While the practice environment has adopted policies aligned with just culture as a mechanism to address errors and support patient safety, academia has traditionally dealt with nursing student errors through various forms of discipline or penalty depending on the severity of the error.1 Contemporary healthcare organizations’ perspectives of human error and principles of just culture encourage the reporting of errors in order to mitigate future instances.2,3 Yet the predominant response to nursing student error continues to be embedded in a historical culture of blame.1 A recent nationwide survey, indicates that only 55% of nursing programs have an error reporting system in place and 50% of schools have no policy at all related to clinical errors or near misses.1 If the expectation is that new-to-practice nurses adopt just culture principles, it is imperative that nursing students learn and adopt the values and functions of a just culture during their education in order to be proficient and safe providers in systems that view error as an opportunity to improve.4,5 The purpose of this study was to assess nursing students’ perception of just culture in academia as a first step in bringing academia in-line with practice regarding errors and near-miss events.
Methods:
The Just Culture Assessment Tool -Nursing Education (JCAT-NE), a 27-item validated assessment tool was distributed to pre-licensure nursing students enrolled in a clinical nursing course.6 Seventeen nursing programs participated in the study following a standardized protocol for recruitment and administration of the survey. Categorical sample statistics were described, mean and standard deviation were obtained for continuous variables, and bivariate analyses were conducted.
Results:
The sample consisted of over 800 pre-licensure nursing students in clinical coursework from baccalaureate (79%), associate (10%), and accelerated (10%) programs. The majority of students (72%) reported their program has a safety reporting system in place while only 11% of students report ever using a safety reporting system. Mean JCAT-NE scores were significantly different between groups; students at the beginning of their nursing program had a higher mean than students at the end of their program indicating that perceptions of just culture in academia decreased as students moved through the program.
Conclusion:
The results of this study suggest the JCAT-NE is effective in assessing nursing students’ perception of just culture in academia and create a call to action for nurse educators to align response to error in academia with that of practice. The findings of this study provide a stepping off point for discussion among faculty and administrators to identify and implement structures and processes that will support student development of a professional identity that values the concepts of just culture. Future investigation is needed into why students’ perceptions of just culture changes as they progress through the program, as this may offer valuable insights into actions that can be taken by faculty and administrators to build a sustainable just culture that supports error reporting as a mechanism for patient safety.