Compassion and affective empathy show opposite links to nurse compassion fatigue

Nurses who report higher levels of compassionate concern tend to experience less compassion fatigue overall, while those with stronger affective empathy report more secondary traumatic stress and burnout, according to a cross-sectional path analysis published in BMC Nursing. The study, led by Funda Veren with Ayşe Burcu Başçı and Hülya Kulakçı Altıntaş, set out to test whether two related but distinct emotional capacities—compassion and affective empathy—carry different associations with the emotional toll of nursing work. The research team surveyed 234 nurses working in a tertiary hospital.

The researchers first examined Spearman correlations between the measures, applying Benjamini–Hochberg adjustment to control the false discovery rate across multiple comparisons. They then estimated two observed-variable path models using maximum likelihood, allowing them to quantify the adjusted association of each emotional trait with each fatigue outcome. The path models revealed a clear dissociation between the two traits.

Compassion was inversely associated with total compassion fatigue, with a standardized coefficient of β = −0.206 (95% confidence interval −0.374 to −0.045), meaning higher compassion scores went along with lower overall fatigue. Affective empathy moved in the opposite direction for both components of compassion fatigue: it was positively associated with secondary traumatic stress (β = 0.186, 95% CI 0.016 to 0.347) and with burnout (β = 0.211, 95% CI 0.054 to 0.365). In other words, nurses who more strongly resonated with patients' distress reported somewhat higher levels of both trauma-like symptoms and emotional exhaustion.

Despite the statistical significance of these coefficients, the associations were small. The complete adjusted models explained 4.8% of the variance in total compassion fatigue, 11.4% in secondary traumatic stress, and 14.1% in burnout, leaving the overwhelming majority of variation in these outcomes unaccounted for by the two emotional traits. The study's conclusions are deliberately restrained.

Because the data are cross-sectional, the findings describe associations at a single point in time and cannot establish whether compassion protects against fatigue, whether empathy heightens it, or whether fatigue shapes how nurses respond emotionally to patients. The authors state that the small adjusted associations are compatible with different association patterns for compassion and affective empathy, but that the low explained variance, measurement limitations, and cross-sectional design preclude causal or intervention conclusions. The results suggest, at most, that compassion and affective empathy may deserve separate attention in future studies of caregiver well-being.

Subject of Research: Differential associations of compassion and affective empathy with compassion fatigue among nurses

Article Title: Differential associations of compassion and affective empathy with compassion fatigue among nurses: a path analysis study

Article References: Veren, F., Başçı, A. B., & Kulakçı Altıntaş, H. (2026). Differential associations of compassion and affective empathy with compassion fatigue among nurses: a path analysis study. BMC Nursing. https://doi.org/10.1186/s12912-026-05553-4

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05553-4

Keywords: nursing, compassion fatigue, affective empathy, compassion, burnout, secondary traumatic stress, path analysis, cross-sectional study, healthcare workers, mental health, BMC Nursing, Differential