Understanding nurses’ current experiences can help guide retention efforts.

COVID-19, officially declared a pandemic in March 2020 and announced as over on May 11, 2023, challenged healthcare workers around the world. Before the pandemic, nurses already struggled to meet the ever-changing demands of the profession; they experienced anxiety, exhaustion, excessive workloads, additional shift rotations, and decreased job satisfaction and quality of patient care. Bureau of Labor Statistics data indicate that 500,000 nurses left the workforce in 2022, creating a U.S. shortage of approximately 1.1 million nurses. In addition, the International Council of Nurses’ National Nurses Associations (NNAs) reported that, since pandemic onset, nurses have remained emotionally and physically drained in their current work environment.

Although a wealth of information exists related to nurses’ pre-pandemic and pandemic viewpoints, little research has been conducted about nurses since the pandemic, especially as it pertains to the exploration of compassion satisfaction, compassion fatigue/burnout, and secondary traumatic stress disorder. According to Abdul Rahim and colleagues, during the pandemic, pooled studies reported that healthcare worker burnout stood at 41% to 52%. In addition, a 2022 study by Guttormson and colleagues noted that pandemic nurses were 47% more likely to develop post-traumatic stress disorder due to the extreme workloads, high number of patient deaths, lack of personal protective equipment, shortage of ventilators, and limited or restricted visitation policies.

In an effort to address this lack of post-pandemic knowledge, we conducted a study to measure the quality-of-life values of staff nurses using the Professional Quality of Life (ProQOL) Scale incorporated into a survey completed by 119 participants at a Magnet® Conference in October 2023.

What we measured

The ProQOL measured compassion satisfaction related to pleasure and drive from work; compassion fatigue/burnout related to exhaustion, anger, or depression; and secondary traumatic stress related to fear or work-related trauma.

We used additional demographic and workplace environment questions to gather data on the following qualities: COVID-19 acquisition and direct care; education; employment status; facility type, setting, and Magnet designation; gender; licensing region; marital status; nurse-to-patient ratio; position retention; race; shift time, hours, and length; unit; and years as a staff nurse. Approximately 88% of respondents were female, white, and married. Most held a bachelor’s degree, and the sample was almost evenly split among three experience groupings: 1 to 5 years, 6 to 10 years, and ≥11 years. (See ProQOL results.)

Current status

When we separated the sample by employment descriptions (including primary shift, hours per week, and shift length), we found several notable findings. Day-shift nurses averaged higher total compassion satisfaction and more moderate compassion fatigue/burnout values than night-shift nurses; evening-shift nurses reported moderate compassion fatigue/burnout.

Not surprisingly, nurses working the longest work week category (>36 hours) reported moderate compassion fatigue/burnout and secondary traumatic stress. Nurses working 9- to 12-hour shifts had higher compassion satisfaction than nurses working more and fewer hours. Those same nurses also had lower average compassion fatigue/burnout and secondary traumatic stress.

These findings aligned with those of Ruiz-Fernández and colleagues. Marital status, healthcare setting, hospital location, and shift all play a role in nurses’ compassion fatigue/burnout.

We didn’t find high compassion fatigue/burnout among any of the sampled nurses, which suggests a decrease since the study by Guttormson and colleagues. Perhaps those with high compassion fatigue/burnout in 2022 resigned, retired, or otherwise moved on from nursing. Although we found moderate compassion fatigue/burnout among most nurses, the results could reflect a consistency among pre-pandemic, pandemic, and post-pandemic levels and suggest the need for steps to decrease these effects for all frontline nurses.

Respondents to our survey averaged about the same compassion satisfaction, compassion fatigue/burnout, and secondary traumatic stress levels regardless of demographic or background. Reasons for changing positions included continuing education, moving to another hospital, or moving into a higher position or administration. The 13% not planning to remain in their positions weren’t innately comparable to the 27.1% national turnover rate cited in 2022 by Nursing Services, Inc. When comparing the levels of those in Magnet-designated hospitals with those that haven’t received that designation, the average scores for all three qualities fell within statistical error. Of those respondents working in hospitals without Magnet designation, only three noted that their organizations were in the process of obtaining that distinction. (See Comparing hospital types.)

Contract/temporary/travel nurses had the highest average compassion satisfaction and lowest compassion fatigue/burnout compared with other specified employment statuses. Nurses in this group tend to receive a higher salary and have a more flexible schedule via agreed-upon contracts and can take time off between assignments to rejuvenate. All of these factors align with environmental descriptions of lower workplace stress and fatigue.

Regarding years of experience, average compassion satisfaction, compassion fatigue/burnout, and secondary traumatic stress values varied little. The levels within these three categories provided more interesting data. As the years of experience increased, the average score within low compassion fatigue/burnout increased such that the lowest calculated values in participants with 21 or more years of experience weren’t as low as those with 20 or fewer years. We noted a similar increase in the low level of secondary traumatic stress in participants with 16 or more years of experience; they reported higher average secondary traumatic stress than those with 15 or fewer years. Perhaps nurses within this experience group have surpassed a tipping point between accumulated exposure to and experience with traumatic events and the development of coping mechanisms.

Nurses who work in intensive care units (ICU), transitional care, and telemetry had the highest average compassion fatigue/burnout. Increased stress and patient demands typical of these units may play a role.

Among ICU nurses, 81% reported compassion fatigue/burnout, which aligns with Guttormson and colleagues’ study. Due to the more specialized nature of the work on these units, hospitals likely struggle to float additional nurses or resources, leaving them with higher nurse–patient ratios. ICU nurses frequently deal with higher acuity and more hemodynamically unstable patients.

Approximately 91% of transitional care and telemetry nurses reported moderate levels of secondary traumatic stress. Many patients on these units experience cardiac events, post-open-heart recoveries, and alcohol or drug withdrawals, leaving nurses vulnerable to secondary traumatic stress; most of the critical care nurses in this study came from trauma hospitals (all levels). In contrast, and aligning with patient type, nurses working on pediatric, neonatal intensive care, mother–baby, and labor and delivery units, averaged higher average compassion satisfaction compared to all other areas.

Among survey respondents, over 80% provided direct care to patients with COVID-19 during the pandemic. Of that group, over 70% reported moderate compassion satisfaction. Nurses who didn’t have direct contact with patients with COVID-19 averaged higher compassion fatigue/burnout and secondary traumatic stress than those with direct care.

We found these results surprising given the assumption of increased stress when caring for patients with a pandemic-related virus. Although less likely to be replicated, an investigation of pre- and post-pandemic retention of nurses to hypothesize a perceived compassion level for nurses caring for patients with pandemic or epidemic diseases (such as the 1918 Spanish Flu pandemic, the 2013 Ebola virus disease outbreak, or the 2002 Severe Acute Respiratory Syndrome Coronavirus outbreak) might prove helpful. (View Detailed Demographic Data)

Future status

Almost 70% of the sampled nurses haven’t switched positions since the pandemic and plan to remain. Nurses who reported switching provided reasons, including the following: “I went from bedside into leadership,” “I didn’t feel supported by management, and I was bringing my work home with me,” “The massive nursing shortage opened up positions,” “So I didn’t harm myself,” and “I moved and desired a position with less stress.”

The nurses who switched positions reported higher compassion satisfaction than those who didn’t switch. Nurses who remained in their positions also reported average higher compassion fatigue/burnout and secondary traumatic stress than their counterparts who moved into new positions. These values suggest that factors outside of those assessed in the ProQOL may result in job changes or that low compassion satisfaction, high compassion fatigue/burnout, and high secondary traumatic stress aren’t direct indicators for remaining in a specific nursing position.

More research required

While the survey setting was a conference geared toward nurses working Magnet hospitals or organizations likely interested in Magnet designation, Cronbach’s Alpha descriptions for compassion, compassion fatigue/burnout, and secondary traumatic stress were all reliable with high power values (0.85, 0.82, 0.85, respectively), which indicates that statistically, the sample serves as a likely representation of the population. Limitations of this study include the small sample size and not also surveying nurses in a setting not geared toward nurses associated with Magnet hospitals. In addition, we didn’t calculate multiple variable regression analyses (for example, secondary traumatic stress experienced by nurses working in midwestern, urban, and Magnet hospitals) due to the high number of comparison values. Studies focused on more specific demographic or hospital feature qualities may note more or less variation in the measured ProQOL values.

Providing continuing education opportunities, increasing pay, and decreasing nurse-to-patient ratios could address these identified concerns and thus increase retention rates. Although clinical nurses may have difficulty attending education programs as a result of time commitments and overlap between professional development and shift schedules, we recommend a continued or increased emphasis on a supportive work environment.

Further research should consider whether post-pandemic interventions, mandatory breaks, resources, guided ratios, resiliency training, and education help to reduce compassion fatigue/burnout and secondary traumatic stress and increase compassion satisfaction. An investigation into the culture of nursing in the United States, including social and institutional norms, knowledge, beliefs, and habits surrounding the nursing profession can shed additional light on the need for change in the healthcare system.

Inclusion of respondents’ specific hospital of employment within both the Magnet and non-Magnet groups in similar format studies could provide an additional angle for identifying potential sources of compassion satisfaction, compassion fatigue/burnout, and secondary traumatic stress variations. Separation of the sample by hospitals that meet most of the Magnet eligibility requirements and those with full Magnet designation might further quantify the quality-of-life differences of nurses in these hospitals. Identifying and incorporating training exercises, incentives, mentoring, or other aspects tied to the specific hospital and type of hospital could help improve the quality of life of all nurses.

Brooke Whittaker is a director in South Bend, Indiana, and adjunct faculty in Toledo, Ohio. Sarah Hummer is an instructional technologist at Saint Mary’s College in Notre Dame, Indiana.

References

Abdul Rahim HF, Fendt-Newlin M, Al-Harahsheh ST, Campbell J. Our Duty of Care: A Global Call to Action to Protect the Mental Health of Health and Care Workers. World Health Organization. 2022. who.int/publications/m/item/wish_report

Al-Majid S, Carlson N, Kiyohara M, Faith M, Rakovski C. Assessing the degree of compassion satisfaction and compassion fatigue among critical care, oncology, and charge nurses. J Nurs Adm. 2018;48(6):310-5. doi:10.1097/NNA.0000000000000620

American Hospital Association. AHA letter re: Challenges facing America’s health care workforce as the U.S. enters third year of COVID-19 pandemic. March 1, 2022. aha.org/lettercomment/2022-03-01-aha-provides-information-congress-re-challenges-facing-americas-health

Guttormson JL, Calkins K, McAndrew N, Fitzgerald J, Losurdo H, Loonsfoot D. Critical care nurse burnout, moral distress, and mental health during the COVID-19 pandemic: A United States survey. Heart Lung. 2022;55:127-33. doi:10.1016/j.hrtlng.2022.04.015

International Council of Nurses. ICN policy brief—The global nursing shortage and nurse retention. March 11, 2021. icn.ch/node/1297

NSI Nursing Solutions, Inc. NSI national health care retention & RN staffing report. (2022).
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Ruiz-Fernández MD, Pérez-García E, Ortega-Galán ÁM. Quality of life in nursing professionals: Burnout, fatigue, and compassion satisfaction. Int J Environ Res Public Health. 2020;17(4):1253. doi:10.3390/ijerph17041253

Stamm BH. The Concise ProQOL Manual. 2nd ed. 2010 img1.wsimg.com/blobby/go/dfc1e1a0-a1db-4456-9391-18746725179b/downloads/ProQOL%20Manual.pdf?ver=1622839353725

American Nurse Journal. 2025; 20(1). Doi: 10.51256/ANJ012537

Key words: Post-Pandemic, compassion satisfaction, compassion fatigue or burnout, secondary traumatic stress