hello,i need someone to help me with my assignment, there are two filesthe first one which called “research project” has the requirements the other one is the resourceplease give me the resources you used in accessible linkthank you in advance
Withdrawal Behaviors Syndrome:
An Ethical Perspective
ABSTRACT. This study aimed to elucidate the withdrawal behaviors syndrome (lateness, absence, and intent
to leave work) among nurses by examining interrelations
between these behaviors and the mediating effect of
organizational commitment upon ethical perceptions
(caring climate, formal climate, and distributive justice)
and withdrawal behaviors. Two-hundred and one nurses
from one hospital in northern Israel participated. Data
collection was based on questionnaires and hospital
records using a two-phase design. The analyses are based
on Hierarchical Multiple Regressions and on Structural
Equation Modeling with AMOS. Affective commitment
was found to mediate the relationship between different
dimensions of nurses’ ethical perceptions (caring climate,
formal climate, and distributive justice) and their intent to
leave work. Lateness was found to be positively related
to absence frequency which was found negatively related
to intent to leave. Males were late more frequently than
females, while seniority was related only to absence frequency. The findings indicated that each withdrawal
behavior exhibits unique relationships. The results may
help policy makers to focus on improving the ethical
environment in order to increase nurses’ commitment
and reduce their intent to leave. Improving the ethical
environment may be achieved through ethical education
for nurses which may promote ethical considerations
becoming an integral part of nurses’ work.
KEY WORDS: absence, distributive justice, ethical climate, ethical perceptions, intent to leave, lateness, nurses,
organizational commitment, organizational justice, withdrawal behaviors
Withdrawal behaviors and behavioral intentions
have long been at the center of health care research
on nurses (Carraher and Buckley, 2008; Somers,
2009). Withdrawal behaviors refer to a set of attitudes
and behaviors used by employees when they stay at
the job but for some reason decide to be less participative (Kaplan et al., 2009). In the present study,
we focused on three key indicators from among the
wide array of potential withdrawal symptoms:
lateness, absence, and intent to leave work. The
importance of studying nurses’ withdrawal behaviors cannot be overstated. Nurses’ withdrawal
behaviors are very costly and result in decreased
standards of patient care. They also cause increased
pressure on those left in the job, resulting in decreased morale on the wards and possibly further
turnover (Borda and Norman, 1997; Shaw et al.,
Previous studies (Hackett and Bycio, 1996;
Staw and Oldham, 1978) indicate that withdrawal
behaviors do not have exclusively detrimental effects
for an organization. They argued that withdrawal
behaviors may give employees a needed break from
stress and might be expected in response to a wide
range of noxious aspects of the work role. Thus, by
withdrawing, all these employees may return to
work with higher motivation which in turn can
ultimately increase organizational effectiveness.
On the other hand, recent studies (Carmeli, 2005;
Hart, 2005; Johns, 2003; Koslowsky, 2009; Ulrich
et al., 2007) found that these withdrawal behaviors stem not only from unavoidable situations, but
also from avoidable ones resulting from perceived
unethical conditions which reduce organizational
commitment and organizational effectiveness. All
these findings point to the relevance of examining
whether ethical perceptions may predict withdrawal behaviors among nurses. The questions that
this study tried to answer are: what are the interrelations between ethical perceptions, organizational commitment, and the three above-mentioned
Journal of Business Ethics (2011) 103:429–451 Springer 2011
withdrawal symptoms (lateness, absence, and intent
to leave work), and what model can best describe
these relationships among nurses.
The withdrawal syndrome
Lateness is described as arriving late to work or
leaving before the end of the day (Koslowsky, 2000)
and has been recognized as having motivational
antecedents. Theoretically, it is classified into three
dimensions: chronic, unavoidable, and avoidable.
Chronic lateness is a response by the employees to a
bad work situation. Relevant antecedents to chronic
lateness are, for example, lack of organizational
commitment and job satisfaction. Avoidable lateness
occurs when employees have better or more
important activities to do than to arrive on time.
Leisure-income tradeoff and work–family conflicts
may be positive antecedents to this type of lateness.
Unavoidable lateness is due to factors beyond the
employee’s control, such as transport problems, bad
weather, and accidents (Blau, 1995).
Work absence is ‘‘the lack of physical presence at
a behavior setting when and where one is expected
to be’’ (Harrison and Price, 2003, p. 204). Sagie
(1998) distinguished between two basic types of
absence: voluntary absences, which are normally under
the direct control of the employee and are frequently
exploited for personal issues such as testing the
market for alternative prospects of employment, and
involuntary absences, which are usually beyond the
employee’s immediate control.
Recent literature reviews emphasized absence as a
variable related not only to the individual’s demographic characteristics but also to the organizational
environment and social context (Felfe and Schyns,
2004; Martocchio and Jimeno, 2003). Previous
studies on nursing have indicated that musculoskeletal disorders, back pain, mental problems, lack of
support in the workplace, low level of perceived
fairness, and negative social relations represent risk
factors for sickness absence (Eriksen et al., 2004;
Josephson et al., 2008; Petterson et al., 2005;)
Intent to leave work is normally viewed as a
proxy for actual voluntary turnover (Carraher and
Buckley, 2008; Griffeth et al., 2000; Lambert and
Hogan, 2009), which is one of the most detrimental
behaviors to organizational effectiveness (Morrow
and McElroy, 2007; Shaw et al., 2005) and costs
organizations billions of dollars per year (Podsakoff
et al., 2007). The theory of reasoned action suggests
that intention is a psychological precursor to a
behavioral act (Ajzen and Fishbein, 1980). Based on
this notion, a nurse who nurtures the thought of
leaving his/her work is more likely to do so if
the right conditions exist. Nurses who intend to
leave their organizations may reduce their efforts
at work. Those who consider leaving are often the
more qualified employees, who are more likely
to find alternate employment, and this may jeopardize organizational standards and affect colleagues’
motivation and efforts (Josephson et al., 2008; Parry,
2008). Previous studies in nursing indicated that the
lack of professional opportunities, restricted professional autonomy, unsatisfactory salary, and poor job
satisfaction contribute to a general intent to leave the
workplace (Fochsen et al., 2005; Morrell, 2004).
Four major theoretical constructs for the internal
structure of withdrawal attitudes and behaviors
have been suggested for describing the relationships between various withdrawal behaviors: independent, spillover, compensatory, and progression
(e.g., Johns, 2003; Koslowsky et al., 1997).
According to the independent model, withdrawal
behaviors have different causes and functions, and
should therefore be unrelated to each other. Thus,
employees can choose the form of withdrawal that
best suits them (Hulin, 1991). The spillover model
posits that withdrawal behaviors are positively
related, without specifying any temporal or
sequential relationship (Beehr and Gupta, 1978).
Thus, an individual is likely to react to certain
antecedents with a set of withdrawal behaviors rather than with just one (Koslowsky et al., 1997).
The compensatory model proposes that similar
antecedents causes specific forms of withdrawal to
be negatively correlated (Nicolson and Goodge,
1976). The most common model is the progressive
model, which posits that withdrawal manifestations
occur in progression, starting with relatively mild
forms of psychological withdrawal, such as occasional lateness, moving to more severe forms such
as absence, and ending with the most severe forms
such as intent to leave work and actual turnover
(Koslowsky et al., 1997).
430 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
In conclusion, the literature does not seem to
afford a clear indication of the interrelations between
the main withdrawal behaviors. Rather, the findings
are actually somewhat ambiguous. A few researchers
reported that no relationship exists (Ross, 1988),
others reported negative relationships (Nicolson and
Goodge, 1976), some reported positive relationships
(Iverson and Deery, 2001; Leigh and Lust, 1988),
while still others claim that there is no sequential
relationship between them and they can occur
concurrently (Benson and Pond, 1987; Wolpin
et al., 1988). These diverse findings indicate that
withdrawal behaviors may have different patterns.
We, therefore, examined the relationships between
different predictors and withdrawal behaviors in
order to study these patterns and understand the
The recuperative role of withdrawal behaviors
One of the explanations for nurses’ withdrawal
behaviors is the Conservation of Resources (COR)
model of Burnout. This model is centered on
environmental and cognitive factors associated with
resources, defined as those ‘‘objects, personal characteristics, conditions, or energies that are valued in
their own right or that are valued because they act as
conduits to the achievement or protection of valued
resources’’ (Hobfoll, 2001, p. 339). The COR
theory suggests that people strive to obtain, protect,
and foster valued resources and minimize any threats
of resource loss. Threats of resource loss are usually
in the form of role demands and efforts expended
toward meeting such demands. In a work context,
stress is caused chiefly because the rate at which
work demands use up employee resources is typically greater than the rate with which resources are
replenished (Halbesleben, 2006).
Consider the nursing profession: nurses can use
withdrawal behaviors as a means to protect their
internal resources so as to continue to perform well
on the job, which may increase hospital effectiveness
(Hackett and Bycio, 1996). Thus, withdrawal
behaviors might be functional to employees in a
variety of ways. Some may provide time to recover
from physical illness or psychological exhaustion.
Others may simply be seen as a way to restore perceived equity to the employment relationship. This
study will expand upon this latter function of
withdrawal behaviors – restoring perceived equity to
the relationship between nurse and hospital – by
studying how ethical perceptions may affect a nurse’s
withdrawal behaviors, in the event that the nurse
perceives that her hospital does not fulfill her
The rapid changes taking place in healthcare increase
ethical questions which may affect nurses’ behaviors
(Deshpande and Joseph, 2008). Two measures of
ethical perceptions were investigated in the present
study: ethical climate and organizational justice. These
were selected because of increasing research interest
in them in recent years, and because they represent
different aspects of ethical perceptions. The ethical
climate represents employees’ perceptions about
organizational norms regarding behavior and decisions that bear ethical content (Cullen et al., 2003;
Victor and Cullen, 1988). In other words, an ethical climate will reflect to what extent the ethical dimensions of the organizational culture have
been incorporated and implanted throughout the
organization by processes of socialization so that
‘‘employees perceive the existence of normative patterns in the organization with measurable degree of
consensus’’ (Victor and Cullen, 1988, p. 103).
Victor and Cullen (1988) proposed a twodimensional model of ethical climate. One dimension represents three basic ethical approaches:
egoism (maximizing self-interest), benevolence
(maximizing joint interests), and principle (adherence to ethical principles). The second dimension
represents the various levels of analysis: individual,
local (organizational), and cosmopolitan (societal).
Cross-tabulation of the two dimensions produces
nine ethical climates. Victor and Cullen (1988)
organized these nine ethical climates into five principal categories: (1) caring (egoism at the cosmopolitan level and benevolence at all levels, where
employees have a genuine interest in each others’
welfare, both inside and outside the organization),
(2) instrumental (egoism on the individual and local
levels, where personal and organizational interests
are most important), (3) rules (principle on the
local level, where employees are mainly guided by
Withdrawal Behaviors Syndrome 431
organizational rules and procedures), (4) law-and-code
(principle on the cosmopolitan level, where
employees are guided by laws, regulations, and
professional codes), and (5) independence (principle on
the individual level, where employees are guided by
personal convictions and personal morality).
In a study conducted in Israel, Shapira-Lishchinsky and Rosenblatt (2009) identified two factors
that emerged as the most powerful and valid predictors of organizational outcomes. These factors
were named caring and formal and were adopted in
the present study due to their relevance to the Israeli
system (the site of the present study). Caring climate is
characterized by the employees’ genuine interest in
each other’s welfare, both inside and outside the
organization, corresponding to the original ‘‘caring’’
dimension of Victor and Cullen (1988) model. A
formal climate emphasizes organizational rules and
encourages respect for them. It combines two of
Victor and Cullen’s (1988) factors: rules and lawand-code. Since a formal climate is based on transparent procedures, it is perceived as protecting
employees from abusive treatment by management
and others. Both types of ethical climate, i.e. caring
and formal, and especially how they are perceived by
employees, may predict employees’ behavior on the
job (Peterson, 2002).
Organizational justice is another concept of
organizational ethics that is used to describe equity in
the workplace (Greenberg, 1995) and taps how
employees’ perceptions of equity are determined
and how these perceptions influence organizational outcomes. Organizational justice research has
focused on two key dimensions: distributive justice,
which refers to the fairness of the outcomes an
employee receives (Adams, 1965) and procedural justice, which describes the fairness of the procedures
used to determine organizational outcomes (Pillai
et al., 2001).
In this study, we focused on nurses’ ethical perspective because it has been shown that nurses
expect fairness in their workplace (Deshpande, 2009;
Deshpande and Joseph, 2008; Elovainio et al., 2004;
O’Donohue and Nelson, 2007; Purvis and Cropley,
2003), and that their perceptions of such fairness
affect their work attitudes and behaviors. Thus, if
nurses perceive that their ethical expectations are not
fulfilled, they will compensate for this disenchantment by withdrawal behaviors.
Nursing and ethical perspective
Nurses are faced with ethical issues on a daily basis
because of inadequate staffing, inappropriate budget allocation, situations in which patients are discussed inappropriately, and sometimes a climate of
withholding information (Corley et al., 2001;
Deshpande et al. 2006; Fry and Daffy, 2001; Metcalf
and Yankou, 2003; Moore, 2000). The quality of
nurses’ ethical decisions has a significant impact on
the quality of healthcare (Loewy and Loewy, 2004).
For example, De Casterle et al. (2008) found, in a
meta-analysis of nine studies from four countries,
that conformist practices by nurses represent a major
barrier to their taking appropriate ethical action.
Raines (2000), in a study of 229 oncology nurses
found that they experienced 32 different types of
ethical dilemmas over a period of 1 year, and some
of these dilemmas were experienced on a daily basis.
In Israel, although all nurses in Israel are encouraged
to obtain an academic degree (Birenbaum-Carmeli,
2007; Ehrenfeld et al., 2007; Fawcett et al., 2007),
their average salaries are among the lowest of all
academic professionals in the public sector (Wage
and Work Agreement Administrator, 2008). Any of
these factors is likely to engender perceptions of
unjust rewards, creating a climate that does not foster
a desire to spend more time at the hospital and
encouraging withdrawal behaviors.
Relations among different dimensions
of ethical perceptions
Each of the ethical concepts below represents nurses’
perceptions. The ethical climate signifies the aspect
of workplace environment and organizational justice
represents managerial actions. These two concepts
are closely interrelated. Gilligan (1982) viewed the
ethics of care and justice as interrelated, since both
revolve around responsibility and social relationships
and both consider morality as the means for resolving interpersonal conflicts. Formal climate is closely
related to distributive justice, since these two concepts focus on the employees’ rights and on the
structure of rules and regulations that protects their
Although some of the values included in the ethical perceptions presented here may be potentially
432 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
conflicting (e.g., caring vs. equality-based distributive justice), the competing values model (Quinn,
1988) asserts that although tension between conflicting values is inevitable, it may contribute to
organizational effectiveness. This gives some credence to our integrative approach to the ethics
concepts presented here and leads to our first
Hypothesis 1: The ethical climate (caring, formal)
and distributive justice are positively related to
The ethical element in withdrawal behaviors
One of the common characteristics of the withdrawal behaviors discussed in the present study is
that they are, for the most part, under the employee’s control. This means that they have a considerable voluntary component. Thus, in many cases, the
nurses’ ethical perspective plays a key role in
explaining decisions to withdraw from work (Blau,
1994). Many established foundational theories,
including equity theory (Adams, 1965), inducements–contributions theory (March and Simon,
1958), and social exchange theory (Thibault and
Kelly, 1959) note the role of withdrawal behaviors as
a means by which employees can withhold inputs
from an organization. According to their theories,
withdrawal behaviors are often controllable forms of
input reduction. Additionally, withdrawal behaviors
permit an employee to reduce the cost of an aversive
job by engaging in more pleasurable activities while
still maintaining the economic benefits offered by
the job (Harrison et al., 2006).
In the case of nursing, lateness, absence, and intent to leave work may have adverse effects on
patients, who are entitled to proper care (Deshpande
and Joseph, 2009; Nielsen et al., 2002; Parry, 2008).
Time lost because of lateness is often not given back,
while time lost due to absence (e.g., when the nurse
reports absence at the last minute) is usually made up
by colleagues who are normally busy with their own
duties, thus adding to their regular workload. Latecomers and absent nurses thus negatively affect their
colleagues, exhibiting inconsiderateness for the
interests of their colleagues. Nurses who entertain
thoughts of leaving, even when present on the job, are
likely to invest less effort at work, either because of
lower motivation or because of time needed to
search for an alternative job. In addition, these
withdrawals are also likely to have an adverse effect
on patient-centered care (Ulrich et al., 2007), and
the patients’ interests may be compromised for the
personal interests of the withdrawing nurses. Thus,
according to the traditional theories, withdrawal
behaviors can be motivated by various personal and
work-related reasons, and they all may share elements of unethical behavior among employees
(Hart, 2005; Olson, 1998; Ones et al., 2003;
Koslowsky, 2009), and in this study, among nurses.
However, we should also consider that the
changes which have occurred in employment
arrangements in this decade have led to a destabilizing of the relationship between employee and
employer (Kabanoff et al. 2000). Prior to these
changes, the employment relationship was constructed around an individual’s loyalty, commitment,
and trust in the employing organization. In
return, the employer provided job security and
career prospects. Today, however, the individual is
required to demonstrate more responsibility and
multiskilling, and to function under conditions of
role ambiguity (O’Donohue and Nelson, 2007).
Thus, the individual professional employee’s allegiance and career aspirations move away from the
organization and are transferred onto the profession.
(O’Donohue and Nelson, 2007; Purvis and Cropley,
2003; Thompson and Bunderson, 2003). These
changes in the work world, together with the
implications of the COR model explained previously, may encourage us to consider that withdrawal
from the hospital by lateness, absence, or intent to
leave, do not necessarily signify withdrawal from the
patient. This decade has seen professional ideology become dominant in the decision-making of
employees (O’Donohue & Nelson, 2009; Thompson & Bunderson, 2003), and that has had a positive
effect on work behaviors affecting patient care
(O’Donohue and Nelson, 2007).
Ideological currency, when applied to the nursing
profession, might include such occupational ideals as
professional competence, expertise and excellence,
client focus, or social ideas, such as the right of every
member of the community to access high quality
health services regardless of their individual socioeconomic status. Consequently, when nurses have a
commitment to the ideology and ethics of nursing,
Withdrawal Behaviors Syndrome 433
reflecting an ‘‘other’’ orientation that goes beyond
the traditional dyadic employee–organization relationship, this may lead them to an increased effort to
protect their patients from the negative consequences of ‘‘unethical’’ organizational decisions,
rather than to withdrawal from the patient
(O’Donohue and Nelson, 2007; Purvis and Cropley,
The relationship between ethical perceptions
components and withdrawal behavior
When the climate in the organizational focuses on
high morality, employees may respond by refraining
from deviant behavior such as withdrawal behaviors
(Hutchison et al., 1986; Peterson, 2002; Wimbush
and Shepard, 1994). More specifically, nurses will be
less likely to withdraw from work when they perceive their workplace as characterized by a caring
climate in which their emotional and other needs are
taken into account, or where there is a formal climate in which the transparency of rules and regulations protects them from managerial abuse of their
rights (Deshpande and Joseph, 2008).
Studies on distributive justice show consistently
that employees expect organizational decisions to be
fair, and that they engage in negative reactions to the
organization when they believe that they are subject
to unjust outcomes (Greenberg, 1995; Moorman,
1991). From this perspective, withdrawal behaviors
are among the various means available for restoring
an inequitable employment relationship (Blau et al.,
2004; Carraher and Buckley, 2008). Consider
absence research, where past absenteeism has been
found to predict subsequent absenteeism; stability of
absenteeism over time may in part be due to
employees’ ethical perceptions. The individual differences perspective on organizational ethics posits
that individuals who have negative ethical perceptions will engage in more undesirable behaviors
(Elovainio et al., 2004; Ones et al., 2003).
All these raise the question of what can explain
the presumed link between nurses’ ethical perceptions and withdrawal behaviors. Based on the
extensive literature on organizational behavior,
where organizational commitment emerges as a
powerful explicator of employees’ work behaviors
(Cohen, 2003; Cohen and Freund, 2005), we suggest that organizational commitment may best
explain the relationships between nurses’ ethical
perceptions and withdrawal behaviors, thus constituting a mediating variable.
The role of psychological contract in nurses’ withdrawal
Previous studies indicate that a violation of the
psychological contract may damage the employment
relationship, giving rise to anger generated by
betrayal of trust (Rousseau, 1995); this, in turn, has
the potential to reduce organizational commitment
and increase withdrawal behaviors (Geurts, 1995;
Nicholson and Johns, 1985; Purvis and Cropley,
2003; Robinson and Rousseau, 1994). The psychological contract is created when an individual
perceives that his or her contributions obligate the
organization to reciprocate, and it is the individual’s
belief in the obligation of the organization to meet
his expectations that constitutes the contract. The
reciprocity in the psychological contract is unique
for each person that accepts it (Rousseau, 1995).
Therefore, it is logical to place the emphasis on the
individual’s subjective perception.
Cavanagh (1996, p. 80) describes the psychological contract as a ‘‘sophisticated set of expectations and
rules which forms the psychological basis for the
continuing commitment of an employee to his/her
employer’’. Indeed, the latest studies expanded the
interpretive framework for the psychological contract (Bunderson, 2001; O’Donohue and Nelson,
2007; Thompson and Bunderson, 2003) and indicate
an additional perspective, namely, the ideologyinfused contract (O’Donohue and Nelson, 2009).
Thompson and Bunderson (2003, p. 574) define
ideological currency as ‘‘credible commitments to
pursue a valued cause or principle that are implicitly
exchanged at the nexus of the individual-organization relationship’’. Thus, by broadening the range of
contract terms included in the psychological contract, the ideology-infused contract provides a means
for exploring the link between professional ideologies and the psychological contract for professional
employees (O’Donohue and Nelson, 2007).
In the case of a transactional perspective, the
individual approach is egoistic and instrumental,
focusing on benefit to oneself. The currency of
434 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
transactional exchange is reasonably explicit, shortterm, and economic in nature. Such an exchange
assumes rational and self-interested parties, and does
not result in ongoing interdependence. For relational perspective, the individual approach is interdependence through a commitment to the collective
interest over self-interest, focusing on benefits
accruing to both the individual and the organization;
its currency is socio-emotional in nature and,
therefore, less clear, and it evolves over time. In the
case of an ideology-infused perspective, the focus is
shifted beyond the individual and the organization to
a third-party beneficiary, defined in general terms as
society. Thus, an ideology-infused psychological
contract reflects a value-oriented model of human
nature, where the notion of benefit to society may
transcend personal gain in the eyes of an employee
(O’Donohue & Nelson, 2009; Thompson & Bunderson, 2003).
Employees sometimes perceive violation of a
contract even in the absence of direct personal
mistreatment by an organization. Psychological contracts can be violated not only when the organization
abandons its obligations to provide economic
(transactional) and socio-emotional (relational) support to the employee, but also when the organization
fails to exemplify some principle or to fulfill
an implied ideological obligation (Thompson and
Bunderson, 2003). There is abundant evidence in
the existing literature to indicate that ideology
can play a key role in defining and shaping the
individual–organization relationship. For example,
George (2001) argues that for many employees, ‘‘the
real motivation comes from believing that their
work has a purpose and that they are part of a larger
effort to achieve something truly worthwhile’’
(p. 42) and Collins and Porras (1996) suggest that
successful organizations adopt cause-driven missions
in an attempt to fulfill the moral expectations of their
employees. However, the existing literature does not
elaborate on how employees react to unmet ideological obligations, for example, when the employers
do not share their employees’ ethical perceptions. As
a result, the organizational literature is poorly
equipped to explain the phenomena resulting from
an ideological breach based on ethical expectations.
Incorporating ideology into the interpretive
framework of the psychological contract allows a
more useful consideration of the influence of values
and ethical standards of behavior in today’s changing
employment environment. If an employee perceives
that the organization has failed to meet its ethical
obligations, he may see this as a breach of the psychological contract (O’Donohue and Nelson, 2009;
Sims and Keon, 2000), which may affect his
Organizational commitment as a mediator between ethical
perceptions and withdrawal behaviors
Meyer and Allen (1997) identified three types of
organizational commitment: affective, normative, and
continuous. Affective commitment refers to employees’
emotional attachment to the organization, and their
identification and involvement with it. Normative
commitment reflects a sense of obligation to continue
working for the organization. Continuous commitment
refers to people’s external reasons for staying with
the organization, such as the cost associated with
leaving it. The general consensus is that organizational commitment is strongly related to work outcomes and job performance (Blau et al., 2006;
Luchak and Gellatly, 2007; Meyer et al., 2002;
Nogueras, 2006). Nevertheless, the relationship
between organizational commitment and work outcomes may not be universal for all types of
commitment. Studies showed that affective and
normative commitment positively affect work outcomes, including withdrawal behaviors, whereas
continuous commitment showed little or negligible
relationships of this type (Cohen, 2003: Luchak and
Gellatly; 2007; Meyer et al., 2002). In the field of
nursing, the strong service element associated with
the vocation of nursing might lead to the dominance
of affective and normative commitment (Somers,
The mediating effect of organizational commitment on the relationship between nurses’ ethical
perceptions and withdrawal behaviors can be explained by the social exchange theory (Robinson
and Rousseau, 1994), which proposes that the parties in any given relationship seek balance and
fairness in the relationship. According to the
psychological contract, the organization provides
resources that address the employee’s values, and in
exchange, the employee offers his loyalty and
commitment. When the employees perceive that the
Withdrawal Behaviors Syndrome 435
organization has failed to meet its ethical obligations,
personalized attachments are compromised (Bundeson, 2001), and the employees may seek ways to
recover the benefits to which they feel entitled, for
example, through withdrawal from work (Kickul,
2001; Turnley et al., 2004).
However, the processes put into operation by the
psychological contract are not all uni-directional.
Previous studies suggest that even when employees are deeply committed to fulfilling ideological
objectives, they will demonstrate tolerance in circumstances when the organization fails to achieve
ideological victories. This is explained in two ways:
first, because the very pursuit of the ideology is in
itself its own reward, and also, because those who
pursue ideological rewards are generally predisposed
to having a future-oriented perspective and willingness for delayed gratification concerning the
organization (Thompson and Bunderson, 2003).
In contrast to economic and socio-emotional
obligations, which usually require relatively shortterm gratification, employees who base their organizational relationship on more remote ideological
goals will be more likely to exhibit tolerance for
short-term breaches of the psychological contract, if
they are persuaded that the organization has
not abandoned its commitment to the long-term
objective. Similarly, Morrison and Robinson (1997)
contend that the likelihood of organizational violation depends on whether the larger social contract,
which is the context for organizational action, adequately justifies the breach. If employees realize that
the ideology to which they are committed must be
counter balanced against other legitimate values,
their emotional response to the perceived breach
may be assuaged.
In line with this theory, we argue that ethical
perceptions may affect the ideological component of
the social exchange to which nurses react. These
ethical perceptions reflect the values guiding nurses’
behaviors (Schein, 1990). When nurses do not feel at
ease with organizationally endorsed values, they
reciprocate with a lower level of commitment,
which may in turn lead to unfavorable work attitudes and behaviors (Bundeson, 2001; Kwantes,
2003), depending on how severe they perceive the
ideological breach to be.
Based on the O’Donohue and Nelson (2007) study,
which established that perceptions of the psychological contract are best understood by reference to an
ideological currency; and based on the most common
model of withdrawal syndrome, the progressive
model, which proposes that withdrawal behaviors
occur in progression, starting with relatively mild
forms of psychological withdrawal and moving on to
more severe forms, we believe that such an ideological
breach will have a greater effect on the more severe
withdrawal behavior, i.e., intent to leave, than on
the other ‘‘mild’’ withdrawal behaviors (lateness,
absence). Organizational commitment thus acts more
significantly as a mediator in the relationships between
nurses’ ethical perceptions and intent to leave than it
does on the other withdrawal behaviors. This leads to
the second hypothesis:
Hypothesis 2: Organizational commitment (affective,
normative) will mediate the relationship between
ethical perceptions (ethical climate, organizational
justice) and intent to leave more significantly than
the relationship between ethical perceptions and
lateness or absence.
Figure 1 summarizes the study model and hypothesis
Population and sample
Two-hundred and one nurses from one hospital in
northern Israel participated in the study. The selection of the hospital was pragmatic, based on finding
an institution where the hospital’s head nurse and
the nurses were willing and available to participate
voluntarily. The reason for conducting research in
only one hospital stems from the differences in
defining lateness and absence, which vary among the
hospitals in Israel depending on the hospital type:
public, governmental, or private. Therefore, we
choose one hospital with a uniform definition of
lateness and absence in all its departments (e.g., in
public hospitals in Israel, lateness is defined as being
more than 5 min late while in private hospitals, it is
generally defined as being only more than 1 min
All subjects received a formal letter describing the
study goals and informing them that the study was
436 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
undertaken in order to collect data about the characteristics of Israeli nurses’ withdrawal behaviors and
their ethical perceptions. The letter also stipulated
the researchers’ obligation to maintain anonymity
according to the Helsinki Treaty. This was a contributing factor in obtaining the nurses’ consent to
participate and may explain the fact that the response
rate was 75%.
The nurses came from diverse clinical backgrounds
(e.g., cardiology, intensive care, oncology, and geriatrics). Eighty percent of the participants were women. The participants’ mean age was 36.28 years
(SD = 9.50). The hospitals’ mean seniority was
9.68 years (SD = 7.35) and the mean job seniority
was 12.76 years (SD = 8.52); 77% of the nurses had
tenure and the others were employed through temporary contracts. These background characteristics are
typical of the Israeli health system (Israeli Central
Bureau of Statistics, 2005), indicating that the
respondents accurately represented the Israeli nurse
Data collection was performed using a two-phase
design. In the first phase, the nurses answered
anonymous questionnaires related to their description of the existing ethical climate and organizational
justice as they perceive it, their organizational
commitment, and personal background. Each nurse
put the questionnaires into an envelope, entered a
code number on the envelope, and gave the envelope to the secretary of his/her department. In the
second phase, which was carried out 1 year later,
each nurse answered an anonymous ‘‘intent to leave
work’’ questionnaire. The nurse then put the ‘‘intent
to leave’’ questionnaire and copies of his/her first
half-year lateness records and the next half-year
absence records (without identifying the nurses’
names), which were supplied by the department
secretary, all with the original code, in an unmarked
envelope and again gave the envelope to the secretary of the department. The codes helped the
researchers to link the questionnaires from the first
phase to relevant data from the second phase.
The author of this study selected different time
periods for the two measures: half a year to measure
lateness and over the subsequent half-year, an additional half-year period to measure absence, since
absence and lateness are contaminated measures.
Thus, for example, if a nurse is absent for five
consecutive days, he/she obviously cannot be late
during this time period.
Intent to leave
Figure 1. Summary of the research model.
Withdrawal Behaviors Syndrome 437
Variables and measures
Lateness data were obtained from the hospital records by calculating the number of times a given
nurse arrived six or more minutes after the shift
began. The rationale for defining lateness as 6 min or
more draws on hospital policy which defines lateness
as arriving six or more minutes after the shift began
and is supported by previous studies that indicated
that this length of time is normatively unacceptable
in various organizations (Blau, 1994, 1995; Blau
et al., 2004). The data indicated 21.9 cumulative
percent of 0–5 lateness frequency events; 15.8
cumulative percent of 7–13 lateness frequency
events; and 13.7 cumulative percent of 14–39 lateness frequency events.
The work absence measure was based on absence
frequency (not duration) as recorded in the hospital records, that is, the number of times a nurse
was absent during the reported period regardless of
the number of days lost. It is generally believed
that absence frequency is the best measure of
voluntary absence, whereas absence duration (total
number of days lost) is the best reflection of
involuntary absences (Blau et al., 2004; Sagie,
1998). Absence frequency was chosen as the
dependent variable because the purpose in this
study was to investigate the interrelations between
ethical perceptions, organizational commitment,
and withdrawal behaviors, which reflect the nurses’
choice of whether or not to come to work. The
data indicated 70.6 cumulative percent of 0–2
absence frequency events; 16.5 cumulative percent
of 3–5 absence frequency events; 5.5 cumulative
percent of 6–7 absence frequency events; and 7.4
cumulative percent of 9–25 absence frequency
The choice of a 6-month period to report lateness
and absence frequency was based on a reasonable
time-span in which hospitals normally retain records
with these data (Johns, 1994). Another reason is that
a 6-month time-span produces a valid picture of
nurse lateness and absence, because it represents half
of a work year.
Intent to leave work
This measure tapped the nurses’ intent to leave their
work (e.g., ‘‘I often think about quitting my hospital’’). It was adopted from the Walsh et al. (1985)
5-item intent to leave scale. Shapira-Lishchinsky
(2009), who used this scale in studies of Israeli
employees, reported a reliability rate of a = 0.92.
This variable elicited the nurses’ description of the
existing ethical climate as they perceive it. Victor
and Cullen’s (1988) original 27-item ethical climate
scale, translated into Hebrew by Rosenblatt and
Peled (2002), was used. Since our model called for
two dimensions (caring and formal), a factor analysis
(principal components, Varimax rotation) of the
Hebrew version of the scale was performed.
This analysis yielded six factors, the first two of
which correspond to the two dimensions selected
a priori for the study, namely: (a) ‘‘caring’’ climate,
defined as a climate of concern for the welfare of all
hospital members (e.g., ‘‘In this hospital, people look
out for each other’s interests,’’ corresponding to the
friendship and social responsibility dimensions of the
original index; a = 0.83, 13.26% of the explained
variance), and (b) ‘‘formal’’ climate, defined as a
climate of compliance with professional and social
codes and with the hospital rules and regulations
(e.g., ‘‘Everyone is expected to stick to hospital rules
and procedures,’’ corresponding to both rules and
procedures, law-and-code dimensions of the original
index; a = 0.87, 28.42% of the explained variance).
All other factors proved negligible in relation to the
factors: caring and formal climate (4.36–8.79% of the
This 21-item measure was based on Moorman
(1991) and was translated into Hebrew by Rosenblatt and Hijazi (2004). A factor analysis (principal
components, Varimax rotation) yielded three factors,
of which the first, representing the dominant types
of justice (distributive), was selected for the present
study. Distributive justice assessed the fairness of
various hospital outcomes (e.g., ‘‘I am fairly paid or
rewarded, considering my job responsibilities’’),
including pay level, work schedule, and work load
(a = 0.87, 44.26% of the explained variance). All
438 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
other factors proved negligible (6.90–8.90% of the
explained variance) in relation to the distributive
Factor analysis (principal components, Varimax
rotation) based on Meyer and Allen’s (1997) original
22-item measure yielded six factors. The first two,
representing the dominant types of commitment
(affective and normative), were selected for the
present study. Affective commitment items (e.g.,
‘‘I really feel as if this hospital’s problems are my
own’’) addressed the nurses’ perceptions of their
reasons for wanting to remain in their hospital fund
(seven items, a = 0.84, 22.67% of the explained
variance). Normative commitment items (‘‘One of
the main reasons I continue to work in this hospital
is that I believe loyalty is important’’) addressed the
nurses’ perceptions of the reasons why they ought to
remain in their hospital (six items, a = 0.77, 18.76%
of the explained variance). Continuous commitment
proved negligible relative to the factors: affective and
normative commitment (5.37% of the explained
Response options for all items ranged from
1 = strongly disagree to 5 = strongly agree.
A set of control background variables that were
likely to be related to withdrawal behaviors and
organizational commitment (Borkowski et al., 2007;
Cohen, 1993; Wright and Bonett, 2002) were used.
These included personal variables such as gender
(0 = men, 1 = women), age, and hospital seniority.
The proposed model describes the mediating effect
of organizational commitment (affective/normative)
on the relationship between nurses’ ethical perceptions (caring climate, formal climate, and distributive
justice) and withdrawal behaviors (lateness, absence
frequency, and intent to leave work). Since the
statistical tools (Hierarchical Multiple Regressions
Analyses, SEM with AMOS) are based on the
assumption of the normal distribution of variables,
we tested the distributions of the variables and found
that lateness and absence did not meet the assumption of normality; therefore, we used the log transformation for these variables.
Two statistical procedures were performed in
order to examine whether there is a mediating effect.
First, we adopted Kenny et al.’s (1998) causal step
approach. In this approach, four criteria must be met
to support a mediating effect: The independent
variables must be related to the mediators; the
independent variables must be related to the
dependent variables; the mediators must be related
to the dependent variables, with the independent
variable included in the model. Mediation is considered full if the relationship between the independent and the dependent variables is no longer
significant in the presence of the mediator.
Then, Structural Equation Modeling (SEM) with
AMOS was used for two purposes: first, in order to
confirm our previous findings based on the Hierarchical Multiple Regressions and on the correlation analyses; and second, in order to obtain a
general perspective about the proposed multivariate
model, which is illustrated in the same figure:
lateness, absence, and intent to leave (according to
Kenny et al., 1998, only one withdrawal behavior
present in each regression). Thus, the advantages of
the SEM include graphical modeling interfaces
which represent multiple dependents and their
relationships to their predictors (Arbuckle, 2006;
Blakely et al., 2005).
The means, standard deviations, and correlations for
the study variables are presented in Table I. In
general, the correlations between the ethical variables were as expected. All ethical perceptions
were significantly intercorrelated, thus confirming
Hypothesis 1, supporting our integrative approach in
considering the ethical variables. Men exhibited
more lateness than women, and seniority was positively related to age and absence frequency. Only
intent to leave work (but not lateness or absence)
was significantly related to all ethical perceptions.
The two dimensions of organizational commitment
were related to all ethical variables, as well as to
intent to leave work (which was not correlated to
normative commitment). This suggests that organizational commitment may mediate the relationship
Withdrawal Behaviors Syndrome 439
between ethical perceptions and intent to leave (but
not lateness or absence).
However, previous studies have indicated that
organizational commitment affects ethical perceptions and withdrawal behaviors such as lateness and
absence among other professions (e.g., Shapira-Lishchinsky, 2007; Shapira-Lishchinsky and Rosenblatt,
2010; Podsakoff et al., 2007). This, then, provides the
basis for using the Kenny et al. (1998) method of
measurement, in addition to simple correlations, in
order to examine the mediating effect of organizational commitment upon the relationship between
ethical perceptions and other withdrawal behaviors
such as lateness and absence (in addition to intent to
leave). According to their study, a series of Hierarchical Multiple Regressions were used to test for the
mediated relationships formulated in Hypothesis 2.
Findings pertaining to the first criterion in the mediation analysis (independent variables relating to the
mediating variable) are presented in Table II. All the
ethical perceptions and control variables were included in two separate analyses for affective and normative commitment. Affective commitment was
found to be related to all ethical variables, whereas
normative commitment was related only to the caring
climate. No significant relationships were found between the control variables and the two dimensions of
organizational commitment. This result partially satisfied Kenny et al.’s (1998) first criterion.
Findings pertaining to the second criterion in the
mediation analysis (independent variables relating to
the dependent variable) are presented in Table III,
Step 1. All ethical variables were found to be directly
related to intent to leave work, but not to lateness or
absence frequency. No significant relationships were
found between the control variables and the three
dimensions of withdrawal behaviors.
Findings pertaining to the third criterion in the
mediation analysis (mediating variable relating to the
dependent variable, with the independent variables
included in the model) are presented in Table III,
Step 2. Only affective (but not normative) commitment was significantly related to intent to leave work
(but not to lateness or absence frequency) in the
presence of all ethical perceptions and control variables. Finally, testing for the fourth criterion of the
mediation analysis, we looked at the remaining
relationships between ethical perceptions and intent
to leave work in Table III, Step 2. The relationships
Means, standard deviations, and correlations
M SD 2 3 4 5 6 7 8 9 10 11
1 Gendera 0.118 0.035 0.039 0.045 0.038 0.064 0.032 -0.144** 0.006 -0.210
2 Age 36.29 9.50 – 0.668** -0.052 0.052 -0.028 0.058 0.090 0.029 0.100 -0.100
3 Seniority 9.69 7.36 – – 0.059 0.192 0.113 0.124 0.096 0.006 0.126** -0.055
4 Caring climate 3.16 0.59 – – (0.83) 0.433** 0.440** 0.570** 0.299** 0.006 0.048 -0.280**
5 Formal climate 4.00 0.53 – – – (0.87) 0.310** 0.431** 0.240** -0.097 -0.060 -0.273**
6 Distributive justice 3.66 0.69 – – – – (0.87) 0.438** 0.092* -0.044 0.072 -0.289**
7 Affective commitment 3.55 0.60 – – – – – (0.84) 0.340** -0.012 0.042 -0.451**
8 Normative commitment 3.32 0.58 – – – – – – (0.77) 0.050 -0.018 -0.223
9 Lateness 8.35 12.98 1 0.447** 0.016
10 Absence frequency 3.61 6.65 1 -0.166*
11 Intent to leave work 2.21 1.01 – – – – – – – – – (0.95)
Notes: N = 201, *p < 0.05, **p < 0.01,amen = 0, women = 1; internal consistency reliability estimates (alphas) are presented in parentheses along the diagonal.
440 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
between all ethical variables and intent to leave
work disappeared, suggesting full mediation. Thus,
Hypothesis 2 was partially supported: Affective
commitment mediated the relationship between
caring climate, formal climate, distributive justice,
and intent to leave work. This hypothesis was only
partially supported because we had hypothesized that
in addition to the mediating effect for intent to leave,
we would find a modest mediating effect concerning
lateness and absence, which we did not find.
As we explained before, the study model was also
illustrated by SEM in order to represent all the three
withdrawal behaviors and control variables in the
same figure. The SEM’s model with completely
standardized path coefficients for the model is presented in Figure 2. According to Chen et al. (2008)
and Hu and Bentler (1999), there is a need to use
several GOF (Goodness of Fit) measures in order to
minimize the error rate in the suggested model. In
the present study, all the calculated GOF measures
show a well goodness of fit with the data,
X2 = 38.97, p = 0.15; X2/df = 1.26; RMSEA =
0.036; NFI = 0.915; CFI = 0.93; IFI = 0.95; TL =
0.95. The overall model explained 40% of the variance in affective commitment, 10% of the variance
in normative commitment, and 21% in intent to
Similar to correlations findings, Figure 2 illustrated that all ethical variables were positively and significantly related to each other (0.31 <r < 0.44,
p < 0.001). In relation to the mediating effect,
Figure 2 indicated positiveand significant relationships
between caring and formal climate and each dimension
of organizational commitment. Only distributive justice was found to be related only to affective (but not to
normative) commitment. Furthermore, only the
relationship between affective (but not normative)
commitment and intent to leave work was negatively
and significantly related (b = -0.45, p < 0.001). The
direct relationships between the ethical variables and
withdrawal behaviors were not significant in the
presence of organizational commitment dimensions.
Thus, the SEM illustration (Figure 2) demonstrates the
partial support of Hypothesis 2 which was found in the
Hierarchical Multiple Regressions results, regarding
the mediating effect (above).
A positive relationship was found between lateness and absence frequency (b = 0.34, p < 0.001),
and a negative relationship was found between
absence frequency and intent to leave work (b =
-0.11, p < 0.05). No significant relationship was
found between lateness and intent to leave work.
Males tended to be late more frequently than females
and seniority weakly related to absence frequency.
Relationship of the study variables to organizational commitment (affective, normative) using Hierarchical Multiple
Affective commitment Normative commitment
B SE B SE
Constant 3.508*** 0.206 3.095*** 0.211
Age -0.007 0.006 0.000 0.007
Gender 0.160 0.122 0.176 0.125
Seniority 0.017 0.008 0.009 0.008
Constant 0.643*** 0.362 1.935*** 0.443
Age 0.002 0.005 0.002 0.007
Gender 0.022 0.099 0.120 0.122
Seniority 0.001 0.007 0.004 0.008
Caring climate 0.386*** 0.072 0.260** 0.088
Formal climate 0.254** 0.077 0.147 0.094
Distributive justice 0.156* 0.056 -0.067 0.069
R2 = 38.2% R2 = 33.4%
Notes: N = 201, **p < 0.01, ***p < 0.001
Withdrawal Behaviors Syndrome 441
Hierarchical Multiple Regression Analyses: mediation of the relationship between the study variables and withdrawal behaviors by affective and normative
Step 1: The relationship between independent variables and
Step 2: Step 1 including affective and normative commitment
Intent to leave Lateness Absence
Intent to leave
B SE B SE B SE B SE B SE B SE
Constant 0.723*** 0.192 0.237 0.162 3.098*** 0.346 0.723*** 0.192 0.237 0.162 3.098*** 0.346
Age 0.002 0.006 0.001 0.005 -0.004 0.011 0.002 0.006 0.001 0.005 -0.004 0.011
Gender -0.264 0.118 0.098 0.101 -0.702 0.205 -0.264 0.118 0.098 0.101 -0.702 0.205
Seniority 0.004 0.008 0.005 0.006 -0.006 0.014 0.004 0.008 0.005 0.006 -0.006 0.014
Constant 0.981* 0.506 0.426 0.406 6.287*** 0.705 0.777 0.539 0.464 0.429 6.750* 0.718
Age 0.001 0.006 0.001 0.005 -0.014 0.01 0 0.006 0.001 0.05 -0.013 0.01
Gender -0.258 0.12 0.089 0.102 -0.571 0.194 -0.264 0.12 0.091 0.102 -0.552 0.187
Seniority 0.006 0.009 0.007 0.007 0.013 0.013 0.005 0.009 0.007 0.007 0.013 0.013
Caring climate 0.051 0.091 0.061 0.073 -0.187* 0.141 0.015 0.102 0.024 0.083 0.046 0.148
Formal climate -0.028 0.105 -0.143 0.082 -0.395** 0.149 -0.05 0.11 -0.166 0.085 -0.243 0.149
Distributive justice -0.077 0.077 0.045 0.062 -0.261* 0.109 -0.069 0.079 0.028 0.062 -0.176 0.108
Affective commit. 0.03 0.107 0.128 0.088 -0.568*** 0.148
Normative commit. 0.087 0.084 -0.07 0.066 -0.051 0.121
R2 = 22.8% R2 = 21.6% R2 = 45.1% R2 = 25% R2 = 26% R2 = 52.4%
Note: N = 201, *p < 0.05, **p < 0.01, ***p < 0.001, amen = 0, women = 1.
442 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
Nurses are at the forefront of healthcare services. It is
thus vital to discover what may impact their withdrawal behaviors syndrome. Since previous studies
both outside of Israel and among Israeli employees
indicate that ethical perceptions affect organizational
commitment and withdrawal behaviors such as
lateness, absence, and intent to leave (Cohen and
Freund, 2005; Gaziel, 2004; Luchak and Gellatly,
2007; Somers, 2009; Wasti, 2003), we therefore,
simultaneously considered three withdrawal behaviors (lateness, absence, and intent to leave work) and
three organizational ethics indicators (caring climate,
formal climate, and distributive justice). Affective
commitment was shown to be a factor that helps
explain these relationships only as a mediator for
intent to leave work but not for lateness and absence.
These findings emphasize the legitimacy of focusing
on specific withdrawal behaviors instead of aggregating them under a single general concept such as
The fact that the mediating effect of organizational commitment was found only for intent to
leave work but not for the other withdrawal
behaviors may be explained by several reasons: first,
in contrast to both lateness and absence, which reflect actual work behaviors, intent to leave work
represents an inner psychological state, where nurses
experience behavioral intentions directed toward
their workplace. Based on Rousseau’s (1995) social
exchange theory, it is conceivable that the intent to
leave work, which represents an intention to behave,
will be more firmly related to the nurses’ ethical
perceptions than to lateness and absence, which
represent actual behaviors. Second, based on the
progressive model which assumes that intent to leave
is a more severe withdrawal behavior than lateness or
absence, we believe that the long term ideologyinfused component, the dominant component of the
psychological contract and an intrinsic motivational
factor, will affect the most long term of the withdrawal behaviors, namely, intent to leave. Third, in
the Israeli context, it seems that nurses will choose
less to be late or absent because of the Israeli health
system which is characterized by rules and regulations in the case of unjustified lateness or absence
(e.g., deducting from nurses’ salaries). Given the fact
that the nurses’ lateness or absence can be directly
observed by their environment (e.g., co-workers,
head nurses, and medical doctors), the nurses’ negative perceptions of the organizational ethics would
have almost no effect on their lateness or absence
because of the strict enforcement of the regulations
X2=38.97, p=.154; X2/df=1.26; RMSEA=.036; NFI=.915; CFI=0.93; IFI=.95; TL=.95
Intent to leave
Figure 2. The mediating effect of affective commitment between organizational ethics and withdrawal behaviors
*p < 0.05, **p < 0.01, ***p < 0.001, amen = 0, women = 1.
Withdrawal Behaviors Syndrome 443
involved. However, behaviors that are discretionary,
such as intent to leave, which cannot be directly
observed by the nurse’s environment, can be affected
adversely to some extent in response to negative
ethical perceptions about the workplace.
The study findings are inconsistent both with
Josephson et al. (2008), who found that similar
predictors, such as being subjected to social exclusion or negative consequences of organizational
change, are predictors of both absence and intent to
leave the workplace, and with Podsakoff et al’s
(2007) meta-analysis which demonstrates that different predictors affect the same withdrawal behaviors. In their meta-analysis, they demonstrate that
stressors account for a significant amount of variance
in turnover intention, turnover, lateness, and absence as a result of indirect effects through strain, job
satisfaction, and organizational commitment.
On the other hand, Somers’ (2009) study, which
was conducted on a sample of 288 hospital nurses,
supports the present findings. Somers found that
lateness and absence produced weaker results than
turnover intentions when taking affective and normative commitment into account. Furthermore,
Carraher and Buckley (2008) conducted a study on a
sample of 386 nurses and found that perceptions of
distributive justice were significantly related to
turnover, but not to absenteeism.
The social exchange theory (Rousseau, 1995) can
be used to argue that when nurses are disenchanted
by the ethics of their hospital, they may reduce their
commitment and entertain thoughts of leaving, a
mind-set which implies a diversion of energy and
time which may be spent on a job search. Although
the intent to leave work is unquestionably a legitimate attitude on the part of employees, the management may perceive it as involving an unethical
element, because intent to leave may lead the employee to less investment in the organization.
The finding that a caring climate appeared together with affective commitment as predictors of
intent to leave work is not surprising in a health
context, where care for patients is a predominant
value and the ideology component is a dominant
factor in the psychological contract. The finding that
the formal climate may also affect intent to leave
work may be explained by the bureaucratic health
system and the nurses’ response to bureaucratic
formalism. In this case, rules and regulations are not
perceived as necessarily symbolizing rigidity, but
rather may be seen as protective mechanisms for
ensuring transparency and fair treatment of the
The direction of the mediating effect and the
interrelations of the ethical perceptions afford credence to our integrative approach, where these
ethical perceptions were considered within a single
cohesive theoretical framework. This integrative
approach to perceptions of organizational ethics
contributes to the existing literature, since the three
ethical perceptions were traditionally studied separately with reference to employees’ withdrawal
In the present study, affective commitment may
have been more sensitive than normative commitment to perceptions of organizational ethics because
of the emotional element in the former. Nurses who
perceive their workplace as ethical may reciprocate
with feelings of gratitude and appreciation, which
are probably linked to emotional attachment more
than to a sense of obligation (normative commitment) (Peterson, 2002).
Our findings demonstrate that each behavior retains its unique characteristics, as attested by each
withdrawal symptom being related to a different
variable (or set of variables). For example, males
were late more often than females, while seniority
was related only to absence frequency. Studies
focusing on gender career choice showed that one of
the main considerations of female employees is that
working conditions suit the traditional female role
and reduce their work–family conflict (WFC)
(Boyar et al., 2005; Ladebo, 2005). It, therefore,
seems that female nurses try to keep their jobs by
making an effort to be on time more than males do.
Furthermore, studies showed that years of service
(seniority) affect voluntary absence (Ingersoll, 2004;
Liu and Meyer, 2005). At an advanced stage in the
nursing career, high seniority involves tenure and
eligibility for social benefits, which make it harder to
fire employees. This may explain why longer
seniority was correlated with higher voluntary
A closer examination of the study results
may support the existence of different withdrawal
behavior relationships. The fact that a positive relationship was found between lateness and voluntary
absence may support a partial progressive model
444 Orly Shapira-Lishchinsky and Shmuel Even-Zohar
which posits that withdrawal behaviors occur in
progression (e.g, starting with lateness and then
moving to absence). The relationship is defined as
partial because a low negative relationship was observed between voluntary absence and intent to leave
work. The fact that a negative relationship was found
between voluntary absence and intent to leave may
support the partial compensatory model. It is defined
as partial because a negative relationship was not
found between lateness and absence frequency. In
any case, the negative relationship that was found
between voluntary absence and intent to leave does
not contradict the established theory that voluntary
absence is considered less severe withdrawal behavior
than intent to leave. The independent forms model
which suggests that withdrawal behaviors are unrelated was not supported, since significant relationships were found between the withdrawal behaviors.
In summation, considering previous studies
(Deshpande, 2009; Purvis and Cropley, 2003) which
indicate that unethical behavior by employees can
negatively impact not only public trust and the
reputation of the hospital, but also its long-term
financial soundness, the findings of this study have
serious implications for healthcare managers and
Implications of the findings
Theoretically, the present study contributes to the
knowledge on nurses’ perceptions of the psychological contract based on the relationship between
ethical perceptions, organizational commitment, and
withdrawal behaviors, by simultaneously considering
various aspects of ethics and different withdrawal
behaviors in the workplace. Previous studies usually
focused on one dimension of ethical perception or of
withdrawal behavior at a time, whereas the present
results offer an integrative framework and focus
attention on the mediating role of organizational
commitment as a consistent link between a spectrum of ethical perceptions and nurses’ withdrawal
Practically, hospitals should promote high standards of caring, formal climate, and distributive
justice which may improve their contribution to the
psychological contract, especially to the ideologyinfused component, which may ultimately increase
nurses’ affective commitment. In the long term,
nurse management may find that the psychological
contract offers their nurses a powerful means of
professional leverage in their aim of ‘‘keeping their
nurses’’, despite the economical, political, and
bureaucratic constraints under which they work.
Promoting the ethical environment, which may
increase nurses’ commitment, may reduce not only
nurses’ intent to leave but also impact on turnover at
the hospital, thus saving money to the health system.
Improving the ethical atmosphere in the organization may be achieved through leaders and nurses
workshops that focus on ethics education and this
may encourage an environment where ethical considerations become part of the decision-making
process of the nurses. As recent studies have shown,
education in ethics had a significant impact on the
ethical behavior of hospital employees and can help
reduce moral stress and improve patient care
(Deshpande et al., 2006; Hanson, 2005). Our findings suggest broadening the ethics modules in
nursing schools by teaching healthcare and ethics in
an integrative approach in order to address ethical
issues that nurses might face in the workplace.
Strengths, limitations, and future study
This article attempted to explain an integrative
phenomenon with variables and constructs that have
usually been presented separately in the literature,
thereby presenting an innovative approach to
withdrawal behaviors. Methodologically, this study
was based on nurses’ self-reports, hospital records,
and appointing separate time intervals to measure
each behavior which allowed for uncontaminated
measures in the model, which may strengthen the
accuracy and quality of the study.
This study suffers from several limitations and the
findings should be viewed with some caution. The
sample was drawn from the nursing population in
one hospital. This is a limited sample which may
consider our study as an exploratory study. Thus, the
findings should be tested as to whether they can be
applicable to other hospitals and occupations in
Israel. In addition, one must consider the generalizability of research based on a framework developed
in one nation and whether it will prove valid in
Withdrawal Behaviors Syndrome 445
Although predictors such as organizational ethics
and organizational commitment seem to be most
appropriate for voluntary behaviors (Koslowsky,
2009), it is often difficult to classify a particular
incident as an example of voluntary or involuntary
withdrawal behavior. In any case, the present study
attempted to cover a large number of withdrawal
behaviors by postulating the existence of several
types of antecedents where one or a combination of
them may provide an adequate explanation.
A basic argument in the study model is the
direction of causality that emanates from ethical perceptions which relate to organizational
commitment, and which in turn affect withdrawal
behaviors. The causal flow in the literature is generally uni-directional (Koslowsky, 2009). However,
investigators have argued that a causal effect in the
opposite direction is also a reasonable expectation
(Clegg, 1983). The present study’s design of a twophase study at different points in time supports the
causal (uni-directional) model which argues that
work perceptions lead to behaviors.
As we have maintained, psychological contracts
can be violated not only when the hospital abandons
its obligations to provide economic and socioemotional support to the nurses but also when the
hospital fails to fulfill an implied ideological obligation. Since we may assume that negative ethical
perceptions may lead to ideology contract breach,
future studies should attempt to study more deeply
the relationship between nurses’ ethical perceptions,
ideological contract, organizational commitment,
and withdrawal behaviors.
Concerning the changes in employees’ perceptions regarding their professional ideology and the
COR model, which points out the advantages of
lateness and absence, we encourage developing
studies to find whether withdrawal behaviors affect
patient care and harm patient treatment, and if so,
how and in which cases. This future study is
significant, considering the theoretical background
whereby most research studies assume that withdrawal behaviors are undesirable (e.g., Blau et al.,
2004; Carraher and Buckley, 2008; Johns, 2003;
Koslowsky, 2009; Lambert and Hogan, 2009).
This is especially so when we consider a severe
withdrawal behavior (intent to leave), which may
be causing the current shortage of nurses in Israel
and many other countries (Borda and Norman,
1997; Coomber and Barriball, 2007; Ehrenfeld
et al., 2007; Fawcett et al., 2007; Krausz et al.,
In addition, although traditionally, withdrawal
behaviors have been of interest to administrators
because of their associated cost, future studies should
investigate whether these costs may be balanced
against the benefits of employees’ withdrawal
behaviors although these benefits are difficult to
measure directly. In the case of nursing, the potential
losses associated with the use of overtired nurses,
poor service, and errors caused by overwork are not
hard to imagine.
Finally, although our findings indicate that the
theoretical mechanism only considers intent to leave,
the general framework could be used as a basis for
future theory building. In fact, the findings considering the difference between the various withdrawal
behaviors and their interrelations suggest that the
theory is incomplete and that scholars should consider, in addition to ethics, other models such as the
conservation of resources model and additional
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Department of Educational Administration,
Leadership and Policy, School of Education,
52900 Ramat-Gan, Israel
Department of Psychology,
52900 Ramat-Gan, Israel
Withdrawal Behaviors Syndrome 451 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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