JAAPA Podcast – “Impact of Adverse Event Exposure on PA and APRN Well-Being”

Date: February 16, 2026
Guest: Samantha Sagisi, PA-C, Lead Author
Host: JAAPA Podcast Team

Episode Overview

This episode explores the profound impact of adverse events, near misses, and medical errors on the well-being and professional lives of Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs or collectively, “APPs”). Lead author Samantha Sagisi joins the JAAPA Podcast to discuss her recent study published in the October edition of JAAPA, which surveyed over 1,000 APPs from a major health system about their experiences with adverse events, symptoms of “second victim syndrome,” burnout, and sources of support. The discussion covers key findings, personal anecdotes, and institutional recommendations to foster provider wellness.

Key Discussion Points & Insights

1. Introduction to Guest and Her Path to Provider Wellness

Timestamp: 00:59–03:46

• Samantha Sagisi’s Background:
  • Originated from Boston; educated at Northeastern University (PA pathway inspired by exposure to profession, clinical research co-ops).
  • Attended Northwestern’s PA program; currently works in nephrology inpatient consult at Northwestern Memorial Hospital.
• Wellness Advocacy Involvement:
  • Joined Northwestern’s “Scholars of Wellness” in 2022, a program focused on workplace well-being.
  • Helped expand wellness initiatives to include APPs (not just physicians), especially post-pandemic.
  • Currently serves as System APP Liaison for workforce well-being.

“As the pandemic was ending, the rates of burnout amongst APPs in our institution were extremely high and so they saw a call to action and brought APPs into this program.”
— Samantha Sagisi [02:56]

2. State of Knowledge Prior to Study & Second Victim Syndrome

Timestamp: 04:11–07:27

• Research Gaps:
  • Lack of clear data and publications specifically about adverse events among APPs; previous studies grouped PAs/APRNs with other clinicians.
  • Existing literature indicates that about half of all physicians and nurses will experience second victim syndrome in their careers.
• Understanding Second Victim Syndrome:
  • Defined as trauma experienced by clinicians after an adverse event, error, or patient death—the patient is the first victim, the clinician the second.
  • Symptoms include anxiety, shame, self-blame, professional isolation, defensive medicine, depression, or even suicidal ideation.
  • Effects vary based on experience level and personal circumstances.

“Second victim syndrome is characterized by this increased feeling of anxiety, shame or self-blame related to the event. Many people feel as though they should have foreseen the event, or maybe they feel personally responsible...”
— Samantha Sagisi [06:37]

3. Study Design and Survey Approach

Timestamp: 07:27–12:10

• Survey Details:
  • 14-question survey sent to 1,000+ APPs across various care settings (academic, community, ambulatory).
  • Covered: professional role, years of experience, work environment, history of adverse events (ever and past six months), second victim syndrome symptoms, consideration of leaving clinical practice, preferred type of support, and burnout/callousness (using the two-question Maslach Burnout Inventory).
  • Included open-ended responses for personal anecdotes.
• Goals:
  • Balanced brevity and depth to avoid survey fatigue but adequately capture the APP experience.
  • Designed to inform expansion of peer support programs.

"Our hope was to get a large enough sample size to represent our diverse workforce while still really hitting all the high points of exploring this concept of adverse events and the impact on the well being in the APP workforce."
— Samantha Sagisi [08:33]

4. Key Results: Adverse Events and Their Prevalence

Timestamp: 12:10–16:14

• 350 APPs responded:
  • 37.4% PAs, 63.6% APRNs.
  • Majority had 10+ years of experience; 4.6% were new graduates.
• Prevalence:
  • Over 55% reported experiencing an adverse event in their career.
  • 25.1% experienced an event in the previous six months.
  • Most events correlated with professional tenure: higher lifetime rates among experienced APPs, but recent events more frequent among less experienced ones.

“60.8% of APPs with 10 or more years of experience reported at least one event compared to 43.8% of APPs with less than one year of experience.”
— Samantha Sagisi [13:38]

• Compared to published literature, rates among APPs are similar to physicians and nurses.
• Raises question of resilience development and changing perceptions with experience.

5. Well-Being Impact and Manifestations of Second Victim Syndrome

Timestamp: 16:14–18:31

• Symptoms and Consequences:
  • 55.4% identified as having experienced an adverse event; 97.4% of them had symptoms of second victim syndrome.
  • Emotional symptoms: 92% reported anxiety, depression, or irritability.
  • Loss of self-confidence: ~75%.
  • Defensive medicine: Over 50% reported practice changes (ordering extra tests, etc.).
  • Depersonalization: About 1/3 felt less connected to patients.
  • Physical symptoms: Over 50% had trouble sleeping.
• Anecdotal Themes: Shame, guilt, fear frequently cited in written responses.

“The emotional impact is huge... our battery can become depleted suddenly. Even small inconveniences can feel like enormous hurdles to overcome.”
— Samantha Sagisi [16:34]

6. Association with Burnout and Turnover

Timestamp: 18:31–21:47

• Burnout:
  • 37% overall burnout among respondents.
  • Burnout higher if exposed to an adverse event: 42% vs. 30.8% among those who had not.
  • Even higher (44%) if event occurred in past six months (not statistically significant due to sample size).
  • Callousness (depersonalization) rates also higher among those with adverse event exposure.
• Turnover Intentions:
  • 1 in 7 APPs considered leaving their role or clinical medicine after an event.

“Alarmingly, one in seven APPs reported that they considered leaving their role or clinical medicine altogether after the event.”
— Samantha Sagisi [19:59]

7. Sources of Support and Institutional Response

Timestamp: 21:47–25:26

• Preferred Support:
  • 87% sought help from a peer (most found it helpful).
  • Only 7% would use employee assistance programs (EAPs).
• Peer Support Programs:
  • Northwestern Medicine expanded its peer-to-peer (P2P) support program—originated for physicians—to include all APPs, informed by survey findings.
  • Trained 40 peer supporters; program is confidential and voluntary, focusing on coping rather than clinical review.
  • Program expansion based on recognition that adverse events affect the entire care team.

“The majority of APPs did seek out support from a peer following an exposure. Actually, 87% ... and nearly all of them said it was helpful for them in coping with the event.”
— Samantha Sagisi [21:52]

• Institutional Incentives:
  • Mitigating burnout and turnover has financial, moral, regulatory, and reputational benefits for health organizations.

8. Next Steps and Final Thoughts

Timestamp: 25:58–27:41

• Research Needs:
  • More large-scale studies needed to clarify the time relationship between adverse events and burnout.
  • Need for more APP leadership and research participation in wellness programs.
• Moral Obligation:
  • Institutions should proactively support clinicians to maintain a healthy workforce.
• Call to Action:
  • Encourages APPs to seek or create leadership opportunities in wellness and contribute to evolving research and advocacy.

“We need more APP leaders... not only in the area of peer support and adverse events but in many other facets of what drives APP wellness and burnout.”
— Samantha Sagisi [26:42]

Notable Quotes & Moments

• “We encounter the occupational hazard of taking care of complex sick patients every day. And these occupational hazards can sometimes lead to emotional, psychological and physical ramifications for the involved clinician.”
  — Samantha Sagisi [05:56]

• “It’s really not just the physician and the nurse, but it’s also the social worker and the physical therapist and the PA ...”
  — Samantha Sagisi [23:56]

• “The more that we train people in peer support, the more you’re just able to use it in your day-to-day interactions ... The ideal state is that the peer support program doesn’t even need to exist ... because that’s just how we all operate.”
  — Samantha Sagisi [26:11]

Timestamps of Important Segments

| Segment | Description | Timestamp | |-----------------------------------------|--------------------------------------------------------|------------| | Guest Introduction & Wellness Journey | Sagisi’s path to PA and wellness programs | 00:59–03:46| | Study Rationale & Literature Review | Gaps in APP-specific research, second victim syndrome | 04:11–07:27| | Study Design & Survey Content | Survey structure, purpose, questions | 07:27–12:10| | Prevalence of Adverse Events | Survey results, experience levels, comparisons | 12:10–16:14| | Impact on Well-Being | Symptoms of second victim syndrome, provider stories | 16:14–18:31| | Burnout & Turnover | Rates of burnout, intentions to leave, bidirectional risk | 18:31–21:47| | Sources of Support, Institutional Action| Peer support vs. EAP, P2P program expansion | 21:47–25:26| | Research Needs & Motivational Message | Call for engagement in research and leadership | 25:58–27:41|

Tone and Style

Throughout the episode, the conversation is warm, earnest, and heavily focused on empathy and support within the healthcare community. Samantha Sagisi’s personal and professional passion is evident, particularly regarding peer support systems and the need for systemic institutional change.

Summary Takeaways

• Adverse events are a common and serious occupational hazard for APPs, not unlike other frontline medical professions.
• Second victim syndrome is prevalent: 97.4% of those experiencing adverse events reported symptoms, most commonly anxiety and loss of confidence.
• Burnout and depersonalization are closely linked to adverse events, influencing APP well-being and retention.
• Peer support is the preferred and most effective support system—far more so than traditional employee assistance schemes.
• Institutions have a moral and practical imperative to support their clinicians after adverse events, with expanding peer support programs a key recommendation.
• More research and leadership from APPs is needed to drive wellness initiatives and address these ongoing challenges in healthcare.

This episode offers a comprehensive look into the emotional landscape of APPs facing adverse events, providing practical institutional solutions and an empowering call to action for listeners.