Just Culture | Concepts & Definitions | North Carolina Board of Nursing

Focus on evaluating the behavioral choices made by an individual, not on the outcome of the event;
Require leadership commitment and modeling;
Distinguish among normal human error, unintentional risk-taking behavior, intentional risk-taking behavior, and reckless behavior;
Foster a learning environment that encourages reporting (including self-reports) of all near misses, mistakes, errors, adverse events, and system weaknesses;
Lends itself to continuous improvement of work processes and systems to ensure the highest level of client and staff safety;
Encourage the use of non-disciplinary actions whenever appropriate (including coaching, counseling, training, and education);
Hold individuals accountable for their own performance in accordance with their job responsibilities; and,
Does not expect individuals to assume accountability for system flaws over which they had no control.

Human Error

Not reportable to NCBON

Nurse inadvertently, unintentionally did something other than intended or other than what should have been done;
A slip;
A lapse; or
An honest mistake.
Isolated event, not a pattern of behavior.

(Repetitive human error or pattern of behavior requires further evaluation)

Examples:

Single medication event/error (wrong dose, wrong route, wrong patient, or wrong time)
Failure to implement a treatment order due to oversight

Responses to Behavior:

At-Risk Behavior

Board of Nursing Practice Consultant to be contacted for consultation

Definition:

Behavioral choice that increases risk where risk may not be recognized or is mistakenly believed to be justified;
Nurse does not appreciate risk;
Unintentional risk taking; and
Nurse’s performance or conduct does not pose a continuing practice risk to clients or others.

(Repetitive at-risk behavior or pattern of behavior requires further evaluation)

Examples:

Exceeding scope of practice
Pre-documentation
Minor deviations from established procedure
Nurse knowingly deviates from a standard due to a lack of understanding of risk to client, organization, self, or others

Responses to Behavior:

Coaching or Counseling

If behavior not a pattern of practice) to raise awareness of accepted procedures and potential risks for failure to comply
Remedial actions taken may include education, training, and assignment of activities appropriate to knowledge and skill
Nurse may be informed failure to change is not an option
If nurse does not accept coaching, may result in disciplinary action

Board Action:

Reckless Behavior

Mandatory report to Board or Nursing required.

Definition:

Nurse consciously disregards a substantial and unjustifiable risk;
Nurse's action or inaction is intentional and purposeful; or
Nurse puts own self/personal interest above that of client, organization or others

Examples:

Nurse abandons patients by leaving workplace before reporting to another appropriately licensed nurse. Nurse leaves workplace before completing all assigned patient/client care (including documentation) for a non-urgent reason.
Nurse does not intervene to protect a patient because nurse is not assigned to patient
Nurse makes serious medication error, when realized tells no one, and when questioned denies any knowledge of reason for change in client condition
Nurse falsifies documentation to conceal an error

Response to Behavior:

Additional Definitions

Consoling – affording comfort or solace; restoring confidence and relieving anxiety.

Coaching – supportive discussion with an employee on the need to engage in safe behavioral choices.

Counseling – a first step in disciplinary action; putting an employee on notice that performance is unacceptable.