Attachment insecurity, professional quality of life, and perceived posttraumatic growth among hospital nurses

Hospital nurses routinely manage emotionally demanding clinical work that may contribute to burnout and secondary traumatic stress, while also providing opportunities for meaning making processes, compassion satisfaction, and perceived posttraumatic growth. Attachment insecurity may shape how nurses regulate distress and engage with supportive relationships, but its associations with both negative and positive professional outcomes remain understudied.

This study examined associations among attachment anxiety, attachment avoidance, professional quality of life, and perceived posttraumatic growth among hospital nurses providing direct patient care.

A cross-sectional online survey was completed by 208 hospital-based registered nurses and licensed practical nurses in the United States. Participants completed the Experiences in Close Relationships-Short Form, Professional Quality of Life Scale, and Posttraumatic Growth Inventory. Hierarchical multiple regression analyses examined associations of attachment anxiety and avoidance with compassion satisfaction, burnout, secondary traumatic stress, total perceived posttraumatic growth, and growth in relating to others. Age was included as a covariate in all models; high-intensity clinical setting was additionally included in the burnout and secondary traumatic stress models.

Attachment avoidance was consistently associated with less favorable outcomes. Greater avoidance was associated with lower compassion satisfaction (β = -0.19, p = 0.006), greater burnout (β = 0.40, p < 0.001), greater secondary traumatic stress (β = 0.45, p < 0.001), lower perceived relational growth (β = -0.15, p = 0.012), and lower total perceived posttraumatic growth (β = -0.15, p = 0.013). Attachment anxiety was independently associated with greater burnout (β = 0.31, p < 0.001) and secondary traumatic stress (β = 0.33, p < 0.001), but was not uniquely associated with compassion satisfaction or perceived posttraumatic growth. Compassion satisfaction was positively associated with relational growth (β = 0.34, p < 0.001) and total perceived posttraumatic growth (β = 0.36, p < 0.001). The final models explained 31.8% of the variance in relational growth, 30.0% in total perceived posttraumatic growth, 39.6% in burnout, and 49.8% in secondary traumatic stress. High-intensity clinical setting was associated with greater burnout and secondary traumatic stress.

Attachment insecurity, particularly attachment avoidance, was associated with both negative and positive dimensions of nurses' professional experiences. Compassion satisfaction was associated with greater perceived growth. Findings identify emotional regulation, supportive connection, professional meaning, and organizational working conditions as potentially relevant targets for future resilience-oriented intervention research. Cross-sectional self-report data preclude causal conclusions, and the posttraumatic growth measure was not anchored to nursing-related events.