National Performance Goal 12 is about allowing the leaders along with the clinicians that are at the bedside to determine the best model of care that's safe and provides high quality care.
Ken Grubbs, Joint Commission Chief Nursing Executive
Appropriate staffing remains a critical priority for ensuring safe, high-quality patient care and supporting healthy work environments for nurses. In 2026, Joint Commission (JC) elevated staffing through the introduction of National Performance Goal 12: Health Professional Resource Management. In this conversation, Ken Grubbs, DNP, MBA, RN, chief nursing executive at TJC, discusses how the collaboration with AACN and the work of the Partners for Nurse Staffing’s National Nurse Task Force helped to inform that goal.
Can you provide a little background on the National Performance Goals and Accreditation 360? What does a frontline nurse need to know?
The frontline nurse needs to know that it was the first significant redesign and streamlining of the Joint Commission accreditation process since 1965 when Medicare was founded. It really is placing focus on patient safety and quality while ensuring we are lifting burden from those on the frontline providing care and making the accreditation process a transparent process. This led to a reduction of more than 700 requirements and resulted in 14 national performance goals that focus on clinical care such as patient identifiers, ensuring care delivery models are safe, procedural/surgical time outs, and the safety of the healthcare workforce.
In 2022, AACN convened and co-led the National Nurse Staffing Task Force, which recommended that Joint Commission include appropriate staffing as a National Performance Goal. We know that staffing across the interprofessional team has long been a priority for The Joint Commission. Can you share what led TJC to elevate staffing to the level of a National Performance Goal?
Well, first and foremost, I would take a moment and thank all of those stakeholders, including AACN, that were engaged in the process, because it really did inform what the next steps would be from a care model delivery standpoint, and how we tied that into the accreditation process from The Joint Commission perspective.
Performance Goal 12, and we'll just abbreviate it as staffing, is really an example of exactly why we needed to step back from an Accreditation 360 standpoint. It's an example where Joint Commission already had a focus because of regulatory requirements. We already had a focus on care delivery models. And National Performance Goal 12 is bringing all of those requirements together in a way that they're understandable. Leaders know what the expectations are; clinicians at the bedside know what the expectations are. And we did want to elevate it to a National Performance Goal, because care delivery models are critical from a patient safety and quality standpoint.
In addition to having enough staff, a healthy work environment impacts patient safety and nurse well-being. Can you share your perspective on the need to not only staff appropriately, but to foster a healthy work environment that promotes patient safety?
Let me start by saying, to all the clinicians, the healthcare team that's out there each and every day and providing care to patients, serving their communities, thank you. Thank you for what you do each and every day. The Joint Commission is an organization that stepped up in this space, and really said workplace violence is not an expected part of care as clinicians deliver care. We're an organization that said leaders should be evaluating events, or what events might occur in their organizations, and coming up with proactive ways to protect the workforce from violence.
It's critically important from our perspective that a culture of safety is foundational to care that's being delivered. It's foundational from a leadership perspective. And that it's an integral part of care delivery, and allowing, if you will, clinicians to be able to speak up from a psychological safety standpoint. Staff should feel empowered to speak up when there are concerns about a process that could be near misses or medical errors. They should also be empowered to be part of the care delivery model discussion and how administrative burden can be lifted off them and the care they provide.
When appropriate nurse staffing is discussed, ratios are often a hot topic. Staffing goes far beyond a specific number of nurses for a specific number of patients. Can you speak to what appropriate staffing looks like from your perspective?
The Joint Commission is not interested in setting a national ratio from a staffing standpoint. And here's the reason why. Care delivery can be influenced by very site-level specific dynamics. There may be times, and it could be in the moment, it could be at the beginning of the day, throughout the day, when clinicians and leaders need to determine how to get the right care to the right patient at the right time. This can be influenced by types of patients served, technologies that have been deployed within the organization, and even the physical environment in which care is provided. We think it is important for those decisions to be made when needed by teams within the organization.
There may be times that a patient requires two nurses based on the care that is being delivered. There may be other times, let's say in critical care, one nurse to two patients is appropriate. What's going on with the patient clinically absolutely determines the need. So that's what National Performance Goal 12 is about: allowing the leaders along with the clinicians that are at the bedside to determine the best model of care that's safe and provides high quality care.
Talking about where we've come in the past year with advancing appropriate staffing and Performance Goal 12, what do you see for the next year?
I think that AI [artificial intelligence] will redefine many ways in which we deliver care. I think that will continue for a number of years, and one that we should all be engaged in, whether it's ambient listening to reduce administrative/documentation burden, or ways to provide augmented clinical decision support for nursing to support the care they deliver.
As the chief nursing executive of The Joint Commission, what do you want our AACN community to know from your perspective?
I would say that it's an absolute privilege to be the chief nursing executive for The Joint Commission. And that privilege is because I get to be a voice for nursing at the table. We have leaders at The Joint Commission who are clinicians. We have leaders, executive leaders, chief executive officers, the chief operating officer, the chief medical officer and myself, and others who come from the real-world operational side, the clinical side. And you're seeing that transformation because of those insights, that operational knowledge, the clinical knowledge, being present at The Joint Commission. So, it's a privilege to be a voice for nursing at the table and continue to do the great work on behalf of nursing.
To review more conversations on nurse staffing and access additional resources, visit AACN’s Staffing in Acute and Critical Care page.
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