Joint Commission includes nurse staffing in national performance goals

Earlier this year, the Joint Commission announced plans to overhaul and streamline its accreditation process through an initiative called "Accreditation 360: The New Standard." Through the initiative, the organization removed 714 requirements from its hospital accreditation program and updated its manual to more clearly identify CMS-directed Conditions of Participation.

The Joint Commission also streamlined its patient safety practice accreditation requirements into 14 National Performance Goals, which include shared goals to prevent patient harm, improve outcomes, and create a safer environment for everyone.  

For the first time, the Joint Commission has included nurse staffing as a key component of quality and patient safety. In the 2026 National Performance Goals, Goal 12 requires a hospital to be "staffed to meet the needs of the patients it serves, and staff are competent to provide safe, quality care."

Under the goal, hospitals are required to have an RN on duty to either directly provide care for patients or supervise nursing care provided by other staff 24/7. "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 goal states.

The 2026 National Performance Goals, including the new nurse staffing standard, will take effect Jan. 1.

According to Optum Advisory's* Matt Fay, the establishment of a nurse staffing goal "has the potential to dramatically reshape how hospitals and health systems staff."

Although the goal includes some specific guidance related to dietary, pharmacy, psychological, and patient access to an RN, Fay noted that language used is not specific about what "adequate" staffing levels are required to meet patient care needs.

Because of this, there will be some debate over what is considered "adequate" staffing, both for nursing titles and other titles that play a critical role in the provision of effective patient care.

"There will also likely be some internal friction as organizations debate adequacy standards and what they can afford," Fay said, noting that the goal also poses a significant reporting workload since hospitals will need to track and report on their performance.

As the new goal goes into effect, Fay recommends hospital leadership teams have a balanced discussion about "industry standard" care models, staffing levels, and skill mixes as they work to establish an adequacy standard that benefits patients, is sustainable for staff, and affordable for the organization based on its budget.

"I expect that these types of standards will have to evolve over the coming year as organizations seek to embrace a standard that they can defend to [the Joint Commission], their communities, and their internal constituents, as well as afford in the current reimbursement environment," Fay said.

*Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.