Relationship between empathy and burnout as well as potential affecting and mediating factors from the perspective of clinical nurses: a systematic review

Abstract

Background

Burnout is prevalent in healthcare professionals, especially among nurses. This review aims to examine the correlation between empathy and burnout as well as the variables that influence and mediate them.

Methods

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, to present a systematic evaluation of literature. A literature search of four electronic databases including CINAHL (EBSCO), EMBASE, PubMed, and Google Scholar was conducted from 2014 to 2024. A total of 1081 articles were identified in the initial search. After screening the title, abstract, and context of these articles, 16 eligible articles were finally included in this review.

Results

This review identified a number of factors related to empathy and burnout levels. The included studies showed consistent results that empathy and burnout were generally negatively related. When considering the different components of empathy or burnout independently, as well as the mediating factors involved, relations between empathy and burnout may alter.

Conclusions

This study provided an excellent summary of some important research on the mediating and affecting factors associated with burnout and empathy. These results can facilitate further development of interventions and policies to better manage and prevent burnout in nurses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-02701-0.

Background

Nursing care is a complex and demanding profession. Nurses are mostly responsible for caring for patients and alleviating their suffering in a challenging and stressful environment [1]. One consequence of continuous stress is burnout, which is described as an inability to cope with emotional stress at work or a sense of failure and exhaustion due to the overuse of energy and resources [2, 3]. Burnout is a psychological syndrome that frequently occurs among individuals who do ‘people-work’. Burnout is associated with increased feelings of emotional exhaustion, the development of negative attitudes, and a tendency to evaluate oneself negatively [4]. According to Maslach’s theory, burnout can be divided into three dimensions: emotional exhaustion, depersonalisation, and reduced personal accomplishment [4]. Emotional exhaustion refers to high emotional demands that deplete personal resources; depersonalisation refers to the attempt to distance oneself emotionally from patients and colleagues; and reduced personal accomplishment refers to a negative view of oneself and a decrease in self-esteem [4]. Burnout is characterised by a high level of emotional exhaustion, a pronounced sense of depersonalisation, and a low level of personal accomplishments [5]. Burnout may adversely affect the psychological well-being of nurses, nursing staff retention, and the quality of patient care [6–8]. The Maslach Burnout Inventory (MBI) is considered the ‘gold standard’ for measuring burnout and has been widely used in most empirical research [9].

On the contrary, empathy is the ability to understand and share other persons’ feelings and communicate their understandings [10, 11]. Empathy is considered an essential skill in the process of communicating with patients within patient-centered care [12, 13]. According to Rogers, empathy is the ability of the clinician to feel the patient’s private world as if it were his or her own, without losing the quality of ‘as if’ [14]. In 2007, Rogers identified three dimensions of empathy, including cognitive, emotional, and behavioural [15]. The emotional and cognitive dimensions refer to the clinician’s ability to experience and share the feelings of others and to be able to objectively and rationally identify and understand the feelings of others. The behavioural dimension usually refers to the clinician’s ability to communicate their understanding of another person’s perspective. Researchers also suggested a fourth dimension of empathy, which is morality [16]. Morality refers to the intrinsic altruistic motivation to feel empathy for others. In addition, Davis suggested four different components of empathy [17]. Two of the components are at the cognitive dimension of empathy, including fantasy and perspective-taking. The other two components of empathy are at the emotional dimension, including empathic concern and personal distress. Empathy is beneficial for building a good nurse-patient relationship, thus resulting in increased patient confidence, better patient compliance with treatment, improved clinical outcomes, and increased patient satisfaction [18–25]. Different from burnout, there is no ‘gold standard’ for measuring empathy [26]. Instead, a variety of tools were used to evaluate the empathy score, including the Jefferson Scale of Physician Empathy (JSPE), Interpersonal Reactivity Index (IRI), and Scale of Empathy Competencies of Clinical Nurses (SECCN) [27, 28].

The relationship between empathy and burnout has been an area of increasing research interest. Although most studies demonstrated that empathy was negatively related to burnout, there is contradicting evidence [29]. It is therefore necessary to critically examine the relationship between the two and elucidate the reasons for the conflicting results. These investigations will further facilitate the development of interventions and policies aiming at helping nurses and healthcare organisations to improve management and prevent burnout.

Methods

Based on the articles related to empathy and burnout, The study aimed to thoroughly and methodically examine the literature evaluating the connection between burnout in clinical nurses and empathy as well as draw a relationship between them. The factors that influence the level of empathy and burnout during the last 11 years were also examined. There are conflicting views on the association between empathy and burnout and we sort to reason the contradicting results. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, which would present more transparent, complete, and accurate reporting of systematic evaluations [30].

Search strategy

A preliminary scoping search was performed from December 21, 2022, in four electronic databases, including CINAHL (EBSCO), EMBASE, PubMed, and Google Scholar. The literature search was based on logical combinations of keywords with truncation and Boolean operators (OR, AND). The following terms were used: (clinical nurse OR nursing staff OR nurse OR nurs*) AND (perspective OR views OR attitudes) AND (empathy OR compassion OR sympathy) AND (burnout OR burn-out OR fatigue).

Eligibility criteria

Literature obtained in the initial scoping search were examined by an investigator and validated by a supervisor to meet the inclusion and exclusion criteria.

Inclusion criteria: (1) Articles aimed at exploring the relationship between empathy and burnout in clinical nurses; (2) Studies investigating the factors that influence burnout or empathy; (3) Articles with qualitative, quantitative, or mixed methodologies; (4) Available original English-language articles; (5) Articles published between 2014 and 2024. Exclusion criteria: (1) Articles published in non-academic journals such as documents, reports, and experiences; (2) Researches conducted during a specific period, such as during the outbreak of coronavirus disease 2019 (COVID-19); (3) Studies that could not provide sufficient details to determine whether they meet the inclusion criteria. The search strategy and eligibility criteria are listed in Table 1.

Table 1.

Searching strategy and eligibility criteria

Research topic	Exploring the relations of empathy and burnout, and other affecting factors from the perspective of clinical nurses
Date	From December 21, 2022
key terms
Clinical nurse	clinical nurse OR nursing staff OR nurse OR nurs*
Perspective	perspective OR views OR attitudes
Empathy	empathy OR compassion OR sympathy
Burnout	burnout OR burn-out OR fatigue
Limits and type of included articles	2014–2023
	Original research articles
	Full text with English language
	Academic journals
Databases and Resources	CINAHL (EBSCO)
	EMBASE
	PubMed
	Google Scholar

Search outcomes

As shown in Fig. 1, the initial search identified 1081 articles. After screening the titles to remove duplicate, irrelevant, and publications written in languages other than English, 400 articles were obtained. The researcher reviewed the abstracts of the selected articles, and further excluded those that were not fitted to the topic and target population. Subsequently, the researcher conducted a full-text review of the remaining 160 articles, excluding conceptual analysis articles, articles conducted in the context of the epidemic, and those that did not fit the research theme. Finally, 16 articles were included in this study.

Fig. 1.

Flowchart of the selection of included articles

Data abstraction

The data was extracted by independent investigators, who read and re-read the finally acquired literature in detail. Information that was extracted from the articles included the basic characteristics (year of publication and participant information) and the main content (research aim, methods, major findings, and recommendations). This information is listed in Table 2 and Supplementary Table 1 respectively.

Table 2.

The basic characteristics of the included articles

Study number	Year of publication	Country	Sample size	Participants (number)	Gender	Age (years)	Experience (years)	Department
1 [31]	2016	France	23	Nurses	Female (21); Male (2)	40.9	8	Haemodialysis units
2 [32]	2016	Midwestern of the USA	12	Trauma surgeon (1); Physician assistant (2); Nurse (6); physical therapist and social workers (3)	Female (8); Male (4)	42.6 ± 7.5	14.7 ± 4.1	Trauma center
3 [33]	2017	Spain	100	Nurse (57); Physician (43)	Female (67); Male (33)	< 30 years (11); 30–39 years (37); 40–49 years (30); 50–59 years (22)	< 5 years (17); 5–10 years (27); 11–15 years (25); 16–20 years (21); >21 years (10)	Public emergency care centers
4 [34]	2019	Greece	173	Doctor (27); Nurse (88); Nurse Assistant (13); Other (44)	Female (148); Male (25)	20–29 years (15); 30–39 years (27); 40–49 years (73); 50–59 years (54); >60 years (4)	0–5 years (24); 6–10 years (16); 11–15 years (26); 16–20 years (27); 21–25 years (22); ≥26 years (57)	Paediatric, Pathological, Cardiological, Psychiatric (46); Orthopedic, Surgery, Gynaecology/Obstetrics, Anaesthesiology (45); Artificial Kidney Unit, Regular Outpatient Clinics, Emergency Department (38); Microbiological, Biochemical/Biopathological, Radiological, Blood Donation (25); Administration Office, Social Service, Physiotherapy, Pharmacy, Paramedics (14)
5 [35]	2014	Japan	25	Nurse	Female (20); Male (5)	26 ± 3.14	1–11 years
6 [36]	2017	Spain	267	Nurse (131); General practitioner (115); Paediatrician (21)	Female (209); Male (58)	31–40 years (60); 41–50 years (95); >50 years (112)		Primary care centers
7 [37]	2021	Spain	184	Nurses (105); Doctors (56); Nursing assistants (13); Other categories (10)	Female (142); Male (42)	44.6 ± 10.46	Nurses (19.24 years); Doctors (20.8 years); Nursing assistants (13.69 years); Other categories (20.3 years)	Emergency and intensive care (47); Surgery and medical specialties (30); Primary care (28); Outpatient consultation, outpatient specialty clinic, central clinical division (26); Paediatrics and gynaecology (15); Palliative care (14); Mental health (10); Others (14)
8 [38]	2020	China	786	Nurse	Female (770); Male (16)	≤ 25 (191); 26–30 (176); 31–35 (153); 36–40 (132); ≥41 (134)	≤ 5 years (241); 6–10 years (194); 11–15 years (106); ≥16 years (245)	Internal ward (244); Surgical ward (175); Other departments (367)
9 [39]	2022	China	335	General (233); Specialist (102); Physician (152); Nurse (75); Medical technician (25); Pharmacist (25); Administrator (34); Others (23)	Female (157); Male (178)	37.65 ± 10.65	More than 1 year	Engaged in medical and health work in Tianjin public medical and health institutions
10 [40]	2020	China	363	Nurse	Female (355); Male (8)	29.33 ± 6.16	7.68 ± 6.96	Medical unit (181); Surgical unit (182)
11 [41]	2017	Portugal	298	Nurse	Female (245); Male (53)	37.86 ± 9.22	14.98 ± 9.19	Public hospitals
12 [42]	2020	Greece	19	Nurse	Female (18); Male (1)	36.16 ± 7.30	12.79 ± 7.95	ICU
13 [43]	2023	Iran	295	Nurses	Females (250); Males (45)	33.63 ± 6.42	9.70 ± 6.4	Hospitals affiliated with the Arak University of Medical Sciences
14 [44]	2023	China	478	Nurses	Female (467); Male (11)	30.49 ± 6.86		Tertiary hospitals (17); Secondary hospitals (4); Community health centers (3)
15 [45]	2023	China	414	Nurses	Female (349); Male (65)	< 25 (45); 25 ~ 30 (206); 31 ~ 35 (133); 36 ~ 40 (24); >41 (6)	6.06 ± 3.5	General hospital (354); Specialty hospital (60)
16 [46]	2023	Northwestern of the USA	614	Nurses	Female (551); Male (56); Others (2); Missing (5)	44.6 ± 12.44		Health care system

Results

Characteristics of the included studies

As shown in Table 2, most of these articles were published from 2016 to 2023, except for one published in 2014. These studies were conducted in eight countries, including France, the United States, Spain, Greece, Japan, China, Portugal, and Iran. The participants in the 10 studies were only composed of nurses, while the other 6 studies also included physicians, doctors, paediatricians, nursing assistants, and other medical workers, in addition to nurses. The sample size ranged from 12 to 786 with far more women than men. In addition, the participants were from various departments including haemodialysis units, trauma centers, the health care system, and emergency and intensive care units.

Most of the studies used MBI to measure the burnout level (Studies 3–10, and 16), except for Studies 2, 11, and 13–15, which used the Professional Quality of Life (ProQOL) scale to evaluate burnout. For measuring empathy, Studies 3, 4, 6, and 9 used JSPE, Studies 5, 7, 8, 11, and 14 used IRI, Study 10 used SECCN, Studies 13 and 15 used ProQOL, and Study 16 used Interpersonal and Social Empathy Index (ISEI) and Self-Compassion Scale-Short Form (SCS-SF) (Supplementary Table 1).

Levels of empathy and burnout

A number of studies measured the empathy and burnout scores of the participants. Study 2 focused on the trauma team members in the USA and showed that one-third of the participants had a high level of burnout. Study 3 was carried out in emergency care centers in Spain and showed that the median empathy and burnout scores were 112 and 37 respectively. Among these participants, 32% showed high empathy, and 35% showed low empathy. The ratio of these participants with low burnout accounted for 36% and with high burnout accounted for 33%. Study 4 showed the mean value for empathy score was 102 and for burnout, the score was 38.1 in Greek medical professionals. Study 6 reported that low empathy ratio accounted for 33.3% and high burnout accounted for 3.7% in primary care centers in Spain. Study 8 investigated 786 nurses in China and suggested that moderate burnout was common (67.4%) and a few nurses (5.7%) experienced a high level of burnout. Study 9 showed that 34.3% of participants had a moderate level and 5.4% had a high level of burnout in China. Study 10 found that the empathy level was between middle and high, while 72.18% of the nurses reported moderate burnout, and 6.06% reported severe burnout. Study 13 found that nurses with moderate levels of compassion satisfaction and burnout had the highest percentages, reaching 76.3% and 80%, respectively. Study 14, which surveyed 478 hospice nurses, found that 84.5% of participants had moderate levels of compassion satisfaction and 67.2% had moderate levels of burnout.

Factors related to empathy and burnout

Empathy and burnout were considered to be affected by different factors, the participants’ gender, age, experience, working department or region, job title, professional level, and employment type were all possible influence factors. For instance, Study 4 which enrolled participants from various departments denoted that female participants and those who worked in the cardiological, paediatric, psychiatric, pathological, artificial kidney units, emergency department, and regular outpatient clinics had higher empathy scores. Study 16 also found that women have more social empathy than men. Study 6 was carried out to compare empathy levels between urban and rural medical professionals and found lower empathy levels in rural settings. Study 10 suggested higher professional level, higher job title, and permanent employment type contribute to a higher level of empathy in nurses. Two studies showed consistent results that more years of working experience correlated with lower levels of burnout (Studies 4 and 8). The results of Study 14 found that nurses aged ≥ 45 years, clinical nursing years > 15 years, and working in tertiary hospitals had higher compassion satisfaction. Furthermore, a fixed shift schedule and a higher level of work were related to lower burnout (Study 8). In addition, age and working hours were also possible factors related to burnout. Medical staff aged 56–66 years, who worked more than 12 h were more prone to burnout (Study 9). Nurses who worked > 8 h per day and more than 8 night shifts per month had higher levels of burnout (Study 14). There were also contradictory findings, as demonstrated by Study 6, which found no correlation between age or gender and empathy and burnout. Marriage also displayed contradictory correlations to burnout in two studies (Studies 9 and 10).

Three qualitative studies also described empathy and burnout-related factors. Study 1 interviewed the nurses in the haemodialysis unit and revealed that age and experience affected some aspects of empathy and stress. Experienced nurses were prone to focus on empathy, whereas less experienced nurses were more likely to be impacted by stress. These nurses also pointed out that the stressors in the haemodialysis unit mainly included emergency situations, time management, and the technicality of the treatment. Study 2 carried out in the trauma team indicated that stress triggers included situations such as injury-based cases, events similar to personal situations, interacting with family members, conflicts with management, and failure to act as a cohesive team. Study 12 explored the concepts of Greek ICU nurses and suggested that integration of empathic care in practice was mainly hindered by compassion fatigue, personal drawbacks, and organisational barriers.

Relations between empathy and burnout

Among the included studies that analysed the general relations between empathy and burnout, results showed consistent negative correlations (Studies 3, 4, 6, 9, 10, 13, and 16).

Moreover, some included studies investigated the relationship between empathy and burnout based on their different components. Studies 3, 4, and 6 consistently revealed that empathy was significantly negatively associated with depersonalisation, and positively associated with personal accomplishment. Study 5 indicated that empathy was positively associated with emotional exhaustion. Consistent with this, Study 8 showed that empathy was positively associated with emotional exhaustion but negatively associated with reduced personal accomplishment. Studies 11 and 15 indicated that burnout was positively correlated with personal distress, and negatively correlated with perspective-taking and empathic concern. Study 7 showed that emotional exhaustion was positively correlated with personal distress; depersonalisation was positively associated with personal distress and negatively associated with empathic concern; and personal accomplishment was negatively correlated with personal distress, and positively correlated with perspective-taking.

Factors mediating empathy and burnout

In addition to the direct correlation between empathy and burnout, seven of the included studies also revealed some factors that mediated the relationship between empathy and burnout. Study 7 indicated that inferring mental states as a mediating factor was positively associated with empathic concern, perspective-taking, and personal accomplishment, and negatively associated with personal distress. Study 8 showed that nursing organisational climate mediated the relationship between empathy and burnout. It was positively associated with empathy and negatively associated with the three dimensions of burnout. Study 9 illustrated that empathy indirectly impacted burnout through job satisfaction and job commitment. Job commitment was positively correlated with empathy but negatively correlated with burnout; job satisfaction was negatively correlated with empathy but positively associated with burnout. Study 10 indicated that coping strategies played a mediating role between empathy and burnout. Positive coping strategies were positively associated with empathy and negatively associated with the three subscales of burnout. Study 11 suggested that pathogenic empathy-based guilt as a mediator, was positively associated with all empathic dimensions, and was also positively associated with burnout. Study 13 indicated that secondary traumatic stress (STS) and workplace spirituality (WPS), as mediating factors, were significantly correlated with compassion satisfaction and burnout. STS was strongly negatively associated with compassion satisfaction and significantly positively correlated with burnout, whereas the association was opposite for WPS. In addition, the nursing work environment (NWE) also affects empathy and burnout, and the better the ICU work environment, the higher the nurses’ compassion satisfaction, and the lower the incidence of burnout (Study 15).

Discussion

Burnout syndrome is a prevalent problem among medical professionals, which would lead to severe consequences not only for the medical staff themselves but may also affect patient treatment outcomes. Due to the increasing responsibilities required to deliver proficient, humane, culturally sensitive, and moral care, burnout is more frequent among nurses than among other health professionals [47]. This review investigated the related literature and summarized the empathy and burnout levels among nurses, their relationships, and the possible affecting factors.

In general, the burnout ratio in China was relatively low. Three studies (Studies 8–10) carried out in China showed that the ratio of severe burnout was 5.7%, 5.4%, and 6.06% respectively. Similarly, results from a study (Study 6) conducted in Spainshowed that high levels of burnout only accounted for 3.7%. On the contrary, two studies carried out in the USA and Spain (Studies 2 and 3) indicated a high ratio of severe burnout that both accounted for one-third of the participants. These great differences in burnout levels may be partly due to differences among different regions. As suggested in other studies, the ratio of high-level burnout was relatively low in France and only accounted for 4.6% [48]. However, for Pakistani house officers and postgraduate trainees, high-level burnout rate amounted to 29.8% [49]. The different burnout levels among different regions may be attributed to the differences in healthcare systems as well as cultural differences in distinct countries. In this review, participants of the two studies (Studies 2 and 3) that reported high levels of burnout were enrolled in trauma centers and emergency care centers. Healthcare workers in both of these departments were more prone to exposure to higher occupational stress than other medical workers [50]. Thus, the different working environments may be a factor that causes high burnout levels.

Many additional factors considered to be related to burnout were included such as age, working experience, shift schedule, and levels of work. Apart from these demographic and work-related characteristics of the participants, empathy was one of the most studied factors that was considered to be related to burnout. The empathic ability of health professionals not only provides high-quality care to patients but can also help to reduce burnout of medical workers [40, 51]. When comparing the general relations between empathy and burnout, the included studies showed a consistently negative correlation. However, when considering the different components of empathy and burnout, the relationships were more complicated. In this review, three studies (Studies 5, 7, and 8) indicated that empathy was positively associated with emotional exhaustion. It is conceivable that an empathetic nurse feels distress and sorrow from patients in their daily work, which might lead to emotional exhaustion. However, they could also feel happy when patients recovered. Therefore, we considered that empathy would not always lead to emotional exhaustion, and their relations need to be investigated further. Studies 7, 11, and 14 indicated that burnout was consistently positively correlated with personal distress, and negatively correlated with perspective-taking and empathic concern. Personal distress is a negative emotion of oneself due to witnessing pain or distress. Understanding the pain of the patient, communicating with them, and offering assistance while acknowledging that their situation is different from one’s own is a crucial component of empathy that allows one to experience the highest levels of compassion satisfaction [52]. Perspective-taking and empathic concern can therefore lead to the desire to help those in distress. However when the level of perspective-taking is low and is accompanied by a high level of personal distress, burnout emerges. This is supported by other literature reporting that emotional sharing with poor self-regulation can cause personal distress, thus leading to decreased empathic concern [53]. Due to these, we concluded that relating empathy and burnout based on their different components is rational. Distinct dimensions of empathy or burnout would be differentially related and thus could illustrate a more specific association between these factors.

Besides the direct relationship between empathy and burnout, seven studies suggested that some factors were also involved in mediating their relationships. Study 7 suggested inference of patients’ mental states was a mediating factor between empathy and burnout. This study considered empathy and burnout at different dimensions and led to complicated results. Perspective-taking was considered to increase the inference of patients’ mental states thus leading to a higher level of personal accomplishment. However, as suggested above, personal distress is a negative consequence of empathy, which is negatively related to social functioning [54]. This study also indicated that increased personal distress was associated with less inference of mental states, leading to negative consequences like increased emotional exhaustion. Based on these results, personal distress should not be included in the definition of empathy, and should not be considered in the intervention programs to improve empathic skills.

Three studies suggested mediating factors involved in empathy and burnout but did not alter their negative relationship. Study 8 suggested the nursing organisational climate as a mediator. It was found that empathy had a positive effect on nursing organisational climate and could protect nurses from burnout. Empathy facilitates to construct a relaxed and comfortable organisational climate [38]. Highly empathetic nurses can communicate well with colleagues and create amicable working relationships, which can provide nurses with positive emotions to achieve high personal accomplishment [55]. It can be concluded from this study that nursing managers can improve nurses’ work environment to reduce burnout. Study 10 indicated that coping style was an essential mediator between empathy and burnout. Highly empathetic nurses have more positive responses to stress and a stronger perception of psychological resilience and social support [56, 57]. Thus, when highly empathetic nurses encounter stressful events, they are more inclined to seek help from others and respond accordingly. Positive coping styles may help nurses alleviate stress, maintain a good psychological state, and calmly deal with problems. It has been found that nurses with positive coping skills were more prone to experience lower levels of depersonalisation, emotional exhaustion, and decreased personal accomplishment [58]. Study 13 showed that STS and WPS, as mediating factors, were significantly correlated with empathy and burnout. Studies have reported that medical staff with high empathy are more prone to STS, especially in the case of high workload and time pressure, because the existence of high empathy is more likely to lead to emotional infection [59, 60]. Therefore, when healthcare workers maintain high enthusiasm for their work, even when the level of empathy is low, the emotional exhaustion is low [61].

The last two studies illustrated that due to the mediating factors involved, the relationship may change between empathy and burnout. Study 11 suggested that when empathic feelings gave rise to pathogenic empathy-based guilt, they might be more vulnerable to developing burnout symptoms. Nurses constantly recruit their empathic abilities in their daily work. Given the close relationship between empathy and guilt, highly empathetic nurses are more likely to experience pathogenic empathy-based guilt, which means excessive and misplaced responsibility for their patients. This unrealistic responsibility may lead to the disruption of the lives of the nurses and also lead to unprofessional caring [41]. Thus, intervention programs targeting pathogenic empathy-based guilt may be particularly important to help reduce burnout. Study 9 indicated that highly empathetic medical staff can better understand the patients and may deepen their professional knowledge to cure their patients, thus enhancing their job commitment [39]. Job commitment provided medical staff with a better understanding of their own behavior when communicating with patients and dealing with colleagues, which significantly attenuated job burnout. However, empathy was suggested to negatively correlate with job satisfaction. Medical staff use empathy to face illness and death in their daily work. The overwhelmed feeling of powerlessness and helplessness may cause dissatisfaction with their work, finally leading to burnout [39].

The current developments concentrating on the relationships between empathy and burnout, as well as any potential influencing or mediating elements, were reviewed together in this review. Intervention programs aiming at reducing stress and burnout should consider these potential factors for better outcomes. It is worth noting that empathy and burnout should be considered based on their different dimensions to elucidate more accurate consequences.

There are several limitations to this study. Since the goal of this study was to examine research conducted within the last 11 years, only a small number of literature was incorporated in this review. Consequently, the perspective on empathy and burnout was not comprehensive. In addition, the sample size varied across different studies. Some studies enrolled a relatively small number of participants, which may lead to bias when interpreting the results.

Conclusions

This review investigated literature published in the last 11 years, illustrating the relationship between empathy and burnout, as well as their affecting and mediating factors. This review is the first to summarize that mediating factors involved in empathy and burnout could alter the relationship between empathy and burnout. These results provided valuable information to aid in designing intervention programs and further establishing approaches to reduce burnout in nurses. It can also be a solid foundation for further research in this field.

Electronic supplementary material

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Abbreviations

PRISMA

Preferred reporting items for systematic reviews and meta analyses

MBI

Maslach burnout inventory

JSPE

Jefferson scale of physician empathy

IRI

Interpersonal reactivity index

SECCN

Scale of empathy competencies of clinical nurses

ProQOL

Professional quality of life scales

Author contributions

Z. H. made significant contributions toward the conception, analysis, and interpretation of results; involved in drafting and revising the manuscript; given final approval of the version to be published.

Funding

None.

Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.