Professional Quality of Life and Occupational Stress Among Nurses in Pediatric Palliative Care: A Cross-Sectional Study in Croatia

Background/Objectives: Pediatric palliative care is a highly demanding field that requires nurses to possess a high level of professional competence and emotional resilience. Continuous exposure to suffering and death places these healthcare workers at an increased risk of psychological distress. The objective of this study was to examine the levels of occupational stress, burnout, secondary traumatic stress, and compassion satisfaction among nurses working in pediatric palliative and terminal care in Split-Dalmatia County, Croatia, and to identify organizational and emotional factors related to their professional quality of life. Methods: A descriptive cross-sectional study was conducted involving 36 female nurses employed in a pediatric hospice, pediatric hemato-oncology department, and neonatology department. Data were collected using the Professional Quality of Life (ProQOL) questionnaire and a custom questionnaire assessing organizational, educational, and emotional challenges. Results: Participants reported high levels of compassion satisfaction (M = 4.55, SD = 0.45), moderate levels of secondary traumatic stress (M = 3.02, SD = 0.68), and relatively low levels of burnout (M = 2.34, SD = 0.65). A significant negative correlation was found between compassion satisfaction and burnout (ρ = -0.542; p < 0.001). Favorable organizational conditions, such as sufficient time for rest (ρ = -0.567; p < 0.001) and emotional support from colleagues (ρ = -0.414; p = 0.012), were significantly associated with lower burnout levels. Although 63.9% of nurses lacked formal psychological support at the workplace, communication with families of terminally ill children remained a major emotional burden (M = 4.25, SD = 1.13), positively correlating with secondary traumatic stress (ρ = 0.460; p = 0.005). Conclusions: Despite the heavy emotional toll, nurses in pediatric palliative care maintain high compassion satisfaction. However, interventions emphasizing organizational improvements, collegial support, and formal psychological assistance are essential to prevent burnout and mitigate secondary traumatic stress.