Nursing Elevated to Patient Safety Goal by Joint Commission
December 1, 2025
Executive Summary
Nurse staffing will be a Joint Commission safety goal in 2026. This is the first time nursing has been elevated to this level when assessing quality.
- Hospitals will have to provide sufficient nurse management.
- Some organizations will face funding shortages when complying.
- There may be cost savings from improved patient safety.
By Gregory Freeman
The Joint Commission is adding nurse staffing to its national performance goals, which means that, as of Jan. 1, 2026, hospitals seeking accreditation will have to meet specified standards for nurse staffing and management.
This is the first time the Joint Commission has included nurse staffing as a fundamental indicator of quality.
The new expectation, known as National Performance Goal (NPG) 12, says that healthcare organizations must have a nurse executive responsible for overseeing staffing policies and procedures. “There must be an adequate number of licensed registered nurses, licensed practical nurses, and other staff to provide nursing care to all patients, as needed,” the rule states. (Goal 12 is available online at http://bit.ly/4hBa52V.)
Nursing advocacy groups immediately praised the move as a major step forward in recognizing the vital role played by nurses in ensuring patient safety.
“Today’s achievement is a defining moment for the nursing profession and for patient care across the nation,” Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, president of the American Nurses Association said in a statement. “For decades, nurses have sounded the alarm that safe staffing saves lives. The inclusion of nurse staffing as a national performance goal validates what nurses have always known — that adequate staffing is essential to prevent patient harm, improve patient outcomes, and create a safer environment. While this marks a tremendous step forward, we will continue to advocate for all accrediting bodies to adopt similar standards so that every hospital upholds safe staffing as a top priority.”
Although this issue has been fraught with controversy, there is evidence that demonstrates a correlation between patient/nurse ratios and adverse events, says Deborah Hunt, PhD, RN, dean of the College of Nursing and Public Health at Adelphi University in Garden City, NY.
“I believe this has potential to improve patient safety, although the issue of patient/nurse ratios and skill mix remains somewhat subjective,” she says, adding that introducing the metric is significant and, while hospital/healthcare administrators will have autonomy (unless they are in a state with mandated ratios), leaders will be required to demonstrate the evidence to support their ratios and skill mix.
The challenges will be financial at the start but should result in a cost savings with improved patient outcomes. Reimbursements are negatively affected when there is poor quality of care, Hunt says. Additional challenges include recruitment, training, and retention as there still is a nursing shortage, which varies in severity across the country and high turnover rates, she says. Meeting this goal will require taking a holistic approach, she says. Healthcare organizations should create an interdisciplinary team to review, plan, and evaluate which should include licensed and unlicensed nursing staff, she says. The first step is to review and understand the performance goal. Then, following the nursing process, they should begin with assessment.
“It’s vital to take a critical look at the current staffing plans and skill mix and determine if the current staffing plans would meet the performance goals. They need to determine what supports the current staffing and look at their performance indicators,” she says. “The next step is to plan and develop goals. If they determine they need to improve staffing and skill mix, they need to determine what the minimum patient/staff ratios should be and have a process/formula for adjusting up or down.”
Organizations need to determine the finances needed to increase staffing (if necessary) and maintain it, Hunt says. They need a plan for recruitment, training, and retention. “If they are not affiliated with a nursing program, they should consider it, as this can create a pipeline of new nurses,” she says. “They need to lay out the interventions or steps they will need to achieve their goals, and a plan to evaluate the outcomes and revise the plan, goals, and interventions/steps as needed.”
This is a defining leap for the nursing profession and a transformative advance in the science and safety of patient care, says Erin Slay, DNP, MHA, RN, associate dean with the New Bridge Cleveland/Central School of Practical Nursing in Cleveland, OH.
The Joint Commission’s recent announcement, effective January 2026, represents “an extraordinary validation of nursing’s voice in shaping safety and quality — a long-awaited alignment between what nurses know and what systems measure,” she says.
With the implementation of NPG 12, staffing adequacy becomes a formal expectation, she says. Accredited hospitals will now be surveyed and held accountable for the rigor of their staffing plans, the number and mix of personnel, competencies, and the review process.
For decades, nursing has followed best-practice guidance from the American Association of Critical-Care Nurses and state boards of nursing, anchoring staffing decisions to patient acuity and clinical complexity, Slay says.
“What distinguishes this change is that it elevates staffing from ‘good practice’ to a binding accreditation expectation, placing explicit accountability on hospital leadership and nurse executives,” she says. “The focus shifts beyond headcount to the knowledge, skills, abilities, and competencies of the full patient-care team, ensuring the clinical and emotional needs of patients and families are consistently and safely met.”
As with any major systems change, new standards can create unintended exposures if implemented without consistent frameworks, she notes. The risk lies not in the goal itself, but in the gap between policy intent and operational readiness. This monumental change marks a leap forward for the profession’s long-standing call to ensure adequate staffing mix for patient needs while safeguarding the clinical care team. Yet, amid this progress, health systems must confront a persistent challenge: the optimal integration of licensed practical/vocational nurses (LPNs/LVNs) and other allied health professionals into care-team models, Slay says.
Hospitals across the country are reintroducing LPNs/LVNs into acute-care settings, reviving the team-based approach of earlier decades, in which registered nurses, LPNs, and nursing assistants collaborated across layers of care, she says.
“While these models have significant potential, their success hinges on clear role delineation, delegation protocols, and mutual understanding of scopes of practice,” Slay says. “Without these, health systems risk fragmented care, inconsistent adherence to care plans, and increased liability exposure.”
Slay says now is the time for hospital nursing leadership and schools of nursing — both RN and LPN programs — to partner in designing the next generation of team-based care models. She says they must take these steps:
- Develop and pilot modern team-based care models that clearly define each role’s responsibilities and delegation parameters.
- Embed these models into nursing education, allowing students to practice team-based care in clinical rotations and simulation settings.
- Collect outcome data — on patient safety, satisfaction, and care-plan adherence — to identify what works and refine the model.
- Invest in mutual learning: Prepare RNs to understand the value, scope, and appropriate placement/usage of LPNs, and prepare LPNs to function confidently within their defined role.
This collaboration will not only strengthen care delivery, she says, but will advance the profession’s capacity to meet today’s complex healthcare needs with safety, efficiency, and respect for every member of the nursing team.
“The Joint Commission’s action is a call not only for compliance, but for collaboration — for every hospital and nursing school to work together to operationalize safety through shared understanding, shared training, and shared purpose,” Slay says. “When nursing education and hospital leadership join forces to architect care-delivery models that reflect the full spectrum of nursing practice, we don’t just fill staffing gaps. We build teams that heal more effectively.”
This move by the Joint Commission has been a long time coming, for this is exactly what the front-line staff have been reporting for years: Understaffing creates harm and not just risk, says Nick Bach, PsyD, a psychologist in Louisville, KY.
When nurses become absorbed by too many duties, there is an increase in decision fatigue and errors, he says. Some patient outcomes can be traced to such factors, if not outright negligence, but often to emotional exhaustion and depleted attention time, he says.
Hospitals may starve for the cost of employing another, but their greater struggle will be to move from a reactive staffing model toward sustainable care environments, Bach says.
This means the administrators must contradict any perception of nurse staffing as a financial liability and embrace its existence and actions as one of patient safety and nurse burnout prevention, he says.
Facilities should begin an honest internal audit of staffing deficiencies immediately, he says, and not just meeting the floor minimums, but whether staff feel safe, both physically and psychologically, while carrying out their shift.
“They will also need nurse executives who are more than just figurehead positions but rather such persons who with authority and empathy could push for meaningful staffing change,” Bach says. “Compliance should not merely concern the passing of any inspection but must rather be about putting into place those systems in which both patients and providers can thrive.”
Greg Freeman has worked with Clinican.com and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Clinician.com products. In addition to his work with Clinician.com, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Sources
- Nick Bach, PsyD, Louisville, KY. Email: [email protected].
- Deborah Hunt, PhD, RN, Dean, College of Nursing and Public Health, Adelphi University, Garden City, NY. Telephone: (800) 233-5744.
- Erin Slay, DNP, MHA, RN, Associate Dean, New Bridge Cleveland/Central School of Practical Nursing, Cleveland, OH. Telephone: (216) 867-9775.
The Joint Commission is adding nurse staffing to its national performance goals, which means that, as of Jan. 1, 2026, hospitals seeking accreditation will have to meet specified standards for nurse staffing and management.
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