Background: Medical errors in pediatric settings have profound implications for patient safety and healthcare professionals’ psychological well-being. However, little is known about how pediatric nurses in low- and middle-income countries experience disclosing errors to families. This study explored the lived experiences of pediatric nurses in Urmia, Iran, regarding medical error disclosure to families.

Methods: A descriptive phenomenological study employing Colaizzi’s seven-step method was conducted. Sixteen pediatric nurses from tertiary teaching hospitals in Urmia, Iran, participated in semi-structured interviews between March and September 2025. Participants had at least one year of pediatric experience and self-reported involvement in a medical error within the prior 24 months. Data analysis followed phenomenological procedures, with trustworthiness ensured through Lincoln and Guba’s criteria.

Results: Four main themes emerged: (1) “The Weight of the Unspoken”—embodied moral distress and fear of family response; (2) “Walking a Tightrope Without a Net”—navigating hierarchical constraints (physician gatekeeping) and institutional silence (absence of disclosure policies); (3) “The Moment of Truth”—disclosure encounters as turning points, with healing disclosure contrasting with nondisclosure regret; (4) “Carrying It Home”—enduring psychological consequences including intrusive memories, hypervigilance, and absence of organizational aftercare. Negative cases demonstrated that supportive environments enabled successful disclosure.

Conclusions: Pediatric nurses experience profound moral distress and second victim symptoms following errors, compounded by hierarchical constraints and lack of institutional support. Culturally tailored disclosure protocols, training, and second victim aftercare are urgently needed.