Why is the Board of Nursing using Just Culture principles to guide its strategic objectives?
It enhances our ability to protect the public. Just Culture allows us to concentrate investigative and disciplinary resources to aggressively intervene with incompetent or unsafe practitioners rather than drilling down to punish someone for an isolated error. It complements our PREP program and helps us to focus public protection on incompetent practitioners, focus on quality improvement for those practitioners making errors, balance system and individual accountability for patient safety, and finally, to base actions on behavioral choices/level of risk, NOT on the outcome of an incident. Working closely with employers—who have responsibility for systems integrity—we’re able to balance system and individual accountability, creating a forum for open dialogue where we all can learn and get at the root of what’s going on. For example, I recall a medication error involving a Pyxis machine; you hear of these quite often. There’s an emergency going on, a nurse from another floor goes to the
