Byline: Sun-Aee Kim, Management and Planning Team, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, Republic of Korea (Dr S.-A. Kim); College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan-si, Gyeongsangnam-do, Republic of Korea (Dr E.-M. Kim); and Department of Nursing, Koje University, Koje, Republic of Korea (Dr Lee).; Eun-Mi Kim; Ju-Ry Lee Abstract BACKGROUND: Unanticipated adverse events could harm not only patients and families but also health care professionals. These people are defined as second victims. Second victim distress (SVD) refers to physical, emotional, and professional problems of health care professionals. While positive patient safety cultures (PSCs) are associated with reducing severity of SVD, there is a dearth of research on the association between PSCs and SVD and the mediation effects in those associations. OBJECTIVES: The purpose of this study was to explore the associations between PSCs and SVD and verify the multiple mediation effects of colleague, supervisor, and institutional supports. METHODS: A cross-sectional study using a self-report questionnaire was conducted among 296 nurses in South Korea. The participants were selected by quota sampling in 41 departments including general wards, intensive care units, etc. Descriptive statistics, Pearson's correlation, multiple linear regression, and multiple mediation analysis were conducted using SPSS 25.0 and the PROCESS macros. RESULTS: Nonpunitive response to errors, communication openness, and colleague, supervisor, and institutional supports had negative correlations with SVD (Ps CONCLUSION: The study suggests that establishing nonpunitive organizational cultures is an effective strategy to reduce SVD. The findings highlight the importance of promoting programs that strengthen PSCs in hospitals and prioritizing support resources to reduce SVD among nurses.