What constitutes a safe staffing level on any given hospital unit, on any given day, is not a mystery. Hospitals know it. Regulators know it. Accrediting bodies know it. The data has confirmed it for decades. But would you, the patient, know it?
Some hospitals intentionally staff below safe nurse-to-patient levels to reduce labor costs and increase profits. Hospitals operating under these conditions know that doing so jeopardizes patient safety. Multiple large-scale studies support this conclusion. One widely cited JAMA Network study found that for each additional patient assigned to a hospital nurse beyond recommended staffing levels, the risk of patient death increases by approximately 7%.
Yet, despite this well-documented risk, hospitals that intentionally understaff have faced remarkably few consequences. In 2026, that may begin to change.
The Joint Commission, formerly known as the Joint Commission on Accreditation of Healthcare Organizations and now referred to simply as TJC is the nation’s most influential hospital accreditor. It has elevated nurse staffing adequacy to a national patient safety priority. Hospitals that have long benefited from minimal oversight and little accountability may now face meaningful scrutiny. Loss of Joint Commission accreditation can place a hospital’s participation in Medicare and Medicaid at risk, an existential financial threat for most institutions.
Let’s hope this initiative carries real weight.
Hospitals that knowingly place patients at risk by understaffing nurses should face consequences that meaningfully deter unsafe practices. Without visible enforcement and accountability, history suggests little will change.
With so many threats to patient safety, why did nurse staffing rise to the top? Because the data made the case. National patient safety goals and accreditation standards are developed through analysis of sentinel event reports, adverse event trends, root-cause analyses, peer-reviewed research, malpractice patterns, and expert clinical input.
The data revealed that chronic understaffing, reliance on overtime and temporary nurses, high turnover, and declining experience levels are deeply embedded in the operating model of some hospitals. These were not isolated instances, but rather systemic patterns.
It’s fair to say that even though the issues with unsafe staffing have existed for a long time, COVID exposed just how fragile and dangerous these practices really are.
Research also suggests the problem is not evenly distributed across the healthcare system. Multiple studies have found that for-profit hospitals and large national hospital chains tend to operate with lower nurse staffing levels and higher workloads than nonprofit or public hospitals. While not every for-profit hospital understaffs, the financial incentives inherent in investor-owned models make labor cost reduction a recurring risk factor with direct implications for patient safety.
It is important to understand that safe staffing is more than just a numeric formula. Hospitals are expected to account for patient acuity, unit complexity, nurse experience, skill mix, and workload intensity. A unit may appear “fully staffed” on paper and still be unsafe in practice.
Hospitals must demonstrate compliance through routine surveys, unannounced inspections, and targeted reviews following serious adverse events. Deficiencies may result in corrective action plans, follow-up surveys, or conditional accreditation. In theory, hospitals can lose accreditation altogether. If that occurs, they may also face the functional death penalty of healthcare: loss of CMS participation and the inability to bill Medicare and Medicaid.
Whether the 2026 staffing initiative produces meaningful change will depend on whether hospitals are required to demonstrate, not merely assert, that staffing decisions prioritize patient safety and whether TJC enforces the standard with real consequences. Historically, hospitals have rarely suffered severe sanctions, and they know it.
Patients are not the only ones harmed by unsafe staffing. Nurses are being pushed to the brink. Burnout, moral distress, and attrition are now endemic.
But nurses are not powerless. In Texas, for example, there are “Safe Harbor” protections when nurses refuse unsafe assignments before patient harm occurs. Nurses can and should refuse to accept assignments that put them in impossible positions. If a hospital seeks to retaliate against them for protecting their patient by refusing an unsafe assignment, there are legal protections in place for them.
TJC’s focus on nurse staffing reflects an overdue acknowledgment that chronic understaffing is not merely inefficient—it is unsafe. Hospitals respond to financial risk. If accreditation standards around staffing carry real consequences, behavior will change. And this is where I always end: why should you care? Because you are a patient. And everyone you love is a patient.
