The impact of the second victim phenomenon on nurse turnover intentions and absenteeism: a systematic review and meta-analysis.

Authors

Jing Liu, Dandan Ma, Jinrong He, Danfeng Tan, Ling Zhang, Xin Peng, Muhammad Sohaib, Shuoting Hu

Published in

BMC nursing. Volume 25. Issue 1. Sep 03, 2026. Epub Sep 03, 2026.

Abstract

The Second Victim Phenomenon (SVP) is the psychological trauma that healthcare workers experience due to their negative experiences with patients. Its incidence in nurses is well known, but its quantitative implications on nurse retention and attendance are poorly understood. This systematic review and meta-analysis summarizes the evidence regarding the relationship between SVP and nurse turnover intentions and absenteeism.
A systematic search of the PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library (CENTRAL) databases was conducted through April 2026, following PRISMA guidelines. The included studies were cross-sectional studies that investigated the relationship between SVP and turnover intentions or absenteeism among nurses. Two independent reviewers used the Newcastle-Ottawa Scale (NOS) to screen, extract data, and evaluate the quality. Random-effects models were used to pool effect sizes in meta-analyses. Heterogeneity was measured using both the I² statistic and the Cochran Q test. Subgroup analyses were performed to examine differences across geographic regions, healthcare settings, and study quality. Publication bias was measured using funnel plots and the Egger test. The quality of evidence was determined according to GRADE criteria.
A total of 38 cross-sectional studies were included, comprising 22,241 participants in the turnover intention analysis and 14,662 participants in the absenteeism analysis. Meta-analysis revealed that nurses experiencing SVP had significantly higher odds of turnover intention (pooled OR = 2.99, 95% CI: 2.81-3.18, p < 0.001, I² = 75.9%) and increased risk of absenteeism (pooled RR = 2.21, 95% CI: 2.05-2.37, p < 0.001, I² = 82.6%). There was significant study heterogeneity. Subgroup analyses showed that the effects were similar in varied geographic areas and health care settings. There was no significant publication bias (Egger test p > 0.05 in both results). GRADE evaluation showed low-quality evidence due to the observational study design and heterogeneity, but upgraded the effect size to large.
This meta-analysis provides strong evidence that SVP is significantly associated with higher turnover intention and absenteeism among nurses, posing a serious risk to the stability of the health care workforce. The results highlight the importance of organizational interventions to support nurses with SVP, such as peer support programs, psychological counseling, and changes in institutional culture. Future studies need to use longitudinal designs to examine temporal relationships and intervention studies to assess the effectiveness of support programs.

PMID:
42760512
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.

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