This study delves into the connections between perceived organizational support, compassion fatigue, and caring behavior in outpatient nurses. The research results support the theoretical hypotheses and provide valuable insights for improving nurses’ caring behavior. Specifically, the findings revealed a positive relationship between perceived organizational support and caring behavior, while compassion fatigue was negatively associated with both perceived organizational support and caring behavior. Moreover, the study demonstrates that compassion fatigue acts as a partial mediator between perceived organizational support and the caring behavior of outpatient nurses. These results suggest that outpatient nurses who perceive lower levels of organizational support are more likely to experience compassion fatigue, leading to a decline in their nursing behaviors. Importantly, this study is the first to investigate the mediating role of compassion fatigue in the relationship between perceived organizational support and caring behaviors among outpatient nurses from a resource-based perspective. As such, these findings contribute to the enrichment of the JD-R model.
The study revealed that the perceived organizational support score was lower compared to previous studies by Cheng (37) and Wang (38). The differences in scores could be attributed to varying levels of economic development in different cities, with Xi’ an lagging behind Wuhan and Suzhou. This lack of economic progress can indirectly affect nurses’ perceived organizational support by influencing working conditions, income levels, career opportunities, and social status. Discrepancies in scores may also be influenced by differences in work departments, with clinical departments having more resources and full-time nurses compared to outpatient departments, where staff shortages and heavy workloads are common. The higher score for instrumental support than emotional support suggests that while necessary resources are provided, emotional connections and psychosocial needs are not adequately addressed (37). Nurse managers should focus on not only providing material support but also showing genuine care and attention to enhance nurses’ sense of organizational support.
In this study, compassion fatigue scores were consistent with Zhang’s (39) study, slightly higher than Yi’s (40) study, but significantly lower than Li’s (41) study. This discrepancy could be attributed to variations in participant sources and the timing of the survey. Yi’s (40) study focused on nursing interns, who are mainly involved in learning and observation tasks rather than full nursing responsibilities, potentially leading to lower emotional involvement and job stress levels. On the other hand, outpatient nurses directly interact with patients and handle complex medical situations, increasing their susceptibility to compassion fatigue. Li (41) conducted research during an epidemic, highlighting that nurses faced heightened work pressure, increased emotional involvement, concerns about personal safety, lack of adequate rest and support, differences in psychological flexibility, and limited emergency skills and psychological training. The average score for job burnout was higher than that for secondary trauma, consistent with previous studies (40–41). While secondary trauma can also impact nurses’ mental health negatively, it is usually a one-time occurrence or episodic event. In contrast, the continuous high workload and stressful environment faced by outpatient nurses are ongoing stressors in their daily work, making them more prone to job burnout than secondary trauma. Research on compassion fatigue among nurses in China has been increasing in recent years, with a focus primarily on clinical departments and limited exploration in outpatient departments. This study provides valuable insights for future research in this area. The findings reveal that while there has been some improvement in compassion fatigue among outpatient nurses, 46.5% of nurses still experience moderate to severe levels of compassion fatigue. As a result, it is recommended that nursing managers prioritize organizing compassion fatigue management training to help nurses effectively identify and manage negative emotions. Additionally, providing psychological counseling services can aid in alleviating work-related stress. Implementing a shift system to more evenly distribute workloads may also prove beneficial. By taking these proactive measures, empathy fatigue among outpatient nurses can be gradually mitigated.
In this study, the score for caring behavior was higher than in Chen’s (1) study but lower than in Qiu’s (42) study, falling within a medium range overall. The differences in results may be attributed to the variation in participants’ sources and the varying levels of economic development in the surveyed regions. This study focused on outpatient nurses, who have more extensive nursing experience, deeper professional knowledge, and stronger empathy compared to nursing interns in Chen’s (1) study. The nurses examined in this study are from Xi’an, a city with high economic, social, and medical standards in China, while Qiu’s (42) research focused on nurses in Fuzhou. Fuzhou has seen significant advancements in recent years, surpassing Xi’an in economic, social, and medical sectors. Cities with high standards tend to have better medical resources and industry standards, promoting high-quality nursing services and nurturing a culture of care. “Support and assurance” scored the highest, “Knowledge and skills” the second highest, and “Respect and connection” the lowest, consistent with previous studies (1,42). Outpatient nurses, dealing with a high volume of mobile patients, may potentially overlook genuine patient needs, resulting in a deficiency in providing humanistic care. This study observed variations in caring behavior scores among outpatient nurses, influenced by factors such as age, length of service in nursing, professional title, marital status, number of children, average monthly income, and employment type. Outpatient nurses who are older, have more experience, and hold higher professional titles tend to exhibit a stronger sense of responsibility and more stable humanistic care qualities. These qualities are manifested in their proactive communication and patient service behaviors (42). Research suggests that married nurses with children are able to balance multiple family roles, enabling them to better understand and address the physical and mental needs of patients (42). Moreover, nurses with higher salaries often report greater happiness and job satisfaction, with satisfaction serving as a positive predictor of their humanistic care abilities. Additionally, formally employed nurses often demonstrate a strong sense of belonging and develop positive work attitudes, fostering the growth of their humanistic philosophy of care. In recent years, China has actively promoted high-quality nursing services, advocated for the strengthening of scientific research and practice related to humanistic care in nursing, and enhanced the caring capabilities of nurses. Medical institutions have responded positively and achieved favorable outcomes (1). However, existing research on nurses’ caring behavior predominantly focuses on clinical departments (42-43), with limited attention given to outpatient clinics. Outpatient clinics serve as the frontline for Chinese hospitals to deliver high-quality nursing services. Enhancing the caring behavior of outpatient nurses is crucial for advancing high-quality nursing services in hospitals. Therefore, nursing managers can enhance the professionalism and service awareness of outpatient nurses by organizing regular training sessions on patient care and communication skills. Implementing a reward system can also help boost nurses’ motivation to provide quality care to patients, ultimately improving caring behaviors among outpatient nurses.
The study findings confirmed the hypothesis that perceived organizational support is a key predictor of caring behavior among outpatient nurses, consistent with previous research by Tian (44). Perceived organizational support refers to nurses’ perception of how much the hospital values and supports them, which can significantly impact their attitudes and behaviors, especially in patient care (44). Social exchange theory suggests that nurses who feel well-supported by their organization are more likely to respond with higher job satisfaction, a stronger professional identity, and positive work behaviors (22). Caring behaviors exhibited by nurses are indicative of their dedication to their work and profession and can be considered positive work behaviors. Therefore, outpatient nurses who perceive strong organizational support are more likely to demonstrate caring behaviors. This underscores the importance for nursing managers to implement interventions that enhance caring behaviors by improving perceived organizational support. Previous studies have emphasized the role of leadership support, welfare benefits, and job support in shaping perceived organizational support (29). Additionally, Jia’s (45) research showed a strong link between career development and perceived organizational support. Hence, nursing managers should not only provide work support but also focus on promoting career growth and emotional support to boost perceived organizational support among outpatient nurses.
The study findings revealed a significant negative correlation between perceived organizational support and compassion fatigue, supporting H2 and consistent with previous research (20). Tang’s study (46) emphasized the crucial role of adequate organizational support in creating a positive work environment. A positive work environment not only boosts nurses’ job satisfaction but also reduces emotional exhaustion, effectively preventing compassion fatigue, especially in high-stress settings. The conservation of resources theory also supported this outcome, showing that organizational support can lower nurses’ physical and mental resource depletion and job burnout, ultimately easing compassion fatigue (47). Existing literature indicated that strong organizational support can meet nurses’ emotional needs and reduce work-related stress (48), further explaining the negative association between perceived organizational support and compassion fatigue. Therefore, nursing managers should actively leverage all organizational resources to establish a supportive work environment for nurses, ultimately alleviating compassion fatigue.
The negative correlation between compassion fatigue and caring behaviors supports H3, indicating that as outpatient nurses experience more severe compassion fatigue, their level of caring behaviors decreases. This finding is in line with Jeon’s (49) perspective. The Conservation of Resources theory suggests that compassion fatigue can deplete nurses’ psychological resources, leading to a decrease in work engagement and caring behavior (47). Insufficient caring behavior from nurses may result in negative feedback from patients and leaders, further reducing their work enthusiasm and worsening compassion fatigue. Marshall (50) also highlights compassion fatigue as a reflection of nurses’ desire to improve their professional skills and caregiving abilities. However, prolonged exposure to compassion fatigue can have adverse effects on nurses’ physical and mental well-being, potentially causing job burnout and a decline in caring behavior. Based on these research findings, it is recommended that nursing managers prioritize the physical and mental well-being of outpatient nurses and address any negative emotions they may be experiencing. Providing adequate humanistic care to nurses can make them feel valued and supported, helping them better cope with psychological stress and ultimately enhance their caring behavior.
The study found that compassion fatigue partially mediates the relationship between outpatient nurses’ perceived organizational support and caring behaviors, confirming Hypothesis H4. This means that compassion fatigue not only has a negative association with caring behavior but also reduces the impact of perceived organizational support on caring behavior among outpatient nurses. Drawing from the JD-R model (26), resources include both work and personal resources, which collectively influence positive work behavior. Perceived organizational support, as a job resource, influences compassion fatigue, a negative personal psychological resource, leading to a decrease in nurses’ caring behavior. The heavy workload of outpatient nurses can deplete their psychological resources, affecting their caring behavior without sufficient organizational support or self-regulation skills (51). Conversely, organizational support can help nurses manage work-related stress effectively (52). The conservation of resources theory suggests that work resources have a spiral value-added effect, enabling nurses to acquire more resources and build resilience in coping with resource depletion (51). This underscores the importance of having adequate working resources. Personal resources, influenced by job resources, significantly shape individuals’ caring behaviors, enriching the understanding of the JD-R model. Therefore, nursing managers should acknowledge the significance of outpatient nurses’ work and personal resources. By effectively leveraging the positive motivational impact of organizational support resources, they can mitigate the negative effects of compassion fatigue on nurses and ultimately enhance their capacity for providing caring behavior.
Implication for nursing management
This study explores the mediating role of compassion fatigue in the relationship between perceived organizational support and caring behaviors among outpatient nurses, emphasizing the importance of addressing both work and personal resources. The findings suggest that nursing managers can impact nurses’ caring behaviors by improving perceived organizational support and understanding the mediating effect of compassion fatigue. The study offers a novel perspective on enhancing caring behaviors among outpatient nurses, establishing a theoretical and practical groundwork for further research on improving caring behaviors in high-pressure nursing environments. Nursing managers can enhance perceived organizational support by providing vocational training, education opportunities, a safe working environment, necessary resources, and reducing work burdens. Additionally, they should address compassion fatigue by promoting humanistic care, encouraging open communication, providing psychological counseling, managing work schedules effectively, and fostering mutual support among nurses.
Limitations
This study is subject to several limitations. Firstly, the use of convenience sampling and data collection from only six tertiary hospitals in Xi’an may limit the generalizability of the study results. Future research should consider expanding the sample scope by including hospitals from various regions and levels to further validate the findings. Secondly, all participants in this study were female nurses. It is suggested that future studies include a higher proportion of male nurses to ensure more comprehensive results. Thirdly, the data in this study was gathered through self-reports by nurses, potentially introducing bias. To enhance the study, future research should consider collecting data from various groups, such as nurse leaders, patients, and physicians. Lastly, the study utilized a cross-sectional design, limiting its ability to establish causal relationships among predictor variables. To address this limitation, future longitudinal and qualitative studies should be conducted to delve deeper into the effects of perceived organizational support and compassion fatigue on the caring behaviors of outpatient nurses.