This study focused on moral and ethical issues experienced by critical care nurses (CCN) and their impact on retention of nursing staff. The purpose of this study was to explore relationships between the levels of moral distress experienced by CCNs and the likelihood of a nurse leaving a position (intent to turnover), as well as moderating effects of these nurses' perceptions of the ethical climate of the work environment on intent to turnover. Moral distress is generally defined as the experience of knowing the right thing to do, but being constrained pursuing the right course of action. Moral distress has been anecdotally associated with professional burnout and leaving a nursing position or the profession itself. Ethical climate is the perception of practices and conditions within the work environment that facilitate the discussion and resolution of difficult patient care issues. Intent to turnover is a variable which measures an individual's likelihood of leaving a job.

A descriptive, correlational study of these three variables was carried out using three Likert-type tools and a demographic data form. A sample of 100 critical care staff nurses from two tertiary level health care institutions in a Midwestern major metropolitan area of the United States revealed significant levels of moral distress that correlated positively with intent to turnover. Factors showing the highest levels of distress were related to questions concerning aggressive treatments for terminally ill patients. The lowest levels of distress related to assisted suicide indicating that this situation rarely occurs. A positive perception of the ethical climate was strongly, negatively correlated with intent to turnover. Specific climate factors, such as relationships with peers and managers, moderated the effect of moral distress levels on intent to turnover. Implications are noted for administrative intervention in these factors to decrease critical care staff turnover.