Examining Changes in Compassion Satisfaction, Burnout, Secondary Traumatic Stress and Work-Related Quality-of-Life of Rural Surgical and Obstetrical Nurses in British Columbia During the COVID-19 Pandemic

For nursing students

Study summary

Rural nurses often work in demanding settings with fewer resources than their urban counterparts, and the COVID-19 pandemic added new strain to their work. This study, published in the Canadian Journal of Nursing Research, followed rural surgical and obstetrical nurses in British Columbia to see how their professional and work-related quality of life changed during the pandemic years. It was part of a larger program evaluation of the Rural Surgical and Obstetrical Networks, known as RSON, a five-year initiative running from 2018 to 2023 that aimed to strengthen and stabilize rural hospitals in British Columbia. A key question was whether the RSON initiative helped protect, or mitigate, the pandemic's impact on nurses' quality of life.

The researchers surveyed nurses in eight communities across British Columbia using online questionnaires at two time points, in 2021 and again in 2023, making this a longitudinal evaluation. They measured two related things. Work-related quality of life was assessed with 23 items covering job satisfaction, general wellbeing, work-life balance, the level of stress experienced at work, sense of control, and working conditions. Professional quality of life was measured along three dimensions: compassion satisfaction, which is the positive feeling that comes from helping others; burnout; and secondary traumatic stress, which is the strain that can come from caring for people who have experienced trauma. Each of these three dimensions was measured with 10 items. Responses were linked over time by a code so the same nurses could be compared, and changes were analyzed using a paired Student's t-test.

Participation dropped substantially between the two surveys. 107 nurses participated at time 1 in 2021, but only 28 participated at time 2 in 2023. This large drop is important to keep in mind when interpreting the findings, because a small follow-up group may not represent everyone who started.

Several results stood out. At time 1, burnout and secondary traumatic stress scores were lower among older nurses and among nurses who had children, suggesting that age and family circumstances may relate to how nurses experience these strains. Over the two-year period from 2021 to 2023, the study found significant increases in burnout, with a p-value of less than 0.001, and in secondary traumatic stress, with a p-value of 0.04. At the same time, work-related quality of life decreased significantly, with a p-value of 0.04. Compassion satisfaction also decreased over time, but this change was not statistically significant, meaning the study could not be confident the decrease was more than chance.

Taken together, these results paint a difficult picture for rural surgical and obstetrical nurses during the later pandemic years. Even with the RSON initiative in place, burnout and secondary traumatic stress rose while work-related quality of life fell. The authors conclude that the RSON initiative could not mitigate these decreases in professional and work-related quality of life during COVID-19. However, they note an important positive: the initiative did offer opportunities for clinical education and professional development among rural nurses, which is a meaningful benefit for a workforce that can struggle to access such opportunities.

For students and nurses, this study offers several lessons. It introduces the widely used concept of professional quality of life and its three parts, compassion satisfaction, burnout, and secondary traumatic stress, which are helpful for understanding both the rewards and the risks of caring work. It shows how a paired design tracks change within the same people over time, and how p-values signal whether a change is statistically meaningful. It also demonstrates honest reporting of a limitation: a steep drop from 107 to 28 participants weakens confidence in the results and limits how far they can be generalized. Because the study describes nurses in eight rural British Columbia communities during a specific and unusual period, its numbers should be read cautiously and not assumed to apply everywhere. The take-home message is compassionate and practical. Rural nursing during the pandemic was hard on wellbeing, targeted programs alone may not offset system-wide strain, and investing in education and support remains valuable. Nurses experiencing burnout or traumatic stress are encouraged to seek support, as these are recognized occupational health concerns rather than personal shortcomings.

For educators

Teaching and appraisal notes

This paper works well for teaching professional quality of life, longitudinal design, and honest appraisal of attrition. Use it to introduce the ProQOL framework and its three dimensions: compassion satisfaction, burnout, and secondary traumatic stress, each measured with 10 items, alongside a 23-item work-related quality-of-life measure. It is a concrete example of a paired, within-person design analyzed with a paired Student's t-test at two time points (2021 and 2023) during the COVID-19 pandemic. The findings give students real p-values to interpret: significant increases in burnout (p < 0.001) and secondary traumatic stress (p = 0.04), a significant decrease in work-related quality of life (p = 0.04), and a non-significant decrease in compassion satisfaction. This is an ideal chance to teach the difference between statistical significance and clinical meaning, and to discuss why a non-significant result is not the same as no change. The steep attrition, from 107 participants at time 1 to only 28 at time 2, is a powerful teaching moment about response bias, statistical power, and cautious interpretation. Situate the study within the RSON rural health initiative and ask students whether a program can be judged a failure if it does not offset a pandemic yet still delivers clinical education and professional development. For trauma-informed care courses, use secondary traumatic stress to discuss occupational risk, normalization, and support-seeking.