Just Culture and Accountability in Nursing Leadership: Closing the Experience Gap, Rebuilding Morale, and Hardwiring Reliability

Nurs Adm Q. 2026 Jul-Sep 01;50(3):156-162. doi: 10.1097/NAQ.0000000000000761.

ABSTRACT

Leadership transitions in nursing have left many first-time nurse leaders underprepared for the most challenging aspects of their role: holding courageous conversations, maintaining accountability, and sustaining civility under stress. These trends were further accelerated by the disruptions of the pandemic. This gap, combined with heightened workplace violence, burnout, and workforce instability, has threatened the culture of safety across health care. Post-COVID-19, restoring trust and resilience requires intentionally integrating Just Culture, the Highly Reliable Experience training, and nursing professional governance. Just Culture offers a fair and structured approach to accountability, distinguishing between human error, at-risk behavior, and recklessness, while promoting psychological safety and reporting. Highly Reliable Experience embeds error-prevention behaviors, leader standard work, and team communication practices, aligning safety and patient experience. Shared governance empowers frontline nurses to lead improvement, standardize processes, and own outcomes. Together, these frameworks address the leadership development gap, strengthen civility as a safety imperative, and re-engage nurses in shaping reliable care environments. Evidence shows that organizations implementing these strategies see reductions in serious safety events, improvements in patient experience, and stronger workforce engagement. As turnover stabilizes but remains above prepandemic levels, equipping nurse leaders with the skills and structures to deliver accountability with compassion is both urgent and essential to sustaining safety, quality, and trust.

PMID:42214422 | DOI:10.1097/NAQ.0000000000000761