Ethical Climate of the Hospital and Insecure Adult Attachment Styles: Relations With Burnout Exhaustion, Demoralization, and Loss of Motive in NICU Nurses

BACKGROUND: Personal and contextual factors are both associated with burnout in NICU nurses, but the latter, particularly moral distress, are usually considered to be the more important. OBJECTIVE: To determine the associations of NICU nurses' (1) perception of the ethical climate of the hospital (contextual factor) and (2) anxious and avoidant adult attachment styles (personal factors) with the exhaustion, demoralization, and loss of motive dimensions of burnout. DESIGN/METHODS: An observational, cross-sectional, correlational study using factor-analyzed versions of self-report questionnaire measures of the ethical climate of the hospital (Hospital Ethical Climate Survey), anxious and avoidant adult attachment styles (Adult Attachment Scale), and burnout (Burnout Measure). RESULTS: One hundred forty-two (24%) of 585 eligible NICU nurses participated in the study. In the final models of the hierarchical multiple regression analyses, anxious attachment (β = 0.25, P < 0.01) predicted burnout exhaustion, anxious attachment (β = 0.37, P < 0.001) and ethics support from doctors (β = -0.23, P < 0.05) predicted burnout demoralization, and ethics support from managers (β = -0.30, P < 0.01) predicted burnout loss of motive. Avoidant attachment and general ethics support did not predict burnout. CONCLUSIONS: Anxious adult attachment style and ethics support from doctors and managers have respective positive and negative correlations with burnout in NICU nurses, but the strengths of the associations differ according to which dimensions of these constructs are being evaluated. Personal factors (e.g., anxious attachment) and contextual factors (e.g., support from doctors and managers) should be considered in equal measure when designing strategies to reduce burnout in NICU nurses.