Nurses’ attachment styles, burnout and intention to leave: the role of cognitive appraisal and responses to conflicts with patients’ relatives

Purpose Burnout among nurses significantly influences turnover rates, yet the psychological processes leading to burnout, particularly those tied to attachment styles, remain underexplored. The study aims to examine how nurses’ attachment styles impact their cognitive appraisal of conflicts with patients’ families, their behavioral responses and subsequent effects on burnout and intention to leave nursing. Design/methodology/approach A cross-sectional study of 140 hospital nurses utilized online questionnaires. Participants responded to three hypothetical conflict scenarios with patients’ relatives, reporting threat appraisal and behavioral responses. Standard questionnaires assessed attachment style, burnout and intention to leave the profession. A serial mediation model was examined using structural equation modeling (SEM) via SPSS Amos 23. Findings SEM results partially supported the mediation model [chi-square (χ2)(41) = 70.35, p = 0.003; comparative fit index (CFI) = 0.94; standardized root mean square residual (SRMR) = 0.071 and root mean square error of approximation (RMSEA) = 0.072]. Anxious attachment style was indirectly associated with higher burnout and intention to leave nursing. This sequential relationship was mediated through threat appraisal and subsequent escalating and self-regulating behaviors. Practical implications To reduce burnout and turnover, healthcare organizations should incorporate attachment theory into training programs and implement targeted interventions that address the emotional and relational challenges faced by nurses. Programs focusing on emotion regulation, adaptive coping mechanisms and conflict resolution skills can mitigate the maladaptive patterns associated with anxious attachment. Originality/value The study emphasizes the psychological underpinnings of burnout, providing actionable insights for occupational health practice by highlighting attachment styles’ role in shaping nurses’ cognitive and behavioral responses during emotionally charged interactions.