The implementation of the Affordable Care Act has been a catalyst for healthcare organizations to reexamine care practices and delivery models of services to meet the demands of healthcare reform mandates and goals. The healthcare environment is an extremely complex system that is challenging for those who are providing care, treatment, and services to consumers within it. The culture within the healthcare setting is critical and directly related to patient outcomes, satisfaction, safety, and quality of care provided. Creating a culture of safety focuses on everyone to create a workplace environment that is inclusive to Just Culture model concepts, harm prevention, and promotion of safe and high-quality patient care outcomes through heightened individual and team awareness. Dermatology nurses at every level have an integral role in promoting a work environment that is conducive to a trustful, safe, and high-quality care experience for dermatology patients, families, and colleagues. This article will review Affordable Care Act impacts, work environment culture of safety dimensions, Just Culture, and a procedural/ambulatory surgery safety checklist as a valuable quality and safety practice tool that can be used in the specialty of dermatology.