Background <p>The “second victim” phenomenon (SVP) refers to healthcare providers who experience profound emotional and physical distress following adverse patient events. This phenomenon is a significant driver of burnout and can severely compromise both professional functioning and patient safety.</p> Objective <p>This study aims to investigate the specific disparities in perceptions between policymakers and frontline nurses regarding the SVP within the Israeli healthcare system.</p> Methods <p>Thirty in-depth interviews were conducted: 15 with policymakers and 15 with nurses who had firsthand experience as second victims. A convenience sampling method was used for both groups. Data were synthesized and analyzed using comparative thematic synthesis.</p> Results <p>The findings revealed profound and pervasive perceptual gaps across several key domains. First, policymakers often restricted the definition of SVP to critical medical errors, whereas nurses perceived it broadly, irrespective of actual outcomes. Second, while policymakers viewed the phenomenon as rare and transient, nurses consistently reported it as an enduring occupational challenge with deep personal impact. Third, organizations predominantly offered reactive support, which stood in stark contrast to the nurses' preference for proactive and routine assistance.</p> Conclusion <p>Significant perceptual gaps exist between Israeli policymakers and nurses regarding SVP. Addressing these disparities is crucial for developing proactive support policies, ultimately fostering provider well-being and enhancing the overall quality of patient care.</p>