Compassion Fatigue Among Australian Oncology Nurses Caring for Adult Cancer Patients: Antecedents, Impact and Mediators

ABSTRACT

Aims

To explore how Australian oncology nurses perceive and experience compassion fatigue when caring for adult cancer patients, how they mitigate compassion fatigue and identify potential interventions to address compassion fatigue.

Design

A qualitative, descriptive study.

Methods

Twenty Australian oncology nurses caring for adult cancer patients were interviewed between August and September 2023. Participants were recruited from a larger, quantitative study. Interviews were conducted virtually, transcribed verbatim and analysed using thematic analysis.

Results

Three themes and nine sub‐themes were identified. Participants viewed heavy workloads, low staffing and organisational support as contributing factors to compassion fatigue. They described compassion fatigue as a feeling of having nothing left to give, impacting their ability to self‐care, deliver quality patient care and maintain relationships. The pride participants felt in their cancer care work helped mitigate compassion fatigue. Self‐care strategies, workplace mentoring and support were identified as ways to mitigate compassion fatigue.

Conclusion

The work of oncology nurses can contribute to compassion fatigue, which may impact nurses and patient care. Organisations would benefit from supporting staff to engage in self‐care activities, professional development and mentoring.

Implications for Professional

Findings support a multi‐tiered approach to addressing compassion fatigue among oncology nurses. Organisations can prioritise adequate staffing levels, mentoring opportunities, focused well‐being interventions and provide avenues for meaningful recognition.

Reporting Method

This study adheres to the COREQ reporting guidelines.

Patient or Public Contribution

No patient or public contribution.

Summary.

• This study explored Australian oncology nurses' experiences of compassion fatigue and identified ways in which nurses can mitigate compassion fatigue.

• Oncology nurses with compassion fatigue report a decreased capacity to provide person‐centred care and reduced engagement in additional work‐related activities.

• Workplace support and culture are critical in a nurse's experiences of compassion fatigue. Organisations can implement interventions that address factors contributing to compassion fatigue.

1. Introduction

Compassion is at the very heart of nursing care (Babaei and Taleghani 2019). Compassion requires a deep feeling of connectedness with the experience of human suffering that requires personal knowing of the suffering of others, evokes a moral response to the recognised suffering, and that results in caring that brings comfort to the sufferer (Peters 2006, 39). Florence Nightingale, who was instrumental in the evolution of nursing as a profession, prioritised the need for nurses to always endeavour to ease suffering through acts of compassion (Gallagher 2020). It is often this desire to help and care for others that leads a person to enter into the nursing profession (McKenna et al. 2023).

Oncology nurses provide complex care daily, managing both the disease and its treatment side effects. Oncology nurses also offer continuous emotional and compassionate support to patients and their families throughout every stage of the cancer journey, including end‐of‐life care. As patients and families often navigate through the five stages of grief—denial, anger, bargaining, depression and acceptance, as identified by Kübler‐Ross (1993)—nurses are called upon to deliver technically proficient and deeply empathetic care. However, the repeated and intense exposure to patients facing traumatic, life‐altering diagnoses places oncology nurses at significant risk of compassion fatigue (CF) (Jarrad and Hammad 2020). The cumulative effect of frequently caring for multiple patients and families in these circumstances can lead to emotional exhaustion, making it essential to recognise and address the risk of CF in oncology nurses. A nurse experiencing CF can feel a range of physical, emotional and behavioural symptoms while also impacting their provision of patient‐centred care (Ondrejková and Halamová 2022).

2. Background

The impact of compassionate care can be far reaching. Patients not only have increased satisfaction with the quality of care provided but also demonstrate improved clinical outcomes (Kondaguil, Rana, and Balagar 2023). Caring compassionately also creates positive feelings for the nurse, often referred to as compassion satisfaction (Stamm 2010). However, while compassion is seen as an empathetic gift, ongoing and repeated exposure to individuals suffering from trauma, or an extremely stressful event, can lead to CF, exhausting the nurse both professionally and personally (Gustafsson and Hemberg 2022).

Compassion fatigue results in a variety of symptoms that impact not only the nurse but also the patient and organisation. Physical and behavioural symptoms of CF can include depression, anger, disrupted sleep disturbances, exhaustion and gastrointestinal symptoms (Ondrejková and Halamová 2022; Pérez‐García et al. 2021). Compassion fatigue can also be a risk to patient safety, causing negative feelings towards patients, decreased interest in patients or even patient avoidance (Ondrejková and Halamová 2022). Nurses with CF can have decreased job satisfaction, increased absenteeism and intent to leave the nursing profession (Pérez‐García et al. 2021), which in turn can lead to staff shortages. Given the importance of adequate staffing and resources in shaping perceived patient safety culture (Mihdawi et al. 2020), the impact of CF within a workplace can be far reaching.

A nurse's risk of developing CF can be related to the intensity of the care setting (Sorenson et al. 2016). The provision of cancer care has been compared to climbing Mount Everest; intense labour that comes with great challenges, work that most people could not tolerate or withstand (Rohan and Bausch 2009). According to the Global Cancer Observatory, the global cancer burden is expected to rise from an estimated 20 million new cancer cases in 2022 to 35 million new cases annually by 2050 (Ferlay et al. 2024). This emotionally taxing work setting places oncology nurses at risk of CF, with as many as 55% reported to have moderate levels of CF (Chen et al. 2022).

Within the Australian setting, it is estimated between 2020 and 2044, 4.56 million new cancer cases will be diagnosed (Luo et al. 2022), while by 2035 there will be an estimated Australian nursing shortage of 79,000 nurses (Department of Health and Aged Care 2024). The Australian Cancer Plan, a government framework released in 2023 recognises the importance of supporting the cancer workforce through a focused strategic objective related to the recruitment and retention of a specialised cancer care workforce. The overall aim of this plan is to ensure improved outcomes for all Australians affected by cancer (Cancer Australia 2023). More knowledge about Australian oncology nurse's experience of CF is needed to guide the development of strategies and pathways to minimise CF and ensure all cancer patients have access to ongoing, safe, person‐centred care.

3. The Study

3.1. Aim

The study aimed to explore the perceptions and experiences of CF among Australian oncology nurses caring for adult cancer patients. The research team also sought to explore how Australian oncology nurses who care for adult cancer patients mitigate CF and identify potential interventions.

4. Methods

4.1. Design

This study was part of a larger, concurrent mixed‐methods study, with the quantitative component having been previously reported (manuscript under review), this paper reports the qualitative findings. A qualitative exploratory‐descriptive design was used for this study. This is the most appropriate design when there is minimal knowledge on the specific area being studied with CF among Australian oncology nurses previously not explored (Hunter and Jacqueline Howes 2019). Qualitative exploratory descriptive design provides the opportunity for the researcher to understand the views of those experiencing the phenomenon being studied within their unique context allowing for an in‐depth, overall rich account of the experience (Villamin et al. 2024). Within qualitative descriptive research, it is accepted that there are many interpretations of reality. The subjective nature of both the participant's experiences and that of the researcher is recognised and acknowledged (Bradshaw, Atkinson, and Doody 2017).

4.2. Study Setting and Recruitment

Virtual interviews were completed with participants from various Australian oncology settings, including inpatient and outpatient. The sample was recruited from participants who completed the quantitative component of the larger study through professional oncology bodies, cancer care organisations and educational centres that provide post‐graduate cancer care education. Upon completing a cross‐sectional, online survey, participants were invited to provide their contact email if they consented to be contacted to further discuss their perceptions and experiences of CF in individual interviews. Participants who provided their email address were then contacted via email with additional study information. Survey results were not linked to interview participants, and there was no requirement for current participants to be experiencing high levels of CF at the time of the interview. The research team believed this provided a better overall picture of how CF impacts all Australian oncology nurses, rather than only those who may be severely impacted. A recruitment incentive (Australian $20 gift voucher) was provided to all interview participants. The sample size was based on data saturation, when no new information can be obtained, and no new coding of themes is feasible (Fusch and Ness 2015).

4.3. Inclusion Criteria

To be eligible to participate in the study, nurses needed to be (1) currently working with cancer patients and (2) have a minimum of 12 months experience within this area of nursing.

4.4. Data Collection

Semi‐structured interviews were completed between August 2023 and September 2023. Each participant completed one interview lasting between 30 and 65 min and occurred face to face using synchronous communication such as over the online platform Zoom or Teams at a time convenient to the participant. Consent was obtained prior to the interview commencing. Using online platforms to complete the interviews permitted participants to complete the interview at a time and day convenient to them from their chosen location, creating a comfortable environment to expand on topics that may be considered personal (Cleary et al. 2024; Gray et al. 2020). The decreased travel requirements and associated costs also allowed for increased geographical recruitment (Oliffe et al. 2021). Only the participant and the interviewer (JB) were present during the interview. Participants also identified a pseudonym at the start of the interviews to preserve confidentiality. Prior to commencing the interview, the researcher introduced themselves and provided their qualifications, clinical background and experience while further explaining the objectives of the study. It was hoped the researcher's clinical background, similar to that of the participants, would help build rapport and create a non‐threatening environment.

Interviews were conducted using an interview guide developed and informed by the literature (e.g., Banks et al. 2024) and reviewed by all members of the research team (Appendix S1). The interview questions were piloted by the primary researcher during interview training, with further probing questions used to explore participants' responses. The interviewers' thoughts on the interview and non‐verbal communication were noted as reflective logs immediately after each interview. Eligible participants were interviewed until data saturation was achieved. The authors found that no new information emerged during the 19th interview, and one further participant was interviewed to confirm data saturation.

4.5. Data Analysis

Thematic analysis was used to guide the analysis of the interviews (Braun and Clarke 2022). Thematic analysis was utilised due to its emphasis on following an inductive process, whereby no initial theory of research findings is established. This aligns with the research objectives of exploring CF among Australian oncology nurses. Thematic analysis is also highly rigorous with the two‐stage review process of initial codes against defined themes ensuring high‐quality analysis (Clarke and Braun 2017). The six phases of this type of analysis included becoming familiar with the data, creating initial codes, identifying themes, reviewing these themes, defining and labelling the identified themes and, finally, producing a report (Braun and Clarke 2022). Analysis began after data collection. All interviews were transcribed verbatim and verified for accuracy (JB) and then entered into NVivo (Lumivero 2023). NVivo provides a platform for sorting, organising and analysing multiple forms of qualitative data (Dhakal 2022). The researcher then became immersed in the data, reading the interview transcripts multiple times to ascertain meanings. Preliminary codes were then created. Initially, 84 codes were identified, with an additional three codes identified in subsequent rounds. When no additional codes could be recognised, the next step of analysis, identification of themes, commenced. The research team regularly met throughout this process to discuss, review and refine identified themes and sub‐themes. Next, the themes were defined and labelled. Once the themes were labelled, the research report was written up addressing the research objectives.

4.6. Ethical Consideration

The study was approved by the CQUniversity Human Research Ethics Committee (0000023848). Participants had been provided with an information sheet before scheduling an interview. Verbal consent was then obtained before commencing the interview using a pre‐determined consent script. Participants could withdraw from the study at any stage before data analysis.

4.7. Rigour and Reflexivity

The trustworthiness of the data was ensured by following the four principles established by Lincoln and Guba (1985): creditability, transferability, dependability and confirmability. Creditability was established through regular peer debriefing throughout the process. Transferability was established by including thick descriptions and direct participant quotes, allowing individual readers to assess the transferability of the findings to their setting (Korstjens and Moser 2018). The study's dependability and confirmability were established through an audit trail that involved thorough records on research decisions made throughout the process, as well as regular team meetings where data and findings were reviewed alongside notes of reflective journaling. The audit trail ensures complete transparency throughout the entire research project. As the primary researcher has previous experience as an oncology nurse and remains involved within the field through membership and on organisational boards, acknowledgement of perspectives and how these may have influenced the study was discussed with the team throughout all phases of this study. This acknowledgment allows for any influence to be recognised and articulated within the research.

5. Findings

5.1. Participants

Twenty interviews were completed. The participant's ages ranged from 26 to 64, their total nursing experience ranged from 1.5 to 43 years, while their experience caring for adult cancer patients ranged from 1.5 to 36 years. Seventeen participants were female, and 3 were male; 15 had completed formal post‐graduate oncology education, while 2 were currently completing further oncology education. Table 1 describes the characteristics of the participants.

TABLE 1.

Characteristics of the participants.

	n = 20
Gender
Female	17
Male	3
Age (years)
≤ 35	4
36–45	6
≥ 46	10
Years in nursing
≤ 5	4
6–15	6
≥ 16	10
Years in oncology nursing
≤ 5	6
6–15	9
≥ 16	5
Formal post‐graduate qualifications
Yes	15
No	3
In progress	2

5.2. Themes

Three main themes and nine subthemes were identified from the interviews. The three main themes were CF antecedents, CF impact and CF mediators. Diagram 1 outlines the main themes and subthemes identified (Figure 1).

FIGURE 1.

Main themes and sub‐themes.

5.3. CF Antecedents: ‘Things Poke Little Holes in the Bottom of That Bucket…You're Just…Fighting to Plug Holes’

While some participants felt drawn to oncology nursing due to their empathetic, caring nature, the very essence of oncology nursing itself was seen by many as an antecedent for developing CF. Three subthemes further support this theme.

5.3.1. The Patient Journey

While participants voiced how much they valued their close relationships with their patients and patient's families, they were also aware that developing these ongoing, close relationships poses a risk of becoming over‐involved with patients. When patients' disease progresses, and they ultimately pass away, nurses feel the loss at a personal level and often need time to grieve. This process in itself can be physically and emotionally exhausting.

We're seeing these patients all the time, we've garnered relationships with them and their family, and now they're possibly going towards end‐of‐life care, and that's taking a toll on us, and I know I didn't realise that took a toll on me. I was just like, “Oh, this is my job. This is what I'm doing,” until you're taking it home, thinking about it all the time, and you're not sleeping, stressing, over‐analysing, making mistakes. P. 16

The day‐to‐day work of oncology nurses can present situations in which they are conflicted between what might be considered the ‘right’ decision for patients and their ethical responsibilities as nurses. At times, a patient's only chance of prolonging their life is through intense treatments that can result in side effects that dramatically decrease their quality of life. The chance of these treatments working may be quite slim, but patients have the right to make these decisions themselves. Participants voiced concerns about the level of understanding from patients when making these decisions, and concerns about proposed treatments presented to patients due to medical staff's inability to ‘let go’ of patients. Several participants identified the most distressing aspect of their job being when treatment was not withdrawn in a timely manner, which went on to impact their ability to provide their patient with a dignified death.

He didn't need treatment. He was not going to survive it. And I just felt really, not angry at the oncologist, but just perplexed, “Why are we doing this to this man? This is just—he needs good palliative care at this point.” But we did it anyway. P. 17

5.3.2. Workload, Staffing and Skill Mix

Most participants voiced concerns with their current workload. When they did not have the time required to provide the standard of care they expected of themselves, they felt their mental well‐being was negatively impacted. The participants' innate desire to care for their patients often meant they were putting patient's needs ahead of their own. This manifested in missing or not having timely breaks, leaving late and unpaid overtime to ensure their patients received quality nursing care.

Nurses are pushed and pushed and pushed, given more jobs, more patients, more to do in their shift than they can possibly do … They're too task‐orientated, too busy. They lose their compassion. They become quite hard, and it's really sad because that's not why people go into nursing. P. 8

Staffing levels and skill mix were also identified by the participants as contributing factors to CF. While some workplaces appeared to be fully staffed in nursing numbers, the skill mix meant participants did not feel they were safely staffed. Some participants again voiced their feelings of responsibility for ensuring their workplaces were correctly staffed. The guilt of leaving their team short‐staffed meant some nurses forced themselves to work even when they were aware that it may not be in the best interests of their mental and physical well‐being. A number of participants voiced concerns about the large number of experienced nurses leaving oncology nursing for various reasons. This results in less experienced nurses missing out on mentorship from highly skilled, knowledgeable staff.

I was literally crying myself to sleep at 1.30 in the morning, but I was like, I can't call in sick for the morning shift. There's no one to cover me … it's just this endless cycle of I'm burnt out because we're short staffed but we're short staffed because we're burnt out. P. 13

5.3.3. Organisational Support

Participants raised several issues that made them feel like they were not supported or valued by their organisation. Participants voiced their frustration at education time regularly being missed or cancelled due to an increased workload and patient care needing to be prioritised. This led to participants feeling that their organisations did not respect the specialised work they were doing and the importance of their professional development. They were also concerned about the impact that missed professional development would have on future patient care and outcomes. The failure of organisations to financially remunerate nursing staff for the extra work or hours being done was another area in which participants felt their specialised work was not valued by their organisation.

There was lots of informal and formal education, and we just don't have that now … You can't expect nurses to become experts if you're not willing to invest the time in them when they're juniors. P. 15

Organisations that were seen to be implementing band‐aid type fixes or short‐sighted financial decisions rather than addressing the key issues needed to improve staff well‐being and workload at a foundational level also led to increased frustration from participants. Participants also felt processes and procedures were often being implemented, ultimately adding to their already heavy workload, and taking further time away from their patients. However, the value these processes added was not always clear or explained to staff, which increased feelings of frustration.

I'm cognizant of just support being like a band‐aid to support people from the trauma that shouldn't be there in the first place because they're not well‐resourced … it's a bit ironic that the system is supporting you through the burnout that itself has created. Support is cheaper than real, meaningful, lasting change sometimes. P. 12

5.4. CF Impact: ‘Having Nothing Left to Give’

All participants reported some understanding of what CF is and were able to articulate the negative impact constant emotional interactions with patients could have on them. This resulted in feelings of having nothing left to give themselves, their patients and significant others. Three subthemes further support this theme.

5.4.1. Nothing Left to Give Self

This sub‐theme is often exhibited as a loss of empathy and compassion, feeling mentally and physically drained to the point of feeling empty, with nothing left to give. Participants felt these feelings of exhaustion and emptiness did not just impact themselves, but also their friends and family, patients, colleagues and organisations.

We give so much of ourselves to our patients that there comes a point where there's nothing left to give …you're just so fatigued from being so compassionate to the patients and to the families, that you become like dead inside, and now there's nothing left. P. 13

5.4.2. Nothing Left to Give Patients, Colleagues and the Organisation

At work, the fatigue and emptiness that arise from CF led some nurses to identify they had nothing ‘extra’ to give a patient. They could only complete tasks rather than provide the holistic care of connection patients need for therapeutic relationships to develop. Some nurses identified additional job responsibilities such as mentoring, and quality improvement projects also felt like additional burdens that the nurse does not have the physical or emotional energy to engage in when experiencing CF. One participant believed nurses' reputation for eating their young was in part due to the emotionally drained feelings that come from CF. These physically and emotionally drained feelings also increased participants' use of sick leave, with one participant referring to it as ‘sick of it leave’ (P. 11). Several participants acknowledged they needed to step away from oncology nursing for some time due to their experience with CF.

I just don't want to be there; I don't want to talk with them. I don't want to have anything more of their story dropped on me. P. 18

You just don't want to hear any of it anymore. You don't want to take it on. You don't want it to be your burden anymore. P. 19

5.4.3. Nothing Left to Give Family/Friends

For those that remain in the specialty, participants voiced concerns about how CF impacts their home life. By the time nurses finish their shift, the feelings of physical and emotional fatigue mean they do not have the capacity to connect with friends and family or do the activities they usually engage in. Some participants shared that they often took patient experiences home with them, continuing to think about the patient, impacting them well after they left work. For some participants, it also resulted in trivialising or having difficulty relating to issues that were important to their loved ones.

Being really fatigued and having nothing left to give in your home life, or in your daily life, because you've given so much at work, and you've taken on so much sadness and hard times, that in your own personal life, you're left feeling like you don't have any compassion for much else. P. 10

5.5. CF Mediators ‘You Can Do a Good Job on a Hard Day…and Still Be the Person You Want to Be’

Participants acknowledged that their work is meaningful despite their physical and emotional fatigue when caring for their cancer patients. They all firmly believe that to successfully remain in their job they must also care for themselves. Participants also voiced the importance of having a supportive culture to mitigate CF. Three subthemes further support this theme.

5.5.1. Caring for Self

Participants identified the need to adequately self‐care to preserve their professional quality of life. More experienced participants reported that this level of self‐awareness was not something they had when first starting oncology nursing but developed as they became more experienced. These participants also believed that the responsibility for ensuring nurse's need for self‐care was met primarily fell on the nurses themselves.

I try to be … self‐aware of if I'm feeling compassion fatigue then I do something to like fill my cup up again. P. 6

Self‐care strategies differed for each participant but included caring for mental well‐being, physical well‐being and relationships. While some found regular therapy sessions an important aspect of mental well‐being, for others, it involved meditation or simply ensuring they took their designated breaks while at work. Others benefited from completing physical activities such as running, bike riding or swimming. Participants also identified the importance of maintaining relationships and having a strong support network of close family and friends. Again, more experienced nurses identified that an element of self‐care is having clear work/life boundaries.

Time and experience and trying different things as well, setting boundaries for myself and for patients and for care … it does take time. P. 11

Several participants were able to identify that the importance of this only became clear to them after their mental well‐being was negatively impacted by taking work home with them. For some, having clear work/life boundaries related to monitoring their involvement with patients, while for others, it involved removing work group chats or messaging systems from their phones.

5.5.2. Professional Identity

While participants articulated the emotional and psychological impact of their work, they also voiced the strong sense of pride, satisfaction and fulfilment they get from their work. Participants felt their job gave them the opportunity to make a difference in their patients' experiences, with the long‐term contact allowing them to develop close relationships with their patients. This gave the participants overall job satisfaction and feelings of positive self‐worth. Participants identified that impacting patient experiences did not always come from the big moments like implementing successful technical interventions. Rather, the small things like spending time just sitting with them or offering a cup of tea were the things that impacted their patients the most.

It makes me proud of what I do, that you know the team, including myself, did make that positive impact on the patient's life … when people ask what you do for work, you know, I'm a nurse and ohh, what kind of nurse and you're very proud to tell them, you know, I care for cancer patients. P. 7

Patient success stories brought the participants a sense of pride and accomplishment, with patients often being remembered for years afterwards. Caring for patients through such vulnerable moments of their cancer journey also brought great value to the nurse's life. It gave them a clear perspective on what is meaningful and an often overwhelming sense of gratitude. It is these feelings of satisfaction and knowing the importance of their job that many participants voiced as driving them to continue in their work, even when they could recognise the negative impact CF was having on them.

It keeps me going back to work. It keeps me working past the fatigue. It keeps me getting up when the alarm goes off and going back the next day when it was mental the day before. And I know it's going to be crazy again today. But it helps me in terms of my feelings of self‐worth and what I'm contributing to the world and what I'm personally achieving in my life. P. 18

5.5.3. Workplace Culture

Participants consistently identified feelings of support and belonging within the workplace as having the ability to mitigate the development of CF. Having managers who demonstrated care for their staff and recognition of the difficult and highly skilled work of oncology nurses, made participants feel valued and appreciated. Supportive colleagues and the overall workplace culture of how staff were treated were all key to positive workplace support. At a higher organisational level, this was demonstrated in simple ways, such as higher‐level managers being present to check in on staff and providing staff with access to well‐being interventions such as meditation or massage while at work. At a ward level, participants valued managers with an open‐door policy who made themselves readily available for staff support. These managers were also willing to provide practical assistance to their staff when they saw that workload was impacting their nurses. Those participants employed in organisations that solely provided cancer care consistently voiced how valuable they felt with their organisations actively involved in ensuring a caring staff culture was present.

[NAME] treat their nurses like rock stars … If you talk to any [NAME] nurse that's really worth their salt, that wants to be there and is passionate about her job, they get the most amazing, amazing support and not just education but support. P. 5

The process of debriefing was seen as a highly effective coping strategy for most participants following both traumatic and unexpected events and the death of long‐term patients. While sometimes debriefing occurred as a formal session, it often was linked to informal support from colleagues. Participants valued the important role their fellow oncology nurses played in their emotional well‐being. Sharing such intense experiences usually meant participants saw their colleagues as being in the best position to provide vital support and informal debriefing.

Cancer nursing team seem to genuinely care about each other as well as their patients. P. 10

While all organisations currently had resources and services in place such as an employee assistance programme participants could access for support if needed, most participants felt there were other specific areas organisations could focus on to specifically assist oncology nurses' well‐being. These recommendations involved the need for well‐being interventions to be incorporated into a workday and an organisational culture that sees the benefits of supporting staff as a valuable investment into the organisation's future. Having additional leave available for times when a nurse might be struggling with symptoms of CF at work was also considered a possible way to minimise CF among staff. Professional development was also seen as important for organisations to invest in, not only for the nurse but also as a symbol of the workplace valuing the skill set their nurses bring.

6. Discussion

This qualitative study explored Australian oncology nurses' perceptions, experiences and mitigating strategies for CF, including identifying potential interventions to support their well‐being. Given the predicted increases in Australian cancer cases and the need to sustain the current cancer care workforce, the findings from this study are vital to ensure the well‐being of the Australian oncology nursing workforce.

6.1. Feelings of Compassion Fatigue

Our results show that oncology nurses identify cancer care work as a risk factor for CF. The emotional toll of developing close, long‐term relationships with their patients and supporting them through their cancer journey can lead to feelings of emptiness and physical and mental exhaustion. These perceptions of CF support previous research where these feelings not only impact the nurse experiencing it but also their personal relationships outside of work (Gustafsson and Hemberg 2022). Given our participants identified connections with their family and friends as one way in which they mitigated the impact of CF, the loss of this connection through CF could, in fact, heighten the overall impact of CF on the nurse.

Patient care is affected by disengaged nurses who only have the emotional and physical capacity to complete the basic required care tasks for their own self‐preservation. From a patient's viewpoint, compassion is essential in providing person‐centred care (Sharp, McAllister, and Broadbent 2016). Without compassionate care, patients are less likely to have trust and confidence in the care being provided, actively participate in their healthcare and have decreased coping skills (Sharp, McAllister, and Broadbent 2016). Participants in this study confirm previous findings that outline the organisational impact of CF through increased sick leave, intent to leave the speciality and overall job performance (Chu 2021; Gustafsson and Hemberg 2022). To ensure cancer patients continue to have access to specialised oncology nurses, organisations need to take steps to ensure increased knowledge among staff on CF while also providing strategies for staff well‐being.

6.2. Organisational Demands

The sense of responsibility an oncology nurse can feel in relation to administering treatments that often cause patients suffering was seen to be a contributing factor for CF. Autonomy and beneficence have long been key ethical values nurses are required to use to help guide their decision‐making, govern their practice and ensure they are providing patients with ethical care (Greaney and O'Mathúna 2017). Cancer patients often face life‐altering decisions about treatment options. While the principle of autonomy grants patients the right to make these decisions, these decisions may at times conflict with what the nurse perceives as being in the patients' best interests (beneficence). These ethical dilemmas led participants to feel unable to uphold the professional standards required of those within oncology nursing. Awareness of the impact these ethically challenging situations may have on oncology nurses could assist workplaces in making provisions for extra debriefing time, regular staff check‐ins or well‐being interventions as these situations arise.

Nurses in our study felt the negative aspects of their job were frequently related to heavy workloads. A previous survey of the Australian oncology nursing workforce supports this, with 88% of participants identifying managing a high workload as the greatest challenge in their workplace (Bradford et al. 2023). Previous research supports a link between unmanageable workloads and experiences of CF (Maillet and Read 2024; Towey‐Swift and Whittington 2021). Many of the participants complained about their inability to take scheduled breaks due to the impact this could have on the quality of patient care being provided. While previous research has highlighted the importance of implementing mandated nurse‐to‐patient ratios in relation to safe workloads (Twigg et al. 2021), these mandated numbers do not consider non‐patient‐related activities that need to occur during a workday. Workplaces could consider changes to the way in which staff are rostered to ensure adequate staffing during key periods of time throughout the day. This would enable all staff to take their designated breaks while knowing their patients are being safely cared for.

This study also identified limited opportunities for professional development. Not having the time or an organisation that did not provide the much‐needed resources to continue to support and develop nurses contributed to feelings of CF among nurses. Not only is ongoing professional development a professional requirement, nurses are also self‐ motivated to increase their competency and knowledge and improve patient care (Pool et al. 2016). Concerningly, a recent literature review identified professional development and opportunity for advancement as a key influence in staff retention (Marufu et al. 2021), while a lack of knowledge on the specific nursing work and skills needed within a work environment can cause feelings of anxiety for nurses when at work (Drury et al. 2014). Organisations should consider ways to ensure staff have adequate time and access to additional learning to mitigate CF among staff.

Given the various geographical locations and the settings of the participants, the level of organisational resources available varied considerably. Participants described CF as a feeling of being empty, having nothing left to give and not having the energy to proactively seek help outside of work hours. Given CF could be considered a work‐related injury, it could be argued interventions to address it should be provided within and by the workplace (Copeland 2021). Focused interventions such as meditation or journaling for as short as 5 min in length during a rostered shift have been shown to have benefits to a nurse's well‐being (Copeland 2021). While these are relatively short in time, it still requires available time within a shift. This continues to highlight the importance of appropriate workloads, and ensuring any increase in workload does not impact a nurse's involvement in non‐direct patient contact activities. It also requires organisations to provide accessibility to a space where these types of interventions can be carried out. While multisensory recharge rooms which staff can access as needed have been shown to reduce anxiety levels in healthcare workers (Besa et al. 2023), there is currently limited research on this and its impact on CF. This is an area that would benefit from more research with larger sample sizes. Interestingly, in this study, participants employed within organisations whose primary focus was on providing cancer care (cancer‐specific hospitals and organisations) felt their organisation prioritised their well‐being and felt well supported. This may be related to a more advanced understanding of cancer care's impact on staff well‐being. Given that all care provided in these institutions is cancer‐related, an employee's intention to leave cancer care would also have a greater impact on staffing levels than organisations that provide care across a range of specialties, where a staff member could merely transfer out of the cancer care setting.

6.3. Caring for Oncology Nurses

Nurses in this study identified their knowledge of the importance of self‐care came with experience. Previous research has identified older, more experienced nurses have higher levels of CS and lower levels of BO (Hunsaker et al. 2015) which may align with a nurse's evolving knowledge of self‐care and its implementation as they progress through their career. Concerningly, our study identified a lack of senior staff in most of the participant's workplaces. This may mean that junior staff may not be supported in developing their clinical knowledge and skills, but also miss out on opportunities to see effective role modelling of coping and self‐care strategies. Previous research has found this type of informal role modelling to be invaluable in decreasing a nurse's level of work‐related stress (Drury et al. 2014).

While our study participants felt nurses need to be responsible for ensuring their self‐care needs are met, they first need to know the importance of this and the different ways in which it can be achieved. This further highlights the importance of organisations supporting the current workforce for long‐term sustainability. Further research that focuses on young nurses with less experience would provide further knowledge on how best to support this specific group. Future research on educational programmes aimed at newly qualified nurses that focus on the importance of self‐care while also providing different methods is another area that requires further exploration. Where workplaces identify a lack of senior staff to support those less‐experienced, remote mentoring programmes may be an important intervention for mentor accessibility and support.

Overall, the emotional toll cancer care appears to have on nursing staff appears to be minimised by the satisfaction that comes from their work. The nurses in our study all had great pride and passion in the work they do, which gave them an increased sense of professional identity and self‐worth. This supports previous research that found a positive sense of professional identity can minimise the impact of CF among nurses (Zhang et al. 2023). Positive professional identity is something that can be developed from an undergraduate level through positive, safe, supported and reflective learning experiences (Vabo, Slettebø, and Fossum 2022). Embedding these types of learning experiences into undergraduate nursing programmes should be an important focus of tertiary organisations and would require continual review.

The importance of a workplace culture where participants felt valued and recognised for their work was highlighted as important in mediating CF. This finding is consistent with previous research where meaningful recognition was identified as significant for increased CS and decreased BO (Kelly and Lefton 2017). Implementation of a structured award programme in which nurses are nominated by anyone within the healthcare setting who may experience or observe compassionate care provides a way for others to acknowledge and express gratitude for the care provided by the nurse (Sweeney et al. 2020), while also assisting organisations build a culture of gratitude and appreciation for their nursing staff (Sweeney 2017).

6.4. Strengths and Limitations

This study is believed to be the first qualitative research conducted on Australian oncology nurses in relation to CF. The sample size of 20 interviewees from a variety of oncology settings located throughout Australia further strengthens the study. However, the main limitation that needs to be considered is the risk of sampling bias. Recruitment for the initial cross‐sectional survey involved the use of professional groups within cancer care. This may mean the participants have a high level of professional identity within oncology nursing, which may impact how they reported their cancer nursing experiences. Only three male participants were included in this study. While this reflects the Australian nursing workforce (Nursing and Midwifery Board of Australia 2024), it would be beneficial for larger studies to include male oncology nurses to determine if they experience CF similarly to their female counterparts. The CF levels of interview participants were not obtained during this research. While this may limit the ability to understand the extent and severity of CF among participants, it does provide a wide overview of participant experiences. The requirement for participants to have Internet access in order to receive study information and participate in the virtual interviews may also be considered a further limitation of this study, but did provide the opportunity for participants from all areas of the country to be involved in the study. Consideration of the possibility of participants responding to certain interview questions in a socially desirable manner should also be acknowledged.

6.5. Recommendations for Future Research

This research has identified ways oncology nurses feel CF can be mitigated. Further research is needed to explore the impact of interventional well‐being programmes that organisations can implement to best support staff well‐being. Given that CF is not only a risk for oncology nurses, but rather can occur in different nursing specialties, future research on the benefit of self‐care education within undergraduate nursing programmes would be important to the sustainability of the nursing workforce as a whole.

6.6. Implications for Policy and Practice

Given the impact CF has on staff well‐being, patient experiences and organisational resources through increased sick leave and nurses leaving the speciality, organisations need to take an active role in improving staff well‐being. This can be considered by minimising identified risk factors related to the work environment while also encouraging mitigating factors. Australian healthcare organisations must prioritise the professional development of oncology nurses to ensure they feel valued and supported. Education on CF including self‐care strategies to improve well‐being may also reduce the burden of CF among nursing staff caring for adult oncology patients. Providing this type of education regularly at both an undergraduate and post‐graduate level should be a consideration in the future to improve all Australian nurse's well‐being irrespective of their speciality area.

7. Conclusion

The very work oncology nurses do places them at risk of developing CF. This research identified the pride oncology nurses have in their work, as well as ways in which CF impacts the nurses and their loved ones, the level of care patients receive, and ultimately affects organisations. Oncology nurses need to feel supported by their workplaces to improve their overall well‐being and ensure they can continue to provide quality patient care. Interventions that both support and educate nurses in effective ways of self‐caring require the involvement and support of their organisations.

Author Contributions

All authors made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; involved in drafting the manuscript or revising it critically for important intellectual content; gave final approval of the version to be published. All authors participated sufficiently in the work to take public responsibility for appropriate portions of the content; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethics Statement

The study was approved by the CQUniversity Human Research Ethics Committee (0000023848). This research received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Appendix S1.

Banks, J. , Lopez V., Thapa D. K., Sahay A., and Cleary M.. 2025. “Compassion Fatigue Among Australian Oncology Nurses Caring for Adult Cancer Patients: Antecedents, Impact and Mediators.” Journal of Advanced Nursing 81, no. 9: 5984–5995. 10.1111/jan.16733.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.