Creating a Fair and Just Culture in Schools of Nursing

Abstract

: In recent years, health care organizations have been moving away from a culture that responds to errors and near misses with "shame and blame" and toward a fair and just culture. Such a culture encourages and rewards people for speaking up about safety-related concerns, thus allowing the information to be used for system improvement. In part 1 of this series, we reported on findings from a study that examined how nursing schools handled student errors and near misses. We found that few nursing schools had a policy or a reporting tool concerning these events; and that when policies did exist, the majority did not reflect the principles of a fair and just culture. This article, part 2 of the series, describes several strategies that nursing schools can use for creating such a culture.

Exploratory factor analysis of the Just Culture Assessment Tool for nursing education

“…Unfortunately, medical errors are still a leading cause of death in the United States (Makary and Daniel, 2016). Just culture acknowledges the high-risk nature of healthcare and potential for human error, while valuing accountability, transparency, respect, trust and reliance on evidence (Barnsteiner and Disch, 2017).…”

“…Nursing students’ fear of blame and disciplinary action for reporting errors and their reluctance to speak up for patient safety is well described in the literature (Christenson, 2018; Cooper, 2017; Fagan et al., 2016; Gorini et al., 2012). In addition, many nursing faculty members do not seem to understand the concept of a fair and just culture (Barnsteiner and Disch, 2017). Penn (2014) describes a safe learning culture as one in which students are treated fairly, errors are viewed justly and leadership is approachable and accepting.…”

Nursing students’ experiences of patient safety incidents and reporting: A scoping review

“…[67] Although typically referenced in relation to clinical settings, the shift toward a just culture can and should extend to nursing schools, wherein everyone has responsibilities (e.g., students must appropriately prepare for clinical and admit mistakes; educators must be apprised of current quality and safety principles and create safe learning environments for student incident disclosure; and organizational leaders must embed philosophies and processes reflective of a fair, just culture) and collaboration among students, faculty and organizational leaders is key (p. 44). [68] Recent work supports the inclusion of just culture principles in underpinning school policies that guide student incident reporting. [69,70] Students should be prepared in managing mistakes, both pragmatically from a procedural perspective (e.g., process and steps to reporting), as well as psychologically.…”

The space to make mistakes: allocating responsibility and accountability for nursing student-committed medication errors

“…It was proposed that using such communication channels for these purposes would lead to a more positive student and teacher experience and would contribute to increased patient safety. This call for increased feedback loops pertaining to patient safety and nursing student practice has also been supported by authors such as Vaismoradi (2012) and Barnsteiner and Disch (2017).…”

“…Instead, teachers, educators, and administrators intended to project their desire for appropriate ownership so the student would take responsibility and accountability only for those aspects of the error that were due to their own decisions and actions and would feel able to accept learning opportunities to help them to move forward. A learning environment which would foster such characteristics has been characterized as ideal by Barnsteiner and Disch (2017).…”