Secure Base Leadership, Organizational Dehumanization, and Psychological Safety Among Intensive Care Nurses: A Cross-Sectional Study.

AIM: Intensive care unit (ICU) nurses operate in highly demanding environments. Secure base leadership (SBL) has been proposed as a resource to help manage these demands. This study examines the associations between ICU nurses' perceptions of their supervisor as a secure base leader and their burnout and work engagement (WE), as well as the pattern of indirect statistical associations involving organizational dehumanization (OD) and psychological safety (PS) between SBL and these outcomes. DESIGN: A cross-sectional study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS: A total of 305 ICU nurses from Spain completed an online questionnaire comprising established measures assessing SBL, OD, PS, burnout, WE, and sociodemographic variables. Data were analyzed using partial least squares structural equation modeling (PLS-SEM). RESULTS: The direct associations between SBL and burnout and WE were not statistically significant. SBL was significantly associated with lower OD and higher PS, and OD and PS were significantly associated with lower burnout and higher WE. The final model explained 20% of the variance in burnout and 15% of the variance in WE. CONCLUSION: SBL was associated with ICU nurses' burnout and WE in a pattern consistent with indirect statistical associations involving OD and PS, whereas the direct associations between SBL and burnout and WE were not statistically significant. Given the cross-sectional design, these findings should not be interpreted as evidence of causal or temporal mediation. IMPLICATIONS FOR NURSING: In highly demanding clinical settings, SBL may represent a relevant leadership resource in relation to more humanized and psychologically safe work environments. IMPLICATIONS FOR NURSING POLICY: Nursing leadership development strategies may benefit from prioritizing PS and addressing OD. Such approaches are consistent with the factors associated with nurses' well-being and engagement in high-pressure healthcare settings.