.
Results based on 202 (of the 205) who answered the question about whether they felt like a SV after an adverse patient safety event in the past 12 months.
Each support option was rated on a 1 to 5 Likert scale, where a response of 4 or 5 represented the support option as being desired.
Comparisons between the two groups were evaluated using the chi-square test for the desirability of each support option.
Discussion
We sought to determine the prevalence and knowledge of SVEs and explore types of support resources utilized and most desired among OBGYN clinical and nonclinical healthcare team members. Our study found a high prevalence of SVs among OBGYN staff, distributed equally between OB and GYN. Nonclinical healthcare workers also suffer as SVs; this may not be recognized by clinical staff and administrators. Our study broadens the knowledge of SVE given the limited number of published studies devoted to understanding SVEs within OBGYN care teams (39 - 44).
Among OBGYN healthcare workers in this study, just under half of clinical and about a quarter of nonclinical participants reported feeling like a SV during their careers. Our prevalence is consistent with previous studies and demonstrates a sizeable cohort of individuals who have suffered due to occurrences at work (2, 4, 6 - 8, 10 - 23, 25, 39 - 45). Self-selection bias may contribute to this sample size, however, a majority indicated they did not experience SVE during their career. Similar prevalence rates have been observed in other studies suggesting this is likely to be an accurate representation of SVs in this OBGYN department. Importantly, an equal percentage of GYN and OB team members identified as a SV and begins to address the paucity of data in GYN regarding SVEs (17, 44). This data also suggests that SVEs may occur among specialties considered to have a lower exposure to potentially traumatizing events and that support resources should be provided to all specialties, including nonclinical staff. Notably, we identified very little data in the literature regarding SVs among nonclinical healthcare workers in OBGYN or, in fact, any medical specialty. While nonclinical staff demonstrated a lower prevalence of SV than clinical staff, the presence of SVEs among this cohort indicates they may also benefit from post-event support resources. The effects of SVEs on nonclinical, yet patient facing, staff may be under-recognized by clinical staff and supervisors. Further research among nonclinical healthcare workers is necessary, as well as exploring the SVEs of other nonclinical staff, such as those in environmental services.
The individuals in this study reported patient death (mother, neonate, surgical patients) as an event likely to trigger a SVE, which may be more readily acknowledged by peers and supervisors and activate the provision of supportive resources when available. However, nonclinical events such as patient accusations or complaints, co-worker complaints and litigation were also characterized as events likely to trigger a SVE and may be less obvious to peers and supervisors. Little literature is published describing nonclinical events as the trigger for development of SVEs. One study has shown that physicians experience worse quality of general health, mental health and vitality, after adjusting for baseline characteristics, following malpractice disputes (49). OBGYN providers are known to have high rates of litigation, suggesting this deserves greater attention as a potential trigger for a SVE (49 - 52). Greater knowledge of the specific events in OBGYN that may trigger SVEs, may provide heightened awareness and increase further peer support. Further research is needed to understand events that trigger SVEs in OBGYN.
Second victim peer support programs implemented in healthcare settings with the goal of improving patient safety and institutional wellness offer a structured means of support for those impacted by SVE and may promote greater awareness of potential triggers (30, 48, 53 - 58). These programs train peers on how to provide emotional first aid to their suffering colleagues. A growing body of research indicates peer support is the most desired type of support for affected healthcare workers (4, 6, 10 - 11, 24, 40 - 41, 44) as was identified in this study. Speaking with a respected peer was desired by a vast majority of staff with SVEs within the last 12 months.
In this study, the SVEST dimensions, outcomes, and desirability of forms of support were compared between those who did or did not identify as a SV in the last 12 months. Although the prevalence is higher for identifying as a SV during a healthcare worker’s career, we chose to compare only the last 12 months to decrease the potential for recall bias. The results indicate that the SVEST scores measuring greater psychological and physical distress and decreased professional self-efficacy were higher in healthcare workers who identified as recent SVs. SVEST scores indicating a greater perception of inadequate institutional and colleague support were also higher amongst recent SVs. OBGYN departments may consider using the SVEST as a tool to screen for potential SV among their healthcare workers after events, determine desired support and assess the adequacy of support provided.
A limitation to the study is that greater than 50% of respondents were nurses. However, like most hospital systems, nurses comprise the majority of healthcare workers and reflect our hospital population (59). A sub-analysis of the nursing respondents has been published separately (60). Another limitation is that this study was conducted in a large suburban tertiary referral medical center. Further studies of OBGYN healthcare workers in different hospitals in diverse localities are needed to understand the generalizability to all healthcare workers. Due to the known demographics of this OBGYN department, our study did not collect comprehensive demographics of the respondents such as gender, age, race, or ethnicity to ensure the anonymity of the healthcare workers in our study population. There have been some studies suggesting that there are differences in SV prevalence based on gender (women > men) (24, 61) however to our knowledge no studies have assessed differences by race or ethnicity. Strengths of this study was the utilization of the widely used and validated SVEST. The response rate was higher than similar studies of healthcare providers for a comparatively high sample size for a single-institution cohort. Non-response bias may also be a limitation given the sensitivity of this topic, particularly among physicians who historically are less likely to respond to surveys (62), however SV prevalence among physicians in this study is similar to what is reported in SVE literature (61).
Key stakeholders in OBGYN departments need to be aware of SVEs among their healthcare workers. Hospital systems and departments should provide educational programs to increase awareness of the SVE and appropriate support resources for those suffering. Knowledge of potentially triggering events can be utilized on a department level to initiate or augment peer support initiatives. OBGYN departments should consider research findings indicating that immediate time away from unit, scheduled time to meet with a counselor, and/or a 24-hour confidential way to get in touch with someone for support are desired by healthcare workers with SVEs when designing peer support programs. Such initiatives may contribute to the ability of affected healthcare workers to thrive after involvement in triggering events, decrease turnover, improve education about the SVE, and increase peer support for affected colleagues.
Understanding the SVEs of healthcare workers within OBGYN enhances SVE awareness and provides an opportunity to reduce stigma around the expression of feelings of trauma following adverse events. Normalizing the SVE may be the start of moving healthcare workers towards recovery and post-event thriving.
Conclusions
GYN staff suffer as SVs at similar rates as OB staff. This suggests that SV prevalence in specialties and healthcare settings perceived as lower risk should be determined in order to identify SV education and support needs, through a mechanism such at the SVEST. Nonclinical staff should also be included in support planning and outreach efforts, since they are not exempt from SVE. The identification of individuals requiring support may help OBGYN departments direct these workers to appropriate support resources, reduce health care worker turnover and promote post-event thriving. Our results suggest SVEST is an effective tool to evaluate SVE in healthcare teams and identify institutional support needs for SVE in OBGYN.
Supplementary Material
Acknowledgments
We would like to thank Sara Klennert for her assistance with recruitment, creation of the REDCap survey, and administrative support. This project was supported by Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Footnotes
The authors report no conflicts of interest
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