The COVID-19 pandemic highlighted hospital environments' complex and dynamic nature within the past two years. Nurses' workday is challenged with inadequate staffing, heavy workloads, and burnout and operating in fractured systems places them in precarious situations for adverse events to occur (Manzano García & Ayala Calvo, 2021). Adverse events (AEs) represent the unintended and unexpected outcome of a patient's care, unrelated to the patient's natural disease state. Estimates in the literature place AEs as a significant cause of patient harm, ranging from minor, moderate to major harm, or death (Hegarty et al., 2020; Leveson et al., 2020; Panagioti et al., 2019). Such events in healthcare signal a potential gap in the processes designed to safeguard patient care.

A root cause analysis (RCA) is the most common investigative technique that dives into an organization's underlying system or process issues to identify gaps in care. RCAs are performed for near misses, preventable adverse events, significant events, or sentinel events that may or may not have caused harm (Agency for Healthcare Research and Quality, 2019; Karkhanis & Thompson, 2021). Healthcare professionals, specifically nurses, are usually at the forefront of these investigations because of the direct care they provide in these complex environments. The experience of registered nurses whose organizations designed RCA processes including staff directly involved as a part of the RCA meeting is an area where no research exists.

Many research studies have evaluated the impact and burden on the healthcare professionals involved in an adverse event. A systematic review and meta-analysis found healthcare professionals' most prevalent psychological symptoms were troubling memories, anxiety, anger, and regret (Busch et al., 2020). Stovall et al. (2020) viewed this problem from the lens of moral distress and found nurses' symptomatology included being in a spiritual-existential crisis and having shame, guilt, and loss of trust about the event. An in-depth exploration of the underlying factors driving these emotions was related to the traumatic nature of the event, feeling personally accountable and responsible for the patient's outcome, fear of being blamed, judged, or deemed incompetent by others, impact on career, potential litigation, or other consequences (Busch et al., 2020; Busch et al., 2021; Chan et al., 2017; Stovall et al., 2020). Through dimensions of coping and supportive measures, these studies have evaluated healthcare professionals' decisions to change their practice, leave their job, or seek an alternate career (Busch et al., 2020; Chan et al., 2017; Kappes et al., 2021; Stovall et al., 2020).

Published studies have analyzed RCA reports to identify the RCA team's impact of RCAs on reducing patient harm and adverse event occurrence (Boussat et al., 2017; Martin-Delgado et al., 2020). The feasibility and effectiveness of conducting RCAs using different methodologies (Kellogg et al., 2017; Peerally et al., 2017) and the strength, implementation, and completion of action plans (Francois et al., 2018; Hamilton et al., 2019) have also been explored. While the literature provides a good understanding of the trajectory of second victims, healthcare professionals involved in a medical error (Wu, 2000), and evaluates the effectiveness of an RCA as an investigative technique, these studies do not address the role of the healthcare professional directly involved in an adverse event and their participation in an RCA meeting. Thus, insight into this specific practice is not known.