Abstract
BACKGROUND: Internship nursing students often face high levels of perceived stress, which is related to symptoms of compassion fatigue. At this crucial stage, the influence of primary support systems, including family and school, may diminish, underscoring the significance of individual psychological factors such as empathy (cognitive/affective) and psychological capital. OBJECTIVES: Utilizing the ABC-X model as the research framework, we aimed to explore the mediating roles of empathy and psychological capital (B), as well as perceived stress (C), in the relationship between stress exposures during the internship (A) and symptoms of compassion fatigue (X). METHODS: We conducted a cross-sectional study involving 640 internship nursing students from 8 junior colleges in Hunan, China, between 7th and 13th of January 2023. The sample was predominantly female (93.6%), with a majority aged 20 years (57.7%), and most were nursing majors interning at tertiary hospitals. We employed multiple scales and a self-designed demographic questionnaire for data collection. Data analysis employed SPSS 26.0 and AMOS 23.0. CLINICAL TRIAL NUMBER: Not applicable. RESULTS: The average compassion fatigue score was 50.2 (24.1). Both work-related stress and negative life events during internships were associated with compassion fatigue through three mediating paths: (a) psychological capital: β = 0.038, P = 0.005; β = 0.039, P = 0.004); (b) perceived stress: β = 0.035, P = 0.001; β = 0.056, P = 0.001); (c) psychological capital and perceived stress sequentially: β = 0.010, P = 0.003; β = 0.011, P = 0.002). In contrast, no mediating role of empathy was found. CONCLUSION: Psychological capital and perceived stress partially mediated the effects of both work-related stressors and negative life events on compassion fatigue. These findings offer valuable insights for designing targeted interventions that strengthen psychological capital and alleviate perceived stress, thereby helping to prevent or mitigate internship nursing students’ compassion fatigue. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-026-04301-y.