The relationship between alarm fatigue and burnout among neonatal intensive care unit nurses: A multi-center cross-sectional study

To investigate the relationship between alarm fatigue and burnout among nurses in neonatal intensive care units. This is a multi-center cross-sectional study. An online questionnaire assessed sociodemographic and occupational characteristics, alarm fatigue (Nurse Alarm Fatigue Questionnaire), and burnout (Maslach Burnout Inventory–General Survey). Associations were analyzed with multiple linear regression and generalized additive models adjusted for key covariates. After adjusting for potential confounders, alarm fatigue was independently associated with burnout (β = 0.95, 95% CI: 0.83–1.07, P < 0.001). Participants in moderate (19.25 ± 2.23) and high (29.42 ± 4.66) alarm fatigue groups demonstrated significantly higher burnout scores compared to the low alarm fatigue group (9.89 ± 3.79), with adjusted mean differences of 10.45 (95% CI: 7.92–12.98) and 18.83 (95% CI: 16.24–21.42) points, respectively (all P < 0.001). Generalized additive modeling revealed a nonlinear relationship (P < 0.001) with an inflection point at an alarm fatigue score of 30, beyond which the association attenuated substantially (β = 0.33, 95% CI: −0.24–0.91, P = 0.256). This study demonstrated a significant nonlinear relationship between alarm fatigue and burnout among Neonatal Intensive Care Units nurses. These findings provide valuable insights for developing targeted interventions to mitigate burnout in critical care settings. This multicenter cross-sectional study helps fill the knowledge gap on the relationship between alarm fatigue and occupational burnout in neonatal intensive care units, particularly regarding nonlinearity and threshold effects. It identifies a significant nonlinear association and delineates key thresholds; accordingly, the study recommends routine screening and early, personalized interventions in neonatal intensive care units to reduce burnout and medical errors and to improve alarm-response quality, patient safety, and team well-being.