The Hidden Burden of Nursing: Compassion Fatigue, Patient Safety, and Second Victim Experiences—Qualitative Study

AIM: To explore the hidden emotional burdens faced by nurses in acute care, focusing on experiences with 'unpopular' patients, compassion fatigue, and the second victim phenomenon, and how these intersect to influence patient safety. DESIGN: A qualitative study using a narrative inquiry approach. METHODS: Semi-structured, in-depth interviews were conducted between September and November 2025 with 24 nurses from hospital departments. Data were analysed using narrative and conventional content analysis within a hermeneutic framework. RESULTS: Content analysis identified emotional solitude in coping as the overarching theme. Two main categories emerged: (1) the manager's role in second-victim situations, highlighting managers as second victims themselves and the burden of responsibility overload; and (2) implications for nursing practice, involving distancing from patients, hesitation in clinical decision-making, and disrupted teamwork. CONCLUSION: Caring for unpopular patients and experiencing second-victim distress creates significant emotional strain and isolation. Integrating compassion fatigue and second-victim awareness into organizational practice is essential for a supportive care environment. IMPLICATIONS: Leadership should implement targeted support systems to address emotional solitude, preventing clinical hesitation and patient distancing that compromise safety. IMPACT: Problem: The study addressed how compassion fatigue and second-victim distress intersect with challenging patient encounters to threaten safety. FINDINGS: Emotional solitude leads to professional distancing, clinical hesitation, and impaired teamwork. IMPACT: Results inform nursing leadership and administrators on developing targeted support systems. REPORTING METHOD: Adhered to COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. GLOBAL CLINICAL CONTRIBUTION: Identifies 'emotional solitude' as a barrier to recovery and safety. Highlights managers' unique vulnerability as second victims. Shows how the emotional burden, increasing risk by narrowing care to basic tasks, increases.