Purpose This study aimed to identify the effects of the nursing practice environment and reciprocity among hospital nurses on their intent to leave, and to investigate the mediating effect of reciprocity in this process. Methods This study was conducted with 218 full-time nurses working for more than 6 months at four general hospitals located in two cities in South Korea. Data were collected using questionnaires from July 26 to August 12, 2022, and analyzed using IBM SPSS/WIN 23.0 and SPSS Process Macro. Results The nursing practice environment (r=-.38, p<.001) and reciprocity (r=-.33, p<.001) were negatively related to the intention to leave. The nursing practice environment and reciprocity affected intent to leave, reciprocity had a partial mediating effect between the nursing practice environment and intent to leave. Conclusion Nursing managers should strengthen the nursing work environment and reciprocity levels to reduce nurses’ intention to leave. Additionally, nursing managers need to effectively manage the organizational culture so that nursing services can be provided in a friendly medical culture that values fair and equal cooperation.