Unpopular patients and compassion fatigue among nurses: a mixed-methods study on emotional burden, workforce well-being, and patient safety

To examine the interrelationships among nurses’ perceptions of unpopular patients, compassion fatigue, compassion satisfaction, and the risk of adverse events, informing organizational strategy and safety protocols in acute care hospital settings. Mixed methods research using quantitative and qualitative approaches. A validated online questionnaire was completed by 130 nurses. Measures included demographics, perceptions of unpopular patients, and the Professional Quality of Life Scale assessing burnout, secondary traumatic stress, and compassion satisfaction. The study followed STROBE guidelines. Most participants were female (72.3%) and aged 41-50. Lower compassion satisfaction and higher burnout or secondary traumatic stress were associated with identifying a greater number of unpopular patient types. Younger nurses and men reported more difficulty, particularly with emotional and logistical care demands. Perceived error probability strongly correlated with socio-behavioral unpopular-patient categories, burnout, and secondary traumatic stress. Nurses who frequently encountered communication-intensive or boundary-challenging patients described heightened cognitive load and increased concern for near-miss situations. Qualitative findings reinforced these trends: participants portrayed unpopular patients as sources of emotional overload, communication conflict, and repeated workflow disruptions that reduced patience, strained attention, and elevated perceived safety risks. Error-reporting patterns further highlighted the interplay between emotional strain, patient mix, and clinical performance, demonstrating how socio-behavioral challenges shape nurses’ sense of safety and vulnerability to errors. Findings reveal broader system-level dynamics in which nurses’ perceptions of unpopular patients trigger emotional strain, which in turn elevates the perceived risk of medical error. These dynamics shape nurse well-being and key organizational patient-safety indicators. The study emphasizes the strategic importance of creating supportive practice environments and providing targeted training and resources to enable nurses to manage challenging patient interactions effectively. Such interventions are crucial for mitigating emotional fatigue, enhancing workforce resilience, and ultimately improving patient safety outcomes across the system. Prioritizing nurse well-being must therefore be recognized as a foundational element of organizational sustainability. This study provides actionable insights for nurse leaders and healthcare administrators, highlighting a previously overlooked pathway that links staff emotional experiences with patients to their clinical performance.