Hospital Ethical Climates and Registered Nurses' Turnover Intentions


  • Sara Elizabeth Hart

    1. Sara Elizabeth Hart, RN, PhD, Pi, Postdoctoral Fellow, University of Kansas School of Nursing, Kansas City, KS. Acknowledgments are given to the members of my doctoral dissertation committee: Nancy Miller, PhD (Chair); Virginia Trotter Betts, RN, JD; Carole Jennings, RN, PhD; Robert Rubinstein, PhD; Connie Ulrich, RN, PhD; and to the UMBC Graduate School for the dissertation fellowship. Correspondence to Dr. Hart, The University of Kansas Medical Center, School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS 66160. E-mail:
    Search for more papers by this author


Purpose: To investigate (a) the effects of hospital ethical climates on positional and professional turnover intentions of registered nurses, and (b) the relationships among demographic factors, employment characteristics, and positional and professional turnover intentions of registered nurses.

Design: A cross-sectional study of randomly selected registered nurses (n=463) in Missouri, USA, conducted in 2003 and 2004.

Methods: A self-administered questionnaire containing the Hospital Ethical Climate Survey, the Anticipated Turnover Scale, and the Nursing Retention Index was used to assess registered nurses' perceptions of the hospital ethical climate and their intentions to leave their position or the nursing profession. Descriptive statistics, Pearson product-moment correlations, and hierarchical regression techniques were used to analyze the data.

Findings: The hospital ethical climate explained 25.4% of the variance in positional turnover intentions and 14.7% of the variance in professional turnover intentions. Together, hospital ethical climate, control over practice, the use of educational reimbursement as a retention strategy, gender, and staff sufficiency explained 29.7% of the variance in positional turnover intentions. Hospital ethical climate, patient load, and control over practice together explained 15.8% of the variance in professional turnover intentions.

Conclusions: Of the variables included in this analysis, the hospital ethical climate was most important in explaining nurses' positional and professional turnover intentions.