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Texas nurse attorney will discuss about: What does the word, culture mean to you? Culture influences our attitudes, values, and beliefs but for whatever reason, our answers may vary depending on the set of circumstances we have experienced as we grow and mature. In our professional lives, it can be learned, and when we are placed into a completely new environment with a totally different culture, in time, we would learn to accept the new one as our own.

Healthcare providers have their own unique culture, one that is different from their patients. This cultural gap has a large impact on how they communicate with each other especially when mistakes are made, and the patient is harmed. For example, on one occasion, a patient underwent abdominal exploration procedure but due to massive adhesions, a bowel was accidentally punctured in the process causing prolonged procedure time for repair. However, the following day, patient continued to have abdominal pain, became tachycardic, had low grade fever, and distended abdomen. Patient was found to have abdominal perforation, sent back to the operating room then to intensive care due to sepsis, and eventually recovered.

A lot of excuses and can be made as to why the bowel was punctured such as patient’s unique anatomy making the event totally unavoidable, malfunctioning equipment, and poor hand-off communication. These reasons might be given if the surgical team is fearful that disclosing the true error will make patient’s significant others’ react irrationally or perhaps, the fear is caused by the organization’s punitive culture. This outcome does not exemplify a just culture.

A just culture holds managers and staff members accountable and responsible for establishing reliable improvements to process of care and adhering to them. James Reason, in his book Managing the Risks of Organizational Accidents, says that a just culture is one in which the atmosphere is one of trust and it encourages and rewards staff members for providing safety-related information but, more importantly, it is also very clear about what is acceptable and unacceptable behavior.1

David Marx says that errors occur because people exhibit one of the three behaviors:

  1. Inadvertent action such as slip or mistake.
  2. At –risk behavior where either the risk isn’t recognized or is believed to be justified.
  3. Reckless behavior, when the individual consciously chooses to disregard a substantial and unjustifiable risk.

Reckless behavior is managed via remedial or disciplinary action. Once these behaviors are understood, it would be possible to ensure that these events will be handled according to established protocols – notify proper personnel, investigate why the event happened, study possible causes and contributing factors to prevent the event from happening again2. Why? Because it is the right thing to do and it is our responsibility to keep our patients from harm while they are under our care.

Contact a Texas Nurse Attorney Today for Legal Guidance

If you or someone you know has been approached by the BON for disciplinary action or have more questions on the BON process, contact The Law Firm of Yong J. An and speak to a Texas Nurse Attorney directly at (832) 428-5679, call or text 24/7.


  1. Reason, James. Managing the Risks of Organizational Accidents. Ashgate Publishing. 1997.
  2. Marx, David. Whack-a-Mole: The Price We Pay for Expecting Perfection. By Your Side Studios. 2009.