Just culture and its influence on nurse interns’ willingness to report near-miss events: a cross-sectional study in five Egyptian university hospitals

TL;DR

This study shows that a supportive work culture increases nurse interns' willingness to report near-miss events in Egyptian hospitals.

Contribution

The study empirically links Just Culture dimensions to willingness to report near-miss events among nurse interns in Egypt.

Findings

Just Culture score strongly predicts willingness to report near-miss events (explaining 55% of variance).

Dimensions like trust and feedback are positively correlated with reporting willingness (p < 0.001).

Abstract

Near-miss incidents represent critical learning opportunities in healthcare, yet they are frequently underreported due to fear of blame and lack of organizational support. A Just Culture framework promotes fairness, trust, and learning from errors, which may encourage voluntary reporting, especially among nurse interns in high-stakes clinical environments.

To assess the perception of Just Culture among nurse interns and examine its influence on their willingness to report near-miss events in governmental university hospitals in Egypt.

A cross-sectional analytical study was conducted among 163 nurse interns (sampling frame N = 264) using systematic random sampling across five university hospitals in Cairo, Egypt. Data were collected between March and April 2025 using a self-administered questionnaire comprising the Just Culture Assessment Tool (JCAT) and a researcher-developed Willingness to Report Near-Miss Scale. Data analysis included descriptive statistics, correlation analysis, and multiple linear regression.

The mean Just Culture score was 3.6 (SD = 0.5), while the mean willingness to report near-miss events was 3.6 (SD = 0.5). Significant positive correlations were observed between Just Culture dimensions (trust, feedback, openness, balance, and continuous improvement) and willingness subdomains (awareness, skills, attitude, behavior) (p < 0.001). Regression analysis indicated that Just Culture score (B = 0.70, β = 0.67, p < 0.001) was the strongest predictor of willingness to report, explaining 55% of the variance.

A supportive Just Culture significantly enhances nurse interns’ willingness to report near-miss events. Strengthening institutional safety culture through leadership, training, and non-punitive policies is essential to fostering early-career nurses’ engagement in safety reporting.

The online version contains supplementary material available at 10.1186/s12912-025-03979-w.