Family involvement in care has been shown to improve patient outcomes and reduce family caregiver burden. However, nurses' attitudes toward family participation vary widely and are influenced by multiple individual and contextual factors. Despite international evidence, there is a lack of data in relation to individual psycho-emotional and organizational predictors across settings.

To assess nurses' attitudes toward involving families in care and individual and organizational factors associated with these attitudes.

A multicenter cross-sectional study between April 2024 and April 2025 across 16 local health authorities in Northern Italy. A total of 1288 registered nurses completed an anonymous online survey. Data included sociodemographic, professional, psychological (burnout, family functioning, caregiver support), and organizational variables, along with the Families' Importance in Nursing Care – Nurses' Attitudes (FINC-NA) scale. Hierarchical linear regression models were used to explore the role of individual and organizational predictors of attitudes across four FINC-NA subscales.

Overall, nurses reported positive attitudes toward family involvement (FINC-NA mean = 100.5). Attitudes were most favorable in pediatric and primary care settings and less so in intensive care. Key individual predictors of positive attitudes included lower depersonalization, higher personal accomplishment, and greater perceived support from caregivers. Burnout, particularly depersonalization and emotional exhaustion, significantly predicted negative perceptions of families as burdens. Shift profile (day–night rotation) and lower private family functioning were also linked to more negative attitudes. Organizational factors, such as the presence of institutional caregiver procedures and unrestricted family access, were associated with more favorable attitudes but did not reduce perception of family as a burden. Notably, traditional variables such as age, gender, education, and work experience showed no influence.

Nurses' attitudes toward family involvement are shaped by a dynamic interplay of psychological, relational, and organizational factors. Structural policies, while necessary, are insufficient on their own. Promoting family-centered care requires addressing nurses' emotional well-being and supporting relational competencies, particularly in high-stress settings. These findings call for integrated interventions and further longitudinal research to explore how attitudes evolve over time and respond to systemic changes.