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Nursing Students' Perceptions of Just Culture in Nursing Programs

A Multisite Study

Walker, Danielle PhD, RN, CNE; Altmiller, Gerry EdD, APRN, ACNS-BC, FAAN; Hromadik, Lora PhD, RN; Barkell, Nina MSN, RN, ACNS-BC; Barker, Nancy EdD, RN; Boyd, Teri EdD, MNSc, RN; Compton, Michelle MSN, RN; Cook, Pamela MSN, RN; Curia, Marianne PhD, MSN, RN; Hays, Deana DNP, FNP-BC; Flexner, Randi DNP, APN, RN; Jordan, Janet MSN, RN; Jowell, Vicki MSN, RN, RN-BSN; Kaulback, Michelle EdD, RN, FNP-BC; Magpantay-Monroe, Edna EdD, APRN; Rudolph, Bethany MSN, RN; Toothaker, Rebecca PhD, RN; Vottero, Beth PhD, RN, CNE; Wallace, Sharon PhD, RN, CCRN-K

doi: 10.1097/NNE.0000000000000739
Nurse Educator: PDF Only

Background While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education.

Purpose The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia.

Methods Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs.

Results The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (χ2[2] = 25.09, P < .001).

Conclusions The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.

Author Affiliations: Assistant Professor (Dr Walker), Texas Christian University, Fort Worth; Professor (Dr Altmiller), The College of New Jersey, Ewing; Associate Professor (Dr Hromadik), Indiana University of Pennsylvania; Nursing Faculty (Mss Barkell and Compton), Oakland Community College, Waterford, Michigan; Assistant Professor (Drs Barker and Kaulback), West Chester University of Pennsylvania; Assistant Professor (Dr Boyd) Goldfarb School of Nursing at Barnes Jewish College, St Louis, Missouri; Assistant Professor (Ms Cook and Dr Toothaker), Bloomsburg University, Pennsylvania; Assistant Professor (Dr Curia), Purdue University Northwest–Westville, Indiana; Assistant Professor (Dr Hays), Oakland University, Rochester, Michigan; Clinical Assistant Professor (Dr Flexner), Rutgers, The State University of New Jersey School of Nursing, New Brunswick; Clinical Instructor (Mss Jordan and Rudolph) and Coordinator (Ms Jowell), Clinical Faculty, University of Texas at Tyler; Professor (Dr Magpantay-Monroe), Chaminade University of Honolulu, Hawaii; Associate Professor (Dr Vottero), Purdue University Northwest, Hammond, Indiana; and Assistant Professor (Dr Wallace), Pacific Lutheran University School of Nursing, Tacoma, Washington.

The authors declare no conflicts of interest.

Correspondence: Dr Walker, TCU Box 298620, Fort Worth, TX 76129 (

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Accepted for publication: July 22, 2019

Published ahead of print: October 9, 2019

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