Nurses provide continuous care around the clock, maintain close contact with patients, and are frequently confronted with death and the care of terminally ill individuals (Nacak & Erden, 2022), which has been described as one of the most profound and stressful experiences in nursing practice (Povedano-Jimenez et al., 2020). In the aftermath of a patient's death, nurses may exhibit a broad spectrum of emotional, physical, cognitive, relational, existential, and spiritual reactions. Short-term reactions typically emerge in the days and weeks after the loss and may include emotional reactions such as helplessness, sadness, guilt, and hopelessness (Cybulska et al., 2022; Kostka et al., 2021; Rahmani et al., 2023), physical symptoms such as fatigue (Granek et al., 2017), and cognitive reactions such as intrusive or unwanted thoughts (Cybulska et al., 2022), among others. Over time, however, long-term reactions may develop beyond these acute reactions, including relational changes, such as social withdrawal (Coetzee & Laschinger, 2018), existential concerns, such as death anxiety (Nia et al., 2016), and spiritual or psychological conflicts (Tornøe et al., 2015). Repeated exposure to patient deaths can gradually create cumulative emotional strain, which may manifest as desensitization (Chen & Chow, 2022; Turgut & Yıldız, 2023). These reactions have been conceptualized in the literature as “professional bereavement” (Du et al., 2020).

Empathy, defined as the ability to understand and share the emotions and perspectives of others (Terezam et al., 2017), is a cornerstone of nursing practice. In clinical care, empathy entails recognizing patients' emotional states, lived experiences, and psychosocial needs, thereby facilitating therapeutic relationships, particularly with terminally ill patients and their families (Skorpen Tarberg et al., 2020). Empathic nurses can identify and address emotional needs more effectively, fostering trust and enhancing the quality of care (Duarte et al., 2016; Wu, 2021). Moreover, empathy helps nurses find meaning in their work and increases their compassion satisfaction (Duarte et al., 2016). However, elevated levels of empathy, when combined with frequent exposure to death, may heighten emotional vulnerability, amplifying the risk of professional bereavement (Kostka et al., 2021; Kowalenko et al., 2024).

Resilience, the capacity to maintain emotional stability and recover rapidly from adversity (Sisto et al., 2019), serves as a protective factor in such contexts. It reflects the ability to adapt to challenging situations and is strengthened through cognitive processing, emotional expression and meaning-making (Babić et al., 2020; Powell et al., 2020). In clinical environments where death is a routine occurrence, resilience allows nurses to better manage the emotional demands of their work, enhancing their tolerance for adversity and capacity for effective coping (Üzar Özçetin et al., 2019).

In the past, deaths mostly occurred in the home environment; however, advances in medical science have changed this reality, leading to deaths occurring primarily in hospitals (Virdun, Luckett, Davidson, & Phillips, 2015). In this context, intensive care, pediatrics, oncology and palliative care nurses in Turkey often witness the death of the patients they care for and experience patient loss (Durmuş Sarıkahya et al., 2023; Keskin Kızıltepe & Koç, 2024; Özsavran et al., 2024; Uzunkaya Oztoprak & Terzioglu, 2024). However, the literature on this nurses' bereavement experiences and the factors influencing them remains limited. This gap is significant because understanding these experiences is crucial for developing interventions aimed at protecting emotional well-being and sustaining professional functionality.

Based on a review of the literature and statistical findings, we formulated the following hypotheses: We hypothesized that empathy positively influences short-term bereavement reactions (Hypothesis 1) and long-term bereavement reactions (Hypothesis 2). Moreover, we hypothesized that resilience may mediate the relationship between empathy and short-term (Hypothesis 3) and long-term bereavement reactions (Hypothesis 4). In other words, resilience may buffer the emotional burden caused by empathy, reducing the intensity and accumulation of bereavement experiences among nurses who are frequently exposed to patient loss (Fig. 1).