Aim <p>To explore the influencing factors of compassion fatigue among professional caregivers in long-term care institutions and to understand their lived experiences.</p> Design <p>A qualitative descriptive study.</p> Methods <p>Semi-structured interviews were conducted with 15 professional caregivers from two long-term care institutions in East China between September and November 2024. Thematic analysis was employed to analyze the interview data. Data collection continued until thematic saturation was achieved, with interviews lasting 30–60&#xa0;min.</p> Results <p>Analysis identified four key themes: high-intensity work with low autonomy, emotional burden within care relationships, vulnerability of individual support systems, and deficiency of a supportive care environment. These themes constitute a systemic pressure network that contributes to compassion fatigue.</p> Conclusion <p>This study demonstrates that compassion fatigue constitutes a fundamental problem inherent to the nature and structure of long-term care work, necessitating a multi-level support system that integrates work context optimization, strengthened interpersonal support, enhanced individual resources, and improved organizational safeguards.</p> Clinical trial number <p>Not applicable.</p>