Changes in Self-Reported Empathy Among Undergraduate Nursing Students: A Four-Year Longitudinal Study

Background: Empathy is widely recognised as a core professional value in nursing, underpinning high-quality, person-centred care and therapeutic relationships in a profession characterised by sustained interaction with patients and families. However, few studies have followed the same nursing students throughout their entire undergraduate programme. Objectives: To examine longitudinal changes in clinical empathy and its dimensions among Spanish nursing students throughout the four-year undergraduate nursing degree and to explore associations between empathy scores and selected sociodemographic characteristics. Methods: A prospective longitudinal cohort study included four annual assessments (2020–2023) at a Spanish public university. Clinical empathy was measured with the Jefferson Scale of Empathy–Health Professions Students (JSE-HPS). Spearman rank correlations assessed score stability; adjusted linear mixed-effects models evaluated changes over time and sociodemographic associations, followed by Tukey-adjusted comparisons. Results: Of 150 eligible students, 126 participated at baseline (84.0%). The mean total score fell from 117.37 at the first assessment to 87.75 at the second and remained relatively stable thereafter. Assessment time was significantly associated with the total score and all three dimensions (all p ≤ 0.003). Total, Compassionate Care, and Standing in the Patient’s Shoes scores were higher at the first than at all subsequent assessments; Perspective Taking differed only between the second and fourth assessments. Age was positively associated only with Compassionate Care (β = 0.15; p = 0.039), but this finding should be considered exploratory given the number of outcomes examined; other covariates showed no associations. Conclusions: Self-reported empathic orientation declined mainly between the first and second academic years and changed little thereafter, although the dimensions followed distinct trajectories. These findings support monitoring empathy and suggest attention to educational support early in nursing education.