Background <p>Patient safety events can have substantial emotional and professional consequences for clinicians involved in them. This study examined second victim experiences among operating room nurses in China and how organisational support, just culture and career resilience were associated with burnout and intention to leave.</p> Methods <p>A sequential explanatory mixed-methods design was used. Between March and July 2025, a cross-sectional survey was administered to operating room nurses in 10 tertiary general hospitals in Shanxi and Henan provinces; 540 of 820 eligible nurses provided analysable data. Measures included the Chinese Second Victim Experience and Support Tool and scales for organisational support, just culture, career resilience, emotional exhaustion and intention to leave. Hierarchical linear and logistic regressions examined associated factors. From August to October 2025, interviews with 24 purposively sampled respondents were analysed thematically.</p> Results <p>Overall, 83.3% reported at least one second victim experience and 62.4% reported an event within the previous 12 months. Psychological distress scored highest (mean 3.64/5), and the second victim impact index¹ was moderate (mean 3.20/5). More frequent recent events and perceived primary responsibility were associated with higher impact scores, whereas greater operating room experience, organisational support, just-culture perceptions and career resilience were associated with lower scores (<InlineEquation ID="IEq1"><EquationSource Format="TEX">\({{\rm{R}}^{\rm{2}}}{\rm{ = 0}}{\rm{.40}}\)</EquationSource></InlineEquation>). High intention to leave was identified in 40.0%. The impact index and emotional exhaustion were associated with higher odds of high intention to leave, whereas organisational support and career resilience were associated with lower odds. Four themes emerged: carrying events alone, support depends on who is in charge, peer solidarity as a lifeline, and wanting a structured but non-punitive response.</p> Conclusions <p>Second victim experiences were common among operating room nurses in Chinese tertiary hospitals and were associated with emotional exhaustion and intention to leave. More favourable organisational support, just-culture perceptions and career resilience were associated with lower second victim impact and lower turnover intention. Structured, non-punitive support pathways warrant development and evaluation in perioperative settings.</p> Trial Registration <p>Not applicable. This was an observational mixed-methods study and not a clinical trial; trial registration was therefore not required.</p>