Just culture in nursing: Implications for patient safety and nurse retention

Nurse retention is strongly shaped by organizational culture and leadership, which influence workplace behaviors, reporting practices, and staff engagement. While blame-free culture emphasizes learning over punishment, just culture balances non-punitive learning with individual accountability, promoting both transparency and fair responsibility.

To examine how just culture influences nurse-related and patient-related outcomes across clinical settings.

An integrative review of the literature was conducted between November 2025 and March across multiple databases, including PubMed/MEDLINE, Scopus, and ScienceDirect, yielding 2,535 articles. Of these, 15 met the predefined inclusion criteria. Thematic analysis identified two core categories: (a) the influence of just culture on nurse retention, and (b) its impact on patient safety culture.

The reviewed evidence indicates that just culture is associated with more open communication, higher incident and near-miss reporting, stronger organizational learning, and greater engagement in patient safety activities. Supportive and non-punitive environments appear to reduce second-victim distress, defensive practice, silence around safety concerns, burnout, and turnover intention, while strengthening trust in leadership, occupational commitment, and nurse retention.

Embedding just culture within safety strategies may strengthen nurse well-being, workforce stability, resilience, and quality of care.