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

BACKGROUND: 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. PURPOSE: To examine how just culture influences nurse-related and patient-related outcomes across clinical settings. METHODS: 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. DISCUSSION: 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. CONCLUSION: Embedding just culture within safety strategies may strengthen nurse well-being, workforce stability, resilience, and quality of care.