The evolution of empathic tendency and professional quality of life in nursing students: a cross-sectional and longitudinal study

Background/Introduction Empathy is a core competence in the nurse–patient therapeutic relationship, influencing quality of care, patient satisfaction, and professional well-being. However, the evolution of empathic tendency throughout nursing education remains controversial. At the same time, continuous exposure to patients’ suffering may affect professional quality of life, promoting either Compassion Satisfaction (CS) or Compassion Fatigue (burnout and secondary traumatic stress). This study aimed to investigate the relationship between empathy, CS, burnout, and secondary traumatic stress among nursing students and to evaluate their evolution over time. Methods/Approach An observational study including both cross-sectional and longitudinal phases was conducted at the Bachelor's Degree in Nursing of the University of Parma, Piacenza Teaching Site. The cross-sectional phase involved first-, second-, and third-year nursing students enrolled during the 2021/2022 academic year, while the longitudinal phase followed a cohort of students from the first to the third year (2020–2023). Data were collected annually using a paper-based questionnaire including socio-demographic variables, the Balanced Emotional Empathy Scale (BEES), and the Professional Quality of Life Scale-5 (ProQOL-5). Statistical analyses included correlational tests and comparisons between groups and across time. Results/Conclusions A total of 228 students were included. Mean BEES scores showed high levels of empathy across all academic years, with a progressive increase from the first to the third year (60.04 vs 65.87). The dimension related to emotional openness showed significant differences between second- and third-year students (p<0.02). CS was moderate to high (mean 36.22), whereas burnout and secondary traumatic stress showed predominantly low-to-moderate levels. Correlational analysis demonstrated a positive association between empathy and CS (r=0.42; p<0.001), together with negative correlations with burnout (r=-0.21; p=0.02) and secondary traumatic stress (r=-0.18; p=0.04). In the longitudinal cohort, empathy and CS progressively increased throughout the educational pathway, while burnout and secondary traumatic stress remained within non-critical levels. Discussion/Implications Findings suggest that empathy represents a dynamic and developable competence during nursing education. The parallel increase in empathy and CS, in the absence of clinically relevant increases in compassion fatigue, supports the protective role of empathy when accompanied by appropriate emotional regulation strategies. The study highlights the importance of integrating educational interventions based on simulation, narrative medicine, and reflective learning into nursing curricula in order to promote resilience, professional well-being, and sustainability of clinical practice. Conclusion Empathy and professional quality of life appear to evolve positively throughout nursing education. Investing in the development of relational and emotional competencies may enhance students’ well-being and improve the future quality of nursing care