The Professional Quality of Life Scale – 5 (ProQOL)

Helping professionals are defined broadly, spanning health care, social services, education, emergency services, clergy, and other roles involving emotional labour or exposure to traumatic material. The ProQOL assesses compassion satisfaction alongside the two components of compassion fatigue, burnout and secondary traumatic stress. The ProQOL is the most widely used measure of the positive and negative effects of working with people who have experienced highly stressful events and was developed by B. Hudnall Stamm, with the fifth edition released in 2009 (Stamm, 2010).

ProQOL Subscales

The ProQOL yields three subscale scores, each scored and interpreted separately, together spanning the positive and negative dimensions of professional quality of life:

• Compassion Satisfaction captures the pleasure and sense of accomplishment derived from being able to do helping work well.
• Burnout captures feelings of exhaustion, frustration, and hopelessness related to work, which typically develops gradually.
• Secondary Traumatic Stress captures work-related distress arising from exposure to other people’s traumatic experiences, which is often rapid in onset and characterised by fear.

Clinical Applications of the ProQOL

The ProQOL is intended primarily for use as a screening and reflection instrument rather than a diagnostic tool (Stamm, 2010), useful for the purpose of self-monitoring professional wellbeing, allowing the identification of emerging burnout or compassion-fatigue. Results are often most useful as a prompt for reflection on which of the three areas, satisfaction, burnout, or trauma exposure, is most elevated or depleted. The ProQOL also supports tracking of professional wellbeing over time, and its results provide a concrete starting point for supervision and self-care planning conversations. Service managers seeking to support staff wellbeing may additionally draw on results, with the respondent’s consent, to inform workload, leave, and support decisions.

ProQOL Scoring

Each of the three ProQOL subscales is scored by summing its 10 items, giving a raw score between 10 and 50 per subscale; five items (1, 4, 15, 17, and 29) are reverse-scored before summing. No total score is produced. Higher scores indicate more of the construct measured, whether more of that construct is a strength or a concern depends on the subscale. Higher Compassion Satisfaction is protective, whereas higher Burnout and Secondary Traumatic Stress are concerning.

The three subscales are:

• Compassion Satisfaction (10 items; items 3, 6, 12, 16, 18, 20, 22, 24, 27, 30; scores range 10 to 50), capturing the pleasure and sense of accomplishment derived from doing helping work well, including positive feelings about colleagues and about one’s contribution to the work setting and the greater good. Higher scores represent greater satisfaction and are protective.
• Burnout (10 items; items 1, 4, 8, 10, 15, 17, 19, 21, 26, 29; scores range 10 to 50), capturing exhaustion, frustration, and hopelessness related to work. These feelings typically have a gradual onset and can reflect a sense that one’s efforts make no difference, a very high workload, or a non-supportive work environment. Higher scores indicate a higher risk of burnout. The Burnout subscale includes several positively worded items about general wellbeing, and scores are best interpreted alongside the item-level responses.
• Secondary Traumatic Stress (10 items; items 2, 5, 7, 9, 11, 13, 14, 23, 25, 28; scores range 10 to 50), capturing work-related distress arising from secondary exposure to traumatic events, such as hearing about or being repeatedly exposed to the details of others’ trauma. Its symptoms are usually rapid in onset and associated with a particular event, and typically include an element of fear. Higher scores indicate greater work-related traumatic stress.

ProQOL Percentile Context

Each subscale score is presented with a percentile rank indicating how the respondent scored in comparison to Australian psychologists (Hegarty & Buchanan, 2021). This is the comparison group closest to the profession of most respondents, and therefore the most relevant context for interpreting a score.

A percentile of 50 represents a typical score relative to the comparison group. On Burnout, for example, a psychologist percentile of 85 indicates the respondent reported more burnout-related experiences than 85 percent of Australian psychologists: notably above most peers, though about one in seven psychologists score at this level or higher. On Compassion Satisfaction the direction of interpretation reverses: a psychologist percentile of 10 indicates the respondent reported less work-related satisfaction than 90 percent of their psychologist peers, and it is the low percentiles on this subscale that signal concern.

ProQOL Score Ranges

Alongside the percentiles, each subscale score is categorised using the developer’s screening convention (Stamm, 2010), derived as quartiles of the manual’s data bank and intended for screening rather than as validated clinical categories (see ProQOL Thresholds):

• Low (22 or less): the score sits in the lower region of the scale range. On Compassion Satisfaction this indicates notably little reported work-related satisfaction; on Burnout and Secondary Traumatic Stress it indicates few reported difficulties.
• Moderate (23 to 41): the score sits in the broad middle region where most helping professionals score on all three subscales.
• High (42 or more): the score sits in the upper region of the scale range. On Compassion Satisfaction this indicates a high reported level of professional satisfaction; on Burnout and Secondary Traumatic Stress it indicates a notably elevated score that is uncommon in professional samples.

The percentile ranks are the primary interpretive frame; the ranges provide a familiar secondary reference consistent with the wider ProQOL literature. When the three subscale positions match one of five combination profiles described by Stamm (2010), the report’s interpretive text briefly describes the constellation.

ProQOL Graphs

On first administration, the report presents a comparison chart of the three subscale scores, with shaded background regions indicating the Low, Moderate, and High score ranges.

When two or more administrations are available, the report adds a line plot for each subscale showing the raw score trajectory of compassion satisfaction, burnout, and secondary traumatic stress across the repeated administrations.

Development of the ProQOL

The ProQOL was developed from the Compassion Fatigue Self Test, originated by Charles Figley in the late 1980s. B. Hudnall Stamm led the measure’s subsequent development, and the fifth edition (the version implemented here) was developed in 2009, with the accompanying Concise ProQOL Manual published in 2010 (Stamm, 2010). The measure frames professional quality of life as the balance of the positive and negative aspects of helping work: compassion satisfaction on the positive side, and compassion fatigue, comprising burnout and secondary traumatic stress, on the negative side. Each of the three constructs is measured by its own 10-item subscale, and the subscales are scored and interpreted separately (Stamm, 2010). Ownership of the ProQOL measures transferred to the Center for Victims of Torture in 2016, and the current version of the measure, its translations, and its permissions conditions are published at proqol.org. The wording administered follows the electronic version published there, in which the bracketed placeholders of the printed form ([help], [helper], [helping]) appear as plain text, and the instructions name the range of helping disciplines those terms are intended to cover.

ProQOL Reliability

The manual reports internal consistency of α = .88 for Compassion Satisfaction, α = .75 for Burnout, and α = .81 for Secondary Traumatic Stress (Stamm, 2010). Modern samples show a closely similar pattern. Hemsworth et al. (2018) examined three samples (Australian nurses, N = 273; Canadian nurses, N = 303; Canadian palliative care workers, N = 503) and found Compassion Satisfaction consistently strong (α = .89 to .91; composite reliability .92 to .93), Secondary Traumatic Stress adequate to good (α = .78 to .85; composite reliability .86 to .89), and Burnout adequate (α = .74 to .80; composite reliability .78 to .83). In the largest Australian sample, 1,615 registered nurses, subscale alphas were .90 (Compassion Satisfaction), .80 (Burnout), and .84 (Secondary Traumatic Stress) (Heritage et al., 2018). In a UK sample of 366 allied mental health professionals, McDonald’s omega was .877 (Compassion Satisfaction), .813 (Burnout), and .837 (Secondary Traumatic Stress) (Singh et al., 2024). Across studies, Compassion Satisfaction is the most reliable subscale and Burnout is the least, though Burnout reliability remains adequate in most samples.

ProQOL Factor Structure

The ProQOL is scored and interpreted as three separate subscales, following the developer’s framework (Stamm, 2010). Compassion Satisfaction is the most robust subscale across the psychometric literature: it demonstrated sound Rasch measurement properties in a sample of 1,615 Australian nurses (Heritage et al., 2018) and shows strong reliability in every published sample. Several large recent studies have proposed revised or shortened arrangements of the scale, including the ProQOL-21 (Heritage et al., 2018) and the Brief ProQOL-12 (Hotchkiss & Wong, 2025), and a network analysis of UK allied mental health professionals suggested a 21-item three-factor arrangement (Singh et al., 2024). A bifactor analysis of the French version supports a strong general professional quality of life dimension underlying all three subscales (Geoffrion et al., 2019). The three-subscale scoring implemented on NovoPsych follows the developer’s original framework, which remains the standard scoring in applied use.

ProQOL Validity

Hemsworth et al. (2018) examined the English version 5 against the DASS-21 in Australian and Canadian nurse samples. Burnout correlated substantially with DASS-21 Stress (r = .69 and r = .50 in the Australian and Canadian samples respectively) and Depression (r = .60 and r = .51), supporting its convergence with general occupational distress. Secondary Traumatic Stress showed moderate correlations with the DASS-21 scales (r = .39 to .56), and Compassion Satisfaction correlated negatively with all DASS-21 scales (r = −.22 to −.38), consistent with its framing as the protective, positive dimension of professional quality of life. Convergent evidence is also available for the French version: in a bifactor analysis of 310 child protection workers, the general professional quality of life factor correlated strongly with wellbeing at work (r = .69) and psychological distress at work (r = −.67), while showing no association with non-work trauma exposure, supporting discriminant validity (Geoffrion et al., 2019).

ProQOL Sample Data

Percentile ranks derive from a sample of 245 Australian psychologists (Hegarty & Buchanan, 2021). In that sample the subscale averages were: Compassion Satisfaction = 37.0(6.0), Burnout = 26.2(5.6), and Secondary Traumatic Stress = 22.4(5.9).

Percentile ranks referenced to helping professionals generally are not reported. The general percentile tables in circulation reproduce the raw-score column of the conversion table in Section 9 of the manual, whose stated purpose is to bridge ProQOL IV raw scores to t-scores. Because ProQOL IV items were scored 0 to 5 and version 5 items are scored 1 to 5, that column is on a different raw metric from version 5 scores, and it contains raw values below the version 5 subscale minimum of 10; applied to version 5 scores it inflates percentiles, most severely at the low end of the range. No substitute general norm is available: the manual reports its normative data only as t-scores standardised within the user’s own sample, and the version 5 validation literature reports factor structure and reliability rather than raw normative distributions. Independently of the metric problem, Hegarty and Buchanan (2021) found the Stamm (2010) reference data produced inflated Burnout and Secondary Traumatic Stress percentiles for psychologists, with 22 percent of psychologists scoring above the general data bank’s 95th percentile on Secondary Traumatic Stress.

For context, values derived from the supplementary materials of Heritage et al. (2018) place 1,615 Australian nurses surveyed in 2013 at Compassion Satisfaction = 39.28(6.47), Burnout = 22.19(5.98), and Secondary Traumatic Stress = 20.11(6.02); these values were derived from the published item-level statistics rather than printed by the authors. More recent occupational snapshots include Indian nurses assessed after the second COVID-19 wave (N = 203; Compassion Satisfaction = 37.56(7.52); Burnout = 24.97(5.35); Secondary Traumatic Stress = 24.42(6.38); Dixit et al., 2024) and United States emergency nurses assessed during the pandemic (N = 50; Compassion Satisfaction = 38.7(5.4); Burnout = 25.6(5.6); Secondary Traumatic Stress = 24.5(5.4); Lopez et al., 2022). Subscale averages sit in a similar region across these occupational groups, with Compassion Satisfaction typically in the high 30s and Burnout and Secondary Traumatic Stress typically in the low-to-mid 20s.

ProQOL Thresholds

Stamm (2010) provides Low, Moderate, and High score ranges for each subscale as the developer’s screening convention. The cut points were set at the 25th and 75th percentiles of the manual’s data bank, and the manual describes them as deliberately over-inclusive for screening purposes, recommending the continuous scores for any use beyond screening (Stamm, 2010, p. 18). The uniform raw ranges, 22 or less (Low), 23 to 41 (Moderate), and 42 or more (High), appear in the manual’s self-scoring worksheet and are applied identically across the three subscales.

Because the three subscales are distributed differently, the uniform raw ranges correspond to very different percentile positions on each subscale. Against the Australian psychologist sample (Hegarty & Buchanan, 2021), a raw score of 42 corresponds to the 99.9th percentile on Burnout and the 99.4th percentile on Secondary Traumatic Stress, so the High range is rarely reached on these two subscales in professional samples; in an Indian nurse sample the High range captured 0.5 percent of respondents on Burnout and none on Secondary Traumatic Stress (Dixit et al., 2024). A raw score of 22 on Compassion Satisfaction corresponds to the 2.4th percentile among Australian psychologists. The percentile ranks presented in the report therefore carry the primary normative interpretation, with the Low, Moderate, and High ranges retained as the developer’s screening convention.

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