Workforce Attachment in Veteran Health Care Sector Social Workers: A Qualitative Study

Background and Purpose: Attachment theory posits that behavior is organized by innate systems.  The theoretical attachment system is explained through the observation of exploration in a particular caregiving environment.  The attachment system organizes behavior to establish protection and security through proximity with safe and caring attachment figures.  Although researchers have applied attachment theory extensively to explain human behavior in the contexts of child development and relationships throughout the lifespan, little research has focused on its application to work behavior.  What is known about attachment theory’s application in this setting focuses on the exploration system, in which behavior is ordered around knowledge acquisition rather than security (e.g. caregiving).  This paper aims to expand this application of attachment theory by examining behavior as organized by a work-based attachment system.  The primary study objective was to identify types of workforce attachment.  The secondary study objective was to pinpoint aspects of the relational, social and physical context that enhanced or diminished workforce attachment security.   

Methods: Thirteen in-depth, semi-structured interviews were conducted with Veteran health care sector social workers.  Interview participants were mostly female (77% female; 23% male), White, and worked primarily in behavioral health (77% behavioral health; 23% medical/surgical).  Participants were recruited via announcement at staff meetings.  Interviews elicited participants’ perceptions of connection with their work with Veterans, including their motivation to work with this population, what makes them feel secure in their work, and times they felt particularly attached to their job.  Interviews were transcribed verbatim and coded thematically.  Findings were member checked for their accuracy and relevance. The protection of human subjects in this study was provided by the oversight of the [name redacted for blind review] Institutional Review Board.

Results: Data analysis reveals three types of workforce attachment, which were Secure, Insecure: Anxious and Insecure: Ambivalent.  Aspects of the relational context that enhanced or diminished workforce attachment security included the presence or absence of family members and/or friends with military experience as well as positive or challenging relationships with administrators, colleagues, supervisors and/or patients.  Organizational and patient culture, including their medical and paramilitary dimensions, as well as a robust or compromised professional identity and perceptions of “loyalties” that supported or interfered with the agency mission were aspects of the social context that affected attachment security.  Bureaucratic policies that protected workers from being fired but also made them feel encumbered in their ability to meet patient need, enjoyable or unpleasant job tasks, the presence or absence of opportunities for career advancement, and the availability or inaccessibility of alternative employment opportunities were aspects of the physical context. 

Conclusions and Implications: Results identify three types of workforce attachment, which are Secure, Insecure: Anxious and Insecure: Ambivalent.  They also reveal that the security of workforce attachment is linked to the relational, social and physical context in which the worker is situated. Supervisors and administrators would benefit from implementing a workforce attachment perspective in conceptualizing worker behavior as well as conducting an assessment of the relational, social and physical context when considering it.