Burnout in neonatal intensive care unit nurses: relationships with moral distress, adult attachment insecurities, and proneness to guilt and shame

Background: Informed by the person-environment transactional model of stress, the purpose of the study was to explore the relationships of environment-related moral distress and person-related anxious and avoidant adult attachment insecurities, and personality proneness to guilt and shame with burnout in neonatal intensive care unit (NICU) nurses. Methods: This was a multicenter cross-sectional self-report questionnaire cohort study comprising 142 NICU nurses currently working on six Level 3-4 NICUs in New South Wales, Australia. Results: Burnout was reported by 37% of NICU nurses. Moral distress, anxious and avoidant attachment, and guilt- and shame-proneness had moderate-large zero-order correlations with burnout. Overall, these predictor variables explained 40% of the variance in burnout. Moral distress (beta=0.40, P <0.001), anxious attachment (beta = 0.18, P < 0.05) and shame-proneness (beta = 0.22, P < 0.01) were unique predictors of burnout. Shame-proneness partially mediated the effect of anxious attachment on burnout [indirect effect, B=0.12, confidence interval (CI) (0.051-0.201)]. Conclusion: The management of burnout in NICU nurses requires attention not only to environment-related moral distress but also to person-related anxious and avoidant adult attachment insecurities and personality proneness to guilt and shame.