People with cancer undergo a multifaceted treatment journey, which includes diagnosis, surgery, chemotherapy, and radiation therapy, and is often accompanied by various side effects. Oncology nurses play a pivotal role in the cancer care continuum. As patient navigators, they are integral to providing patient-centered, integrated care and facilitating effective communication [1]. In this process, oncology nurses frequently face challenging circumstances, such as patients’ pain, medical constraints, and family distress. These professionals experience unique emotional burdens, including fear of death, guilt, and emotional weight while attending to patients. These challenges, combined with the distinct characteristics of oncology nursing, contribute to increased job stress and burnout and reduced job satisfaction [2, 3, 4]. Unfortunately, the resultant burnout, compassion fatigue, increased job stress, and diminished job satisfaction among oncology nurses can adversely influence their ability to provide quality patient care [5].

However, the relationship between work-related stress and job satisfaction in oncology nurses varies among individuals and is influenced by factors such as resilience. Resilience, defined as the ability to adapt positively to external adversities, plays a critical role in coping with stress [6]. Highly resilient nurses overcome impossibilities by actively using internal and external resources [7]. Several studies have reported that higher resilience leads to a better sense of well-being, lower burnout [8, 9, 10], and higher job satisfaction [4]. High resilience positively affects job performance [11]. Therefore, it is expected that high resilience could be one of the factors contributing to individual differences in the response to challenging clinical situations faced by oncology nurses.

Professional quality of life is an indicator used to measure nurses’ job satisfaction [12]. This indicator is relevant to all healthcare providers who help individuals experiencing trauma and suffering. Professional quality of life has three main aspects: compassion satisfaction, burnout, and secondary traumatic stress [12]. In previous studies, oncology nurses experienced high levels of burnout [2] and secondary traumatic stress [13], and reported low compassion satisfaction [4]. Low professional quality of life affects nurses’ intentions to leave [4] and ultimately negatively affects the quality of patient care [14]. A significant relationship is expected between the level of resilience and professional quality of life, including burnout and compassion satisfaction. Much research has been conducted on the relationship between resilience and job stress in oncology nurses [15, 16, 17].

However, a review of the literature reveals a challenge in definitively establishing the correlation between resilience and professional quality of life, as well as the relationship between caring behavior, resilience, and professional quality of life. Previous research has primarily focused on the influence of resilience on job stress, with limited insight into their combined impact on nurses’ caring behavior [2, 4, 15, 16, 17]. Furthermore, despite its pivotal role in caring for patients with cancer, there is a dearth of research on the factors shaping caring behavior, specifically within the context of oncology nursing [14]. Consequently, it is imperative to unravel the intricate interplay between resilience, professional quality of life, and caring behavior within the realm of oncology nursing. This impetus is underscored by the necessity to comprehensively illuminate the distinctive attributes inherent in oncology nurses and expound upon the compelling rationale that underscores the pivotal significance of caring within this specialized domain.

In this study, we explored the factors associated with oncology nurses’ degree of caring behavior, which can further improve the quality of care they provide to patients with cancer. We examined oncology nurses’ resilience, professional quality of life, and degree of caring behavior to provide interventions necessary to improve care. Specifically, we aimed to (1) assess nurses’ resilience, professional quality of life, and degree of caring behavior; (2) analyze the differences in levels of resilience, professional quality of life, and degree of caring behavior based on general characteristics; (3) identify the relationship between resilience, professional quality of life, and degree of caring behavior; and (4) identify the factors associated with the degree of caring behavior of oncology nurses.

In this study, we aimed to clarify the factors associated with oncology nurses’ caring behavior. We described oncology nurses’ resilience, professional quality of life, and degree of caring behavior. We also examined the factors associated with oncology nurses’ degree of caring behavior. The participants had low scores for resilience and caring behavior. More than half the participants had moderate or high burnout and secondary traumatic stress. It was confirmed that the degree of caring behavior, resilience, and compassion satisfaction were positively correlated, while caring behavior and burnout were negatively correlated. Compassion satisfaction and education beyond graduate school were significantly associated with the degree of caring behavior.

In this study, the oncology nurses’ levels of resilience were lower than those found in previous studies conducted nationally and internationally with operating room nurses, adult intensive care nurses, nurses across all hospital departments, and critical care nurses [8]. In an integrative review that identified resilience in nurses and related factors [8], in nine out of 10 studies that used the same tool as the present study, resilience levels were higher than identified by us. This may be attributed to the elevated levels of burnout reported by the participants in this study. In this study, 75.7% of nurses reported moderate or greater burnout, 83.1% reported moderate or greater secondary traumatic stress, and 26.2% reported high compassion satisfaction. Oncology nurses have to deal with the complexities of cancer treatment, and they also have to bear emotional burdens as they are frequently exposed to dying patients [23, 24, 25]. Therefore, oncology nurses may experience greater burnout. Burnout has been identified as a factor that negatively affect resilience [8] and workability [26, 27]. Resilience [15] and professional quality of life can also be improved [28]. A systematic review of the literature on coping and resilience in oncology and palliative care nurses highlighted the efficacy of interventions, such as team cohesion promotion, stress-reducing education and training, recovery facilitation, and support for emotional processing and experiential learning [15]. Other studies have corroborated the effectiveness of recognizing compassion fatigue and its consequences, along with developing strategies to mitigate it, to enhance resilience and improve professional quality of life [28]. In an effort to provide quality care to patients with cancer, it is proposed that professional quality of life be measured regularly, and intervention programs should be implemented to increase resilience among oncology nurses.

We found that a total clinical experience between one and three years, working on a rotating shift schedule, particularly in the ward, as a staff nurse with lower job satisfaction, would generate higher levels of burnout and secondary traumatic stress. Additionally, oncology nurses who did not have supporters or counselors reported lower levels of compassion satisfaction and higher burnout rates. Previous research on the emotional burden experienced by oncology nurses has demonstrated that novice nurses report experiencing more emotional distress when they are unprepared for emotional experiences and do not have healthy coping strategies [29]. This may explain why nurses with between one and three years of clinical experience have high levels of burnout and secondary traumatic stress. Benner [30] stated that although a nurse with two to three years of clinical experience can provide appropriate care, the risk of burnout is high, and consequently, the nursing outcome may be poor. Therefore, we suggest that hospitals assign mentors to nurses with fewer than three years of clinical experience or inadequate resources to build a support system and implement interventions that can increase compassion satisfaction or build healthy coping skills. This may help improve nursing outcomes, including the degree of caring behavior.

The average score for the degree of caring behavior was 4.76, lower than the average of 5.77 (range: 5.69~5.93) among nurses across all hospital departments, measured using the same tool as in another study [31]. The evaluation of the degree of caring behavior in this study encompassed physical, mental, and spiritual care. However, as the care provided by the participants focused on the physical aspect, the level of caring behavior seemed low. This may have been affected by the clinical characteristics of the hospitals from which the participants were recruited. Urban tertiary hospitals in South Korea base the requirement of intensive cancer treatment on the acute stage of the disease, such as chemotherapy, radiotherapy, surgery, etc. In cases where patients have higher levels of severity in an acute care setting, it is not unusual for psychosocial and spiritual care to receive lower priority than physical care [32]. It can also be seen from the list that most of the patient care-related education that hospitals provided to oncology nurses in this study concerned acute care and procedures. Holistic nursing, including psychological and spiritual aspects, is essential for patient-centered nursing [33, 34]. Hence, to promote patient-centered nursing, it is necessary to re-educate nurses on the importance of holistic nursing by providing programs that encourage emotional and spiritual nursing practices, as well as physical nursing care.

In addition, care is affected by nurses’ emotional intelligence, coping skills, and work environments [35]. In this study, 5.6% of the nurses showed high burnout, secondary traumatic stress, and low compassion satisfaction. The average resilience and degree of caring behavior of this group were lower than those of all participants, and professional quality of life was found to be associated with resilience and degree of caring behavior. This is consistent with our findings regarding resilience, compassion satisfaction, and burnout in relation to care. The high-risk group, on average, was under 30 years of age and had a minimum of two years and a maximum of eight years of clinical experience, suggesting that providing interventions to improve resilience may be necessary for both novice and experienced oncology nurses. Hence, healthcare organizations and nursing leaders should develop programs that focus on building positive coping systems. Interventions to increase compassion satisfaction may help improve quality of care behaviors in oncology nurses. Age has also been reported to be an individual factor associated with high resilience [27] and high job satisfaction [36]. Unlike Western countries, where most nurses are over 35 years old [37] and can, therefore, be expected to provide high-quality nursing care [37, 38], only 12.1% of the nurses in this study were over 35 years old. This may explain why the degree of caring behavior was lower in this study than in studies conducted abroad. Therefore, it is necessary to explore the factors affecting oncology nurses’ turnover intention in the South Korean context and provide them with appropriate interventions.

This study had several limitations. First, as our definition of resilience covered only individual factors, excluding organizational factors, there were limitations to understanding nurses’ resilience. Therefore, a study that includes both individual and organizational factors is necessary. Second, the regression model explained 32.5% of the variance in caring behavior. This highlights the fact that the determinants of caring behavior go beyond individual influences. Due to the limited number of participants from whom we were able to collect data in this study, we were unable to include in our statistical analysis all of the variables that were expected to influence the extent of oncology nurses’ caring behavior when conducting the regression analysis. To overcome this limitation, we conducted a regression analysis using a combination of all of the variables that were identified in the literature and in this study as being significantly related to oncology nurses’ caring behavior. Further research is needed to synthesize individual variables that have not yet been identified and to identify additional dimensions such as environmental factors. Finally, as the data collection period was before the coronavirus disease 2019 pandemic, there is the possibility of changes in oncology nurses’ resilience, professional quality of life, and caring behavior since then. Therefore, follow-up studies are needed to explore changes in the factors affecting caring behavior after the pandemic. Despite these limitations, this study is significant because it contributes to the understanding of oncology nurses’ resilience, professional quality of life, and caring behavior, which affect the provision of quality nursing care and the treatment outcomes of patients with cancer.

More comprehensive research on the influencing factors and effective strategies is needed to increase caring behavior among oncology nurses. Interventions and educational efforts are required to improve oncology nurses’ resilience and professional quality of life in clinical settings. Healthcare organizations should develop targeted education and training programs to increase job satisfaction in clinical practice. Policymakers should prioritize the creation of healthcare environments that foster nurses’ compassion satisfaction and impact their care of patients with cancer. Ultimately, these efforts will improve patients’ health and quality of life through enhanced caring behavior.

We found that oncology nurses’ resilience, professional quality of life, and degree of caring behavior were interrelated, and the factors associated with these characteristics were identified. These findings highlight the need for oncology nurses to develop healthy coping skills, including resilience and compassion satisfaction, in order to provide high-quality care. For oncology nurses to develop healthy coping strategies, concerted efforts are required at both the individual and organizational levels. This study has practical implications as it offers valuable insights into oncology nursing, which can be used to develop and implement high-quality nursing care approaches for patients with cancer.