Introduction
In recent years, the global spread of COVID-19 has not only profoundly altered lifestyles but also imposed an unprecedented strain on healthcare systems [1]. Nurses have been at the forefront of the pandemic response, carrying immense responsibilities and stress [2]. While the contributions of the nursing workforce have been widely recognized, their underlying career development challenges cannot be overlooked. Numerous studies indicate that nurses face issues such as burnout [3], sexual harassment [4], workplace violence [5], and high workload [6]. These challenges pose serious threats to nurses’ mental health and safety, affecting their work engagement and hindering their career development and ability to achieve decent work.
“Decent work” is a concept introduced by the International Labour Organization (ILO). At the 87th International Labour Conference in June 1999, then ILO Director-General Juan Somavia introduced the concept of “decent work,” outlining four strategic objectives: “the promotion of rights at work, employment, social protection, and social dialogue“ [7]. Subsequently, scholars have continued to explore the concept of decent work. Duffy concretized decent work as including safe working conditions, hours that allow for free time and adequate rest, organizational values that complement family and social values, adequate compensation, and access to adequate healthcare, among other individual perceptions [8]. Additionally, a qualitative study by Xue on nurses defines decent work as engagement in a profession within a secure, fair, and friendly practice environment where they could receive respect, support, reasonable compensation, social security, and opportunities for career development, all of which could enable nurses to recognize their intrinsic values and achieve a state of professional and personal fulfillment [9].
Anzeige
In past, researchers have explored several factors that may influence nurses’ perception of decent work. The findings show that decent work is related to social support and effort-reward imbalance [10], as well as organizational support and professional quality of life [11]. A qualitative study funded key factors influencing nurses’ perception of decent work, including the work environment, atmosphere, and safety; attitudes from patients and family support; managerial attitudes, leadership style, and professional development; public perception and self-value; and personal traits, professional experience, and income level [9]. Furthermore, decent work is positively associated with job satisfaction and negatively associated with burnout, while compassion fatigue is negatively correlated with decent work [11, 12]. Other research has shown that compassion fatigue negatively impacts work engagement [13]. However, nurses, who face patients’ suffering daily and feel empathy for their pain, are prone to compassion fatigue [14]. There is a lack of studies that explore the relationships between compassion fatigue, work engagement, and decent work among nurses.
The term “Compassion Fatigue” (CF) was first introduced by Johnson in 1992 in a study on nurse burnout [15]. Later, trauma specialist Figley (1995) provided a detailed explanation of CF, describing it as the physical and emotional discomfort experienced by caregivers as a result of indirectly encountering traumatic events through empathy with patients, leading to a diminished capacity for compassion [16]. The mechanisms behind the development of compassion fatigue have long been a focus of trauma psychology research. Studies show that the nursing population is particularly vulnerable to compassion fatigue, especially in work environments characterized by emotional burdens and the pain of patients [17]. Understanding the negative consequences of compassion fatigue is crucial for comprehending its impact on nurses’ well-being and professional functions. Research has shown that compassion fatigue has numerous adverse effects on nurses, including sleep disturbances, depression, emotional numbness, and feelings of helplessness [18, 19]. Furthermore, compassion fatigue is not only a psychological response to patients’ suffering but also a key factor influencing nurses’ professional behavior. Studies have found that compassion fatigue is negatively correlated with nurses’ professional identity and work engagement [14]. Increased compassion fatigue is associated with poorer nursing quality, lower job satisfaction, and higher turnover intentions [20]. Therefore, understanding how compassion fatigue influences nurses’ work engagement and perceptions of decent work is crucial for addressing these challenges and improving nursing outcomes.
Work engagement is a positive psychological state characterized by vigor, dedication, and absorption. Vigor is defined as strong energy, psychological resilience, and the desire to exert effort. Dedication refers to a deep involvement in the value and meaning of one’s efforts, with a sense of pride, challenge, inspiration, and enthusiasm. Absorption is characterized by complete concentration on one’s efforts, making it challenging to detach from work [21]. Kahn et al., based on role identity theory, define work engagement as a state where individuals experience a seamless integration of mind and body in the workplace, free from distractions, and are able to freely express their physical, cognitive, and emotional states [22]. Schaufeli defines work engagement as “a psychological process characterized by active optimism and striving for progress, experienced over the long term in the workplace. Its main features are vigor, dedication, and absorption [23]. The Nursing Executive Center (NEC) defines engaged nurses as ‘individuals who are inspired to do their best work, feel personally motivated to help their larger organization succeed, and are willing to exceed the expected level of effort [24]. Previous studies have shown that nurse engagement is a key driver of care quality [25], and can predict levels of fatigue among nurses [26]. When engagement levels are low, nurses may disengage from their work roles, potentially leading to an increased intention to leave the profession [27].
Stamm’s Professional Quality of Life Model provides a framework for understanding the relationships between compassion fatigue, work engagement, and decent work among nurses [28]. The model divides professional quality of life into two dimensions: compassion satisfaction (comprising burnout and secondary traumatic stress) and compassion fatigue (representing the sense of achievement and satisfaction derived from work). Nurses who experience prolonged compassion fatigue may face emotional resource depletion, which leads to a decline in work engagement [14]. High levels of compassion fatigue can cause nurses to lose enthusiasm and a sense of responsibility for their work, thus affecting their work efficiency and quality [29, 30]. Work engagement not only helps nurses improve job performance but also provides more opportunities for career advancement (e.g., promotions, increased compensation) [31]. These rewards further enhance nurses’ sense of job identity, strengthening their perception of decent work [32]. However, despite extensive research on compassion fatigue and work engagement, there is limited exploration of how these two factors interact to influence nurses’ perceptions of decent work. While existing studies have examined the direct impact of compassion fatigue on job satisfaction and work performance, fewer studies have considered its role in shaping nurses’ perceptions of decent work. Additionally, the mediation effect of work engagement between compassion fatigue and decent work has not been sufficiently addressed in the literature.
Anzeige
Therefore, this study focuses on analyzing the relationships among compassion fatigue, work engagement, and the perception of decent work in nurses, aiming to provide a reference for developing interventions to improve nurses’ perception of decent work.
Methods
Study design
This study used a cross-sectional survey design.
Participants
A convenience sampling method was used to select clinical nurses from five hospitals in Hangzhou, Zhejiang Province, from April to May 2024. These five hospitals employed a total of approximately 1800 nurses. According to Kendall’s sample size estimation [33], the sample size should be 10 to 20 times the number of variables. With 23 variables, the calculated sample size ranged from 230 to 460. Accounting for a 20% invalid response rate, the minimum required sample size was 276.
Inclusion criteria: (1) Registered nurses; (2) Frontline clinical nurses, including general and management nurses; (3) Informed about the study and willing to participate. Exclusion criteria: (1) Intern nurses; (2) Nurses not on duty during the survey period.
A total of 846 questionnaires were collected, resulting in a recovery rate of 52.38%. After excluding 8 invalid questionnaires (due to incomplete responses or obvious errors), the final sample size was 838, leading to an effective response rate of 99.05%.
Instruments
Demographic characteristics
This self-designed questionnaire collected demographic data, including gender, age, educational background, years of working, professional title, department, hospital level, marital status, number of children, monthly income, monthly night shifts, and employment status.
Decent work perception scale (DWPS)
The DWPS, developed by Mao [34], measures perceptions of decent work across five dimensions: work rewards, work position, career development, work recognition, and work atmosphere. The scale contains 16 items rated on a 5-point Likert scale (1 = “strongly disagree,” 5 = “strongly agree”). The total score ranges from 16 to 80, with higher scores indicating greater perceptions of decent work. The scale has been widely used among clinical nurses, with a Cronbach’s α of 0.961 in this study.
Chinese version of the compassion fatigue short scale (C-CFSS)
The C-CFSS, adapted by Sun [35], is widely used to assess compassion fatigue. It includes two dimensions: secondary trauma and burnout, with 13 items rated on a 10-point Likert scale (1 = “never,” 10 = “very frequent”). The total score ranges from 13 to 130, with higher scores indicating more severe compassion fatigue. The C-CFSS demonstrated a Cronbach’s α of 0.957 in this study, with 0.931 and 0.934 for secondary trauma and burnout dimensions, respectively.
Gallup workplace audit (GWA)
The GWA, also known as the Gallup Q12 survey, assesses employee engagement and the work environment, providing results for targeted interventions [36]. It includes four dimensions: basic needs, managerial support, teamwork, and development, with 12 items rated on a 5-point Likert scale (1 = “strongly disagree,” 5 = “strongly agree”). The total score ranges from 12 to 60, with higher scores indicating greater engagement. In this study, the Cronbach’s α was 0.958.
Data collection
The study used an online survey platform, Questionnaire Star, to create electronic versions of all questionnaires, which included an introduction explaining the purpose, content, significance, and instructions for completing the survey. An informed consent form was provided, emphasizing the voluntary nature of participation, anonymity of responses, and the right of participants to withdraw at any time without any negative consequences. The content of the questionnaire excluded any potentially harmful questions. Each IP address was limited to a single submission. Subsequently, we contacted the nursing administrators at the target hospitals, and after obtaining their approval, distributed the electronic survey through nurses’ DingTalk or WeChat groups for voluntary completion.
Data analysis
Data was entered and organized by two independent researchers using Excel software, and statistical analysis was performed with SPSS version 26.0. Continuous variables following a normal distribution were described using means and standard deviations (x̄ ± s), while categorical variables were reported as frequencies and percentages. Relationships between variables were examined through Pearson correlation analysis, and multiple linear regression analysis. Relationships between variables were examined using Pearson correlation analysis and multiple linear regression analysis. Harman’s single-factor test was used to assess common method bias, with the first factor’s variance explained as a percentage of the total variance serving as the criterion for evaluation. Mediation effects were assessed using the PROCESS 3.3 macro, with Model 4 applied to test the mediation relationships. A significance level of p < 0.05 was used for all tests.
Results
Common method bias test
Harman’s single-factor test revealed that the variance explained by the first factor was 49.47%, which did not exceed the 50% threshold, indicating that there was no significant common method bias [37].
Anzeige
Nurses demographic characteristics
Among the 838 nurses, most were aged 31–40 (337, 40.2%), held a bachelor’s degree (736, 87.8%), and had 5–15 years of experience (413, 49.3%). The primary professional titles were supervisor nurses (358, 42.7%). Most nurses worked in clinical departments (566, 67.5%) and secondary hospitals (363, 43.3%). A significant number of nurses were unmarried (630 nurses, 75.2%). 561 (66.9%) nurses had 1–2 children. The common monthly income was 5,000–9,999 RMB (550, 65.6%). Most had permanent employment (618, 73.8%), with night shifts predominantly 4 or fewer per month (376, 44.9%). See Table S1.
The scores of engagement, compassion fatigue, and decent work
The results show that clinical nurses had an average score of 43.51 ± 26.45 for compassion fatigue, 46.47 ± 9.57 for engagement, and 54.98 ± 13.18 for decent work. See Table 1.
Table 1
Scores of Engagement, Compassion fatigue, and decent work among nurses (N = 838)
Category | Items | Score Range | Score (M ± SD) |
|---|---|---|---|
Compassion Fatigue | 13 | 13~130 | 43.51 ± 26.45 |
Engagement | 12 | 12~60 | 46.47 ± 9.57 |
Decent Work | 16 | 16~80 | 54.98 ± 13.18 |
The relationship between compassion fatigue, engagement, and decent work
The correlation analysis showed that compassion fatigue was significantly negatively correlated with both decent work (r = -0.482, p < 0.001) and engagement (r = -0.461, p < 0.001). Additionally, decent work was significantly positively correlated with engagement (r = 0.811, p < 0.001). See Table 2. The relationships between the various dimensions are presented in Table S2.
Anzeige
Table 2
Correlation Analysis of Compassion Fatigue, Engagement, and decent work
Variable | 1 | 2 | 3 |
|---|---|---|---|
Compassion fatigue | 1 | ||
Decent Work | -0.482** | 1 | |
Engagement | -0.461** | 0.811** | 1 |
Hierarchical regression analysis results
In this study, hierarchical regression analysis was used to examine the relationships between decent work and other variables, conducted in three stages: (1) the relationship between compassion fatigue and decent work, (2) the relationship between compassion fatigue and engagement, and (3) the relationship between compassion fatigue, engagement, and decent work. In the first step, demographic characteristics such as gender, age, education level, and work-related variables (e.g., work experience, department, and income) were controlled. The results indicated that these control variables accounted for approximately 7.4% of the variance in decent work (R² = 0.074). In the second step, compassion fatigue was introduced as a predictor. The results showed that compassion fatigue had a significant negative effect on decent work (β = -0.467, p < 0.001), explaining an additional 21.2% of the variance in decent work. In the third step, when work engagement was introduced as a mediator, the negative impact of compassion fatigue on decent work remained substantial (β = -0.140, p < 0.001), but the explanatory power of the model increased significantly to 67.4% (R² change = 0.394). Additionally, work engagement was positively correlated with decent work (β = 0.734, p < 0.001). See Table 3.
Table 3
Hierarchical regression analysis results
Step | Independent Variable | Dependent Variable | R2 | SE | β | p |
|---|---|---|---|---|---|---|
1 | Demographic | Decent Work | 0.074 | / | / | / |
2 | Compassion Fatigue | Decent Work | 0.212 | 0.015 | -0.467 | <0.001 |
3 | Compassion Fatigue | Decent Work | 0.671 | 0.011 | -0.140 | <0.001 |
Work Engagement | 0.032 | -0.734 | <0.001 |
Mediation effect analysis
The path analysis revealed that compassion fatigue was significantly negatively associated with work engagement (β = -0.18, p < 0.001) and decent work (β = -0.05, p < 0.001). Additionally, work engagement was positively associated with decent work (β = 0.772, p < 0.001). The direct effect of compassion fatigue on decent work was − 0.056 (p < 0.001), accounting for 28.71% of the total effect. The indirect effect mediated by work engagement was − 0.14 (p < 0.001), representing 71.79% of the total effect. The total effect of compassion fatigue on decent work was − 0.195 (p < 0.001). See Table 4. The mediation model is illustrated in Fig. 1.
Anzeige
Table 4
Mediating Effect of Work Engagement between Compassion fatigue and decent work
Path | Effect Size | SE | BootLLCI | BootULCI |
|---|---|---|---|---|
Compassion Fatigue → Work Engagement | -0.473 | 0.003 | -0.054 | -0.042 |
Work Engagement → Decent Work | 0.808 | 0.099 | 3.794 | 4.182 |
Compassion Fatigue → Decent Work | -0.100 | 0.010 | -0.069 | -0.030 |
Indirect effect | -0.383 | 0.027 | -0.435 | -0.328 |
Total effect | -0.482 | 0.015 | -0.270 | -0.211 |
Fig. 1
Decent work mediation effect structural model
×
![]()
Discussion
This multicenter cross-sectional study measured compassion fatigue, work engagement, and decent work among nurses. The results demonstrated that compassion fatigue has a direct impact on nurses’ perception of decent work. Work engagement was also found to be significantly positively correlated with decent work. Moreover, compassion fatigue indirectly decreases nurses’ perception of decent work by reducing their level of work engagement.
The study revealed a negative correlation between compassion fatigue and decent work, indicating that nurses with higher levels of compassion fatigue may experience a diminished sense of dignity at work. This finding aligns with previous research [11]. Compassion fatigue in nurses is characterized by the physical, emotional, and mental exhaustion that arises from sustained empathetic engagement and high emotional involvement with patients [38]. Prolonged exposure to others’ suffering, working in high-stress environments, and intense professional commitment, often without clear boundaries or self-care strategies, may hinder nurses’ ability to perceive dignity and value in their work. This not only affects their physical and mental well-being but also weakens their perception of decent work. On the other hand, compassion fatigue may also weaken nurses’ positive identification with their professional roles, further affecting their experience of decent work. A decline in nurses’ empathetic abilities can make it challenging to establish positive and supportive relationships with patients. This difficulty in responding effectively to patient needs may not only strain nurse-patient interactions but can also erode nurses’ sense of dignity at work. Consequently, reducing compassion fatigue is a crucial pathway to enhancing nurses’ experience of dignity at work.
The results of this study found that compassion fatigue is negatively correlated with work engagement, which is consistent with findings from several other studies [13, 14]. This suggests that the level of compassion fatigue is a key factor influencing nurses’ work engagement. Compassion fatigue not only affects nurses’ emotional state but also depletes their psychological resources, such as self-efficacy, emotional regulation, and resilience [14]. When nurses feel that their psychological resources are exhausted, they may struggle to regulate their emotions effectively at work, leading to negative perceptions of their professional role, diminished motivation, and reduced job satisfaction. Consequently, it becomes challenging for them to maintain high levels of engagement and effort. Nurse managers can enhance engagement by fostering a supportive work environment, providing effective emotional regulation strategies, and ensuring access to adequate work resources, helping nurses sustain a high level of psychological resources.
Furthermore, this study also found a positive correlation between work engagement and decent work, indicating that nurses who are more engaged in their work tend to perceive their working conditions as more decent. This finding contrasts with previous research on the impact of decent work on nurses’ work engagement [39]. Decent work, by providing better working conditions and higher professional recognition, directly stimulates nurses’ work engagement. When nurses feel respected, supported, and treated fairly in their work environment, they are more motivated to fully engage in their work [39]. However, other studies have found that, compared to passion for nursing, variables related to decent work, such as wages and benefits, are not the primary drivers of nurses’ work engagement [40]. Nurses with high work engagement typically demonstrate higher work efficiency, greater responsibility, and better job performance [41]. These factors lead to high recognition from organizations and management, including promotion opportunities, more career development resources, and better compensation, further enhancing their perception of decent work [42, 43]. Therefore, work engagement not only reflects nurses’ work attitudes and sense of responsibility but can also enhance their perception of decent work by improving their professional status, rewards, and recognition.
In addition, this study found that work engagement plays a partial mediating role between compassion fatigue and the perception of decent work among nurses. This finding further supports the Professional Quality of Life Model [28], emphasizing the critical role of work engagement in nurses’ professional experiences. Mechanistically, engagement serves as a key factor enabling nurses to maintain a positive identification with their professional roles despite facing compassion fatigue [14]. When nurses have high work engagement, they are more likely to sustain a sense of self-efficacy and derive accomplishment and satisfaction from their work, which helps maintain a positive perception of decent work. However, when compassion fatigue depletes their emotional and psychological resources, engagement declines, making it difficult for them to find positive meaning in their work, thereby diminishing their sense of decent work. Managers can implement various strategies and interventions to enhance nurses’ work engagement and effectively manage compassion fatigue.
Implication
This study holds significant implications for further understanding the decent work of nurses. Firstly, it underscores the importance of decent work for nurses, which not only relates to their dignity and well-being but also directly impacts their work efficiency and quality of care. Therefore, managers can implement interventions such as compassion fatigue resiliency programs [44], progressive muscle relaxation exercises [45], and work stress management programs to alleviate nurses’ compassion fatigue and, consequently, enhance their perception of decent work. In addition, this study emphasizes the critical role of work engagement in promoting decent work among nurses. It suggests that managers can enhance nurses’ work engagement through interventions such as participatory action interventions and personal resource interventions combined with strengths use [46, 47]. These approaches can mitigate the negative effects of compassion fatigue. Lastly, by improving the work environment, establishing equitable compensation systems, and strengthening nurses’ rights and welfare, managers can further support nurses’ perception of decent work.
Limitation
This study has several limitations. Firstly, due to the use of a cross-sectional survey design, it is not possible to infer causal relationships between variables, which may limit the interpretation of the findings. Secondly, the sample had a small proportion of male nurses, leading to an uneven gender distribution that may affect the generalizability of the results and the interpretation of gender differences. Finally, since the participants were limited to nurses in Hangzhou, the geographical scope may restrict the representativeness of the findings, making it difficult to generalize to nurses in other regions. These limitations suggest that future research should consider longitudinal study designs, gender-balanced samples, and similar studies across different regions to enhance the generalizability of the results.
Conclusion
This study found that compassion fatigue and work engagement are significant factors influencing nurses’ perception of decent work. Additionally, work engagement plays a mediating role in the relationship between compassion fatigue and decent work perception. Future research can further explore the mechanisms underlying these relationships and develop intervention studies aimed at enhancing work engagement and reducing compassion fatigue, to examine their effects on improving nurses’ perception of decent work.
Acknowledgements
We would like to thank all nurses who participated in this study.
Declarations
Ethics approvals and to participants
In accordance with the principles outlined in the Helsinki Declaration, this study was approved by the Ethics Committee of Affiliated Hospital of Hangzhou Normal University (2024(E2)KS-025). Participants were informed about the study‘s goals and had the freedom to withdraw at any time. All data collected were anonymized and treated with strict confidentiality, following ethical guidelines. Informed consent was obtained from all participants.
Consent for publication
No applicable.
Competing interests
The authors declare no competing interests.
Clinical trial number
Not applicable.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
