Influence of psychological resilience on compassion fatigue in nurses in the operating room: a cross-sectional study in China

Compassion fatigue is a specific mental health issue for caregivers. It refers to the reduction in a caregiver’s empathy or interest in the person they are helping, caused by emotional investment or suffering due to the person’s experiences. This leads to a sense of burnout in the caregiving role and may even alter the caregiver’s original work values, accompanied by a range of uncomfortable symptoms [1]. Figley’s Compassion Stress and Fatigue Model outlines how exposure to trauma and stress in caregiving roles leads to secondary traumatic stress and burnout. This framework highlights key factors such as empathy, coping mechanisms, and social support, which interact to influence caregivers’ vulnerability to compassion fatigue [2].

According to Stamm, compassion fatigue comprises two core components: burnout and secondary traumatic stress. Burnout is associated with work-related stress and feelings of hopelessness, whereas secondary traumatic stress results from exposure to traumatic events experienced by others [3]. Nursing work is high-risk and involves a heavy workload, making nurses a high-risk group for compassion fatigue [4]. Currently, research on compassion fatigue, both domestically and internationally, primarily focuses on intensive care unit nurses, emergency department nurses, and oncology nurses, with limited studies on the status of compassion fatigue among operating room nurses. Operating room nurses are particularly vulnerable to these issues due to their exposure to high-stakes, time-sensitive procedures and frequent emergencies. Their work environment often involves unpredictable schedules, long hours, and limited direct interaction with patients, which can exacerbate the risks of compassion fatigue and psychological inflexibility. In 2019, Wang Xiangru et al. [5] conducted a study involving nurses from four tertiary care hospitals in Xi’an City. They found that the incidence of compassion fatigue among oncology nurses in the area was 71.54%, whereas severe compassion fatigue among emergency nurses in China was as high as 83.57% [6]. Mangoulia et al. [7] reported that emergency department caregivers were 57.9% more likely to develop compassion fatigue at a high-risk level. Gomez et al. [8] investigated 67 emergency department nursing staff at three general hospitals in California, USA, and found that 33% of the participants had compassion fatigue, which was significantly higher than among oncology nursing staff. Current studies have identified several factors affecting nurses’ compassion fatigue, including experience with fertility, years of service, regular psychological counseling, work stress, quality of humanistic care, social support, income, and physical exercise [9‐11].

In Chinese hospitals, nurses work within a hierarchical structure that includes support systems such as regular training, mental health services, and professional counseling. However, the implementation and utilization of these resources can vary widely. Operating room nursing presents unique challenges compared with general nursing roles. The work environment is dynamic and often unpredictable, requiring nurses to adapt to high-stakes decision-making during complex and time-sensitive surgeries. The variability of patient outcomes, dealing with unexpected complications, and other emergencies can also drain the energy of operating room nurses. Compassion fatigue among operating room nurses can negatively impact patients by increasing medical errors, lowering care quality, delaying recovery, and reducing patient satisfaction [12]. Given the above, it is necessary to pay attention to the mental health of operating room nurses [13].

This study aims to investigate the status and influencing factors of compassion fatigue among operating room nurses. By identifying key factors such as night shift frequency, labor relations, and psychological resilience, the research seeks to inform practical interventions. The results of the study will guide the development of stress resilience training programs, the optimization of shift schedules to reduce the burden of night shifts, and the establishment of support systems, such as peer counseling groups or stress management seminars.

The results of this study showed that the scores for compassion satisfaction, secondary trauma and burnout among operating room nurses were 33.14 ± 9.20, 25.07 ± 7.29 and 25.86 ± 6.73, respectively. The score for secondary trauma was higher than that reported in the study of oncology nurses by Su Jiliang et al. [18]. In this study, 118 operating room nurses (45.7%) were classified as having severe compassion fatigue, which was higher than the findings of Miao Huan-lan et al. [19]. This indicates that compassion fatigue among operating room nurses is at a severe level, which may be related to the following factors: (1) the operating room, as a specialized department of the hospital, handles a wide range of surgeries. Instrument nurses and circuit nurses face a heavy workload, collaborating with various surgical teams, communicating with different surgeons and anesthesiologists and adapting to rapidly evolving surgical technologies and instruments, all of which contribute to the increasing pressure on operating room nurses. (2) Unpredictable emergency surgeries and lengthy procedures make operating room nursing work more unique and unstable, which increases the likelihood of compassion fatigue among operating room nurses [20]. (3) Due to the special nature of the operating room, the nurse-patient relationship is often unstable, as nurses are frequently confronted with illness and death. Additionally, patients have a wide age range and complex and fluctuating conditions, which, combined with the high work pressure and intensity, contribute to increased stress for operating room nurses [21]. (4) In Chinese culture, the emphasis on collectivism and professional dedication often leads nurses to prioritize patient care over personal well-being. This strong sense of responsibility may contribute to higher levels of secondary trauma and burnout, as nurses may suppress their own emotional needs to meet the demands of their role [22]. Therefore, compassion fatigue is common among operating room nurses. Nurse managers should optimize workloads and schedules, provide resilience training and mental health resources and foster a supportive work environment through regular communication and recognition. These steps can help reduce stress, enhance morale and improve the quality of care.

The degree of compassion fatigue among authorized nurses was low, whereas the degree of compassion fatigue among unauthorized nurses was high. Registered nurses benefit from stable working relationships, access to state benefits, promotion opportunities and good retirement plans, resulting in lower work pressure. In contrast, unauthorized nurses typically receive lower salaries and bonuses, and most remain in precarious positions. They often bear a heavier workload, making them more susceptible to moderate and severe compassion fatigue. Liao Dejun et al. [23] found that emergency department nurses in lower positions, who handled greater workloads and treated more critically ill patients, experienced higher levels of psychological stress. Nurse managers should prioritize workload balance, psychological support and equitable treatment for all nurses to minimize compassion fatigue and improve patient care.

The more night shifts a week, the higher the level of compassion fatigue among operating room nurses, which aligns with the findings of Tian Meimei et al. [24]. Chen Hailing and Huang Qingxiu [25] also demonstrated that nurses’ compassion fatigue scores increased with the number of night shifts worked. Studies from abroad have similarly indicated that night shifts are closely linked to compassion fatigue [26]. Night shifts are an integral part of nursing work, and frequent night shifts can disrupt nurses’ work-rest patterns and negatively impact physical health, leading to endocrine disorders and an increased risk of illness [27]. Nurses working night shifts often have smaller teams, larger workloads and the need to monitor patient conditions throughout the night, which results in greater responsibility and psychological pressure [28], contributing to higher rates of compassion fatigue. Nurse managers should rotate night shifts to minimize fatigue, ensure adequate staffing to reduce the workload and implement stress reduction programs to address the specific challenges of night shift nursing.

Nurses with high psychological resilience were more able to maintain a positive attitude in nursing; therefore, the score of empathy satisfaction was high. The higher the level of psychological resilience, the lighter the degree of compassion fatigue. Psychological resilience refers to the ability of nurses to maintain a better adaptive state in the face of negative events or emotional challenges. Nurses with high psychological resilience can recover quickly from trauma [29]. The results showed a positive correlation between psychological resilience and positive emotions. Nurses with low psychological resilience may struggle to release internal pressure promptly, leading to secondary traumatic effects and reduced empathy satisfaction after encountering or witnessing situations where the aid recipient is suffering, which aligns with the findings of Zhao Chuyi et al. [30]. The results also indicated that resilience was negatively correlated with the score of secondary trauma. This may be because operating room nurses with high levels of resilience possess stronger psychological endurance and are better able to process secondary trauma through various coping mechanisms after experiencing negative events. Psychological resilience was negatively correlated with burnout. Operating room nurses with high levels of resilience possess strong self-repair abilities, enabling them to effectively use their own experiences and external support to overcome negative emotions. They can self-repair through practice, strengthen their emotional resilience, accumulate experience and continue to grow. In contrast, nurses with low psychological resilience may struggle to adjust themselves in time and are more prone to burnout, which is consistent with the findings of Tian Meimei et al. [24]. In the high-load nursing environment of the operating room, equipment and circuit nurses often cannot reserve enough time and energy for themselves to effectively manage the negative psychological emotions caused by patients’ adverse events, leading to the continuous accumulation of secondary trauma. Therefore, it is essential to implement the necessary training and interventions focused on psychological resilience. This would help promote the self-repair of operating room nurses, reduce the risk of secondary trauma and burnout and contribute to establishing and expanding the operating room nursing team.

The above results indicate that the level of compassion fatigue among operating room nurses is severe. Nursing administrators in the operating room should implement targeted measures to address this issue. These measures could include strengthening communication with nurses to better understand their emotional and mental well-being and scientifically and rationally scheduling night shifts. Additionally, there should be increased support for unemployed nurses, offering them opportunities for professional communication and growth. Furthermore, time and workload should be reasonably allocated to help reduce work pressure and alleviate compassion fatigue.

Through further review of the literature, we learned that differences in care settings also can greatly influence the relationship between psychological resilience and compassion fatigue. A study found that nurses working in high-stress environments, such as intensive care units, exhibited higher levels of compassion fatigue, which inversely correlated with their psychological resilience levels [31]. This suggests that the demanding nature of certain nursing settings can exacerbate compassion fatigue while diminishing resilience. Another research indicated that supportive work environments can bolster nurses’ resilience, thereby mitigating the effects of compassion fatigue [32]. These studies suggest that psychological resilience is not only an important individual trait for coping with compassion fatigue, but can be further enhanced by targeted interventions (e.g., socio-environmental support, etc.), informing the design of future interventions.

This study makes several contributions to the existing literature. First, it explores the role of emotional labor in mediating the relationship between role pressure and silence behavior, expanding the theoretical understanding of emotional labor beyond traditional service contexts. Second, by focusing on nurses in a women-children specialty hospital, the study addresses a significant gap in research on the emotional labor dynamics in healthcare settings that involve both high emotional demand and specialized care. Finally, the findings provide practical insights for healthcare administrators in developing strategies to manage nurse well-being and improve organizational communication.

This study also has several limitations. First, the sample size of 258 nurses from a single hospital may limit the generalisability of the findings. Key factors such as cultural context, institutional policies and coping styles were not examined, yet these could significantly influence compassion fatigue. Additionally, the study’s regional focus restricts its applicability to other healthcare systems or cultural contexts. Future research should expand the sample size, include multiple hospitals and consider additional variables to provide a broader understanding. Finally, the inclusion of nurses with over 1 year of operating room experience may limit the findings’ applicability to those with less experience. Early-career nurses often face adjustment-related stress and burnout, which could offer valuable insights into how compassion fatigue develops. Future studies should explore this group for a more comprehensive understanding.

The status of compassion fatigue in operating room nurses is severe. Factors such as the frequency of night shifts, labour and personnel relations and the level of psychological resilience influence the extent of compassion fatigue. Therefore, nursing managers in the operating room should take timely and appropriate measures, including dynamically observing the psychological mood changes of each nurse, scientifically planning work tasks according to the nurses’ characteristics and reducing their workload. Leveraging the strengths and characteristics of nurses, along with providing relevant training to improve psychological resilience, plays a key role in reducing compassion fatigue, establishing the nursing team, enhancing the quality of nursing services and promoting the development of nursing work in the operating room.