For rural and remote healthcare workers, the possibility of an adverse event can be one of the most frightening aspects of the job. Despite our training, care and best intentions, human beings are fallible, systems can fail, communication can break down, and decisions are made under pressure. Sometimes, despite everything we do, something goes terribly wrong.
When an adverse event contributes to serious harm or the loss of a patient’s life, the emotional impact on the healthcare workers involved can be overwhelming.
If you have experienced this, your emotional response means you are human, and that what happened matters to you.
Start with the facts, not the story your mind is telling you
After an adverse event, we often try to make sense of what happened. This can quickly turn into self-blame. You might find yourself thinking, “I should have known,” or “If only I had checked one more time.” These thoughts can feel like facts, but they are often our best attempt to find certainty and control after something frightening and painful. Try to gently separate what happened from what you are telling yourself about what happened.
A medication error may have occurred. A patient may have died. These are facts.
“I should never have become a nurse.” “Everything is my fault.” These are interpretations.
This doesn’t mean avoiding accountability. It means creating enough perspective to understand the full picture. Healthcare adverse events rarely occur because of one person’s actions alone. Contributing factors may include systems, processes, workload, staffing, communication, fatigue, interruptions, training, or organisational culture. Accountability and self-compassion can exist together.
Allow yourself to feel what you feel
There is no “right” way to feel after an adverse event. You might experience shock, helplessness, guilt, shame, anger, numbness, embarrassment, worry or something completely different. You may lose confidence, fear what others think, or replay what happened, wondering what you could have done differently.
You may also be grieving.
The death of a patient can affect healthcare workers deeply, particularly when you believe your actions played a part. In rural and remote settings, this impact can be even more complex. You may know the patient and their family personally, have cared for them over many years, or continue to see family in community after the event.
You don’t have to carry this alone.
Talk to someone you trust:
- A colleague who understands healthcare.
- Your manager, if you feel safe doing so.
- A trusted friend or family member.
- A GP, psychologist (including 24/7 on the Bush Support Line), or counsellor.
Navigating the next step
The investigation process can be incredibly stressful. You might constantly anticipate the next meeting, email, or phone call, or worry about repercussions, job security or your registration. Remember that an investigation is a process for understanding what happened and why. It is not your job to solve the entire situation in your head before the investigation is complete.
Where appropriate:
- Write down what you remember while events are still relatively fresh.
- Stick to the facts and distinguish these from what you think/assumed happened.
- Seek appropriate professional or union support.
- Ask questions if you don’t understand the process.
- Take someone with you to meetings where you are entitled to have support.
- Give yourself permission to focus on what is happening today, rather than trying to predict every possible outcome.
Working with guilt
Guilt can sometimes be useful. It can tell us that something important has happened and motivate us to learn, repair and change. But guilt can become harmful when it turns into shame.
Guilt says: “I made a mistake.”
Shame says: “I am a mistake.”
The first can help us reflect and learn. The second can keep us trapped.
Instead, try asking yourself: What can I learn from this? What was within my control? What wasn’t within my control? What would I want a colleague I cared about to hear if they were in my position?
Learning from an adverse event doesn’t mean punishing yourself for it.
Take care of your nervous system
Your nervous system may remain on high alert, even after the situation has passed. You might feel restless, exhausted, tense, distracted or unable to switch off. You may experience nightmares, sleep disturbance, physical symptoms or social withdrawal.
For the next few days, focus on the basics:
- Eat regularly and stay hydrated. Rest when you can; your body may need more recovery than usual.
- Move gently – even a short walk can help your nervous system shift out of prolonged stress.
- Limit alcohol and other substances, which can worsen sleep and emotional regulation.
- Stay connected – isolation can make guilt and shame grow stronger.
- Take breaks from thinking about the incident. You are allowed to laugh, spend time with family or do something completely unrelated to work.
- Notice when your inner dialogue becomes harsh or absolute.
- If you’re struggling to focus at work, step away when possible to recharge and clear your head.
You are more than the worst thing that has happened at work. You are still the person who has cared for patients, supported families, helped colleagues, worked long shifts, made good decisions and tried to do your best in difficult circumstances.
Whatever comes next, try to remember: you are a human being who experienced something profoundly difficult. Keep choosing connection – to yourself, others and what matters.
SJ Stratton (she/her)
Senior Psychologist, Mental Health and Wellbeing
